Hospital

Newman Memorial Hospital

Newman Memorial Hospital in Shattuck, OK publishes cash prices for 363 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Oklahoma median for 218 of 357 procedures and below it for 132. By typical cash price it ranks #36 of 60 Oklahoma hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

905 S Main St, Shattuck, OK, 73858 Collected Sep 27, 2026 Source price file (580) 938-2551

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 371336 · CMS hospital register NPI 1083617807

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN WITH & WITHOUT IV CONTRAST	$1,400.00	$1,750.00	$143.01–$1,225.00	7% above	20%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN WITH & WITHOUT IV CONTRAST	$1,400.00	$1,750.00	$143.01–$1,225.00	—	20%
Abdominal X-ray, 2 views CPT 74019 HC XRAY ABDOMEN 2 VIEWS	$320.80	$401.00	$17.82–$280.70	53% above	20%
Abdominal X-ray, 2 views inpatient CPT 74019 HC XRAY ABDOMEN 2 VIEWS	$320.80	$401.00	$17.82–$280.70	—	20%
Ankle X-ray, complete, 3 or more views CPT 73610 HC ANKLE 3+ VW	$178.40	$223.00	$19.14–$198.11	2% above	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 HC ANKLE 3+ VW,Right side of body	$178.40	$223.00	$19.14–$198.11	2% above	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 HC ANKLE 3+ VW,Left side of body	$178.40	$223.00	$19.14–$198.11	2% above	20%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC ANKLE 3+ VW	$178.40	$223.00	$19.14–$198.11	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 HC ANKLE 3+ VW,Left side of body	$178.40	$223.00	$19.14–$198.11	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 HC ANKLE 3+ VW,Right side of body	$178.40	$223.00	$19.14–$198.11	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC ARTERIAL STUDY EXTREM BILATERAL LIMITED	$200.80	$251.00	$73.43–$251.00	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC ARTERIAL STUDY EXTREM BILATERAL LIMITED	$200.80	$251.00	$73.43–$251.00	—	20%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY NON CONTRAST	$969.60	$1,212.00	$85.12–$848.40	6% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 HC CT UPPER EXTREMITY NON CONTRAST,Right side of body	$969.60	$1,212.00	$85.12–$848.40	6% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 HC CT UPPER EXTREMITY NON CONTRAST,Left side of body	$969.60	$1,212.00	$85.12–$848.40	6% above	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREMITY NON CONTRAST	$969.60	$1,212.00	$85.12–$848.40	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 HC CT UPPER EXTREMITY NON CONTRAST,Left side of body	$969.60	$1,212.00	$85.12–$848.40	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 HC CT UPPER EXTREMITY NON CONTRAST,Right side of body	$969.60	$1,212.00	$85.12–$848.40	—	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CT ANGIO ABDOMEN PELVIS W WO CON	$1,380.00	$1,725.00	$228.47–$1,207.50	39% below	20%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CT ANGIO ABDOMEN PELVIS W WO CON	$1,380.00	$1,725.00	$228.47–$1,207.50	—	20%
CT angiography (CTA) of the head CPT 70496 HC CT ANGIO HEAD WITH AND WITHOUT CONTRAST	$919.20	$1,149.00	$143.26–$804.30	31% below	20%
CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIO HEAD WITH AND WITHOUT CONTRAST	$919.20	$1,149.00	$143.26–$804.30	—	20%
CT angiography (CTA) of the neck CPT 70498 HC CT ANGIO NECK	$1,096.00	$1,370.00	$143.26–$959.00	17% below	20%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIO NECK	$1,096.00	$1,370.00	$143.26–$959.00	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIO CHEST W CONTRAST	$1,479.20	$1,849.00	$143.26–$1,294.30	1% below	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIO CHEST W CONTRAST	$1,479.20	$1,849.00	$143.26–$1,294.30	—	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CARDIAC ANGIO W CORO EVAL	$1,160.00	$1,450.00	$174.50–$1,015.00	6% below	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CARDIAC ANGIO W CORO EVAL	$1,160.00	$1,450.00	$174.50–$1,015.00	—	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT SCREEN CARDIAC SCORING	$1,026.40	$1,283.00	$60.40–$898.10	997% above	20%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT SCREEN CARDIAC SCORING	$1,026.40	$1,283.00	$60.40–$898.10	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABDOMEN PELVIS WO CONTRAST	$1,280.00	$1,600.00	$84.69–$1,120.00	4% below	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABDOMEN PELVIS WO CONTRAST	$1,280.00	$1,600.00	$84.69–$1,120.00	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN PELVIS W CONTRAST	$1,380.00	$1,725.00	$178.32–$1,207.50	17% below	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN PELVIS W CONTRAST	$1,380.00	$1,725.00	$178.32–$1,207.50	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN PELVIS WWO CONTRAST	$1,480.00	$1,850.00	$201.24–$1,295.00	26% below	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABDOMEN PELVIS WWO CONTRAST	$1,480.00	$1,850.00	$201.24–$1,295.00	—	20%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN WITH IV CONTRAST	$1,300.00	$1,625.00	$157.95–$1,137.50	23% above	20%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN WITH IV CONTRAST	$1,300.00	$1,625.00	$157.95–$1,137.50	—	20%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN NON IV CONTRAST	$1,200.00	$1,500.00	$66.90–$1,050.00	23% above	20%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN NON IV CONTRAST	$1,200.00	$1,500.00	$66.90–$1,050.00	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT SINUS FACIAL BONES NON CONTRAST	$969.60	$1,212.00	$72.57–$848.40	2% above	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT SINUS FACIAL BONES NON CONTRAST	$969.60	$1,212.00	$72.57–$848.40	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD NON CONTRAST	$520.80	$651.00	$55.30–$455.70	45% below	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD NON CONTRAST	$520.80	$651.00	$55.30–$455.70	—	20%
CT scan of the head with contrast CPT 70460 HC CT HEAD WITH CONTRAST	$576.00	$720.00	$79.02–$504.00	51% below	20%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD WITH CONTRAST	$576.00	$720.00	$79.02–$504.00	—	20%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD WITH & WITHOUT CONTRAST	$644.00	$805.00	$94.13–$563.50	50% below	20%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD WITH & WITHOUT CONTRAST	$644.00	$805.00	$94.13–$563.50	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE NON CONTRAST	$911.20	$1,139.00	$94.14–$797.30	11% below	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE NON CONTRAST	$911.20	$1,139.00	$94.14–$797.30	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL SPINE NON CONTRAST	$911.20	$1,139.00	$69.06–$797.30	15% below	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT CERVICAL SPINE NON CONTRAST	$911.20	$1,139.00	$69.06–$797.30	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS WITH IV CONTRAST	$1,260.00	$1,575.00	$157.95–$1,102.50	16% above	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS WITH IV CONTRAST	$1,260.00	$1,575.00	$157.95–$1,102.50	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUPLEX CAROTID BILAT	$470.40	$588.00	$167.80–$483.44	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DUPLEX CAROTID BILAT	$470.40	$588.00	$167.80–$483.44	—	20%
Chest CT scan without and with contrast CPT 71270 HC CT CHEST WITH & WITHOUT CONTRAST	$1,200.00	$1,500.00	$113.56–$1,050.00	4% below	20%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT CHEST WITH & WITHOUT CONTRAST	$1,200.00	$1,500.00	$113.56–$1,050.00	—	20%
Chest X-ray, 2 views CPT 71046 HC XRAY CHEST 2 VIEWS	$178.40	$223.00	$15.99–$198.11	at median	20%
Chest X-ray, 2 views inpatient CPT 71046 HC XRAY CHEST 2 VIEWS	$178.40	$223.00	$15.99–$198.11	—	20%
Chest X-ray, single view CPT 71045 HC XRAY CHEST 1 VIEW	$157.60	$197.00	$12.06–$197.00	9% below	20%
Chest X-ray, single view inpatient CPT 71045 HC XRAY CHEST 1 VIEW	$157.60	$197.00	$12.06–$197.00	—	20%
Collarbone (clavicle) X-ray, complete CPT 73000 HC XRAY CLAVICLE COMPLETE	$178.40	$223.00	$16.78–$198.11	at median	20%
Collarbone (clavicle) X-ray, complete one side CPT 73000 HC XRAY CLAVICLE COMPLETE,Left side of body	$178.40	$223.00	$16.78–$198.11	at median	20%
Collarbone (clavicle) X-ray, complete one side CPT 73000 HC XRAY CLAVICLE COMPLETE,Right side of body	$178.40	$223.00	$16.78–$198.11	at median	20%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC XRAY CLAVICLE COMPLETE	$178.40	$223.00	$16.78–$198.11	—	20%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 HC XRAY CLAVICLE COMPLETE,Left side of body	$178.40	$223.00	$16.78–$198.11	—	20%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 HC XRAY CLAVICLE COMPLETE,Right side of body	$178.40	$223.00	$16.78–$198.11	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE	$492.00	$615.00	$56.37–$430.50	7% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE	$492.00	$615.00	$56.37–$430.50	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT CHEST NON CONTRAST	$969.60	$1,212.00	$68.25–$848.40	2% above	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT CHEST NON CONTRAST	$969.60	$1,212.00	$68.25–$848.40	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT CHEST WITH CONTRAST	$1,096.00	$1,370.00	$149.48–$959.00	2% below	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT CHEST WITH CONTRAST	$1,096.00	$1,370.00	$149.48–$959.00	—	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUPLEX ARTERY OR BYPASS LE BILAT	$596.00	$745.00	$161.27–$521.50	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUPLEX ARTERY OR BYPASS LE BILAT	$596.00	$745.00	$161.27–$521.50	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUPLEX VEIN EXTREM BILAT	$454.40	$568.00	$123.25–$483.44	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUPLEX VEIN EXTREM BILAT	$454.40	$568.00	$123.25–$483.44	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC TTE 2D CMPLT WO CON W DOPPLER AND COLOR	$1,417.60	$1,772.00	$176.84–$1,240.40	30% above	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC TTE 2D CMPLT WO CON W DOPPLER AND COLOR	$1,417.60	$1,772.00	$176.84–$1,240.40	—	20%
Elbow X-ray, 2 views CPT 73070 HC ELBOW 2 VW	$157.60	$197.00	$14.68–$197.00	9% below	20%
Elbow X-ray, 2 views one side CPT 73070 HC ELBOW 2 VW,Left side of body	$157.60	$197.00	$14.68–$197.00	9% below	20%
Elbow X-ray, 2 views one side CPT 73070 HC ELBOW 2 VW,Right side of body	$157.60	$197.00	$14.68–$197.00	9% below	20%
Elbow X-ray, 2 views inpatient CPT 73070 HC ELBOW 2 VW	$157.60	$197.00	$14.68–$197.00	—	20%
Elbow X-ray, 2 views inpatient one side CPT 73070 HC ELBOW 2 VW,Left side of body	$157.60	$197.00	$14.68–$197.00	—	20%
Elbow X-ray, 2 views inpatient one side CPT 73070 HC ELBOW 2 VW,Right side of body	$157.60	$197.00	$14.68–$197.00	—	20%
Elbow X-ray, complete, 3 or more views CPT 73080 HC ELBOW 3+ VW	$178.40	$223.00	$16.25–$198.11	at median	20%
Elbow X-ray, complete, 3 or more views one side CPT 73080 HC ELBOW 3+ VW,Left side of body	$178.40	$223.00	$16.25–$198.11	at median	20%
Elbow X-ray, complete, 3 or more views one side CPT 73080 HC ELBOW 3+ VW,Right side of body	$178.40	$223.00	$16.25–$198.11	at median	20%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC ELBOW 3+ VW	$178.40	$223.00	$16.25–$198.11	—	20%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 HC ELBOW 3+ VW,Right side of body	$178.40	$223.00	$16.25–$198.11	—	20%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 HC ELBOW 3+ VW,Left side of body	$178.40	$223.00	$16.25–$198.11	—	20%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT POST FOSSA EAR NON CONTRAST	$1,008.00	$1,260.00	$81.72–$882.00	10% above	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT POST FOSSA EAR NON CONTRAST	$1,008.00	$1,260.00	$81.72–$882.00	—	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC FACIAL BONES 3+ VW	$320.80	$401.00	$23.85–$280.70	47% above	20%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC FACIAL BONES 3+ VW	$320.80	$401.00	$23.85–$280.70	—	20%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC FOREARM 2 VW	$178.40	$223.00	$14.94–$198.11	2% below	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 HC FOREARM 2 VW,Left side of body	$178.40	$223.00	$14.94–$198.11	2% below	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 HC FOREARM 2 VW,Right side of body	$178.40	$223.00	$14.94–$198.11	2% below	20%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC FOREARM 2 VW	$178.40	$223.00	$14.94–$198.11	—	20%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 HC FOREARM 2 VW,Right side of body	$178.40	$223.00	$14.94–$198.11	—	20%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 HC FOREARM 2 VW,Left side of body	$178.40	$223.00	$14.94–$198.11	—	20%
Hand X-ray, 2 views CPT 73120 HC XR HAND 1 VW	$212.80	$266.00	$15.99–$239.27	14% above	20%
Hand X-ray, 2 views CPT 73120 HC HAND 2 VW	$284.00	$355.00	$15.99–$248.50	52% above	20%
Hand X-ray, 2 views one side CPT 73120 HC HAND 2 VW,Left side of body	$284.00	$355.00	$15.99–$248.50	52% above	20%
Hand X-ray, 2 views one side CPT 73120 HC HAND 2 VW,Right side of body	$284.00	$355.00	$15.99–$248.50	52% above	20%
Hand X-ray, 2 views inpatient CPT 73120 HC XR HAND 1 VW	$212.80	$266.00	$15.99–$239.27	—	20%
Hand X-ray, 2 views inpatient CPT 73120 HC HAND 2 VW	$284.00	$355.00	$15.99–$248.50	—	20%
Hand X-ray, 2 views inpatient one side CPT 73120 HC HAND 2 VW,Left side of body	$284.00	$355.00	$15.99–$248.50	—	20%
Hand X-ray, 2 views inpatient one side CPT 73120 HC HAND 2 VW,Right side of body	$284.00	$355.00	$15.99–$248.50	—	20%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC CALCANEUS 2+ VW	$178.40	$223.00	$14.68–$198.11	10% above	20%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC CALCANEUS 2+ VW	$178.40	$223.00	$14.68–$198.11	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMN W/CPAP SPLIT NIGHT	$3,211.20	$4,014.00	$627.23–$2,809.80	9% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMN W/CPAP >=6YRS	$3,736.00	$4,670.00	$627.23–$3,269.00	27% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMN W/CPAP SPLIT NIGHT	$3,211.20	$4,014.00	$627.23–$2,809.80	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMN W/CPAP >=6YRS	$3,736.00	$4,670.00	$627.23–$3,269.00	—	20%
Knee X-ray, 3 views CPT 73562 HC KNEE 3 VW	$210.40	$263.00	$21.76–$198.11	9% above	20%
Knee X-ray, 3 views one side CPT 73562 HC KNEE 3 VW,Left side of body	$210.40	$263.00	$21.76–$198.11	9% above	20%
Knee X-ray, 3 views one side CPT 73562 HC KNEE 3 VW,Right side of body	$210.40	$263.00	$21.76–$198.11	9% above	20%
Knee X-ray, 3 views inpatient CPT 73562 HC KNEE 3 VW	$210.40	$263.00	$21.76–$198.11	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 HC KNEE 3 VW,Right side of body	$210.40	$263.00	$21.76–$198.11	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 HC KNEE 3 VW,Left side of body	$210.40	$263.00	$21.76–$198.11	—	20%
Knee X-ray, complete, 4 or more views CPT 73564 HC XR KNEE 4+ VW	$320.80	$401.00	$23.85–$280.70	14% above	20%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC XR KNEE 4+ VW	$320.80	$401.00	$23.85–$280.70	—	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY NON CONTRAST	$1,096.00	$1,370.00	$68.79–$959.00	22% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 HC CT LOWER EXTREMITY NON CONTRAST,Left side of body	$1,096.00	$1,370.00	$68.79–$959.00	22% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 HC CT LOWER EXTREMITY NON CONTRAST,Right side of body	$1,096.00	$1,370.00	$68.79–$959.00	22% above	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTREMITY NON CONTRAST	$1,096.00	$1,370.00	$68.79–$959.00	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 HC CT LOWER EXTREMITY NON CONTRAST,Left side of body	$1,096.00	$1,370.00	$68.79–$959.00	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 HC CT LOWER EXTREMITY NON CONTRAST,Right side of body	$1,096.00	$1,370.00	$68.79–$959.00	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED	$435.20	$544.00	$45.62–$380.80	13% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMEN LIMITED	$435.20	$544.00	$45.62–$380.80	—	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US JOINT OR NONVASC EXT LIMITED	$435.20	$544.00	$24.12–$380.80	68% above	20%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC US JOINT OR NONVASC EXT LIMITED,Right side of body	$435.20	$544.00	$24.12–$380.80	68% above	20%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC US JOINT OR NONVASC EXT LIMITED,Left side of body	$435.20	$544.00	$24.12–$380.80	68% above	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US JOINT OR NONVASC EXT LIMITED	$435.20	$544.00	$24.12–$380.80	—	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC US JOINT OR NONVASC EXT LIMITED,Right side of body	$435.20	$544.00	$24.12–$380.80	—	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC US JOINT OR NONVASC EXT LIMITED,Left side of body	$435.20	$544.00	$24.12–$380.80	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT CHEST LOW DOSE FOR LUNG CA SCREEN	$941.51	$1,176.89	$72.00–$823.82	168% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT CHEST LOW DOSE FOR LUNG CA SCREEN	$941.51	$1,176.89	$72.00–$823.82	—	20%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC TIB FIB SINGLE VIEW	$120.00	$150.00	$16.51–$150.00	29% below	20%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC TIBIA AND FIBULA 2 VW	$178.40	$223.00	$16.51–$198.11	6% above	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 HC TIBIA AND FIBULA 2 VW,Right side of body	$178.40	$223.00	$16.51–$198.11	6% above	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 HC TIBIA AND FIBULA 2 VW,Left side of body	$178.40	$223.00	$16.51–$198.11	6% above	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC TIB FIB SINGLE VIEW	$120.00	$150.00	$16.51–$150.00	—	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC TIBIA AND FIBULA 2 VW	$178.40	$223.00	$16.51–$198.11	—	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 HC TIBIA AND FIBULA 2 VW,Left side of body	$178.40	$223.00	$16.51–$198.11	—	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 HC TIBIA AND FIBULA 2 VW,Right side of body	$178.40	$223.00	$16.51–$198.11	—	20%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA ANGIO HEAD NON CONTRAST	$1,177.60	$1,472.00	$131.62–$1,030.40	12% above	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA ANGIO HEAD NON CONTRAST	$1,177.60	$1,472.00	$131.62–$1,030.40	—	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXT ANY JOINT NON CONTRAST	$1,175.20	$1,469.00	$115.42–$1,028.30	14% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI LOWER EXT ANY JOINT NON CONTRAST,Right side of body	$1,175.20	$1,469.00	$115.42–$1,028.30	14% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI LOWER EXT ANY JOINT NON CONTRAST,Left side of body	$1,175.20	$1,469.00	$115.42–$1,028.30	14% below	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXT ANY JOINT NON CONTRAST	$1,175.20	$1,469.00	$115.42–$1,028.30	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI LOWER EXT ANY JOINT NON CONTRAST,Right side of body	$1,175.20	$1,469.00	$115.42–$1,028.30	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI LOWER EXT ANY JOINT NON CONTRAST,Left side of body	$1,175.20	$1,469.00	$115.42–$1,028.30	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXT ANY JNT W AND WO CONTRAST	$1,880.00	$2,350.00	$232.54–$1,645.00	5% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXT ANY JNT W AND WO CONTRAST	$1,880.00	$2,350.00	$232.54–$1,645.00	—	20%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN NON CONTRAST	$1,379.20	$1,724.00	$105.19–$1,206.80	20% above	20%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN NON CONTRAST	$1,379.20	$1,724.00	$105.19–$1,206.80	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN WITH & WITHOUT CONTRAST	$2,758.40	$3,448.00	$193.41–$2,413.60	47% above	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN WITH & WITHOUT CONTRAST	$2,758.40	$3,448.00	$193.41–$2,413.60	—	20%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN NON CONTRAST	$1,632.00	$2,040.00	$105.19–$1,428.00	50% above	20%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN NON CONTRAST	$1,632.00	$2,040.00	$105.19–$1,428.00	—	20%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN WITH & WITHOUT CONTRAST	$1,844.00	$2,305.00	$174.52–$1,613.50	24% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN WITH & WITHOUT CONTRAST	$1,844.00	$2,305.00	$174.52–$1,613.50	—	20%
MRI of the lower back, no contrast dye CPT 72148 HC MRI SPINE LUMBAR NON CONTRAST	$1,041.60	$1,302.00	$100.61–$911.40	13% below	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI SPINE LUMBAR NON CONTRAST	$1,041.60	$1,302.00	$100.61–$911.40	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI SPINE LUMBAR WITH & WITHOUT CONTRAST	$1,276.00	$1,595.00	$174.52–$1,116.50	18% below	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI SPINE LUMBAR WITH & WITHOUT CONTRAST	$1,276.00	$1,595.00	$174.52–$1,116.50	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI SPINE THORACIC NON CONTRAST	$1,041.60	$1,302.00	$100.34–$911.40	4% below	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI SPINE THORACIC NON CONTRAST	$1,041.60	$1,302.00	$100.34–$911.40	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI SPINE CERVICAL WITH & WITHOUT CONTRAST	$1,276.00	$1,595.00	$175.06–$1,116.50	20% below	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI SPINE CERVICAL WITH & WITHOUT CONTRAST	$1,276.00	$1,595.00	$175.06–$1,116.50	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI SPINE CERVICAL NON CONTRAST	$1,041.60	$1,302.00	$100.07–$911.40	7% below	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI SPINE CERVICAL NON CONTRAST	$1,041.60	$1,302.00	$100.07–$911.40	—	20%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WITH & WITHOUT CONTRAST	$2,312.80	$2,891.00	$192.33–$2,023.70	48% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS WITH & WITHOUT CONTRAST	$2,312.80	$2,891.00	$192.33–$2,023.70	—	20%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS NON CONTRAST	$1,156.00	$1,445.00	$131.64–$1,011.50	12% above	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS NON CONTRAST	$1,156.00	$1,445.00	$131.64–$1,011.50	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXT ANY JOINT NON CONTRAST	$1,175.20	$1,469.00	$115.69–$1,028.30	18% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 HC MRI UPPER EXT ANY JOINT NON CONTRAST,Right side of body	$1,175.20	$1,469.00	$115.69–$1,028.30	18% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 HC MRI UPPER EXT ANY JOINT NON CONTRAST,Left side of body	$1,175.20	$1,469.00	$115.69–$1,028.30	18% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPER EXT ANY JOINT NON CONTRAST	$1,175.20	$1,469.00	$115.69–$1,028.30	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 HC MRI UPPER EXT ANY JOINT NON CONTRAST,Right side of body	$1,175.20	$1,469.00	$115.69–$1,028.30	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 HC MRI UPPER EXT ANY JOINT NON CONTRAST,Left side of body	$1,175.20	$1,469.00	$115.69–$1,028.30	—	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC CERVICAL SPINE MIN 4+ VW	$320.80	$401.00	$27.00–$280.70	15% above	20%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC CERVICAL SPINE MIN 4+ VW	$320.80	$401.00	$27.00–$280.70	—	20%
Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK WITH CONTRAST	$1,096.00	$1,370.00	$98.72–$959.00	3% above	20%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT SOFT TISSUE NECK WITH CONTRAST	$1,096.00	$1,370.00	$98.72–$959.00	—	20%
Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK NON CONTRAST	$969.60	$1,212.00	$74.45–$848.40	14% above	20%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SOFT TISSUE NECK NON CONTRAST	$969.60	$1,212.00	$74.45–$848.40	—	20%
Neck soft tissue X-ray CPT 70360 HC NECK SOFT TISSUE	$178.40	$223.00	$15.73–$198.11	10% above	20%
Neck soft tissue X-ray inpatient CPT 70360 HC NECK SOFT TISSUE	$178.40	$223.00	$15.73–$198.11	—	20%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CONTRAST	$1,191.20	$1,489.00	$67.98–$1,042.30	24% above	20%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS WO CONTRAST	$1,191.20	$1,489.00	$67.98–$1,042.30	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIS LIMITED	$435.20	$544.00	$17.56–$380.80	44% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIS LIMITED	$435.20	$544.00	$17.56–$380.80	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIS COMPLETE	$492.00	$615.00	$55.58–$430.50	1% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIS COMPLETE	$492.00	$615.00	$55.58–$430.50	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB 14+ WKS SINGLE GEST	$461.60	$577.00	$66.59–$403.90	3% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB 14+ WKS SINGLE GEST	$461.60	$577.00	$66.59–$403.90	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US OB < 14 WKS SINGLE GEST	$461.60	$577.00	$53.48–$403.90	22% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US OB < 14 WKS SINGLE GEST	$461.60	$577.00	$53.48–$403.90	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US PREGNANT UTERUS LIMITED 1+ FETUSES	$461.60	$577.00	$38.01–$403.90	37% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US PREGNANT UTERUS LIMITED 1+ FETUSES	$461.60	$577.00	$38.01–$403.90	—	20%
Rib X-ray, one side, 2 views one side CPT 71100 HC RIBS UNILATERAL 2 VW,Right side of body	$178.40	$223.00	$17.82–$198.11	6% below	20%
Rib X-ray, one side, 2 views one side CPT 71100 HC RIBS UNILATERAL 2 VW	$178.40	$223.00	$17.82–$198.11	6% below	20%
Rib X-ray, one side, 2 views one side CPT 71100 HC RIBS UNILATERAL 2 VW,Left side of body	$178.40	$223.00	$17.82–$198.11	6% below	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC RIBS UNILATERAL 2 VW,Left side of body	$178.40	$223.00	$17.82–$198.11	—	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC RIBS UNILATERAL 2 VW,Right side of body	$178.40	$223.00	$17.82–$198.11	—	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC RIBS UNILATERAL 2 VW	$178.40	$223.00	$17.82–$198.11	—	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 HC RIBS UNILATERAL W PA CHEST,Right side of body	$284.00	$355.00	$20.18–$248.50	17% above	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 HC RIBS UNILATERAL W PA CHEST,Left side of body	$284.00	$355.00	$20.18–$248.50	17% above	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 HC RIBS UNILATERAL W PA CHEST	$284.00	$355.00	$20.18–$248.50	17% above	20%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 HC RIBS UNILATERAL W PA CHEST,Left side of body	$284.00	$355.00	$20.18–$248.50	—	20%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 HC RIBS UNILATERAL W PA CHEST,Right side of body	$284.00	$355.00	$20.18–$248.50	—	20%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 HC RIBS UNILATERAL W PA CHEST	$284.00	$355.00	$20.18–$248.50	—	20%
Screening mammogram, both breasts both sides CPT 77067 HC MAMM SCREEN BILAT INCLUDES CAD/AI	$628.80	$786.00	$72.62–$550.20	—	20%
Screening mammogram, both breasts one side CPT 77067 HC MAMM SCREEN UNILAT INCLUDES CAD/AI	$628.80	$786.00	$72.62–$550.20	247% above	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 HC MAMM SCREEN BILAT INCLUDES CAD/AI	$628.80	$786.00	$72.62–$550.20	—	20%
Screening mammogram, both breasts inpatient one side CPT 77067 HC MAMM SCREEN UNILAT INCLUDES CAD/AI	$628.80	$786.00	$72.62–$550.20	—	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC SHOULDER 2+ VW	$178.40	$223.00	$17.30–$198.11	15% below	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 HC SHOULDER 2+ VW,Left side of body	$178.40	$223.00	$17.30–$198.11	15% below	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 HC SHOULDER 2+ VW,Right side of body	$178.40	$223.00	$17.30–$198.11	15% below	20%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC SHOULDER 2+ VW	$178.40	$223.00	$17.30–$198.11	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 HC SHOULDER 2+ VW,Left side of body	$178.40	$223.00	$17.30–$198.11	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 HC SHOULDER 2+ VW,Right side of body	$178.40	$223.00	$17.30–$198.11	—	20%
Skull X-ray, fewer than 4 views CPT 70250 HC SKULL < 4 VW	$284.00	$355.00	$18.61–$248.50	40% above	20%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC SKULL < 4 VW	$284.00	$355.00	$18.61–$248.50	—	20%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMN 4 OR MORE >=6YRS	$3,736.00	$4,670.00	$597.13–$3,269.00	35% above	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMN 4 OR MORE >=6YRS	$3,736.00	$4,670.00	$597.13–$3,269.00	—	20%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC XRAY FEMUR MINIMUM 2 VIEWS	$178.40	$223.00	$18.61–$198.11	8% below	20%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 HC XRAY FEMUR MINIMUM 2 VIEWS,Left side of body	$178.40	$223.00	$18.61–$198.11	8% below	20%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 HC XRAY FEMUR MINIMUM 2 VIEWS,Right side of body	$178.40	$223.00	$18.61–$198.11	8% below	20%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC XRAY FEMUR MINIMUM 2 VIEWS	$178.40	$223.00	$18.61–$198.11	—	20%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 HC XRAY FEMUR MINIMUM 2 VIEWS,Left side of body	$178.40	$223.00	$18.61–$198.11	—	20%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 HC XRAY FEMUR MINIMUM 2 VIEWS,Right side of body	$178.40	$223.00	$18.61–$198.11	—	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT THORACIC SPINE NON CONTRAST	$911.20	$1,139.00	$68.79–$797.30	10% below	20%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT THORACIC SPINE NON CONTRAST	$911.20	$1,139.00	$68.79–$797.30	—	20%
Toe X-ray, 2 or more views CPT 73660 HC TOES 2+ VW	$178.40	$223.00	$15.73–$198.11	8% above	20%
Toe X-ray, 2 or more views one side CPT 73660 HC TOES 2+ VW,Left side of body	$178.40	$223.00	$15.73–$198.11	8% above	20%
Toe X-ray, 2 or more views one side CPT 73660 HC TOES 2+ VW,Right side of body	$178.40	$223.00	$15.73–$198.11	8% above	20%
Toe X-ray, 2 or more views inpatient CPT 73660 HC TOES 2+ VW	$178.40	$223.00	$15.73–$198.11	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 HC TOES 2+ VW,Left side of body	$178.40	$223.00	$15.73–$198.11	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 HC TOES 2+ VW,Right side of body	$178.40	$223.00	$15.73–$198.11	—	20%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON OB	$492.00	$615.00	$65.28–$430.50	24% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON OB	$492.00	$615.00	$65.28–$430.50	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 HC US PREGNANT UTERUS TRANSVAGINAL	$521.60	$652.00	$43.00–$456.40	67% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US PREGNANT UTERUS TRANSVAGINAL	$521.60	$652.00	$43.00–$456.40	—	20%
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMEN COMPLETE	$492.00	$615.00	$60.56–$430.50	7% below	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMEN COMPLETE	$492.00	$615.00	$60.56–$430.50	—	20%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM AND CONTENTS	$492.00	$615.00	$54.01–$430.50	38% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM AND CONTENTS	$492.00	$615.00	$54.01–$430.50	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US HEAD NECK TISSUES REAL TIME	$492.00	$615.00	$64.76–$430.50	21% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US HEAD NECK TISSUES REAL TIME	$492.00	$615.00	$64.76–$430.50	—	20%
Upper arm X-ray (humerus), 2 views CPT 73060 HC HUMERUS 2+ VW	$178.40	$223.00	$16.78–$198.11	2% above	20%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HC HUMERUS 2+ VW,Left side of body	$178.40	$223.00	$16.78–$198.11	2% above	20%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HC HUMERUS 2+ VW,Right side of body	$178.40	$223.00	$16.78–$198.11	2% above	20%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC HUMERUS 2+ VW	$178.40	$223.00	$16.78–$198.11	—	20%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HC HUMERUS 2+ VW,Right side of body	$178.40	$223.00	$16.78–$198.11	—	20%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HC HUMERUS 2+ VW,Left side of body	$178.40	$223.00	$16.78–$198.11	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUPLEX VEIN EXTREM UNILAT,Left side of body	$282.40	$353.00	$94.14–$247.10	40% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUPLEX VEIN EXTREM UNILAT,Right side of body	$282.40	$353.00	$94.14–$247.10	40% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUPLEX VEIN EXTREM UNILAT	$282.40	$353.00	$94.14–$247.10	40% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC DUPLEX VEIN EXTREM UNILAT,Right side of body	$282.40	$353.00	$94.14–$247.10	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC DUPLEX VEIN EXTREM UNILAT,Left side of body	$282.40	$353.00	$94.14–$247.10	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC DUPLEX VEIN EXTREM UNILAT	$282.40	$353.00	$94.14–$247.10	—	20%
Wrist X-ray, 2 views CPT 73100 HC WRIST 2 VW	$157.60	$197.00	$17.82–$197.00	3% below	20%
Wrist X-ray, 2 views one side CPT 73100 HC WRIST 2 VW,Left side of body	$157.60	$197.00	$17.82–$197.00	3% below	20%
Wrist X-ray, 2 views one side CPT 73100 HC WRIST 2 VW,Right side of body	$157.60	$197.00	$17.82–$197.00	3% below	20%
Wrist X-ray, 2 views inpatient CPT 73100 HC WRIST 2 VW	$157.60	$197.00	$17.82–$197.00	—	20%
Wrist X-ray, 2 views inpatient one side CPT 73100 HC WRIST 2 VW,Left side of body	$157.60	$197.00	$17.82–$197.00	—	20%
Wrist X-ray, 2 views inpatient one side CPT 73100 HC WRIST 2 VW,Right side of body	$157.60	$197.00	$17.82–$197.00	—	20%
Wrist X-ray, complete, 3 or more views CPT 73110 HC WRIST 3+ VW	$178.40	$223.00	$22.02–$198.11	1% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 HC WRIST 3+ VW,Left side of body	$178.40	$223.00	$22.02–$198.11	1% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 HC WRIST 3+ VW,Right side of body	$178.40	$223.00	$22.02–$198.11	1% below	20%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC WRIST 3+ VW	$178.40	$223.00	$22.02–$198.11	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 HC WRIST 3+ VW,Right side of body	$178.40	$223.00	$22.02–$198.11	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 HC WRIST 3+ VW,Left side of body	$178.40	$223.00	$22.02–$198.11	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC XRAY HIP UNILAT 2-3 VIEWS,Right side of body	$212.00	$265.00	$24.90–$198.11	12% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC XRAY HIP UNILAT 2-3 VIEWS,Left side of body	$212.00	$265.00	$24.90–$198.11	12% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC XRAY HIP UNILAT 2-3 VIEWS	$212.00	$265.00	$24.90–$198.11	12% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC XRAY HIP UNILAT 2-3 VIEWS	$212.00	$265.00	$24.90–$198.11	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC XRAY HIP UNILAT 2-3 VIEWS,Right side of body	$212.00	$265.00	$24.90–$198.11	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC XRAY HIP UNILAT 2-3 VIEWS,Left side of body	$212.00	$265.00	$24.90–$198.11	—	20%
X-ray of the abdomen, 1 view CPT 74018 HC XRAY ABDOMEN 1 VIEW	$178.40	$223.00	$14.68–$198.11	5% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XRAY ABDOMEN 1 VIEW	$178.40	$223.00	$14.68–$198.11	—	20%
X-ray of the ankle, 2 views CPT 73600 HC ANKLE 2 VW	$178.40	$223.00	$17.04–$198.11	1% above	20%
X-ray of the ankle, 2 views one side CPT 73600 HC ANKLE 2 VW,Left side of body	$178.40	$223.00	$17.04–$198.11	1% above	20%
X-ray of the ankle, 2 views one side CPT 73600 HC ANKLE 2 VW,Right side of body	$178.40	$223.00	$17.04–$198.11	1% above	20%
X-ray of the ankle, 2 views inpatient CPT 73600 HC ANKLE 2 VW	$178.40	$223.00	$17.04–$198.11	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 HC ANKLE 2 VW,Right side of body	$178.40	$223.00	$17.04–$198.11	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 HC ANKLE 2 VW,Left side of body	$178.40	$223.00	$17.04–$198.11	—	20%
X-ray of the finger(s), 2 or more views CPT 73140 HC XRAY FINGER(S) MIN 2 VW	$178.40	$223.00	$20.97–$198.11	10% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 HC XRAY FINGER(S) MIN 2 VW,Left side of body	$178.40	$223.00	$20.97–$198.11	10% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 HC XRAY FINGER(S) MIN 2 VW,Right side of body	$178.40	$223.00	$20.97–$198.11	10% above	20%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XRAY FINGER(S) MIN 2 VW	$178.40	$223.00	$20.97–$198.11	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 HC XRAY FINGER(S) MIN 2 VW,Right side of body	$178.40	$223.00	$20.97–$198.11	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 HC XRAY FINGER(S) MIN 2 VW,Left side of body	$178.40	$223.00	$20.97–$198.11	—	20%
X-ray of the foot, 2 views CPT 73620 HC FOOT 2 VW REDUCED SERVICE	$136.00	$170.00	$14.68–$170.00	20% below	20%
X-ray of the foot, 2 views CPT 73620 HC FOOT 2 VW	$178.40	$223.00	$14.68–$198.11	5% above	20%
X-ray of the foot, 2 views one side CPT 73620 HC FOOT 2 VW,Left side of body	$178.40	$223.00	$14.68–$198.11	5% above	20%
X-ray of the foot, 2 views one side CPT 73620 HC FOOT 2 VW,Right side of body	$178.40	$223.00	$14.68–$198.11	5% above	20%
X-ray of the foot, 2 views inpatient CPT 73620 HC FOOT 2 VW REDUCED SERVICE	$136.00	$170.00	$14.68–$170.00	—	20%
X-ray of the foot, 2 views inpatient CPT 73620 HC FOOT 2 VW	$178.40	$223.00	$14.68–$198.11	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 HC FOOT 2 VW,Right side of body	$178.40	$223.00	$14.68–$198.11	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 HC FOOT 2 VW,Left side of body	$178.40	$223.00	$14.68–$198.11	—	20%
X-ray of the foot, complete, 3 or more views CPT 73630 HC FOOT 3+ VW	$228.00	$285.00	$17.82–$199.50	9% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 HC FOOT 3+ VW,Left side of body	$228.00	$285.00	$17.82–$199.50	9% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 HC FOOT 3+ VW,Right side of body	$228.00	$285.00	$17.82–$199.50	9% above	20%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC FOOT 3+ VW	$228.00	$285.00	$17.82–$199.50	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 HC FOOT 3+ VW,Right side of body	$228.00	$285.00	$17.82–$199.50	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 HC FOOT 3+ VW,Left side of body	$228.00	$285.00	$17.82–$199.50	—	20%
X-ray of the hand, 3 or more views CPT 73130 HC HAND 3+ VW	$300.00	$375.00	$19.14–$262.50	42% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 HC HAND 3+ VW,Left side of body	$300.00	$375.00	$19.14–$262.50	42% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 HC HAND 3+ VW,Right side of body	$300.00	$375.00	$19.14–$262.50	42% above	20%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC HAND 3+ VW	$300.00	$375.00	$19.14–$262.50	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HC HAND 3+ VW,Right side of body	$300.00	$375.00	$19.14–$262.50	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HC HAND 3+ VW,Left side of body	$300.00	$375.00	$19.14–$262.50	—	20%
X-ray of the knee, 1 or 2 views CPT 73560 HC KNEE 1 OR 2 VW	$178.40	$223.00	$18.35–$198.11	1% above	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 HC KNEE 1 OR 2 VW,Left side of body	$178.40	$223.00	$18.35–$198.11	1% above	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 HC KNEE 1 OR 2 VW,Right side of body	$178.40	$223.00	$18.35–$198.11	1% above	20%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC KNEE 1 OR 2 VW	$178.40	$223.00	$18.35–$198.11	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 HC KNEE 1 OR 2 VW,Left side of body	$178.40	$223.00	$18.35–$198.11	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 HC KNEE 1 OR 2 VW,Right side of body	$178.40	$223.00	$18.35–$198.11	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC LUMBAR SPINE 2 OR 3 VW	$284.00	$355.00	$19.66–$248.50	34% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC LUMBAR SPINE 2 OR 3 VW	$284.00	$355.00	$19.66–$248.50	—	20%
X-ray of the lower back, 4 or more views CPT 72110 HC LUMBAR SPINE 4+ VW	$320.80	$401.00	$25.95–$280.70	5% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC LUMBAR SPINE 4+ VW	$320.80	$401.00	$25.95–$280.70	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC THORACIC SPINE 2 VW	$284.00	$355.00	$15.73–$248.50	35% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC THORACIC SPINE 2 VW	$284.00	$355.00	$15.73–$248.50	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 HC NASAL BONES	$178.40	$223.00	$20.18–$198.11	9% above	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC NASAL BONES	$178.40	$223.00	$20.18–$198.11	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC CERVICAL SPINE 2 OR 3 VW	$178.40	$223.00	$19.66–$198.11	13% below	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC CERVICAL SPINE 2 OR 3 VW	$178.40	$223.00	$19.66–$198.11	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC PELVIS 1 OR 2 VW	$284.00	$355.00	$14.42–$248.50	48% above	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC PELVIS 1 OR 2 VW	$284.00	$355.00	$14.42–$248.50	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC SACRUM AND COCCYX	$178.40	$223.00	$16.51–$198.11	at median	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC SACRUM AND COCCYX	$178.40	$223.00	$16.51–$198.11	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
ACTH blood test CPT 82024 LCHG ACTH	$139.20	$174.00	$19.07–$81.85	5% above	20%
ACTH blood test inpatient CPT 82024 LCHG ACTH	$139.20	$174.00	$19.07–$81.85	—	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 LCHG ALT	$34.40	$43.00	$2.62–$20.23	4% above	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 LCHG ALT	$34.40	$43.00	$2.62–$20.23	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 LCHG AST BLOOD	$34.40	$43.00	$2.56–$20.23	9% below	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 LCHG AST BLOOD	$34.40	$43.00	$2.56–$20.23	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 LCHG HEPATITIS SCREEN ACUTE	$151.20	$189.00	$23.52–$88.91	17% below	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 LCHG HEPATITIS SCREEN ACUTE	$151.20	$189.00	$23.52–$88.91	—	20%
Albumin blood test CPT 82040 LCHG ALBUMIN BLOOD	$34.40	$43.00	$2.44–$20.23	12% above	20%
Albumin blood test inpatient CPT 82040 LCHG ALBUMIN BLOOD	$34.40	$43.00	$2.44–$20.23	—	20%
Aldosterone blood test CPT 82088 LCHG ALDOSTERONE	$139.20	$174.00	$20.12–$81.85	at median	20%
Aldosterone blood test inpatient CPT 82088 LCHG ALDOSTERONE	$139.20	$174.00	$20.12–$81.85	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN INDIVIDUAL	$15.20	$19.00	$2.58–$8.94	30% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN SPEC IGE QUANT EACH	$48.00	$60.00	$2.58–$28.22	122% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN MILK IGE	$48.00	$60.00	$2.58–$28.22	122% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN BIRCH IGE	$48.00	$60.00	$2.58–$28.22	122% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN LATEX IGE	$48.00	$60.00	$2.58–$28.22	122% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN DERM PTERONYSSINUS IGE	$48.00	$60.00	$2.58–$28.22	122% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN RAGWEED IGE	$48.00	$60.00	$2.58–$28.22	122% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN DERM FARINAE IGE	$48.00	$60.00	$2.58–$28.22	122% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN PEANUT IGE	$48.00	$60.00	$2.58–$28.22	122% above	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN INDIVIDUAL	$15.20	$19.00	$2.58–$8.94	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN MILK IGE	$48.00	$60.00	$2.58–$28.22	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN BIRCH IGE	$48.00	$60.00	$2.58–$28.22	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN SPEC IGE QUANT EACH	$48.00	$60.00	$2.58–$28.22	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN PEANUT IGE	$48.00	$60.00	$2.58–$28.22	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN DERM FARINAE IGE	$48.00	$60.00	$2.58–$28.22	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN LATEX IGE	$48.00	$60.00	$2.58–$28.22	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN RAGWEED IGE	$48.00	$60.00	$2.58–$28.22	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN DERM PTERONYSSINUS IGE	$48.00	$60.00	$2.58–$28.22	—	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 LCHG ALPHA FETOPROTEIN BLOOD MATERNAL	$57.60	$72.00	$8.28–$33.87	8% above	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 LCHG ALPHA FETOPROTEIN BLOOD TUMOR	$64.80	$81.00	$8.28–$38.10	22% above	20%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 LCHG ALPHA FETOPROTEIN BLOOD MATERNAL	$57.60	$72.00	$8.28–$33.87	—	20%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 LCHG ALPHA FETOPROTEIN BLOOD TUMOR	$64.80	$81.00	$8.28–$38.10	—	20%
Ammonia blood test CPT 82140 LCHG AMMONIA URINE TIMED	$54.40	$68.00	$7.20–$31.99	9% below	20%
Ammonia blood test CPT 82140 LCHG AMMONIA	$64.80	$81.00	$7.20–$38.10	8% above	20%
Ammonia blood test inpatient CPT 82140 LCHG AMMONIA URINE TIMED	$54.40	$68.00	$7.20–$31.99	—	20%
Ammonia blood test inpatient CPT 82140 LCHG AMMONIA	$64.80	$81.00	$7.20–$38.10	—	20%
Amylase blood test CPT 82150 LCHG AMYLASE BLOOD	$64.80	$81.00	$3.20–$38.10	40% above	20%
Amylase blood test inpatient CPT 82150 LCHG AMYLASE BLOOD	$64.80	$81.00	$3.20–$38.10	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 LCHG CYCLIC CITRUL PEPTIDE AB IGG (CCP)	$56.00	$70.00	$6.39–$32.93	15% below	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 LCHG CYCLIC CITRUL PEPTIDE AB IGG (CCP)	$56.00	$70.00	$6.39–$32.93	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 LCHG ANA BLOOD SCREEN	$56.00	$70.00	$5.97–$32.93	8% below	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 LCHG ANA BLOOD SCREEN	$56.00	$70.00	$5.97–$32.93	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 LCHG PRO BRAIN NATRIURETIC PEPTIDE	$193.60	$242.00	$16.76–$113.84	71% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 LCHG PRO BRAIN NATRIURETIC PEPTIDE	$193.60	$242.00	$16.76–$113.84	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 LCHG CULTURE GENITAL	$10.58	$13.23	$4.26–$11.64	76% below	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 LCHG CULTURE FLUID	$42.40	$53.00	$4.26–$24.93	4% below	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 LCHG CULTURE WOUND	$42.40	$53.00	$4.26–$24.93	4% below	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 LCHG CULTURE ROUTINE	$50.40	$63.00	$4.26–$29.64	14% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 LCHG CULTURE RESPIRATORY	$50.40	$63.00	$4.26–$29.64	14% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 LCHG CULTURE GENITAL	$10.58	$13.23	$4.26–$11.64	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 LCHG CULTURE FLUID	$42.40	$53.00	$4.26–$24.93	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 LCHG CULTURE WOUND	$42.40	$53.00	$4.26–$24.93	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 LCHG CULTURE ROUTINE	$50.40	$63.00	$4.26–$29.64	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 LCHG CULTURE RESPIRATORY	$50.40	$63.00	$4.26–$29.64	—	20%
Basic metabolic panel (blood test) CPT 80048 LCHG BASIC METABOLIC PANEL (CA TOTAL)	$61.60	$77.00	$4.18–$36.22	35% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 LCHG BASIC METABOLIC PANEL (CA TOTAL)	$61.60	$77.00	$4.18–$36.22	—	20%
Bilirubin blood test, total CPT 82247 LCHG BILIRUBIN TOTAL BLOOD	$34.40	$43.00	$2.48–$20.23	9% below	20%
Bilirubin blood test, total inpatient CPT 82247 LCHG BILIRUBIN TOTAL BLOOD	$34.40	$43.00	$2.48–$20.23	—	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LCHG SP G+M LEVEL IV TC NL	$132.00	$165.00	$14.29–$106.86	4% below	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 CHG LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM	$132.00	$165.00	$21.05–$106.86	4% below	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LCHG SP G+M LEVEL IV TC NL	$132.00	$165.00	$14.29–$106.86	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 CHG LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM	$132.00	$165.00	$21.05–$106.86	—	20%
Blood culture for bacteria CPT 87040 LCHG CULTURE BLOOD	$160.00	$200.00	$5.10–$94.08	119% above	20%
Blood culture for bacteria inpatient CPT 87040 LCHG CULTURE BLOOD	$160.00	$200.00	$5.10–$94.08	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 LCHG BLOOD DRAW NURSE	$16.80	$21.00	$1.08–$10.02	62% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 LCHG BLOOD DRAW	$16.80	$21.00	$1.08–$10.02	62% above	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 LCHG BLOOD DRAW	$16.80	$21.00	$1.08–$10.02	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 LCHG BLOOD DRAW NURSE	$16.80	$21.00	$1.08–$10.02	—	20%
Blood glucose (sugar) test CPT 82947 LCHG GLUCOSE FASTING	$34.40	$43.00	$1.94–$20.23	31% above	20%
Blood glucose (sugar) test CPT 82947 LCHG GLUCOSE	$34.40	$43.00	$1.94–$20.23	31% above	20%
Blood glucose (sugar) test inpatient CPT 82947 LCHG GLUCOSE	$34.40	$43.00	$1.94–$20.23	—	20%
Blood glucose (sugar) test inpatient CPT 82947 LCHG GLUCOSE FASTING	$34.40	$43.00	$1.94–$20.23	—	20%
Blood lead test CPT 83655 LCHG LEAD BLOOD	$81.60	$102.00	$5.98–$47.98	77% above	20%
Blood lead test inpatient CPT 83655 LCHG LEAD BLOOD	$81.60	$102.00	$5.98–$47.98	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 LCHG HCG BLOOD QUALITATIVE	$76.00	$95.00	$3.72–$44.69	67% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 LCHG HCG BLOOD QUALITATIVE	$76.00	$95.00	$3.72–$44.69	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 LCHG BLOOD TYPE ABO I	$16.00	$20.00	$1.48–$20.00	73% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 CHG BLOOD TYPING SEROLOGIC ABO	$268.80	$336.00	$1.48–$257.80	357% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 LCHG BLOOD TYPE ABO	$268.80	$336.00	$1.48–$257.80	357% above	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 LCHG BLOOD TYPE ABO I	$16.00	$20.00	$1.48–$20.00	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 LCHG BLOOD TYPE ABO	$268.80	$336.00	$1.48–$257.80	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 CHG BLOOD TYPING SEROLOGIC ABO	$268.80	$336.00	$1.48–$257.80	—	20%
Blood urea nitrogen (BUN) test CPT 84520 LCHG BUN	$34.40	$43.00	$1.95–$20.23	40% above	20%
Blood urea nitrogen (BUN) test inpatient CPT 84520 LCHG BUN	$34.40	$43.00	$1.95–$20.23	—	20%
C-peptide blood test CPT 84681 LCHG C-PEPTIDE	$67.20	$84.00	$10.28–$39.51	21% below	20%
C-peptide blood test inpatient CPT 84681 LCHG C-PEPTIDE	$67.20	$84.00	$10.28–$39.51	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 LCHG C-REACTIVE PROTEIN	$56.00	$70.00	$2.56–$32.93	47% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 LCHG C-REACTIVE PROTEIN	$56.00	$70.00	$2.56–$32.93	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 LCHG CLOSTRIDIUM DIFF PCR	$48.00	$60.00	$17.33–$50.31	43% below	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 LCHG CLOSTRIDIUM DIFF PCR	$48.00	$60.00	$17.33–$50.31	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 LCHG CA 19-9	$180.80	$226.00	$10.28–$106.31	98% above	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 LCHG CA 19-9	$180.80	$226.00	$10.28–$106.31	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 LCHG CA 125 BLOOD	$164.00	$205.00	$10.28–$96.43	102% above	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 LCHG CA 125 BLOOD	$164.00	$205.00	$10.28–$96.43	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 LCHG SARS-COV-2 (COVID-19)	$84.00	$105.00	$18.48–$69.27	5% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 LCHG SARS-COV-2 (COVID-19)	$84.00	$105.00	$18.48–$69.27	—	20%
Calcium blood test, total CPT 82310 LCHG CALCIUM BLOOD	$34.40	$43.00	$2.55–$20.23	5% below	20%
Calcium blood test, total CPT 82310 LCHG CALCIUM I	$34.40	$43.00	$2.55–$20.23	5% below	20%
Calcium blood test, total inpatient CPT 82310 LCHG CALCIUM I	$34.40	$43.00	$2.55–$20.23	—	20%
Calcium blood test, total inpatient CPT 82310 LCHG CALCIUM BLOOD	$34.40	$43.00	$2.55–$20.23	—	20%
Carcinoembryonic antigen (CEA) test CPT 82378 LCHG CEA BLOOD	$64.80	$81.00	$9.36–$38.10	37% below	20%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 LCHG CEA BLOOD	$64.80	$81.00	$9.36–$38.10	—	20%
Chickenpox (varicella) immunity blood test CPT 86787 LCHG VARICELLA ZOSTER ANTIBODY IGG	$56.00	$70.00	$6.36–$32.93	3% below	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 LCHG VARICELLA ZOSTER ANTIBODY IGG	$56.00	$70.00	$6.36–$32.93	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 LCHG CHLAMYDIA TRACH AMPLIFIED PROBE	$48.00	$60.00	$17.33–$47.37	40% below	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 LCHG CHLAMYDIA DNA PROBE I	$48.00	$60.00	$17.33–$47.37	40% below	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 LCHG CHLAMYDIA DNA PROBE	$111.20	$139.00	$17.33–$65.39	39% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 LCHG CHLAMYDIA TRACH AMPLIFIED PROBE	$48.00	$60.00	$17.33–$47.37	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 LCHG CHLAMYDIA DNA PROBE I	$48.00	$60.00	$17.33–$47.37	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 LCHG CHLAMYDIA DNA PROBE	$111.20	$139.00	$17.33–$65.39	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LCHG LIPID PROFILE	$61.60	$77.00	$6.61–$36.22	7% below	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LCHG LIPID PROFILE	$61.60	$77.00	$6.61–$36.22	—	20%
Complete blood count (CBC) with differential CPT 85025 LCHG CBC W AUTO DIFFERENTIAL I	$40.00	$50.00	$3.84–$23.52	12% below	20%
Complete blood count (CBC) with differential CPT 85025 LCHG CBC W AUTO DIFFERENTIAL	$42.40	$53.00	$3.84–$24.93	6% below	20%
Complete blood count (CBC) with differential inpatient CPT 85025 LCHG CBC W AUTO DIFFERENTIAL I	$40.00	$50.00	$3.84–$23.52	—	20%
Complete blood count (CBC) with differential inpatient CPT 85025 LCHG CBC W AUTO DIFFERENTIAL	$42.40	$53.00	$3.84–$24.93	—	20%
Complete blood count (CBC), no differential CPT 85027 LCHG CBC W/O AUTO DIFFERENTIAL	$48.00	$60.00	$3.19–$28.22	13% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 LCHG CBC W/O AUTO DIFFERENTIAL	$48.00	$60.00	$3.19–$28.22	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 LCHG COMPREHENSIVE METABOLIC PANEL	$61.60	$77.00	$5.22–$36.22	11% below	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 LCHG COMPREHENSIVE METABOLIC PANEL	$61.60	$77.00	$5.22–$36.22	—	20%
Cortisol blood test, total CPT 82533 LCHG CORTISOL BLOOD AM	$125.60	$157.00	$8.05–$73.85	88% above	20%
Cortisol blood test, total CPT 82533 LCHG CORTISOL BLOOD	$139.20	$174.00	$8.05–$81.85	109% above	20%
Cortisol blood test, total inpatient CPT 82533 LCHG CORTISOL BLOOD AM	$125.60	$157.00	$8.05–$73.85	—	20%
Cortisol blood test, total inpatient CPT 82533 LCHG CORTISOL BLOOD	$139.20	$174.00	$8.05–$81.85	—	20%
Creatine kinase (CK) blood test, total CPT 82550 LCHG CK BLOOD	$34.40	$43.00	$3.21–$20.23	7% below	20%
Creatine kinase (CK) blood test, total inpatient CPT 82550 LCHG CK BLOOD	$34.40	$43.00	$3.21–$20.23	—	20%
Creatinine blood test CPT 82565 LCHG CREATININE BLOOD	$34.40	$43.00	$2.53–$20.23	16% above	20%
Creatinine blood test inpatient CPT 82565 LCHG CREATININE BLOOD	$34.40	$43.00	$2.53–$20.23	—	20%
Cytomegalovirus (CMV) antibody test CPT 86644 LCHG CMV NEG UNIT	$92.80	$116.00	$7.11–$54.57	55% above	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 LCHG CMV NEG UNIT	$92.80	$116.00	$7.11–$54.57	—	20%
D-dimer blood test (blood clot marker) CPT 85379 LCHG D-DIMER QUANTITATIVE	$81.60	$102.00	$5.03–$47.98	15% below	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 LCHG D-DIMER QUANTITATIVE	$81.60	$102.00	$5.03–$47.98	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 LCHG DHEA SULFATE	$139.20	$174.00	$10.98–$81.85	84% above	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 LCHG DHEA SULFATE	$139.20	$174.00	$10.98–$81.85	—	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 LCHG DRUG SCREEN SGLCLS A V	$199.20	$249.00	$28.73–$117.13	110% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 LCHG OXYCODONE URINE SCREEN II	$199.20	$249.00	$28.73–$117.13	110% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 LCHG DRUG SCREEN PAIN MGT 80307	$199.20	$249.00	$28.73–$117.13	110% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 LCHG OPIATES URINE SCREEN I	$199.20	$249.00	$28.73–$117.13	110% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 LCHG DRUG SCREEN COMPREHENSIVE	$199.20	$249.00	$28.73–$117.13	110% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 LCHG URINE DRUG PANEL 10 - 793488	$199.20	$249.00	$28.73–$117.13	110% above	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 LCHG OPIATES URINE SCREEN I	$199.20	$249.00	$28.73–$117.13	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 LCHG DRUG SCREEN SGLCLS A V	$199.20	$249.00	$28.73–$117.13	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 LCHG OXYCODONE URINE SCREEN II	$199.20	$249.00	$28.73–$117.13	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 LCHG URINE DRUG PANEL 10 - 793488	$199.20	$249.00	$28.73–$117.13	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 LCHG DRUG SCREEN COMPREHENSIVE	$199.20	$249.00	$28.73–$117.13	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 LCHG DRUG SCREEN PAIN MGT 80307	$199.20	$249.00	$28.73–$117.13	—	20%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 LCHG LYTES (NA K CL CO2) BLOOD	$61.60	$77.00	$3.46–$36.22	2% above	20%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 LCHG LYTES (NA K CL CO2) BLOOD	$61.60	$77.00	$3.46–$36.22	—	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 LCHG EPSTEIN-BARR VIRUS ANTIBODY IGM	$80.00	$100.00	$8.96–$47.04	16% above	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 LCHG EPSTEIN-BARR VIRUS ANTIBODY VCA IGM	$92.80	$116.00	$8.96–$54.57	34% above	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 LCHG EPSTEIN-BARR VIRUS ANTIBODY IGG	$92.80	$116.00	$8.96–$54.57	34% above	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 LCHG EPSTEIN-BARR VIRUS ANTIBODY VCA	$160.00	$200.00	$8.96–$94.08	131% above	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 LCHG EPSTEIN-BARR VIRUS ANTIBODY IGM	$80.00	$100.00	$8.96–$47.04	—	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 LCHG EPSTEIN-BARR VIRUS ANTIBODY VCA IGM	$92.80	$116.00	$8.96–$54.57	—	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 LCHG EPSTEIN-BARR VIRUS ANTIBODY IGG	$92.80	$116.00	$8.96–$54.57	—	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 LCHG EPSTEIN-BARR VIRUS ANTIBODY VCA	$160.00	$200.00	$8.96–$94.08	—	20%
Estradiol blood test CPT 82670 LCHG ESTRADIOL	$139.20	$174.00	$13.80–$81.85	56% above	20%
Estradiol blood test inpatient CPT 82670 LCHG ESTRADIOL	$139.20	$174.00	$13.80–$81.85	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 LCHG FSH	$137.60	$172.00	$9.18–$80.91	100% above	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 LCHG FSH	$137.60	$172.00	$9.18–$80.91	—	20%
Fecal calprotectin (stool inflammation test) CPT 83993 LCHG CALPROTECTIN	$144.40	$180.50	$9.69–$84.91	at median	20%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 LCHG CALPROTECTIN	$144.40	$180.50	$9.69–$84.91	—	20%
Ferritin blood test (iron stores) CPT 82728 LCHG FERRITIN	$64.80	$81.00	$6.73–$38.10	at median	20%
Ferritin blood test (iron stores) inpatient CPT 82728 LCHG FERRITIN	$64.80	$81.00	$6.73–$38.10	—	20%
Fibrinogen blood test CPT 85384 LCHG FIBRINOGEN ACTIVITY	$28.80	$36.00	$4.19–$16.93	55% below	20%
Fibrinogen blood test inpatient CPT 85384 LCHG FIBRINOGEN ACTIVITY	$28.80	$36.00	$4.19–$16.93	—	20%
Folate (folic acid) blood test CPT 82746 LCHG FOLATE	$64.80	$81.00	$7.26–$38.10	4% above	20%
Folate (folic acid) blood test inpatient CPT 82746 LCHG FOLATE	$64.80	$81.00	$7.26–$38.10	—	20%
Free T3 thyroid hormone test CPT 84481 LCHG T3 FREE	$104.80	$131.00	$8.37–$61.62	17% above	20%
Free T3 thyroid hormone test inpatient CPT 84481 LCHG T3 FREE	$104.80	$131.00	$8.37–$61.62	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 LCHG T4 FREE	$92.80	$116.00	$4.45–$54.57	51% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 LCHG T4 FREE	$92.80	$116.00	$4.45–$54.57	—	20%
Free testosterone test CPT 84402 LCHG TESTOSTERONE FREE	$139.20	$174.00	$12.58–$81.85	61% above	20%
Free testosterone test inpatient CPT 84402 LCHG TESTOSTERONE FREE	$139.20	$174.00	$12.58–$81.85	—	20%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 LCHG GGT	$34.40	$43.00	$3.56–$20.23	30% below	20%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 LCHG GGT	$34.40	$43.00	$3.56–$20.23	—	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 CHG GENERAL HEALTH PANEL	$196.80	$246.00	$16.92–$115.72	1% above	20%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 CHG GENERAL HEALTH PANEL	$196.80	$246.00	$16.92–$115.72	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 LCHG GLUCOSE 1 HR POST PRANDIAL	$28.80	$36.00	$2.34–$16.93	2% below	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 LCHG GTT 1 HR GESTATIONAL SCREEN	$34.40	$43.00	$2.34–$20.23	18% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 LCHG GLUCOSE 1 HR POST PRANDIAL	$28.80	$36.00	$2.34–$16.93	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 LCHG GTT 1 HR GESTATIONAL SCREEN	$34.40	$43.00	$2.34–$20.23	—	20%
Glucose tolerance test, 3 samples CPT 82951 LCHG GTT 2 HR GESTATIONAL DIAGNOSTIC	$54.40	$68.00	$6.36–$31.99	14% below	20%
Glucose tolerance test, 3 samples CPT 82951 LCHG GTT 3 SPEC + DOSE	$64.80	$81.00	$6.36–$38.10	3% above	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 LCHG GTT 2 HR GESTATIONAL DIAGNOSTIC	$54.40	$68.00	$6.36–$31.99	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 LCHG GTT 3 SPEC + DOSE	$64.80	$81.00	$6.36–$38.10	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 LCHG GC AMPLIFIED PROBE II	$155.20	$194.00	$17.33–$91.26	87% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 LCHG GC DNA PROBE I	$155.20	$194.00	$17.33–$91.26	87% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 LCHG GC AMPLIFIED PROBE	$180.80	$226.00	$17.33–$106.31	117% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 LCHG GC AMPLIFIED PROBE II	$155.20	$194.00	$17.33–$91.26	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 LCHG GC DNA PROBE I	$155.20	$194.00	$17.33–$91.26	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 LCHG GC AMPLIFIED PROBE	$180.80	$226.00	$17.33–$106.31	—	20%
H. pylori stool antigen test CPT 87338 LCHG HELICOBACTER PYLORI ANTIGEN STOOL	$56.00	$70.00	$7.10–$32.93	50% below	20%
H. pylori stool antigen test CPT 87338 CHG IAAD IA HPYLORI STOOL	$185.64	$232.05	$7.10–$109.15	65% above	20%
H. pylori stool antigen test inpatient CPT 87338 LCHG HELICOBACTER PYLORI ANTIGEN STOOL	$56.00	$70.00	$7.10–$32.93	—	20%
H. pylori stool antigen test inpatient CPT 87338 CHG IAAD IA HPYLORI STOOL	$185.64	$232.05	$7.10–$109.15	—	20%
HIV-1 and HIV-2 antibody test CPT 86703 LCHG HIV-1 HIV-2 ANTIBODY	$56.00	$70.00	$6.77–$32.93	15% above	20%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 LCHG HIV-1 HIV-2 ANTIBODY	$56.00	$70.00	$6.77–$32.93	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 LCHG HIV-1 AG W HIV-1+HIV-2 AB	$76.80	$96.00	$11.89–$45.16	60% above	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE	$141.12	$176.40	$11.89–$82.98	194% above	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 LCHG HIV-1 AG W HIV-1+HIV-2 AB	$76.80	$96.00	$11.89–$45.16	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE	$141.12	$176.40	$11.89–$82.98	—	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 LCHG HPV HIGH RISK TYPES	$50.40	$63.00	$17.33–$47.37	42% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 LCHG HPV HIGH RISK TYPES I	$156.00	$195.00	$17.33–$91.73	78% above	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 LCHG HPV HIGH RISK TYPES	$50.40	$63.00	$17.33–$47.37	—	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 LCHG HPV HIGH RISK TYPES I	$156.00	$195.00	$17.33–$91.73	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 LCHG HEMOGLOBIN A1C	$57.60	$72.00	$4.80–$33.87	34% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 LCHG HEMOGLOBIN A1C	$57.60	$72.00	$4.80–$33.87	—	20%
Hemoglobin blood test CPT 85018 LCHG HEMOGLOBIN	$42.40	$53.00	$1.17–$24.93	112% above	20%
Hemoglobin blood test inpatient CPT 85018 LCHG HEMOGLOBIN	$42.40	$53.00	$1.17–$24.93	—	20%
Hepatitis B core antibody test (total) CPT 86704 LCHG HEPATITIS B CORE ANTIBODY	$48.00	$60.00	$5.95–$28.22	2% below	20%
Hepatitis B core antibody test (total) CPT 86704 LCHG HEPATITIS B CORE ANTIBODY I	$56.00	$70.00	$5.95–$32.93	14% above	20%
Hepatitis B core antibody test (total) inpatient CPT 86704 LCHG HEPATITIS B CORE ANTIBODY	$48.00	$60.00	$5.95–$28.22	—	20%
Hepatitis B core antibody test (total) inpatient CPT 86704 LCHG HEPATITIS B CORE ANTIBODY I	$56.00	$70.00	$5.95–$32.93	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 LCHG HEPATITIS B SURFACE ANTIBODY	$56.00	$70.00	$5.30–$32.93	26% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 LCHG HEPATITIS B SURFACE ANTIBODY	$56.00	$70.00	$5.30–$32.93	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 LCHG HEPATITIS B SURFACE ANTIGEN I	$48.00	$60.00	$5.10–$28.22	15% above	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 LCHG HEPATITIS B SURFACE ANTIGEN	$56.00	$70.00	$5.10–$32.93	35% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 LCHG HEPATITIS B SURFACE ANTIGEN I	$48.00	$60.00	$5.10–$28.22	—	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 LCHG HEPATITIS B SURFACE ANTIGEN	$56.00	$70.00	$5.10–$32.93	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 LCHG HEPATITIS C ANTIBODY I	$80.00	$100.00	$7.05–$47.04	57% above	20%
Hepatitis C antibody blood test (screening) CPT 86803 LCHG HEPATITIS C ANTIBODY	$92.80	$116.00	$7.05–$54.57	82% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 LCHG HEPATITIS C ANTIBODY I	$80.00	$100.00	$7.05–$47.04	—	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 LCHG HEPATITIS C ANTIBODY	$92.80	$116.00	$7.05–$54.57	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 LCHG HEPATITIS C QUANTITATIVE	$123.20	$154.00	$21.15–$72.44	45% below	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 LCHG HEPATITIS C RNA PCR QUANT	$180.80	$226.00	$21.15–$106.31	19% below	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 LCHG HEPATITIS C QUANTITATIVE	$123.20	$154.00	$21.15–$72.44	—	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 LCHG HEPATITIS C RNA PCR QUANT	$180.80	$226.00	$21.15–$106.31	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 CHG ANTIBODY HERPES SMPLX TYPE 1	$74.76	$93.45	$6.51–$43.96	28% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 LCHG HERPES SIMPLEX 1 ANTIBODY IGG	$80.80	$101.00	$6.51–$47.51	38% above	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 CHG ANTIBODY HERPES SMPLX TYPE 1	$74.76	$93.45	$6.51–$43.96	—	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 LCHG HERPES SIMPLEX 1 ANTIBODY IGG	$80.80	$101.00	$6.51–$47.51	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 LCHG HERPES SIMPLEX 2 ANTIBODY IGG	$48.80	$61.00	$9.56–$28.69	12% below	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 LCHG HERPES SIMPLEX 2 ANTIBODY IGG	$48.80	$61.00	$9.56–$28.69	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 LCHG C-REACTIVE PROTEIN SENSITIVE	$56.00	$70.00	$6.39–$32.93	3% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 LCHG C-REACTIVE PROTEIN SENSITIVE	$56.00	$70.00	$6.39–$32.93	—	20%
Homocysteine blood test CPT 83090 LCHG HOMOCYSTEINE BLOOD QUANT	$139.20	$174.00	$8.33–$81.85	13% above	20%
Homocysteine blood test inpatient CPT 83090 LCHG HOMOCYSTEINE BLOOD QUANT	$139.20	$174.00	$8.33–$81.85	—	20%
Insulin blood test CPT 83525 LCHG INSULIN LEVEL	$104.80	$131.00	$5.64–$61.62	122% above	20%
Insulin blood test inpatient CPT 83525 LCHG INSULIN LEVEL	$104.80	$131.00	$5.64–$61.62	—	20%
Iron blood test (serum iron) CPT 83540 LCHG IRON BLOOD	$34.40	$43.00	$3.20–$20.23	5% below	20%
Iron blood test (serum iron) inpatient CPT 83540 LCHG IRON BLOOD	$34.40	$43.00	$3.20–$20.23	—	20%
Iron-binding capacity (TIBC) test CPT 83550 LCHG TIBC	$64.80	$81.00	$4.32–$38.10	38% above	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 LCHG TIBC	$64.80	$81.00	$4.32–$38.10	—	20%
Kidney function blood test panel CPT 80069 LCHG RENAL FUNCTION PANEL	$69.60	$87.00	$4.29–$40.92	at median	20%
Kidney function blood test panel inpatient CPT 80069 LCHG RENAL FUNCTION PANEL	$69.60	$87.00	$4.29–$40.92	—	20%
LH (luteinizing hormone) test CPT 83002 LCHG LH	$139.20	$174.00	$9.14–$81.85	91% above	20%
LH (luteinizing hormone) test inpatient CPT 83002 LCHG LH	$139.20	$174.00	$9.14–$81.85	—	20%
Lactate (lactic acid) blood test CPT 83605 LCHG LACTIC ACID BLOOD	$64.80	$81.00	$5.27–$38.10	35% above	20%
Lactate (lactic acid) blood test inpatient CPT 83605 LCHG LACTIC ACID BLOOD	$64.80	$81.00	$5.27–$38.10	—	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LCHG LDH BLOOD	$34.40	$43.00	$2.98–$20.23	2% below	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LCHG LDH FLUID	$35.20	$44.00	$2.98–$20.70	at median	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LCHG LDH BLOOD	$34.40	$43.00	$2.98–$20.23	—	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LCHG LDH FLUID	$35.20	$44.00	$2.98–$20.70	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LCHG LIPASE BLOOD	$34.40	$43.00	$3.40–$20.23	36% below	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LCHG LIPASE BLOOD	$34.40	$43.00	$3.40–$20.23	—	20%
Liver function blood test panel CPT 80076 LCHG HEPATIC FUNCTION PANEL	$69.60	$87.00	$4.04–$40.92	27% above	20%
Liver function blood test panel inpatient CPT 80076 LCHG HEPATIC FUNCTION PANEL	$69.60	$87.00	$4.04–$40.92	—	20%
Lyme disease antibody test CPT 86618 LCHG LYME DISEASE AB TOTAL I	$92.80	$116.00	$8.41–$54.57	14% above	20%
Lyme disease antibody test CPT 86618 LCHG LYME DISEASE ANTIBODY SCREEN BLOOD	$92.80	$116.00	$8.41–$54.57	14% above	20%
Lyme disease antibody test CPT 86618 LCHG LYME DISEASE AB IGM	$112.00	$140.00	$8.41–$65.86	38% above	20%
Lyme disease antibody test CPT 86618 LCHG LYME DISEASE AB IGG I	$160.00	$200.00	$8.41–$94.08	97% above	20%
Lyme disease antibody test inpatient CPT 86618 LCHG LYME DISEASE AB TOTAL I	$92.80	$116.00	$8.41–$54.57	—	20%
Lyme disease antibody test inpatient CPT 86618 LCHG LYME DISEASE ANTIBODY SCREEN BLOOD	$92.80	$116.00	$8.41–$54.57	—	20%
Lyme disease antibody test inpatient CPT 86618 LCHG LYME DISEASE AB IGM	$112.00	$140.00	$8.41–$65.86	—	20%
Lyme disease antibody test inpatient CPT 86618 LCHG LYME DISEASE AB IGG I	$160.00	$200.00	$8.41–$94.08	—	20%
Magnesium blood test CPT 83735 LCHG MAGNESIUM URINE TIMED II	$30.40	$38.00	$3.31–$17.88	11% below	20%
Magnesium blood test CPT 83735 LCHG MAGNESIUM BLOOD	$30.40	$38.00	$3.31–$17.88	11% below	20%
Magnesium blood test inpatient CPT 83735 LCHG MAGNESIUM URINE TIMED II	$30.40	$38.00	$3.31–$17.88	—	20%
Magnesium blood test inpatient CPT 83735 LCHG MAGNESIUM BLOOD	$30.40	$38.00	$3.31–$17.88	—	20%
Measles (rubeola) antibody test CPT 86765 LCHG RUBEOLA ANTIBODY IGG	$56.00	$70.00	$6.36–$32.93	36% above	20%
Measles (rubeola) antibody test inpatient CPT 86765 LCHG RUBEOLA ANTIBODY IGG	$56.00	$70.00	$6.36–$32.93	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 LCHG MONONUCLEOSIS SCREEN	$56.00	$70.00	$2.56–$32.93	56% above	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 LCHG MONONUCLEOSIS SCREEN	$56.00	$70.00	$2.56–$32.93	—	20%
Mumps immunity blood test CPT 86735 LCHG MUMPS ANTIBODY IGG	$56.00	$70.00	$6.44–$32.93	at median	20%
Mumps immunity blood test inpatient CPT 86735 LCHG MUMPS ANTIBODY IGG	$56.00	$70.00	$6.44–$32.93	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 LCHG PSA FREE	$64.80	$81.00	$9.08–$38.10	28% below	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 LCHG PSA FREE	$64.80	$81.00	$9.08–$38.10	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 LCHG PROSTATE SPECIFIC ANTIGEN DIAG	$64.80	$81.00	$9.08–$38.10	16% below	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 LCHG PSA TOTAL	$125.60	$157.00	$9.08–$73.85	63% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 LCHG PROSTATE SPECIFIC ANTIGEN DIAG	$64.80	$81.00	$9.08–$38.10	—	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 LCHG PSA TOTAL	$125.60	$157.00	$9.08–$73.85	—	20%
Pap test (liquid-based, automated screening with review) CPT 88175 LCHG CYTOPATH SUREPATH PAP	$84.00	$105.00	$13.08–$49.39	21% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 LCHG CYTO PATH IMAGING TC NL	$84.00	$105.00	$13.08–$49.39	21% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 LCHG CYTOPATH IMAGING TC	$96.00	$120.00	$13.08–$56.45	38% above	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 LCHG CYTOPATH SUREPATH PAP	$84.00	$105.00	$13.08–$49.39	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 LCHG CYTO PATH IMAGING TC NL	$84.00	$105.00	$13.08–$49.39	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 LCHG CYTOPATH IMAGING TC	$96.00	$120.00	$13.08–$56.45	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 LCHG PTH HORMONE	$118.40	$148.00	$20.38–$69.62	15% below	20%
Parathyroid hormone (PTH) blood test CPT 83970 LCHG PTH INTACT	$139.20	$174.00	$20.38–$81.85	at median	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 LCHG PTH HORMONE	$118.40	$148.00	$20.38–$69.62	—	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 LCHG PTH INTACT	$139.20	$174.00	$20.38–$81.85	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 LCHG PTT	$26.40	$33.00	$2.97–$15.52	19% below	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LCHG PTT	$26.40	$33.00	$2.97–$15.52	—	20%
Phosphorus (phosphate) blood test CPT 84100 LCHG PHOSPHORUS BLOOD	$34.40	$43.00	$2.34–$20.23	5% above	20%
Phosphorus (phosphate) blood test inpatient CPT 84100 LCHG PHOSPHORUS BLOOD	$34.40	$43.00	$2.34–$20.23	—	20%
Potassium blood test CPT 84132 LCHG POTASSIUM BLOOD	$34.40	$43.00	$2.27–$20.23	6% above	20%
Potassium blood test inpatient CPT 84132 LCHG POTASSIUM BLOOD	$34.40	$43.00	$2.27–$20.23	—	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 LCHG FETAL ANEUPLOIDY DNA SEQUENCE ANALYSIS I	$507.20	$634.00	$298.23–$634.00	57% below	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 LCHG FETAL ANEUPLOIDY DNA SEQUENCE ANALYSIS I	$507.20	$634.00	$298.23–$634.00	—	20%
Progesterone blood test CPT 84144 LCHG PROGESTERONE	$104.80	$131.00	$10.30–$61.62	44% above	20%
Progesterone blood test inpatient CPT 84144 LCHG PROGESTERONE	$104.80	$131.00	$10.30–$61.62	—	20%
Prolactin blood test CPT 84146 LCHG PROLACTIN	$139.20	$174.00	$9.57–$81.85	48% above	20%
Prolactin blood test inpatient CPT 84146 LCHG PROLACTIN	$139.20	$174.00	$9.57–$81.85	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 LCHG PT-INR	$23.20	$29.00	$1.94–$13.64	29% below	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LCHG PT-INR	$23.20	$29.00	$1.94–$13.64	—	20%
Rapid flu test (influenza antigen) CPT 87804 LCHG INFLUENZA A+B ANTIGEN RAPID	$56.80	$71.00	$5.92–$33.40	6% above	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 LCHG INFLUENZA A+B ANTIGEN RAPID	$56.80	$71.00	$5.92–$33.40	—	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC LAB STREP A POCT (IP) BEAKER	$44.80	$56.00	$5.92–$26.34	8% below	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 LCHG STREP A SCREEN DIRECT IMMUNO	$50.40	$63.00	$5.92–$29.64	4% above	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC LAB STREP A POCT (IP) BEAKER	$44.80	$56.00	$5.92–$26.34	—	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 LCHG STREP A SCREEN DIRECT IMMUNO	$50.40	$63.00	$5.92–$29.64	—	20%
Renin blood test CPT 84244 LCHG RENIN	$139.20	$174.00	$10.86–$81.85	32% above	20%
Renin blood test inpatient CPT 84244 LCHG RENIN	$139.20	$174.00	$10.86–$81.85	—	20%
Rh blood typing CPT 86901 LCHG BLOOD TYPE RH ONLY REF	$33.60	$42.00	$1.48–$42.00	22% below	20%
Rh blood typing CPT 86901 LCHG BLOOD TYPE RH I	$92.00	$115.00	$1.48–$78.50	112% above	20%
Rh blood typing inpatient CPT 86901 LCHG BLOOD TYPE RH ONLY REF	$33.60	$42.00	$1.48–$42.00	—	20%
Rh blood typing inpatient CPT 86901 LCHG BLOOD TYPE RH I	$92.00	$115.00	$1.48–$78.50	—	20%
Rheumatoid factor (RF) test CPT 86431 LCHG RHEUMATOID FACTOR II	$48.00	$60.00	$2.80–$28.22	67% above	20%
Rheumatoid factor (RF) test CPT 86431 LCHG RHEUMATOID FACTOR BLOOD QUANT	$56.00	$70.00	$2.80–$32.93	94% above	20%
Rheumatoid factor (RF) test inpatient CPT 86431 LCHG RHEUMATOID FACTOR II	$48.00	$60.00	$2.80–$28.22	—	20%
Rheumatoid factor (RF) test inpatient CPT 86431 LCHG RHEUMATOID FACTOR BLOOD QUANT	$56.00	$70.00	$2.80–$32.93	—	20%
Rubella antibody test (immunity check) CPT 86762 LCHG RUBELLA ANTIBODY IGG	$48.00	$60.00	$7.11–$28.22	9% below	20%
Rubella antibody test (immunity check) CPT 86762 LCHG RUBELLA IMMUNE STATUS	$49.60	$62.00	$7.11–$29.16	6% below	20%
Rubella antibody test (immunity check) inpatient CPT 86762 LCHG RUBELLA ANTIBODY IGG	$48.00	$60.00	$7.11–$28.22	—	20%
Rubella antibody test (immunity check) inpatient CPT 86762 LCHG RUBELLA IMMUNE STATUS	$49.60	$62.00	$7.11–$29.16	—	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 LCHG SED RATE WESTERGREN AUTO	$47.20	$59.00	$1.33–$27.75	127% above	20%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 LCHG SED RATE WESTERGREN AUTO	$47.20	$59.00	$1.33–$27.75	—	20%
Sodium blood test CPT 84295 LCHG SODIUM BLOOD	$34.40	$43.00	$2.38–$20.23	8% above	20%
Sodium blood test inpatient CPT 84295 LCHG SODIUM BLOOD	$34.40	$43.00	$2.38–$20.23	—	20%
Stool ova and parasites exam CPT 87177 LCHG O+P	$50.40	$63.00	$4.40–$29.64	18% below	20%
Stool ova and parasites exam inpatient CPT 87177 LCHG O+P	$50.40	$63.00	$4.40–$29.64	—	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 LCHG OCCULT BLOOD FECES 1-3 SCREEN	$34.40	$43.00	$1.61–$20.23	51% above	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 LCHG OCCULT BLOOD FECES 1-3 SCREEN	$34.40	$43.00	$1.61–$20.23	—	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 LCHG OCCULT BLOOD FECES 1-3 IMMUNO	$54.40	$68.00	$7.86–$31.99	7% below	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 LCHG OCCULT BLOOD FECES 1-3 IMMUNO	$54.40	$68.00	$7.86–$31.99	—	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 LCHG TREPONEMA PALLIDUM AB IGG	$56.00	$70.00	$6.54–$32.93	41% above	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 LCHG TREPONEMA PALLIDUM ANTIBODY	$80.00	$100.00	$6.54–$47.04	101% above	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 LCHG TREPONEMA PALLIDUM AB IGG BY ELISA	$81.60	$102.00	$6.54–$47.98	105% above	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 LCHG FTA ANTIBODY	$92.80	$116.00	$6.54–$54.57	134% above	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 LCHG TREPONEMA PALLIDUM AB IGG	$56.00	$70.00	$6.54–$32.93	—	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 LCHG TREPONEMA PALLIDUM ANTIBODY	$80.00	$100.00	$6.54–$47.04	—	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 LCHG TREPONEMA PALLIDUM AB IGG BY ELISA	$81.60	$102.00	$6.54–$47.98	—	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 LCHG FTA ANTIBODY	$92.80	$116.00	$6.54–$54.57	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 LCHG RPR I	$48.00	$60.00	$2.11–$28.22	66% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 LCHG RPR	$49.60	$62.00	$2.11–$29.16	72% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 LCHG RPR I	$48.00	$60.00	$2.11–$28.22	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 LCHG RPR	$49.60	$62.00	$2.11–$29.16	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$190.68	$238.35	$30.61–$112.12	11% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 LCHG QUANTIFERON TB-GOLD	$215.20	$269.00	$30.61–$126.54	26% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$190.68	$238.35	$30.61–$112.12	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 LCHG QUANTIFERON TB-GOLD	$215.20	$269.00	$30.61–$126.54	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 LCHG TESTOSTERONE TOTAL	$139.20	$174.00	$12.75–$81.85	55% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 LCHG TESTOSTERONE TOTAL I	$139.20	$174.00	$12.75–$81.85	55% above	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 LCHG TESTOSTERONE TOTAL	$139.20	$174.00	$12.75–$81.85	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 LCHG TESTOSTERONE TOTAL I	$139.20	$174.00	$12.75–$81.85	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 LCHG MICROSOMAL ANTIBODY	$92.80	$116.00	$7.19–$54.57	55% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 LCHG THYROID PEROXIDASE ANTIBODY	$104.80	$131.00	$7.19–$61.62	75% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LCHG MICROSOMAL ANTIBODY	$92.80	$116.00	$7.19–$54.57	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LCHG THYROID PEROXIDASE ANTIBODY	$104.80	$131.00	$7.19–$61.62	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 LCHG TSH	$92.80	$116.00	$8.30–$54.57	73% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 LCHG TSH	$92.80	$116.00	$8.30–$54.57	—	20%
Total IgE blood test CPT 82785 LCHG IGE	$48.00	$60.00	$8.13–$28.22	7% below	20%
Total IgE blood test inpatient CPT 82785 LCHG IGE	$48.00	$60.00	$8.13–$28.22	—	20%
Total cholesterol blood test CPT 82465 LCHG CHOLESTEROL BLOOD	$34.40	$43.00	$2.15–$20.23	3% above	20%
Total cholesterol blood test inpatient CPT 82465 LCHG CHOLESTEROL BLOOD	$34.40	$43.00	$2.15–$20.23	—	20%
Total thyroxine (T4) blood test CPT 84436 CHG ASSAY OF THYROXINE TOTAL	$40.32	$50.40	$3.39–$23.71	7% below	20%
Total thyroxine (T4) blood test CPT 84436 LCHG T4 TOTAL	$92.80	$116.00	$3.39–$54.57	113% above	20%
Total thyroxine (T4) blood test inpatient CPT 84436 CHG ASSAY OF THYROXINE TOTAL	$40.32	$50.40	$3.39–$23.71	—	20%
Total thyroxine (T4) blood test inpatient CPT 84436 LCHG T4 TOTAL	$92.80	$116.00	$3.39–$54.57	—	20%
Total triiodothyronine (T3) blood test CPT 84480 LCHG T3 TOTAL	$111.20	$139.00	$7.00–$65.39	88% above	20%
Total triiodothyronine (T3) blood test inpatient CPT 84480 LCHG T3 TOTAL	$111.20	$139.00	$7.00–$65.39	—	20%
Transferrin blood test CPT 84466 LCHG TRANSFERRIN	$54.40	$68.00	$6.30–$31.99	5% below	20%
Transferrin blood test CPT 84466 CHG ASSAY OF L7383TRANSFERRIN	$84.84	$106.05	$6.30–$49.88	48% above	20%
Transferrin blood test inpatient CPT 84466 LCHG TRANSFERRIN	$54.40	$68.00	$6.30–$31.99	—	20%
Transferrin blood test inpatient CPT 84466 CHG ASSAY OF L7383TRANSFERRIN	$84.84	$106.05	$6.30–$49.88	—	20%
Trichomonas test (NAAT) CPT 87661 CHG IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH	$104.00	$130.00	$17.33–$61.15	18% above	20%
Trichomonas test (NAAT) CPT 87661 LCHG TRICHOMONAS VAGINALIS AMPLIFIED PROBE	$155.20	$194.00	$17.33–$91.26	77% above	20%
Trichomonas test (NAAT) CPT 87661 LCHG TRICHOMONAS VAGINALIS AMPLIFIED PROBE I	$155.20	$194.00	$17.33–$91.26	77% above	20%
Trichomonas test (NAAT) inpatient CPT 87661 CHG IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH	$104.00	$130.00	$17.33–$61.15	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 LCHG TRICHOMONAS VAGINALIS AMPLIFIED PROBE	$155.20	$194.00	$17.33–$91.26	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 LCHG TRICHOMONAS VAGINALIS AMPLIFIED PROBE I	$155.20	$194.00	$17.33–$91.26	—	20%
Triglycerides blood test CPT 84478 LCHG TRIGLYCERIDES BLOOD	$34.40	$43.00	$2.84–$20.23	at median	20%
Triglycerides blood test inpatient CPT 84478 LCHG TRIGLYCERIDES BLOOD	$34.40	$43.00	$2.84–$20.23	—	20%
Troponin test, quantitative CPT 84484 LCHG TROPONIN I	$64.80	$81.00	$4.86–$38.10	9% below	20%
Troponin test, quantitative inpatient CPT 84484 LCHG TROPONIN I	$64.80	$81.00	$4.86–$38.10	—	20%
Uric acid blood test CPT 84550 LCHG URIC ACID BLOOD	$34.40	$43.00	$2.23–$20.23	30% above	20%
Uric acid blood test inpatient CPT 84550 LCHG URIC ACID BLOOD	$34.40	$43.00	$2.23–$20.23	—	20%
Urinalysis with microscope exam, automated CPT 81001 LCHG URINALYSIS ROUTINE AUTO W MICROSCOPIC	$18.40	$23.00	$1.57–$10.82	35% below	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 LCHG URINALYSIS ROUTINE AUTO W MICROSCOPIC	$18.40	$23.00	$1.57–$10.82	—	20%
Urinalysis without microscope exam, automated CPT 81003 LCHG URINALYSIS DIPSTICK AUTO	$14.40	$18.00	$1.11–$8.47	1% above	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 LCHG URINALYSIS DIPSTICK AUTO	$14.40	$18.00	$1.11–$8.47	—	20%
Urine culture for bacteria, with colony count CPT 87086 LCHG CULTURE URINE	$50.40	$63.00	$3.99–$29.64	4% above	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 LCHG CULTURE URINE	$50.40	$63.00	$3.99–$29.64	—	20%
Urine microalbumin (albumin) test CPT 82043 LCHG ALBUMIN URINE RANDOM QUANT	$17.60	$22.00	$2.85–$10.35	54% below	20%
Urine microalbumin (albumin) test CPT 82043 LCHG MICROALBUMIN URINE RANDOM QUANT	$20.80	$26.00	$2.85–$12.23	46% below	20%
Urine microalbumin (albumin) test inpatient CPT 82043 LCHG ALBUMIN URINE RANDOM QUANT	$17.60	$22.00	$2.85–$10.35	—	20%
Urine microalbumin (albumin) test inpatient CPT 82043 LCHG MICROALBUMIN URINE RANDOM QUANT	$20.80	$26.00	$2.85–$12.23	—	20%
Urine pregnancy test, read by color change CPT 81025 LCHG HCG URINE QUALITATIVE	$25.60	$32.00	$3.12–$15.05	5% below	20%
Urine pregnancy test, read by color change CPT 81025 HC LAB HCG URINE QUAL POCT (IP) BEAKER	$36.80	$46.00	$3.12–$21.64	36% above	20%
Urine pregnancy test, read by color change inpatient CPT 81025 LCHG HCG URINE QUALITATIVE	$25.60	$32.00	$3.12–$15.05	—	20%
Urine pregnancy test, read by color change inpatient CPT 81025 HC LAB HCG URINE QUAL POCT (IP) BEAKER	$36.80	$46.00	$3.12–$21.64	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 LCHG VITAMIN B12	$104.80	$131.00	$7.44–$61.62	69% above	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 LCHG VITAMIN B12	$104.80	$131.00	$7.44–$61.62	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 LCHG VITAMIN D 25-HYDROXY D2+D3	$166.40	$208.00	$14.62–$97.84	27% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 LCHG VITAMIN D 25-HYDROXY	$193.60	$242.00	$14.62–$113.84	48% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 LCHG VITAMIN D 25-HYDROXY D2+D3	$166.40	$208.00	$14.62–$97.84	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 LCHG VITAMIN D 25-HYDROXY	$193.60	$242.00	$14.62–$113.84	—	20%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 LCHG VITAMIN D 1 25 DIHYDROXY	$193.60	$242.00	$19.01–$113.84	24% above	20%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 LCHG VITAMIN D 1 25 DIHYDROXY	$193.60	$242.00	$19.01–$113.84	—	20%
Zinc blood test CPT 84630 LCHG ZINC BLOOD	$95.20	$119.00	$5.62–$55.98	65% above	20%
Zinc blood test inpatient CPT 84630 LCHG ZINC BLOOD	$95.20	$119.00	$5.62–$55.98	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 LCHG HCG BETA BLOOD QUANTITATIVE	$92.80	$116.00	$7.43–$54.57	53% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 LCHG HCG QUANTITATIVE I	$104.80	$131.00	$7.43–$61.62	72% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 LCHG HCG BETA BLOOD QUANTITATIVE	$92.80	$116.00	$7.43–$54.57	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 LCHG HCG QUANTITATIVE I	$104.80	$131.00	$7.43–$61.62	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 HP REMV ADENOIDS PRIM UNDER 12 YRS	$518.66	$648.33	$178.60–$648.33	51% below	20%
Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 HP REMV ADENOIDS PRIM UNDER 12 YRS	$518.66	$648.33	$178.60–$648.33	—	20%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 HP ARTHROSCOPY ACL RECONSTRUCTION	$3,013.42	$3,766.77	$816.83–$3,766.77	79% below	20%
Arthroscopic ACL reconstruction or repair of the knee one side CPT 29888 HP ARTHROSCOPY ACL RECONSTRUCTION,Right side of body	$3,013.42	$3,766.77	$816.83–$3,766.77	79% below	20%
Arthroscopic ACL reconstruction or repair of the knee one side CPT 29888 HP ARTHROSCOPY ACL RECONSTRUCTION,Left side of body	$3,013.42	$3,766.77	$816.83–$3,766.77	79% below	20%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 HP ARTHROSCOPY ACL RECONSTRUCTION	$3,013.42	$3,766.77	$816.83–$3,766.77	—	20%
Arthroscopic ACL reconstruction or repair of the knee inpatient one side CPT 29888 HP ARTHROSCOPY ACL RECONSTRUCTION,Left side of body	$3,013.42	$3,766.77	$816.83–$3,766.77	—	20%
Arthroscopic ACL reconstruction or repair of the knee inpatient one side CPT 29888 HP ARTHROSCOPY ACL RECONSTRUCTION,Right side of body	$3,013.42	$3,766.77	$816.83–$3,766.77	—	20%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 HP ARTHROSCOPY ROTATOR CUFF REPAIR	$2,593.13	$3,241.41	$896.06–$3,241.41	81% below	20%
Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 HP ARTHROSCOPY ROTATOR CUFF REPAIR,Right side of body	$2,593.13	$3,241.41	$896.06–$3,241.41	81% below	20%
Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 HP ARTHROSCOPY ROTATOR CUFF REPAIR,Left side of body	$2,593.13	$3,241.41	$896.06–$3,241.41	81% below	20%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 HP ARTHROSCOPY ROTATOR CUFF REPAIR	$2,593.13	$3,241.41	$896.06–$3,241.41	—	20%
Arthroscopic rotator cuff repair of the shoulder inpatient one side CPT 29827 HP ARTHROSCOPY ROTATOR CUFF REPAIR,Left side of body	$2,593.13	$3,241.41	$896.06–$3,241.41	—	20%
Arthroscopic rotator cuff repair of the shoulder inpatient one side CPT 29827 HP ARTHROSCOPY ROTATOR CUFF REPAIR,Right side of body	$2,593.13	$3,241.41	$896.06–$3,241.41	—	20%
Carpal tunnel release, open surgery one side CPT 64721 HP CARPAL TUNNEL RELEASE UNILAT,Left side of body	$1,080.10	$1,350.12	$435.61–$1,350.12	54% below	20%
Carpal tunnel release, open surgery one side CPT 64721 HP CARPAL TUNNEL RELEASE UNILAT,Right side of body	$1,080.10	$1,350.12	$435.61–$1,350.12	54% below	20%
Carpal tunnel release, open surgery one side CPT 64721 HP CARPAL TUNNEL RELEASE UNILAT	$1,080.10	$1,350.12	$435.61–$1,350.12	54% below	20%
Carpal tunnel release, open surgery inpatient one side CPT 64721 HP CARPAL TUNNEL RELEASE UNILAT	$1,080.10	$1,350.12	$435.61–$1,350.12	—	20%
Carpal tunnel release, open surgery inpatient one side CPT 64721 HP CARPAL TUNNEL RELEASE UNILAT,Right side of body	$1,080.10	$1,350.12	$435.61–$1,350.12	—	20%
Carpal tunnel release, open surgery inpatient one side CPT 64721 HP CARPAL TUNNEL RELEASE UNILAT,Left side of body	$1,080.10	$1,350.12	$435.61–$1,350.12	—	20%
Colonoscopy with polyp removal CPT 45385 HP COLONOSCOPY FLEX W REMV LES SNARE	$1,079.38	$1,349.22	$240.63–$1,349.22	38% below	20%
Colonoscopy with polyp removal inpatient CPT 45385 HP COLONOSCOPY FLEX W REMV LES SNARE	$1,079.38	$1,349.22	$240.63–$1,349.22	—	20%
Colonoscopy with tissue sample CPT 45380 HP COLONOSCOPY FLEX WITH BIOPSY	$1,024.08	$1,280.10	$190.97–$1,280.10	35% below	20%
Colonoscopy with tissue sample inpatient CPT 45380 HP COLONOSCOPY FLEX WITH BIOPSY	$1,024.08	$1,280.10	$190.97–$1,280.10	—	20%
Earwax removal with instruments, one ear CPT 69210 HC REMOVE CERUMEN IMPACTED W INSTRUMENT BIL	$166.40	$208.00	$43.60–$145.60	113% above	20%
Earwax removal with instruments, one ear inpatient CPT 69210 HC REMOVE CERUMEN IMPACTED W INSTRUMENT BIL	$166.40	$208.00	$43.60–$145.60	—	20%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 HP ENDO NASAL SINUS EXPLOR FRONTAL SINUS	$918.67	$1,148.34	$297.68–$1,148.34	88% below	20%
Endoscopic sinus surgery: opening the frontal sinus one side CPT 31276 HP ENDO NASAL SINUS EXPLOR FRONTAL SINUS,Left side of body	$918.67	$1,148.34	$297.68–$1,148.34	88% below	20%
Endoscopic sinus surgery: opening the frontal sinus one side CPT 31276 HP ENDO NASAL SINUS EXPLOR FRONTAL SINUS,Right side of body	$918.67	$1,148.34	$297.68–$1,148.34	88% below	20%
Endoscopic sinus surgery: opening the frontal sinus inpatient CPT 31276 HP ENDO NASAL SINUS EXPLOR FRONTAL SINUS	$918.67	$1,148.34	$297.68–$1,148.34	—	20%
Endoscopic sinus surgery: opening the frontal sinus inpatient one side CPT 31276 HP ENDO NASAL SINUS EXPLOR FRONTAL SINUS,Left side of body	$918.67	$1,148.34	$297.68–$1,148.34	—	20%
Endoscopic sinus surgery: opening the frontal sinus inpatient one side CPT 31276 HP ENDO NASAL SINUS EXPLOR FRONTAL SINUS,Right side of body	$918.67	$1,148.34	$297.68–$1,148.34	—	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 HP ENDOSCOPY SINUS W RMVL TISS MAXILLARY	$645.05	$806.31	$209.60–$806.31	at median	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue one side CPT 31267 HP ENDOSCOPY SINUS W RMVL TISS MAXILLARY,Right side of body	$645.05	$806.31	$209.60–$806.31	at median	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue one side CPT 31267 HP ENDOSCOPY SINUS W RMVL TISS MAXILLARY,Left side of body	$645.05	$806.31	$209.60–$806.31	at median	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 HP ENDOSCOPY SINUS W RMVL TISS MAXILLARY	$645.05	$806.31	$209.60–$806.31	—	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient one side CPT 31267 HP ENDOSCOPY SINUS W RMVL TISS MAXILLARY,Right side of body	$645.05	$806.31	$209.60–$806.31	—	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient one side CPT 31267 HP ENDOSCOPY SINUS W RMVL TISS MAXILLARY,Left side of body	$645.05	$806.31	$209.60–$806.31	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HP INJ EPIDURAL CERVICAL THOR W IMG	$388.00	$485.00	$103.01–$485.00	41% below	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HP INJ EPIDURAL CERVICAL THOR W IMG	$388.00	$485.00	$103.01–$485.00	—	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HP INJ FACET JNT L/S SNGL LVL	$420.96	$526.20	$87.37–$526.20	61% below	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 HP INJ FACET JNT L/S SNGL LVL,Right side of body	$420.96	$526.20	$87.37–$526.20	61% below	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HP INJ FACET JNT L/S SNGL LVL	$420.96	$526.20	$87.37–$526.20	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 HP INJ FACET JNT L/S SNGL LVL,Right side of body	$420.96	$526.20	$87.37–$526.20	—	20%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 HP RPR HERNIA ANT ABD INIT 3-10CM REDUCBL	$1,390.80	$1,738.50	$484.62–$1,738.50	89% below	20%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 HP RPR HERNIA ANT ABD INIT 3-10CM REDUCBL	$1,390.80	$1,738.50	$484.62–$1,738.50	—	20%
Gallbladder removal, laparoscopic CPT 47562 HP LAPAROSCOPIC CHOLECYSTECTOMY	$1,604.11	$2,005.14	$578.66–$2,005.14	82% below	20%
Gallbladder removal, laparoscopic inpatient CPT 47562 HP LAPAROSCOPIC CHOLECYSTECTOMY	$1,604.11	$2,005.14	$578.66–$2,005.14	—	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 HP LAPCHOLECYSTECTOMY W CHOLANGIOGRAM	$1,744.15	$2,180.19	$626.93–$2,180.19	80% below	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 HP LAPCHOLECYSTECTOMY W CHOLANGIOGRAM	$1,744.15	$2,180.19	$626.93–$2,180.19	—	20%
Hammertoe correction surgery one side CPT 28285 HP HAMMERTOE REPAIR UNILAT	$1,290.19	$1,612.74	$392.49–$1,612.74	62% below	20%
Hammertoe correction surgery inpatient one side CPT 28285 HP HAMMERTOE REPAIR UNILAT	$1,290.19	$1,612.74	$392.49–$1,612.74	—	20%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 HP CONV TO TOT HIP ARTHROPLASTY	$4,042.15	$5,052.69	$1,383.82–$3,536.88	—	20%
Hip replacement after an earlier hip surgery (conversion to total hip) one side CPT 27132 HP CONV TO TOT HIP ARTHROPLASTY,Right side of body	$4,042.15	$5,052.69	$1,383.82–$3,536.88	—	20%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 HP CONV TO TOT HIP ARTHROPLASTY	$4,042.15	$5,052.69	$1,383.82–$3,536.88	—	20%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient one side CPT 27132 HP CONV TO TOT HIP ARTHROPLASTY,Right side of body	$4,042.15	$5,052.69	$1,383.82–$3,536.88	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 HP ID ABSCESS SMPL SNGL	$833.47	$1,041.84	$105.41–$575.10	270% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 HC ED I&D ABSCESS SMPL SNGL	$1,172.80	$1,466.00	$116.21–$1,026.20	421% above	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HP ID ABSCESS SMPL SNGL	$833.47	$1,041.84	$105.41–$575.10	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC ED I&D ABSCESS SMPL SNGL	$1,172.80	$1,466.00	$116.21–$1,026.20	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HP ARTHROCENTESIS JOINT MAJOR WO US	$156.46	$195.57	$42.53–$195.57	38% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENTESIS JOINT MAJOR WO US	$1,472.80	$1,841.00	$42.53–$1,016.23	487% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ED ARTHROCENTESIS JOINT MAJOR WO US	$1,472.80	$1,841.00	$62.42–$1,288.70	487% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC ED ARTHROCENTESIS JOINT MAJOR WO US,Right side of body	$1,472.80	$1,841.00	$62.42–$1,288.70	487% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HP ARTHROCENTESIS JOINT MAJOR WO US	$156.46	$195.57	$42.53–$195.57	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ED ARTHROCENTESIS JOINT MAJOR WO US	$1,472.80	$1,841.00	$62.42–$1,288.70	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ARTHROCENTESIS JOINT MAJOR WO US	$1,472.80	$1,841.00	$42.53–$1,016.23	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC ED ARTHROCENTESIS JOINT MAJOR WO US,Right side of body	$1,472.80	$1,841.00	$62.42–$1,288.70	—	20%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 HP ARTHROSCOPY KNEE W MENISCECTOMY	$1,676.18	$2,095.23	$587.53–$2,095.23	75% below	20%
Knee arthroscopy with meniscus repair (one side of the knee) one side CPT 29882 HP ARTHROSCOPY KNEE W MENISCECTOMY,Right side of body	$1,676.18	$2,095.23	$587.53–$2,095.23	75% below	20%
Knee arthroscopy with meniscus repair (one side of the knee) one side CPT 29882 HP ARTHROSCOPY KNEE W MENISCECTOMY,Left side of body	$1,676.18	$2,095.23	$587.53–$2,095.23	75% below	20%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 HP ARTHROSCOPY KNEE W MENISCECTOMY	$1,676.18	$2,095.23	$587.53–$2,095.23	—	20%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient one side CPT 29882 HP ARTHROSCOPY KNEE W MENISCECTOMY,Right side of body	$1,676.18	$2,095.23	$587.53–$2,095.23	—	20%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient one side CPT 29882 HP ARTHROSCOPY KNEE W MENISCECTOMY,Left side of body	$1,676.18	$2,095.23	$587.53–$2,095.23	—	20%
Knee arthroscopy with meniscus trim CPT 29881 HP MENISCECTOMY MEDIAL OR LAT KNEE	$1,726.91	$2,158.64	$470.00–$2,158.64	74% below	20%
Knee arthroscopy with meniscus trim one side CPT 29881 HP MENISCECTOMY MEDIAL OR LAT KNEE,Left side of body	$1,726.91	$2,158.64	$470.00–$2,158.64	74% below	20%
Knee arthroscopy with meniscus trim one side CPT 29881 HP MENISCECTOMY MEDIAL OR LAT KNEE,Right side of body	$1,726.91	$2,158.64	$470.00–$2,158.64	74% below	20%
Knee arthroscopy with meniscus trim inpatient CPT 29881 HP MENISCECTOMY MEDIAL OR LAT KNEE	$1,726.91	$2,158.64	$470.00–$2,158.64	—	20%
Knee arthroscopy with meniscus trim inpatient one side CPT 29881 HP MENISCECTOMY MEDIAL OR LAT KNEE,Right side of body	$1,726.91	$2,158.64	$470.00–$2,158.64	—	20%
Knee arthroscopy with meniscus trim inpatient one side CPT 29881 HP MENISCECTOMY MEDIAL OR LAT KNEE,Left side of body	$1,726.91	$2,158.64	$470.00–$2,158.64	—	20%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 HP MENISCECTOMY MEDIAL AND LAT KNEE	$1,798.54	$2,248.18	$486.19–$2,248.18	73% below	20%
Knee arthroscopy with removal of both torn meniscus parts one side CPT 29880 HP MENISCECTOMY MEDIAL AND LAT KNEE,Left side of body	$1,798.54	$2,248.18	$486.19–$2,248.18	73% below	20%
Knee arthroscopy with removal of both torn meniscus parts one side CPT 29880 HP MENISCECTOMY MEDIAL AND LAT KNEE,Right side of body	$1,798.54	$2,248.18	$486.19–$2,248.18	73% below	20%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 HP MENISCECTOMY MEDIAL AND LAT KNEE	$1,798.54	$2,248.18	$486.19–$2,248.18	—	20%
Knee arthroscopy with removal of both torn meniscus parts inpatient one side CPT 29880 HP MENISCECTOMY MEDIAL AND LAT KNEE,Right side of body	$1,798.54	$2,248.18	$486.19–$2,248.18	—	20%
Knee arthroscopy with removal of both torn meniscus parts inpatient one side CPT 29880 HP MENISCECTOMY MEDIAL AND LAT KNEE,Left side of body	$1,798.54	$2,248.18	$486.19–$2,248.18	—	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 HP ARTHROSCOPY WITH PATELLAR SHAVE	$2,060.40	$2,575.50	$535.61–$2,575.50	69% below	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) one side CPT 29877 HP ARTHROSCOPY WITH PATELLAR SHAVE,Left side of body	$2,060.40	$2,575.50	$535.61–$2,575.50	69% below	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) one side CPT 29877 HP ARTHROSCOPY WITH PATELLAR SHAVE,Right side of body	$2,060.40	$2,575.50	$535.61–$2,575.50	69% below	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 HP ARTHROSCOPY WITH PATELLAR SHAVE	$2,060.40	$2,575.50	$535.61–$2,575.50	—	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient one side CPT 29877 HP ARTHROSCOPY WITH PATELLAR SHAVE,Left side of body	$2,060.40	$2,575.50	$535.61–$2,575.50	—	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient one side CPT 29877 HP ARTHROSCOPY WITH PATELLAR SHAVE,Right side of body	$2,060.40	$2,575.50	$535.61–$2,575.50	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HP RPR SCLP/TRNK/EXTREM INTERMED <=2.5 CM	$378.40	$473.00	$140.97–$473.00	12% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC ED RPR SCLP/TRNK/EXTREM INTERMED <=2.5CM	$1,083.20	$1,354.00	$233.37–$947.80	219% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HP RPR SCLP/TRNK/EXTREM INTERMED <=2.5 CM	$378.40	$473.00	$140.97–$473.00	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC ED RPR SCLP/TRNK/EXTREM INTERMED <=2.5CM	$1,083.20	$1,354.00	$233.37–$947.80	—	20%
Lower-back epidural injection, with imaging guidance CPT 62323 HP INJ EPIDURAL LUMBAR SACRAL W IMG	$609.24	$761.55	$96.10–$761.55	8% below	20%
Lower-back epidural injection, with imaging guidance one side CPT 62323 HP INJ EPIDURAL LUMBAR SACRAL W IMG,Right side of body	$609.24	$761.55	$96.10–$761.55	8% below	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HP INJ EPIDURAL LUMBAR SACRAL W IMG	$609.24	$761.55	$96.10–$761.55	—	20%
Lower-back epidural injection, with imaging guidance inpatient one side CPT 62323 HP INJ EPIDURAL LUMBAR SACRAL W IMG,Right side of body	$609.24	$761.55	$96.10–$761.55	—	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HP INJ TRANSFOR EPID LUM/SAC SNGL	$582.67	$728.34	$106.89–$728.34	39% below	20%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HP INJ TRANSFOR EPID LUM/SAC SNGL,Right side of body	$582.67	$728.34	$106.89–$728.34	39% below	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HP INJ TRANSFOR EPID LUM/SAC SNGL	$582.67	$728.34	$106.89–$728.34	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 HP INJ TRANSFOR EPID LUM/SAC SNGL,Right side of body	$582.67	$728.34	$106.89–$728.34	—	20%
Partial knee replacement (one compartment) CPT 27446 HP ARTHROPLSTY MEDIL/LATERL CMPRT KNEE	$2,782.82	$3,478.53	$961.75–$3,478.53	89% below	20%
Partial knee replacement (one compartment) one side CPT 27446 HP ARTHROPLSTY MEDIL/LATERL CMPRT KNEE,Right side of body	$2,782.82	$3,478.53	$961.75–$3,478.53	89% below	20%
Partial knee replacement (one compartment) inpatient CPT 27446 HP ARTHROPLSTY MEDIL/LATERL CMPRT KNEE	$2,782.82	$3,478.53	$961.75–$3,478.53	—	20%
Partial knee replacement (one compartment) inpatient one side CPT 27446 HP ARTHROPLSTY MEDIL/LATERL CMPRT KNEE,Right side of body	$2,782.82	$3,478.53	$961.75–$3,478.53	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HP DESTRUCT FACET JNT W IMG L/S SNG LVL	$1,043.28	$1,304.10	$185.91–$1,304.10	41% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 HP DESTRUCT FACET JNT W IMG L/S SNG LVL,Right side of body	$1,043.28	$1,304.10	$185.91–$1,304.10	41% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 HP DESTRUCT FACET JNT W IMG L/S SNG LVL,Left side of body	$1,043.28	$1,304.10	$185.91–$1,304.10	41% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HP DESTRUCT FACET JNT W IMG L/S SNG LVL	$1,043.28	$1,304.10	$185.91–$1,304.10	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient one side CPT 64635 HP DESTRUCT FACET JNT W IMG L/S SNG LVL,Right side of body	$1,043.28	$1,304.10	$185.91–$1,304.10	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient one side CPT 64635 HP DESTRUCT FACET JNT W IMG L/S SNG LVL,Left side of body	$1,043.28	$1,304.10	$185.91–$1,304.10	—	20%
Removal of a foreign object under the skin, simple CPT 10120 HP REMOVAL FOREIGN BODY SUBQ SIMPLE	$992.74	$1,240.92	$107.05–$799.06	225% above	20%
Removal of a foreign object under the skin, simple CPT 10120 HC ED REMOVAL FOREIGN BODY SUBQ SIMPLE	$1,172.80	$1,466.00	$141.32–$1,026.20	284% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HP REMOVAL FOREIGN BODY SUBQ SIMPLE	$992.74	$1,240.92	$107.05–$799.06	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC ED REMOVAL FOREIGN BODY SUBQ SIMPLE	$1,172.80	$1,466.00	$141.32–$1,026.20	—	20%
Septoplasty to straighten the nasal septum CPT 30520 HP NASAL SEPTOPLASTY OR SUBMUCOUS RESECT	$1,621.46	$2,026.83	$556.76–$2,026.83	52% below	20%
Septoplasty to straighten the nasal septum inpatient CPT 30520 HP NASAL SEPTOPLASTY OR SUBMUCOUS RESECT	$1,621.46	$2,026.83	$556.76–$2,026.83	—	20%
Short arm splint (forearm and hand) CPT 29125 HP APPLIC SPLINT SHORT ARM STATIC	$97.60	$122.00	$42.92–$122.00	24% below	20%
Short arm splint (forearm and hand) CPT 29125 HC ED APPLIC SPLINT SHORT ARM STATIC	$994.40	$1,243.00	$70.65–$870.10	673% above	20%
Short arm splint (forearm and hand) CPT 29125 HC APPLIC SPLINT SHORT ARM STATIC	$994.40	$1,243.00	$70.65–$870.10	673% above	20%
Short arm splint (forearm and hand) one side CPT 29125 HP APPLIC SPLINT SHORT ARM STATIC,Right side of body	$97.60	$122.00	$42.92–$122.00	24% below	20%
Short arm splint (forearm and hand) one side CPT 29125 HP APPLIC SPLINT SHORT ARM STATIC,Left side of body	$97.60	$122.00	$42.92–$122.00	24% below	20%
Short arm splint (forearm and hand) one side CPT 29125 HC APPLIC SPLINT SHORT ARM STATIC,Left side of body	$994.40	$1,243.00	$70.65–$870.10	673% above	20%
Short arm splint (forearm and hand) one side CPT 29125 HC APPLIC SPLINT SHORT ARM STATIC,Right side of body	$994.40	$1,243.00	$70.65–$870.10	673% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 HP APPLIC SPLINT SHORT ARM STATIC	$97.60	$122.00	$42.92–$122.00	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLIC SPLINT SHORT ARM STATIC	$994.40	$1,243.00	$70.65–$870.10	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 HC ED APPLIC SPLINT SHORT ARM STATIC	$994.40	$1,243.00	$70.65–$870.10	—	20%
Short arm splint (forearm and hand) inpatient one side CPT 29125 HP APPLIC SPLINT SHORT ARM STATIC,Left side of body	$97.60	$122.00	$42.92–$122.00	—	20%
Short arm splint (forearm and hand) inpatient one side CPT 29125 HP APPLIC SPLINT SHORT ARM STATIC,Right side of body	$97.60	$122.00	$42.92–$122.00	—	20%
Short arm splint (forearm and hand) inpatient one side CPT 29125 HC APPLIC SPLINT SHORT ARM STATIC,Right side of body	$994.40	$1,243.00	$70.65–$870.10	—	20%
Short arm splint (forearm and hand) inpatient one side CPT 29125 HC APPLIC SPLINT SHORT ARM STATIC,Left side of body	$994.40	$1,243.00	$70.65–$870.10	—	20%
Short leg splint (calf to foot) CPT 29515 HP APPLIC SPLINT SHORT LEG	$480.96	$601.20	$52.42–$331.86	226% above	20%
Short leg splint (calf to foot) CPT 29515 HC ED APPLIC SPLINT SHORT LEG	$994.40	$1,243.00	$74.24–$870.10	573% above	20%
Short leg splint (calf to foot) one side CPT 29515 HP APPLIC SPLINT SHORT LEG,Right side of body	$480.96	$601.20	$52.42–$331.86	226% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 HP APPLIC SPLINT SHORT LEG	$480.96	$601.20	$52.42–$331.86	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 HC ED APPLIC SPLINT SHORT LEG	$994.40	$1,243.00	$74.24–$870.10	—	20%
Short leg splint (calf to foot) inpatient one side CPT 29515 HP APPLIC SPLINT SHORT LEG,Right side of body	$480.96	$601.20	$52.42–$331.86	—	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 HP ARTHROSCOPY SHLDR DISTAL CLAV	$1,647.24	$2,059.05	$583.18–$2,059.05	75% below	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) one side CPT 29824 HP ARTHROSCOPY SHLDR DISTAL CLAV,Right side of body	$1,647.24	$2,059.05	$583.18–$2,059.05	75% below	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) one side CPT 29824 HP ARTHROSCOPY SHLDR DISTAL CLAV,Left side of body	$1,647.24	$2,059.05	$583.18–$2,059.05	75% below	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 HP ARTHROSCOPY SHLDR DISTAL CLAV	$1,647.24	$2,059.05	$583.18–$2,059.05	—	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient one side CPT 29824 HP ARTHROSCOPY SHLDR DISTAL CLAV,Right side of body	$1,647.24	$2,059.05	$583.18–$2,059.05	—	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient one side CPT 29824 HP ARTHROSCOPY SHLDR DISTAL CLAV,Left side of body	$1,647.24	$2,059.05	$583.18–$2,059.05	—	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 HP ARTHROSCOPY SHLDR DCMPRN SBCRML	$668.14	$835.17	$137.26–$461.01	89% below	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 HP ARTHROSCOPY SHLDR DCMPRN SBCRML,Right side of body	$668.14	$835.17	$137.26–$461.01	89% below	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 HP ARTHROSCOPY SHLDR DCMPRN SBCRML	$668.14	$835.17	$137.26–$461.01	—	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient one side CPT 29826 HP ARTHROSCOPY SHLDR DCMPRN SBCRML,Right side of body	$668.14	$835.17	$137.26–$461.01	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HP RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM	$615.24	$769.05	$46.88–$424.52	211% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC ED RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM	$1,083.20	$1,354.00	$101.86–$947.80	448% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HP RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM	$615.24	$769.05	$46.88–$424.52	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC ED RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM	$1,083.20	$1,354.00	$101.86–$947.80	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HP RPR SCLP/TRNK/EXTRM SMPL 2.6-7.5 CM	$747.86	$934.83	$61.24–$516.03	254% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC ED RPR SCLP/TRNK/EXTRM SMPL 2.6-7.5 CM	$1,083.20	$1,354.00	$124.87–$947.80	413% 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 HP RPR SCLP/TRNK/EXTRM SMPL 2.6-7.5 CM	$747.86	$934.83	$61.24–$516.03	—	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 HC ED RPR SCLP/TRNK/EXTRM SMPL 2.6-7.5 CM	$1,083.20	$1,354.00	$124.87–$947.80	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HP RPR FACE EAR SMPL <=2.5CM	$139.20	$174.00	$57.98–$174.00	39% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC ED RPR FACE EAR SMPL <=2.5CM	$1,083.20	$1,354.00	$124.95–$947.80	371% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HP RPR FACE EAR SMPL <=2.5CM	$139.20	$174.00	$57.98–$174.00	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC ED RPR FACE EAR SMPL <=2.5CM	$1,083.20	$1,354.00	$124.95–$947.80	—	20%
Tonsil and adenoid removal, age 12 or older CPT 42821 HP REMV TONSILS AND ADENOIDS OVER 12 YRS	$743.40	$929.25	$250.80–$929.25	77% below	20%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 HP REMV TONSILS AND ADENOIDS OVER 12 YRS	$743.40	$929.25	$250.80–$929.25	—	20%
Tonsil and adenoid removal, child under 12 CPT 42820 HP REMV TONSILS AND ADENOIDS UNDER 12 YRS	$712.42	$890.52	$240.44–$890.52	84% below	20%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 HP REMV TONSILS AND ADENOIDS UNDER 12 YRS	$712.42	$890.52	$240.44–$890.52	—	20%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 HP REMOVAL OF TONSILS 12+ Y/O	$624.10	$780.12	$212.51–$780.12	61% below	20%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 HP REMOVAL OF TONSILS 12+ Y/O	$624.10	$780.12	$212.51–$780.12	—	20%
Total hip replacement CPT 27130 HP ARTHROPLASTY TOTAL HIP	$3,111.55	$3,889.44	$1,068.48–$3,889.44	43% below	20%
Total hip replacement one side CPT 27130 HP ARTHROPLASTY TOTAL HIP,Left side of body	$3,111.55	$3,889.44	$1,068.48–$3,889.44	43% below	20%
Total hip replacement one side CPT 27130 HP ARTHROPLASTY TOTAL HIP,Right side of body	$3,111.55	$3,889.44	$1,068.48–$3,889.44	43% below	20%
Total hip replacement inpatient CPT 27130 HP ARTHROPLASTY TOTAL HIP	$3,111.55	$3,889.44	$1,068.48–$3,889.44	—	20%
Total hip replacement inpatient one side CPT 27130 HP ARTHROPLASTY TOTAL HIP,Left side of body	$3,111.55	$3,889.44	$1,068.48–$3,889.44	—	20%
Total hip replacement inpatient one side CPT 27130 HP ARTHROPLASTY TOTAL HIP,Right side of body	$3,111.55	$3,889.44	$1,068.48–$3,889.44	—	20%
Total knee replacement CPT 27447 HP ARTHROPLASTY TOTAL KNEE	$3,186.84	$3,983.55	$1,066.26–$3,983.55	78% below	20%
Total knee replacement one side CPT 27447 HP ARTHROPLASTY TOTAL KNEE,Right side of body	$3,186.84	$3,983.55	$1,066.26–$3,983.55	78% below	20%
Total knee replacement one side CPT 27447 HP ARTHROPLASTY TOTAL KNEE,Left side of body	$3,186.84	$3,983.55	$1,066.26–$3,983.55	78% below	20%
Total knee replacement inpatient CPT 27447 HP ARTHROPLASTY TOTAL KNEE	$3,186.84	$3,983.55	$1,066.26–$3,983.55	—	20%
Total knee replacement inpatient one side CPT 27447 HP ARTHROPLASTY TOTAL KNEE,Left side of body	$3,186.84	$3,983.55	$1,066.26–$3,983.55	—	20%
Total knee replacement inpatient one side CPT 27447 HP ARTHROPLASTY TOTAL KNEE,Right side of body	$3,186.84	$3,983.55	$1,066.26–$3,983.55	—	20%
Total shoulder replacement CPT 23472 HP RECONSTRUCT SHOULDER JOINT	$2,730.40	$3,413.00	$1,196.97–$3,413.00	87% below	20%
Total shoulder replacement one side CPT 23472 HP RECONSTRUCT SHOULDER JOINT,Left side of body	$2,730.40	$3,413.00	$1,196.97–$3,413.00	87% below	20%
Total shoulder replacement one side CPT 23472 HP RECONSTRUCT SHOULDER JOINT,Right side of body	$2,730.40	$3,413.00	$1,196.97–$3,413.00	87% below	20%
Total shoulder replacement inpatient CPT 23472 HP RECONSTRUCT SHOULDER JOINT	$2,730.40	$3,413.00	$1,196.97–$3,413.00	—	20%
Total shoulder replacement inpatient one side CPT 23472 HP RECONSTRUCT SHOULDER JOINT,Right side of body	$2,730.40	$3,413.00	$1,196.97–$3,413.00	—	20%
Total shoulder replacement inpatient one side CPT 23472 HP RECONSTRUCT SHOULDER JOINT,Left side of body	$2,730.40	$3,413.00	$1,196.97–$3,413.00	—	20%
Total thyroid removal (thyroidectomy) CPT 60240 HP THYROIDECTOMY TOTAL OR COMPLETE	$2,230.87	$2,788.59	$765.93–$2,788.59	75% below	20%
Total thyroid removal (thyroidectomy) inpatient CPT 60240 HP THYROIDECTOMY TOTAL OR COMPLETE	$2,230.87	$2,788.59	$765.93–$2,788.59	—	20%
Trigger finger release surgery CPT 26055 HP INCISE FINGER TENDON SHEATH	$1,387.56	$1,734.45	$299.10–$1,734.45	at median	20%
Trigger finger release surgery inpatient CPT 26055 HP INCISE FINGER TENDON SHEATH	$1,387.56	$1,734.45	$299.10–$1,734.45	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HP DEBRIDE SUBQ TISSUE 1ST 20 CM OR LESS	$842.83	$1,053.54	$59.52–$799.06	107% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDE SUBQ TISSUE 1ST 20 CM OR LESS	$1,176.80	$1,471.00	$118.98–$811.99	190% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HP DEBRIDE SUBQ TISSUE 1ST 20 CM OR LESS	$842.83	$1,053.54	$59.52–$799.06	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDE SUBQ TISSUE 1ST 20 CM OR LESS	$1,176.80	$1,471.00	$118.98–$811.99	—	20%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 HP TX FX RAD DISTAL OPEN W INT FIX	$1,805.78	$2,257.23	$635.83–$2,257.23	77% below	20%
Wrist fracture surgery (plate and screws), distal radius one side CPT 25607 HP TX FX RAD DISTAL OPEN W INT FIX,Right side of body	$1,805.78	$2,257.23	$635.83–$2,257.23	77% below	20%
Wrist fracture surgery (plate and screws), distal radius one side CPT 25607 HP TX FX RAD DISTAL OPEN W INT FIX,Left side of body	$1,805.78	$2,257.23	$635.83–$2,257.23	77% below	20%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 HP TX FX RAD DISTAL OPEN W INT FIX	$1,805.78	$2,257.23	$635.83–$2,257.23	—	20%
Wrist fracture surgery (plate and screws), distal radius inpatient one side CPT 25607 HP TX FX RAD DISTAL OPEN W INT FIX,Right side of body	$1,805.78	$2,257.23	$635.83–$2,257.23	—	20%
Wrist fracture surgery (plate and screws), distal radius inpatient one side CPT 25607 HP TX FX RAD DISTAL OPEN W INT FIX,Left side of body	$1,805.78	$2,257.23	$635.83–$2,257.23	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
Blood transfusion (giving blood or blood components) CPT 36430 LCHG TRANSFUSION SERVICE FEE	$1,840.80	$2,301.00	$41.40–$1,610.70	154% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION SERVICE	$1,840.80	$2,301.00	$41.40–$1,610.70	154% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 LCHG TRANSFUSION SERVICE FEE	$1,840.80	$2,301.00	$41.40–$1,610.70	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION SERVICE	$1,840.80	$2,301.00	$41.40–$1,610.70	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHALATION TREATMENT W/MED SUBSEQUENT	$487.73	$609.66	$7.57–$426.76	269% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHALATION TREATMENT W/MED	$487.73	$609.66	$7.57–$426.76	269% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHALATION TREATMENT W/MED SUBSEQUENT	$487.73	$609.66	$7.57–$426.76	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHALATION TREATMENT W/MED	$487.73	$609.66	$7.57–$426.76	—	20%
Critical care, first 30 to 74 minutes CPT 99291 HP CRITICAL CARE E/M 30-74 MIN	$555.20	$694.00	$216.46–$694.00	40% below	20%
Critical care, first 30 to 74 minutes CPT 99291 HC ED CRITICAL CARE E/M 30-74 MIN	$2,052.00	$2,565.00	$284.40–$1,795.50	123% above	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HP CRITICAL CARE E/M 30-74 MIN	$555.20	$694.00	$216.46–$694.00	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC ED CRITICAL CARE E/M 30-74 MIN	$2,052.00	$2,565.00	$284.40–$1,795.50	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG 12 LEAD	$160.00	$200.00	$5.10–$140.00	26% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC EKG 12 LEAD	$160.00	$200.00	$5.10–$140.00	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HP EMERGENCY DEPT VISIT LEVEL 1	$53.60	$67.00	$10.41–$67.00	62% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED EMERGENT LEVEL I	$176.80	$221.00	$10.41–$221.00	25% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HP EMERGENCY DEPT VISIT LEVEL 1	$53.60	$67.00	$10.41–$67.00	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED EMERGENT LEVEL I	$176.80	$221.00	$10.41–$221.00	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED EMERGENT LEVEL II	$348.00	$435.00	$38.21–$435.00	14% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED EMERGENT LEVEL II	$348.00	$435.00	$38.21–$435.00	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED EMERGENT LEVEL III	$607.20	$759.00	$65.64–$600.00	20% above	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED EMERGENT LEVEL III	$607.20	$759.00	$65.64–$600.00	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HP EMERGENCY DEPT VISIT LEVEL 4	$296.00	$370.00	$111.74–$370.00	60% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED EMERGENT LEVEL IV	$954.40	$1,193.00	$111.74–$835.10	30% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HP EMERGENCY DEPT VISIT LEVEL 4	$296.00	$370.00	$111.74–$370.00	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED EMERGENT LEVEL IV	$954.40	$1,193.00	$111.74–$835.10	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HP EMERGENCY DEPT VISIT LEVEL 5	$436.00	$545.00	$162.14–$545.00	62% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED EMERGENT LEVEL V	$1,390.40	$1,738.00	$162.14–$1,216.60	21% above	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HP EMERGENCY DEPT VISIT LEVEL 5	$436.00	$545.00	$162.14–$545.00	—	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED EMERGENT LEVEL V	$1,390.40	$1,738.00	$162.14–$1,216.60	—	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARD STRESS TEST ROUTINE	$718.40	$898.00	$34.12–$628.60	86% above	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CARD STRESS TEST ROUTINE	$718.40	$898.00	$34.12–$628.60	—	20%
Family therapy with the patient, 50 minutes CPT 90847 HC FAMILY PSYCHOTHERAPY W PT 50 MIN	$676.00	$845.00	$105.82–$466.44	126% above	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC FAMILY PSYCHOTHERAPY W PT 50 MIN	$676.00	$845.00	$105.82–$466.44	—	20%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYCHOTHERAPY WO PT 50 MIN	$644.00	$805.00	$102.15–$444.36	123% above	20%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYCHOTHERAPY WO PT 50 MIN	$644.00	$805.00	$102.15–$444.36	—	20%
Group psychotherapy session CPT 90853 HC IOP GROUP PSYCHOTHERAPY SESSION	$588.00	$735.00	$28.91–$405.72	206% above	20%
Group psychotherapy session inpatient CPT 90853 HC IOP GROUP PSYCHOTHERAPY SESSION	$588.00	$735.00	$28.91–$405.72	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC ED IV INF HYDRATION INIT 31 MIN TO 1HR	$472.00	$590.00	$29.79–$590.00	174% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INF HYDRATION INIT 31 MIN TO 1HR	$472.00	$590.00	$29.79–$421.38	174% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC ED IV INF HYDRATION INIT 31 MIN TO 1HR	$472.00	$590.00	$29.79–$590.00	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV INF HYDRATION INIT 31 MIN TO 1HR	$472.00	$590.00	$29.79–$421.38	—	20%
IV infusion of a medicine, first hour CPT 96365 HC ED IV INF THER/PROPH/DIAG 1ST HR	$472.00	$590.00	$59.34–$421.38	102% above	20%
IV infusion of a medicine, first hour CPT 96365 HC IV INF THER/PROPH/DIAG 1ST HR	$472.00	$590.00	$59.34–$421.38	102% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 HC ED IV INF THER/PROPH/DIAG 1ST HR	$472.00	$590.00	$59.34–$421.38	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INF THER/PROPH/DIAG 1ST HR	$472.00	$590.00	$59.34–$421.38	—	20%
IV push of a medicine, first drug CPT 96374 HC INJ THER/PROPH/DIAG IVP SNGL OR INIT	$472.00	$590.00	$33.58–$421.38	221% above	20%
IV push of a medicine, first drug CPT 96374 HC ED INJ THER/PROPH/DIAG IVP SNGL OR INIT	$472.00	$590.00	$33.58–$590.00	221% above	20%
IV push of a medicine, first drug inpatient CPT 96374 HC ED INJ THER/PROPH/DIAG IVP SNGL OR INIT	$472.00	$590.00	$33.58–$590.00	—	20%
IV push of a medicine, first drug inpatient CPT 96374 HC INJ THER/PROPH/DIAG IVP SNGL OR INIT	$472.00	$590.00	$33.58–$421.38	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJ THER/PROPH/DIAG SUBQ/IM	$40.80	$51.00	$14.00–$51.00	35% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC ED INJ THER/PROPH/DIAG SUBQ/IM	$151.20	$189.00	$14.00–$189.00	141% above	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJ THER/PROPH/DIAG SUBQ/IM	$40.80	$51.00	$14.00–$51.00	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC ED INJ THER/PROPH/DIAG SUBQ/IM	$151.20	$189.00	$14.00–$189.00	—	20%
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSC REEDUCAT 1+ AREAS EA 15 MIN PT	$120.00	$150.00	$28.34–$105.00	73% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSC REEDUCAT 1+ AREAS EA 15 MIN OT	$120.00	$150.00	$28.34–$105.00	73% above	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSC REEDUCAT 1+ AREAS EA 15 MIN PT	$120.00	$150.00	$28.34–$105.00	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSC REEDUCAT 1+ AREAS EA 15 MIN OT	$120.00	$150.00	$28.34–$105.00	—	20%
New patient office visit, about 30 minutes CPT 99203 HP OFFICE/OUTPT VISIT NEW LEVL III	$112.00	$140.00	$66.78–$140.00	32% below	20%
New patient office visit, about 30 minutes CPT 99203 HP H AND P OP NEW PT LEVEL 3	$206.40	$258.00	$77.68–$170.94	25% above	20%
New patient office visit, about 30 minutes CPT 99203 HC FACLTY OP NEW LEVEL 3	$291.24	$364.05	$107.89–$200.96	76% above	20%
New patient office visit, about 30 minutes inpatient CPT 99203 HP OFFICE/OUTPT VISIT NEW LEVL III	$112.00	$140.00	$66.78–$140.00	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 HP H AND P OP NEW PT LEVEL 3	$206.40	$258.00	$77.68–$170.94	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 HC FACLTY OP NEW LEVEL 3	$291.24	$364.05	$107.89–$200.96	—	20%
New patient office visit, about 45 minutes CPT 99204 HP H AND P OP NEW PT LEVEL 4	$270.40	$338.00	$127.08–$256.97	20% above	20%
New patient office visit, about 45 minutes CPT 99204 HP OFFICE/OUTPT VISIT NEW LEVL IV	$310.40	$388.00	$127.08–$256.97	38% above	20%
New patient office visit, about 45 minutes CPT 99204 HP OP NEW PT LEVEL IV	$310.40	$388.00	$127.08–$256.97	38% above	20%
New patient office visit, about 45 minutes CPT 99204 HC FACLTY OP NEW LEVEL 4	$445.60	$557.00	$163.41–$307.46	98% above	20%
New patient office visit, about 45 minutes inpatient CPT 99204 HP H AND P OP NEW PT LEVEL 4	$270.40	$338.00	$127.08–$256.97	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 HP OFFICE/OUTPT VISIT NEW LEVL IV	$310.40	$388.00	$127.08–$256.97	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 HP OP NEW PT LEVEL IV	$310.40	$388.00	$127.08–$256.97	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 HC FACLTY OP NEW LEVEL 4	$445.60	$557.00	$163.41–$307.46	—	20%
New patient office visit, about 60 minutes CPT 99205 HP OFFICE/OUTPT VISIT NEW LEVEL V	$408.80	$511.00	$173.87–$339.58	47% above	20%
New patient office visit, about 60 minutes inpatient CPT 99205 HP OFFICE/OUTPT VISIT NEW LEVEL V	$408.80	$511.00	$173.87–$339.58	—	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HP H AND P OP NEW PT LEVEL 2	$133.60	$167.00	$44.79–$109.31	23% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC FACLTY OP NEW LEVEL 2	$291.24	$364.05	$68.76–$200.96	169% above	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HP H AND P OP NEW PT LEVEL 2	$133.60	$167.00	$44.79–$109.31	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC FACLTY OP NEW LEVEL 2	$291.24	$364.05	$68.76–$200.96	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MNT INIT INDIV EA 15 MIN	$83.20	$104.00	$33.98–$72.80	72% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MNT INIT INDIV EA 15 MIN	$83.20	$104.00	$33.98–$72.80	—	20%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEXITY	$168.80	$211.00	$88.91–$158.47	55% above	20%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEXITY	$168.80	$211.00	$88.91–$158.47	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEXITY	$195.20	$244.00	$86.75–$170.80	24% above	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEXITY	$195.20	$244.00	$86.75–$170.80	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEXITY	$152.00	$190.00	$86.75–$154.55	35% above	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEXITY	$152.00	$190.00	$86.75–$154.55	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEXITY	$173.60	$217.00	$86.75–$154.55	32% above	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEXITY	$173.60	$217.00	$86.75–$154.55	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THER TECH 1+REGIONS EA 15 MIN PT	$120.00	$150.00	$24.06–$105.00	74% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THER TECH 1+REGIONS EA 15 MIN PT	$120.00	$150.00	$24.06–$105.00	—	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXERCISE EA 15 MIN OT	$116.00	$145.00	$25.48–$101.50	73% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXERCISE EA 15 MIN PT	$116.00	$145.00	$25.48–$101.50	73% above	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXERCISE EA 15 MIN PT	$116.00	$145.00	$25.48–$101.50	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXERCISE EA 15 MIN OT	$116.00	$145.00	$25.48–$101.50	—	20%
Psychotherapy session, 30 minutes CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN	$488.00	$610.00	$81.88–$336.72	125% above	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN	$488.00	$610.00	$81.88–$336.72	—	20%
Psychotherapy session, 45 minutes CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN	$604.00	$755.00	$108.56–$416.76	120% above	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN	$604.00	$755.00	$108.56–$416.76	—	20%
Psychotherapy session, 60 minutes CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN	$616.00	$770.00	$159.32–$425.04	102% above	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN	$616.00	$770.00	$159.32–$425.04	—	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HP OFFICE OUTPT VISIT EST LEVL V	$1,206.43	$1,508.04	$136.75–$832.44	451% above	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HP OFFICE OUTPT VISIT EST LEVL V	$1,206.43	$1,508.04	$136.75–$832.44	—	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC FACLTY OP EST PT LEVEL 3	$147.77	$184.71	$86.89–$139.60	11% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HP OFFICE OUTPT VISIT EST LEVL III	$605.02	$756.27	$62.66–$417.46	354% above	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC FACLTY OP EST PT LEVEL 3	$147.77	$184.71	$86.89–$139.60	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HP OFFICE OUTPT VISIT EST LEVL III	$605.02	$756.27	$62.66–$417.46	—	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC FACLTY OP EST PT LEVEL 4	$217.94	$272.43	$124.87–$196.78	28% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HP OFFICE/OUTPT VISIT EST LEVEL IV	$855.50	$1,069.38	$92.17–$590.30	404% above	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC FACLTY OP EST PT LEVEL 4	$217.94	$272.43	$124.87–$196.78	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HP OFFICE/OUTPT VISIT EST LEVEL IV	$855.50	$1,069.38	$92.17–$590.30	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC FACLTY OP EST PT LEVEL 2	$373.97	$467.46	$54.25–$258.04	339% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HP OFFICE OUTPT VISIT EST LEVL II	$373.97	$467.46	$33.82–$258.04	339% above	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HP OFFICE OUTPT VISIT EST LEVL II	$373.97	$467.46	$33.82–$258.04	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC FACLTY OP EST PT LEVEL 2	$373.97	$467.46	$54.25–$258.04	—	20%
Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND PROD W LANG 30 MIN	$223.20	$279.00	$131.24–$279.00	24% above	20%
Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND PROD W LANG 60 MIN	$223.20	$279.00	$131.24–$279.00	24% above	20%
Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND PROD W LANG 15 MIN	$223.20	$279.00	$131.24–$279.00	24% above	20%
Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND PROD W LANG 60 MIN	$223.20	$279.00	$131.24–$279.00	—	20%
Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND PROD W LANG 30 MIN	$223.20	$279.00	$131.24–$279.00	—	20%
Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND PROD W LANG 15 MIN	$223.20	$279.00	$131.24–$279.00	—	20%
Speech therapy session, individual CPT 92507 HC TX SPEECH DISORDER INDIVID 15 MIN ST	$124.80	$156.00	$66.83–$118.83	6% above	20%
Speech therapy session, individual CPT 92507 HC TX SPEECH DISORDER INDIVID 30 MIN ST	$223.20	$279.00	$66.83–$195.30	90% above	20%
Speech therapy session, individual CPT 92507 HC TX SPEECH DISORDER INDIVID 45 MIN ST	$223.20	$279.00	$66.83–$195.30	90% above	20%
Speech therapy session, individual inpatient CPT 92507 HC TX SPEECH DISORDER INDIVID 15 MIN ST	$124.80	$156.00	$66.83–$118.83	—	20%
Speech therapy session, individual inpatient CPT 92507 HC TX SPEECH DISORDER INDIVID 30 MIN ST	$223.20	$279.00	$66.83–$195.30	—	20%
Speech therapy session, individual inpatient CPT 92507 HC TX SPEECH DISORDER INDIVID 45 MIN ST	$223.20	$279.00	$66.83–$195.30	—	20%
Spirometry (breathing test) CPT 94010 HC SPIROMETRY	$357.19	$446.49	$26.54–$312.92	99% above	20%
Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY	$357.19	$446.49	$26.54–$312.92	—	20%
Spirometry before and after a bronchodilator CPT 94060 HC BRONCHODILATOR PRE/POST TEST	$718.40	$898.00	$38.66–$628.60	90% above	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC BRONCHODILATOR PRE/POST TEST	$718.40	$898.00	$38.66–$628.60	—	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THER ACTIVITIES EA 15 MIN PT	$120.00	$150.00	$30.30–$105.00	100% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THER ACTIVITIES EA 15 MIN OT	$120.00	$150.00	$30.30–$105.00	100% above	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THER ACTIVITIES EA 15 MIN PT	$120.00	$150.00	$30.30–$105.00	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THER ACTIVITIES EA 15 MIN OT	$120.00	$150.00	$30.30–$105.00	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY THER	$232.00	$290.00	$85.75–$257.80	91% above	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY THER	$232.00	$290.00	$85.75–$257.80	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 MRNA VACC (MODERNA) 50 MCG/0.5ML IM SUSY [186206]	$449.22	$561.53	$158.42–$309.96	—	20%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID-19 MRNA VACC (MODERNA) 50 MCG/0.5ML IM SUSY [186206]	$449.22	$561.53	$158.42–$309.96	—	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR [131324]	$608.23	$760.29	$201.73–$419.68	122% above	20%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR [131324]	$608.23	$760.29	$201.73–$419.68	—	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV VACCINE 0.5 ML IM SUSY [107776]	$210.79	$263.49	$65.96–$145.45	135% above	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP-IPV VACCINE 0.5 ML IM SUSY [107776]	$210.79	$263.49	$65.96–$145.45	—	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP [19451]	$96.02	$120.03	$31.07–$66.26	43% above	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP [19451]	$96.02	$120.03	$31.07–$66.26	—	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP-HEPATITIS B RECOMB-IPV IM SUSY [34550]	$350.34	$437.92	$102.87–$241.73	173% above	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP-HEPATITIS B RECOMB-IPV IM SUSY [34550]	$350.34	$437.92	$102.87–$241.73	—	20%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-IPV-HIB VACCINE IM SUSR [107434]	$411.54	$514.43	$126.06–$283.97	293% above	20%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP-IPV-HIB VACCINE IM SUSR [107434]	$411.54	$514.43	$126.06–$283.97	—	20%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 DTAP-IPV-HIB-HEPATITIS B RECMB IM SUSY [172839]	$527.82	$659.78	$163.40–$364.20	517% above	20%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 DTAP-IPV-HIB-HEPATITIS B RECMB IM SUSY [172839]	$527.82	$659.78	$163.40–$364.20	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA FLUZONE TRIVALENT 0.5 ML IM SUSY [300522]	$65.75	$82.19	$22.76–$45.37	36% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA FLUZONE TRIVALENT 0.5 ML IM SUSY [300522]	$65.75	$82.19	$22.76–$45.37	—	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSY [145112]	$1,042.17	$1,302.71	$345.54–$719.10	334% above	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSY [145112]	$1,042.17	$1,302.71	$345.54–$719.10	—	20%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSY [305843]	$283.35	$354.19	$72.07–$195.51	72% above	20%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSY [305843]	$283.35	$354.19	$72.07–$195.51	—	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE 25 UNIT/0.5ML IM SUSP [175578]	$126.29	$157.86	$41.09–$87.14	10% above	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSP [175568]	$127.21	$159.01	$41.09–$87.77	10% above	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VACCINE 25 UNIT/0.5ML IM SUSP [175578]	$126.29	$157.86	$41.09–$87.14	—	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSP [175568]	$127.21	$159.01	$41.09–$87.77	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SSM SO [903935]	$237.53	$296.91	$73.64–$163.89	131% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SSM SO [903935]	$237.53	$296.91	$73.64–$163.89	—	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY [182230]	$94.98	$118.73	$32.54–$65.54	71% above	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY [182230]	$94.98	$118.73	$32.54–$65.54	—	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP [143912]	$99.31	$124.14	$33.04–$68.53	26% above	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP [143912]	$99.31	$124.14	$33.04–$68.53	—	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA FLUZONE TRIVALENT VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY [146006]	$272.78	$340.98	$96.20–$188.22	77% above	20%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA FLUZONE TRIVALENT VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY [146006]	$272.78	$340.98	$96.20–$188.22	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR [10512]	$163.78	$204.73	$96.30–$113.01	27% above	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR [10512]	$163.78	$204.73	$96.30–$113.01	—	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MEASLES-MUMPS-RUBELLA-VARICELL SC SUSR [162588]	$914.50	$1,143.13	$303.63–$631.01	409% above	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MEASLES-MUMPS-RUBELLA-VARICELL SC SUSR [162588]	$914.50	$1,143.13	$303.63–$631.01	—	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENING ACY&W-135 DIPHTH CONJ IM SOLN [178240]	$470.84	$588.55	$165.22–$324.88	193% above	20%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENING ACY&W-135 DIPHTH CONJ IM SOLN [178240]	$470.84	$588.55	$165.22–$324.88	—	20%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENING ACY&W-135 TETANUS CONJ IM SOLN [178241]	$560.69	$700.86	$180.57–$386.87	166% above	20%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENING ACY&W-135 TETANUS CONJ IM SOLN [178241]	$560.69	$700.86	$180.57–$386.87	—	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL 13-VAL CONJ VACC IM SUSP [119466]	$716.94	$896.18	$252.83–$494.69	166% above	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL 13-VAL CONJ VACC IM SUSP [119466]	$716.94	$896.18	$252.83–$494.69	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY [177391]	$1,004.37	$1,255.46	$306.64–$693.01	58% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY [177391]	$1,004.37	$1,255.46	$306.64–$693.01	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY [11037]	$370.92	$463.65	$130.80–$255.93	124% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY [11037]	$370.92	$463.65	$130.80–$255.93	—	20%
Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VACCINE INACTIVATED IJ SUSP [124707]	$1,510.69	$1,888.36	$46.97–$1,042.37	2270% above	20%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOVIRUS VACCINE INACTIVATED IJ SUSP [124707]	$1,510.69	$1,888.36	$46.97–$1,042.37	—	20%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 NIRSEVIMAB-ALIP 100 MG/ML IM SOSY [185846]	$1,885.16	$2,356.45	$583.94–$1,300.76	64% above	20%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 NIRSEVIMAB-ALIP 100 MG/ML IM SOSY [185846]	$1,885.16	$2,356.45	$583.94–$1,300.76	—	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5ML IM SOSY [185845]	$1,885.16	$2,356.45	$583.94–$1,300.76	143% above	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5ML IM SOSY [185845]	$1,885.16	$2,356.45	$583.94–$1,300.76	—	20%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR [185215]	$971.94	$1,214.93	$309.75–$670.64	119% above	20%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR [185215]	$971.94	$1,214.93	$309.75–$670.64	—	20%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR [22120]	$1,376.84	$1,721.05	$313.36–$950.02	128% above	20%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC IM SUSR [22120]	$1,376.84	$1,721.05	$313.36–$950.02	—	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN [140296]	$278.02	$347.52	$107.88–$191.83	163% above	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN [140296]	$278.02	$347.52	$107.88–$191.83	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP [11515]	$144.66	$180.83	$38.19–$99.82	99% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP [11515]	$144.66	$180.83	$38.19–$99.82	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SSM SO [903852]	$157.66	$197.08	$38.90–$108.79	100% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP [41628]	$160.63	$200.79	$38.90–$110.84	104% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SSM SO [903852]	$157.66	$197.08	$38.90–$108.79	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP [41628]	$160.63	$200.79	$38.90–$110.84	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZ ADMIN 1 SNGL/COMB VAC/TOXOID	$151.20	$189.00	$19.84–$142.34	155% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZ ADMIN 1 SNGL/COMB VAC/TOXOID	$151.20	$189.00	$19.84–$142.34	—	20%

Source file: https://newmanmemorialhospital.org/wp-content/uploads/2026/07/730570773_newman-memorial-hospital-inc_standardcharges.csv