Hospital

Welia Health

Welia Health in Mora, MN publishes cash prices for 240 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 Minnesota median for 161 of 235 procedures and below it for 73. By typical cash price it ranks #62 of 81 Minnesota hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

301 Hwy 65 S, Mora, MN, 55051 Collected Sep 28, 2026 Source price file (320) 679-1212

Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 3 of 5 CCN 241367 · CMS hospital register NPI 1528031390

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 3 actions for a hospital named Welia Health in Mora, MN:

Jan 21, 2026 Warning notice
Apr 23, 2026 Corrective action plan requested
May 21, 2026 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 HCHG RAD XRAY ANKLE COMPLETE 3 VIEWS OR MORE	$295.40	$422.00	$271.77	32% above	30%
Ankle X-ray, complete, 3 or more views CPT 73610 HCHG RAD XRAY ANKLE COMPLETE 3 VIEWS OR MORE PORTABLE	$328.30	$469.00	$302.04	47% above	30%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HCHG RAD XRAY ANKLE COMPLETE 3 VIEWS OR MORE	$295.40	$422.00	$271.77	—	30%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HCHG RAD XRAY ANKLE COMPLETE 3 VIEWS OR MORE PORTABLE	$328.30	$469.00	$302.04	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HCHG RAD US UPPER OR LOWER BRACHIAL INDEX LTD STUDY BILAT	$742.70	$1,061.00	$683.28	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HCHG RAD US UPPER OR LOWER BRACHIAL INDEX LTD STUDY BILAT	$742.70	$1,061.00	$683.28	—	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HCHG RAD XRAY ESOPHAGUS	$295.40	$422.00	$271.77	1% above	30%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HCHG RAD XRAY ESOPHAGUS	$295.40	$422.00	$271.77	—	30%
Bone scan, whole body (nuclear medicine) CPT 78306 HCHG RAD NM BONE SCAN WHOLE BODY	$2,287.60	$3,268.00	$2,104.59	87% above	30%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HCHG RAD NM BONE SCAN WHOLE BODY	$2,287.60	$3,268.00	$2,104.59	—	30%
Breast ultrasound, complete, one breast CPT 76641 HCHG RAD US BREAST COMPLETE	$998.90	$1,427.00	$918.99	152% above	30%
Breast ultrasound, complete, one breast inpatient CPT 76641 HCHG RAD US BREAST COMPLETE	$998.90	$1,427.00	$918.99	—	30%
Breast ultrasound, limited (one breast or one area) CPT 76642 HCHG RAD US BREAST LIMITED	$742.70	$1,061.00	$683.28	136% above	30%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HCHG RAD US BREAST LIMITED	$742.70	$1,061.00	$683.28	—	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HCHG RAD CT ANGIO CHEST	$1,953.00	$2,790.00	$1,796.76	18% above	30%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HCHG RAD CT ANGIO CHEST	$1,953.00	$2,790.00	$1,796.76	—	30%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HCHG RAD CT ANGIO HEART CORONARY ARTERIES	$3,127.60	$4,468.00	$2,877.39	193% above	30%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HCHG RAD CT ANGIO HEART CORONARY ARTERIES	$3,127.60	$4,468.00	$2,877.39	—	30%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HCHG RAD CT CARDIAC CALCIUM SCORING WO	$1,703.10	$2,433.00	$1,566.85	1383% above	30%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HCHG RAD CT CARDIAC CALCIUM SCORING WO	$1,703.10	$2,433.00	$1,566.85	—	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HCHG RAD CT ABDOMEN PELVIS WO	$2,074.10	$2,963.00	$1,908.17	6% above	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HCHG RAD CT ABDOMEN PELVIS WO	$2,074.10	$2,963.00	$1,908.17	—	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HCHG RAD CT ABDOMEN PELVIS W	$2,500.40	$3,572.00	$2,300.37	at median	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HCHG RAD CT ABDOMEN PELVIS W	$2,500.40	$3,572.00	$2,300.37	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HCHG RAD CT ABDOMEN PELVIS WWO	$2,819.60	$4,028.00	$2,594.03	9% above	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HCHG RAD CT ABDOMEN PELVIS WWO	$2,819.60	$4,028.00	$2,594.03	—	30%
CT scan of the abdomen with contrast CPT 74160 HCHG RAD CT ABDOMEN W	$1,778.70	$2,541.00	$1,636.40	18% above	30%
CT scan of the abdomen with contrast inpatient CPT 74160 HCHG RAD CT ABDOMEN W	$1,778.70	$2,541.00	$1,636.40	—	30%
CT scan of the abdomen without contrast CPT 74150 HCHG RAD CT ABDOMEN WO	$1,526.70	$2,181.00	$1,404.56	30% above	30%
CT scan of the abdomen without contrast CPT 74150 HCHG RAD CT ABDOMEN WO LIMITED	$1,526.70	$2,181.00	$1,404.56	30% above	30%
CT scan of the abdomen without contrast inpatient CPT 74150 HCHG RAD CT ABDOMEN WO	$1,526.70	$2,181.00	$1,404.56	—	30%
CT scan of the abdomen without contrast inpatient CPT 74150 HCHG RAD CT ABDOMEN WO LIMITED	$1,526.70	$2,181.00	$1,404.56	—	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 HCHG RAD CT FACIAL BONES AND SINUS WO	$2,204.30	$3,149.00	$2,027.96	74% above	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 HCHG RAD CT FACIAL BONES AND SINUS WO LIMITED	$2,204.30	$3,149.00	$2,027.96	74% above	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HCHG RAD CT FACIAL BONES AND SINUS WO	$2,204.30	$3,149.00	$2,027.96	—	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HCHG RAD CT FACIAL BONES AND SINUS WO LIMITED	$2,204.30	$3,149.00	$2,027.96	—	30%
CT scan of the head or brain, no contrast dye CPT 70450 HCHG RAD CT HEAD BRAIN WO	$1,526.70	$2,181.00	$1,404.56	21% above	30%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HCHG RAD CT HEAD BRAIN WO	$1,526.70	$2,181.00	$1,404.56	—	30%
CT scan of the head with contrast CPT 70460 HCHG RAD CT HEAD BRAIN W	$1,778.70	$2,541.00	$1,636.40	37% above	30%
CT scan of the head with contrast inpatient CPT 70460 HCHG RAD CT HEAD BRAIN W	$1,778.70	$2,541.00	$1,636.40	—	30%
CT scan of the head without and with contrast CPT 70470 HCHG RAD CT HEAD BRAIN WWO	$2,279.20	$3,256.00	$2,096.86	43% above	30%
CT scan of the head without and with contrast inpatient CPT 70470 HCHG RAD CT HEAD BRAIN WWO	$2,279.20	$3,256.00	$2,096.86	—	30%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HCHG RAD CT SPINE LUMBAR OR SACRUM WO	$1,526.70	$2,181.00	$1,404.56	11% above	30%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HCHG RAD CT SPINE LUMBAR OR SACRUM WO	$1,526.70	$2,181.00	$1,404.56	—	30%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HCHG RAD CT SPINE CERVICAL WO	$2,204.30	$3,149.00	$2,027.96	61% above	30%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HCHG RAD CT SPINE CERVICAL WO	$2,204.30	$3,149.00	$2,027.96	—	30%
CT scan of the pelvis, with contrast dye CPT 72193 HCHG RAD CT PELVIS W	$1,778.70	$2,541.00	$1,636.40	21% above	30%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HCHG RAD CT PELVIS W	$1,778.70	$2,541.00	$1,636.40	—	30%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HCHG RAD US CAROTID DUPLEX BILATERAL	$831.60	$1,188.00	$765.07	—	30%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HCHG RAD US CAROTID DUPLEX BILATERAL	$831.60	$1,188.00	$765.07	—	30%
Chest X-ray, 2 views CPT 71046 HCHG RAD XRAY CHEST 2 VIEWS PA AND LATERAL	$255.50	$365.00	$235.06	10% above	30%
Chest X-ray, 2 views CPT 71046 HCHG RAD XRAY CHEST 2 VIEWS PA AND LAT PORTABLE	$288.40	$412.00	$265.33	25% above	30%
Chest X-ray, 2 views inpatient CPT 71046 HCHG RAD XRAY CHEST 2 VIEWS PA AND LATERAL	$255.50	$365.00	$235.06	—	30%
Chest X-ray, 2 views inpatient CPT 71046 HCHG RAD XRAY CHEST 2 VIEWS PA AND LAT PORTABLE	$288.40	$412.00	$265.33	—	30%
Chest X-ray, single view CPT 71045 HCHG RAD XRAY CHEST FRONTAL 1 VIEW	$222.60	$318.00	$204.79	21% above	30%
Chest X-ray, single view CPT 71045 HCHG RAD XRAY CHEST FRONTAL 1 VIEW PORTABLE	$255.50	$365.00	$235.06	39% above	30%
Chest X-ray, single view inpatient CPT 71045 HCHG RAD XRAY CHEST FRONTAL 1 VIEW	$222.60	$318.00	$204.79	—	30%
Chest X-ray, single view inpatient CPT 71045 HCHG RAD XRAY CHEST FRONTAL 1 VIEW PORTABLE	$255.50	$365.00	$235.06	—	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HCHG RAD US RETROPERITONEAL COMPLETE	$863.10	$1,233.00	$794.05	64% above	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HCHG RAD US RETROPERITONEAL COMPLETE PORTABLE	$894.60	$1,278.00	$823.03	70% above	30%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HCHG RAD US RETROPERITONEAL COMPLETE	$863.10	$1,233.00	$794.05	—	30%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HCHG RAD US RETROPERITONEAL COMPLETE PORTABLE	$894.60	$1,278.00	$823.03	—	30%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HCHG RAD DEXA BONE DENSITY 1/> SITE AXIAL SKELETON	$336.70	$481.00	$309.76	3% above	30%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HCHG RAD DEXA BONE DENSITY 1/> SITE AXIAL SKELETON	$336.70	$481.00	$309.76	—	30%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HCHG RAD DEXA BONE DENSITY 1/> PERIPHERAL SKELETON	$233.10	$333.00	$214.45	21% above	30%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HCHG RAD DEXA BONE DENSITY 1/> PERIPHERAL SKELETON	$233.10	$333.00	$214.45	—	30%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HCHG RAD US OB FETAL ANATOMY SINGLE GESTATION	$742.70	$1,061.00	$683.28	63% above	30%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HCHG RAD US OB FETAL ANATOMY SINGLE GESTATION	$742.70	$1,061.00	$683.28	—	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC	$1,526.70	$2,181.00	$1,404.56	18% above	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC ADD-ON	$1,526.70	$2,181.00	$1,404.56	18% above	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC LOW DOSE	$1,526.70	$2,181.00	$1,404.56	18% above	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC	$1,526.70	$2,181.00	$1,404.56	—	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC ADD-ON	$1,526.70	$2,181.00	$1,404.56	—	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC LOW DOSE	$1,526.70	$2,181.00	$1,404.56	—	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HCHG RAD CT CHEST W CONTRAST DIAGNOSTIC ADD-ON	$1,778.70	$2,541.00	$1,636.40	17% above	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HCHG RAD CT CHEST W CONTRAST DIAGNOSTIC	$1,778.70	$2,541.00	$1,636.40	17% above	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HCHG RAD CT CHEST W CONTRAST DIAGNOSTIC	$1,778.70	$2,541.00	$1,636.40	—	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HCHG RAD CT CHEST W CONTRAST DIAGNOSTIC ADD-ON	$1,778.70	$2,541.00	$1,636.40	—	30%
Diagnostic mammogram, both breasts both sides CPT 77066 HCHG RAD MAMMO BILAT DIAGNOSTIC 3D WWO CAD	$504.70	$721.00	$464.32	—	30%
Diagnostic mammogram, both breasts both sides CPT 77066 HCHG RAD MAMMO BILAT DIAGNOSTIC WWO CAD	$504.70	$721.00	$464.32	—	30%
Diagnostic mammogram, both breasts both sides CPT 77066 HCHG RAD MAMMO BILAT ADDL VIEWS WWO CAD	$504.70	$721.00	$464.32	—	30%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HCHG RAD MAMMO BILAT ADDL VIEWS WWO CAD	$504.70	$721.00	$464.32	—	30%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HCHG RAD MAMMO BILAT DIAGNOSTIC 3D WWO CAD	$504.70	$721.00	$464.32	—	30%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HCHG RAD MAMMO BILAT DIAGNOSTIC WWO CAD	$504.70	$721.00	$464.32	—	30%
Diagnostic mammogram, one breast CPT 77065 HCHG RAD MAMMO UNI DIAGNOSTIC 3D WWO CAD	$390.60	$558.00	$359.35	26% above	30%
Diagnostic mammogram, one breast CPT 77065 HCHG RAD MAMMO UNI IMPLANT W ADDL VIEWS WWO CAD	$390.60	$558.00	$359.35	26% above	30%
Diagnostic mammogram, one breast CPT 77065 HCHG RAD MAMMO UNI DIAGNOSTIC ADDL VIEWS WWO CAD	$390.60	$558.00	$359.35	26% above	30%
Diagnostic mammogram, one breast CPT 77065 HCHG RAD MAMMO UNI DIAGNOSTIC WWO CAD	$390.60	$558.00	$359.35	26% above	30%
Diagnostic mammogram, one breast inpatient CPT 77065 HCHG RAD MAMMO UNI IMPLANT W ADDL VIEWS WWO CAD	$390.60	$558.00	$359.35	—	30%
Diagnostic mammogram, one breast inpatient CPT 77065 HCHG RAD MAMMO UNI DIAGNOSTIC WWO CAD	$390.60	$558.00	$359.35	—	30%
Diagnostic mammogram, one breast inpatient CPT 77065 HCHG RAD MAMMO UNI DIAGNOSTIC 3D WWO CAD	$390.60	$558.00	$359.35	—	30%
Diagnostic mammogram, one breast inpatient CPT 77065 HCHG RAD MAMMO UNI DIAGNOSTIC ADDL VIEWS WWO CAD	$390.60	$558.00	$359.35	—	30%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HCHG RAD US LOWER EXTREMITY BILATERAL COMPLETE	$987.70	$1,411.00	$908.68	—	30%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HCHG RAD US LOWER EXTREMITY BILATERAL COMPLETE PORTABLE	$1,019.90	$1,457.00	$938.31	—	30%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HCHG RAD US LOWER EXTREMITY BILATERAL COMPLETE	$987.70	$1,411.00	$908.68	—	30%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HCHG RAD US LOWER EXTREMITY BILATERAL COMPLETE PORTABLE	$1,019.90	$1,457.00	$938.31	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HCHG RAD US DUPLEX SCAN EXTREMITY BILATERAL COMPLETE	$1,022.70	$1,461.00	$940.88	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HCHG RAD US VENOUS INSUFFICIENCY LOWER EXTREMITY BILATERAL	$1,022.70	$1,461.00	$940.88	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HCHG RAD US DUPLEX SCAN EXTREMITY BILAT COMPLETE PORTABLE	$1,055.60	$1,508.00	$971.15	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HCHG RAD US VENOUS INSUFFICIENCY LOWER EXTREMITY BILATERAL	$1,022.70	$1,461.00	$940.88	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HCHG RAD US DUPLEX SCAN EXTREMITY BILATERAL COMPLETE	$1,022.70	$1,461.00	$940.88	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HCHG RAD US DUPLEX SCAN EXTREMITY BILAT COMPLETE PORTABLE	$1,055.60	$1,508.00	$971.15	—	30%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HCHG RAD ECHO 2D COMP WO CONT W SPECTRAL-COLOR	$1,885.80	$2,694.00	$1,734.94	44% above	30%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HCHG ECHO 2D COMP WO CONT W BUBBLE-SPECTRAL-COLOR	$1,885.80	$2,694.00	$1,734.94	44% above	30%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HCHG ECHO 2D COMP WO CONT W SPECTRAL-COLOR	$1,885.80	$2,694.00	$1,734.94	44% above	30%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HCHG RAD ECHO 2D COMP WO CONT W SPECTRAL-COLOR	$1,885.80	$2,694.00	$1,734.94	—	30%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HCHG ECHO 2D COMP WO CONT W SPECTRAL-COLOR	$1,885.80	$2,694.00	$1,734.94	—	30%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HCHG ECHO 2D COMP WO CONT W BUBBLE-SPECTRAL-COLOR	$1,885.80	$2,694.00	$1,734.94	—	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HCHG RAD NM HEPATOBILIARY	$1,207.50	$1,725.00	$1,110.90	10% below	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HCHG RAD NM HEPATOBILIARY	$1,207.50	$1,725.00	$1,110.90	—	30%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HCHG HOME SLEEP APNEA MONITOR STUDY REDUCE SERVICES	$630.00	$900.00	$579.60	1% above	30%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HCHG HOME SLEEP APNEA MONITOR STUDY REDUCE SERVICES	$630.00	$900.00	$579.60	—	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HCHG POLYSOMNOGRAPHY => 6YRS =>4 PARAMETERS W CPAP OR BILEVEL	$3,744.30	$5,349.00	$3,444.76	8% above	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HCHG POLYSOMNOGRAPHY => 6YRS =>4 PARAMETERS W CPAP OR BILEVEL	$3,744.30	$5,349.00	$3,444.76	—	30%
Knee X-ray, 3 views CPT 73562 HCHG RAD XRAY KNEE 3 VIEWS	$295.40	$422.00	$271.77	27% above	30%
Knee X-ray, 3 views CPT 73562 HCHG RAD XRAY KNEE 3 VIEWS PORTABLE	$328.30	$469.00	$302.04	41% above	30%
Knee X-ray, 3 views inpatient CPT 73562 HCHG RAD XRAY KNEE 3 VIEWS	$295.40	$422.00	$271.77	—	30%
Knee X-ray, 3 views inpatient CPT 73562 HCHG RAD XRAY KNEE 3 VIEWS PORTABLE	$328.30	$469.00	$302.04	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HCHG RAD US ABDOMEN LIMITED	$742.70	$1,061.00	$683.28	76% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HCHG RAD US ABDOMEN LIMITED PORTABLE	$772.80	$1,104.00	$710.98	83% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HCHG RAD US ABDOMEN LIMITED	$742.70	$1,061.00	$683.28	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HCHG RAD US ABDOMEN LIMITED PORTABLE	$772.80	$1,104.00	$710.98	—	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HCHG RAD CT THORAX LOW DOSE LUNG CANCER SCREEN WO	$1,526.70	$2,181.00	$1,404.56	164% above	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HCHG RAD CT THORAX LOW DOSE LUNG CANCER SCREEN WO	$1,526.70	$2,181.00	$1,404.56	—	30%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HCHG RAD MRI JOINT LOWER EXTREMITY WO	$2,791.60	$3,988.00	$2,568.27	51% above	30%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HCHG RAD MRI JOINT LOWER EXTREMITY WO LIMITED	$2,791.60	$3,988.00	$2,568.27	51% above	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HCHG RAD MRI JOINT LOWER EXTREMITY WO	$2,791.60	$3,988.00	$2,568.27	—	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HCHG RAD MRI JOINT LOWER EXTREMITY WO LIMITED	$2,791.60	$3,988.00	$2,568.27	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HCHG RAD MRI JOINT OF LOWER EXTREMITY WWO	$3,103.80	$4,434.00	$2,855.50	21% above	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HCHG RAD MRI JOINT OF LOWER EXTREMITY WWO	$3,103.80	$4,434.00	$2,855.50	—	30%
MRI of the abdomen without contrast CPT 74181 HCHG RAD MRI ABDOMEN WO	$2,791.60	$3,988.00	$2,568.27	28% above	30%
MRI of the abdomen without contrast inpatient CPT 74181 HCHG RAD MRI ABDOMEN WO	$2,791.60	$3,988.00	$2,568.27	—	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 HCHG RAD MRI ABDOMEN WWO	$3,103.80	$4,434.00	$2,855.50	5% above	30%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HCHG RAD MRI ABDOMEN WWO	$3,103.80	$4,434.00	$2,855.50	—	30%
MRI of the brain, no contrast dye CPT 70551 HCHG RAD MRI HEAD BRAIN WO	$2,791.60	$3,988.00	$2,568.27	34% above	30%
MRI of the brain, no contrast dye CPT 70551 HCHG RAD MRI HEAD BRAIN WO LIMITED	$2,791.60	$3,988.00	$2,568.27	34% above	30%
MRI of the brain, no contrast dye inpatient CPT 70551 HCHG RAD MRI HEAD BRAIN WO	$2,791.60	$3,988.00	$2,568.27	—	30%
MRI of the brain, no contrast dye inpatient CPT 70551 HCHG RAD MRI HEAD BRAIN WO LIMITED	$2,791.60	$3,988.00	$2,568.27	—	30%
MRI of the brain, with and without contrast dye CPT 70553 HCHG RAD MRI HEAD BRAIN WWO	$3,103.80	$4,434.00	$2,855.50	11% above	30%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HCHG RAD MRI HEAD BRAIN WWO	$3,103.80	$4,434.00	$2,855.50	—	30%
MRI of the lower back, no contrast dye CPT 72148 HCHG RAD MRI SPINE LUMBAR WO	$2,791.60	$3,988.00	$2,568.27	33% above	30%
MRI of the lower back, no contrast dye inpatient CPT 72148 HCHG RAD MRI SPINE LUMBAR WO	$2,791.60	$3,988.00	$2,568.27	—	30%
MRI of the lower back, without and then with contrast dye CPT 72158 HCHG RAD MRI SPINE LUMBAR WWO	$3,103.80	$4,434.00	$2,855.50	19% above	30%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HCHG RAD MRI SPINE LUMBAR WWO	$3,103.80	$4,434.00	$2,855.50	—	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HCHG RAD MRI SPINE THORACIC WO	$2,791.60	$3,988.00	$2,568.27	31% above	30%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HCHG RAD MRI SPINE THORACIC WO	$2,791.60	$3,988.00	$2,568.27	—	30%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HCHG RAD MRI SPINE CERVICAL WWO	$3,103.80	$4,434.00	$2,855.50	24% above	30%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HCHG RAD MRI SPINE CERVICAL WWO	$3,103.80	$4,434.00	$2,855.50	—	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HCHG RAD MRI SPINE CERVICAL WO	$2,791.60	$3,988.00	$2,568.27	32% above	30%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HCHG RAD MRI SPINE CERVICAL WO	$2,791.60	$3,988.00	$2,568.27	—	30%
MRI of the pelvis without and with contrast CPT 72197 HCHG RAD MRI PELVIS WWO	$3,103.80	$4,434.00	$2,855.50	14% above	30%
MRI of the pelvis without and with contrast inpatient CPT 72197 HCHG RAD MRI PELVIS WWO	$3,103.80	$4,434.00	$2,855.50	—	30%
MRI of the pelvis, no contrast dye CPT 72195 HCHG RAD MRI PELVIS WO	$2,791.60	$3,988.00	$2,568.27	32% above	30%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HCHG RAD MRI PELVIS WO	$2,791.60	$3,988.00	$2,568.27	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HCHG RAD MRI JOINT OF UPPER EXTREMITY WO	$2,791.60	$3,988.00	$2,568.27	31% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HCHG RAD MRI JOINT OF UPPER EXTREMITY WO	$2,791.60	$3,988.00	$2,568.27	—	30%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HCHG RAD NM CARDIAC MYOCARD MULT SPECT WWO EF AND WM	$4,925.20	$7,036.00	$4,531.18	74% above	30%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HCHG RAD NM CARDIAC MYOCARD MULT SPECT WWO EF AND WM	$4,925.20	$7,036.00	$4,531.18	—	30%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HCHG RAD PET CT SKULL BASE TO MID THIGH INITIAL TREAT	$1,899.10	$2,713.00	$1,747.17	26% below	30%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HCHG RAD PET CT SKULL BASE TO MID THIGH SUBSEQUENT TREAT	$1,899.10	$2,713.00	$1,747.17	26% below	30%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HCHG RAD PET CT SKULL BASE TO MID THIGH INITIAL TREAT	$1,899.10	$2,713.00	$1,747.17	—	30%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HCHG RAD PET CT SKULL BASE TO MID THIGH SUBSEQUENT TREAT	$1,899.10	$2,713.00	$1,747.17	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HCHG RAD US PELVIS LIMITED STUDY	$550.20	$786.00	$506.18	80% above	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HCHG RAD US PELVIS LIMITED STUDY PORTABLE	$582.40	$832.00	$535.81	90% above	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HCHG RAD US PELVIS LIMITED STUDY	$550.20	$786.00	$506.18	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HCHG RAD US PELVIS LIMITED STUDY PORTABLE	$582.40	$832.00	$535.81	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HCHG RAD US PELVIS COMPLETE NONOBSTETRIC	$742.70	$1,061.00	$683.28	52% above	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HCHG RAD US PELVIS COMPLETE NONOBSTETRIC PORTABLE	$773.50	$1,105.00	$711.62	58% above	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HCHG RAD US PELVIS COMPLETE NONOBSTETRIC	$742.70	$1,061.00	$683.28	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HCHG RAD US PELVIS COMPLETE NONOBSTETRIC PORTABLE	$773.50	$1,105.00	$711.62	—	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HCHG RAD US OB EQUAL OR GREATER THAN 14 WKS SINGLE GEST	$742.70	$1,061.00	$683.28	49% above	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HCHG RAD US OB EQUAL OR GREATER THAN 14 WKS SINGLE GEST	$742.70	$1,061.00	$683.28	—	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HCHG RAD US OB 1ST TRI SINGLE TRANSABD	$742.70	$1,061.00	$683.28	78% above	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HCHG RAD US OB 1ST TRI SINGLE TRANSABD	$742.70	$1,061.00	$683.28	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HCHG RAD US OB LIMITED ANY TRI 1 OR MORE FETUSES	$384.30	$549.00	$353.56	18% above	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HCHG RAD US OB LTD ANY TRI 1 OR MORE FETUS PORTABLE	$414.40	$592.00	$381.25	27% above	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HCHG RAD US OB LIMITED ANY TRI 1 OR MORE FETUSES	$384.30	$549.00	$353.56	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HCHG RAD US OB LTD ANY TRI 1 OR MORE FETUS PORTABLE	$414.40	$592.00	$381.25	—	30%
Screening mammogram, both breasts both sides CPT 77067 HCHG RAD MAMMO BILAT SCREENING LTD WWO CAD	$331.80	$474.00	$305.26	—	30%
Screening mammogram, both breasts both sides CPT 77067 HCHG RAD MAMMO BILAT SCREENING WWO CAD	$490.00	$700.00	$450.80	—	30%
Screening mammogram, both breasts both sides CPT 77067 HCHG RAD MAMMO BILAT SCREENING W IMPLANT WWO CAD	$490.00	$700.00	$450.80	—	30%
Screening mammogram, both breasts both sides CPT 77067 HCHG RAD MAMMO BILAT SCREENING 3D WWO CAD	$490.00	$700.00	$450.80	—	30%
Screening mammogram, both breasts CPT 77067 HCHG RAD MAMMO UNI SCREENING 3D WWO CAD	$331.80	$474.00	$305.26	1% below	30%
Screening mammogram, both breasts inpatient both sides CPT 77067 HCHG RAD MAMMO BILAT SCREENING LTD WWO CAD	$331.80	$474.00	$305.26	—	30%
Screening mammogram, both breasts inpatient both sides CPT 77067 HCHG RAD MAMMO BILAT SCREENING 3D WWO CAD	$490.00	$700.00	$450.80	—	30%
Screening mammogram, both breasts inpatient both sides CPT 77067 HCHG RAD MAMMO BILAT SCREENING W IMPLANT WWO CAD	$490.00	$700.00	$450.80	—	30%
Screening mammogram, both breasts inpatient both sides CPT 77067 HCHG RAD MAMMO BILAT SCREENING WWO CAD	$490.00	$700.00	$450.80	—	30%
Screening mammogram, both breasts inpatient CPT 77067 HCHG RAD MAMMO UNI SCREENING 3D WWO CAD	$331.80	$474.00	$305.26	—	30%
Shoulder X-ray, complete, 2 or more views CPT 73030 HCHG RAD XRAY SHOULDER COMPLETE 2 VIEWS OR MORE	$255.50	$365.00	$235.06	12% above	30%
Shoulder X-ray, complete, 2 or more views CPT 73030 HCHG RAD XRAY SHOULDER COMPLETE 2 VIEWS OR MORE PORTABLE	$282.10	$403.00	$259.53	24% above	30%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HCHG RAD XRAY SHOULDER COMPLETE 2 VIEWS OR MORE	$255.50	$365.00	$235.06	—	30%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HCHG RAD XRAY SHOULDER COMPLETE 2 VIEWS OR MORE PORTABLE	$282.10	$403.00	$259.53	—	30%
Sleep study in a lab (polysomnography) CPT 95810 HCHG POLYSOMNOGRAPHY => 6YRS =>4 PARAMETERS	$3,744.30	$5,349.00	$3,444.76	21% above	30%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HCHG POLYSOMNOGRAPHY => 6YRS =>4 PARAMETERS	$3,744.30	$5,349.00	$3,444.76	—	30%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 (IA) HCHG STRESS ECHO 2D EXERCISE W STRESS TEST WO CONTRAST	$1,653.40	$2,362.00	$1,521.13	7% below	30%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 (IA) HCHG STRESS ECHO 2D EXERCISE W STRESS TEST WO CONTRAST	$1,653.40	$2,362.00	$1,521.13	—	30%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HCHG RAD XRAY VIDEO SWALLOW STUDY	$191.80	$274.00	$176.46	35% below	30%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HCHG RAD XRAY VIDEO SWALLOW STUDY	$191.80	$274.00	$176.46	—	30%
Transvaginal pelvic ultrasound CPT 76830 HCHG RAD US TRANSVAGINAL	$443.10	$633.00	$407.65	12% above	30%
Transvaginal pelvic ultrasound CPT 76830 HCHG RAD US PELVIS COMPLETE TV ADD ON	$443.10	$633.00	$407.65	12% above	30%
Transvaginal pelvic ultrasound CPT 76830 HCHG RAD US TRANSVAGINAL FOLLICLE STUDY	$443.10	$633.00	$407.65	12% above	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 HCHG RAD US PELVIS COMPLETE TV ADD ON	$443.10	$633.00	$407.65	—	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 HCHG RAD US TRANSVAGINAL FOLLICLE STUDY	$443.10	$633.00	$407.65	—	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 HCHG RAD US TRANSVAGINAL	$443.10	$633.00	$407.65	—	30%
Transvaginal ultrasound during pregnancy CPT 76817 HCHG RAD US OB TRANSVAGINAL	$443.10	$633.00	$407.65	28% above	30%
Transvaginal ultrasound during pregnancy CPT 76817 HCHG RAD US OB TRANSVAGINAL LTD	$443.10	$633.00	$407.65	28% above	30%
Transvaginal ultrasound during pregnancy CPT 76817 HCHG RAD US OB TRANSVAGINAL PORTABLE	$473.90	$677.00	$435.99	37% above	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HCHG RAD US OB TRANSVAGINAL LTD	$443.10	$633.00	$407.65	—	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HCHG RAD US OB TRANSVAGINAL	$443.10	$633.00	$407.65	—	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HCHG RAD US OB TRANSVAGINAL PORTABLE	$473.90	$677.00	$435.99	—	30%
Ultrasound of the abdomen, complete CPT 76700 HCHG RAD US ABDOMEN COMPLETE	$998.90	$1,427.00	$918.99	66% above	30%
Ultrasound of the abdomen, complete CPT 76700 HCHG RAD US ABDOMEN COMPLETE PORTABLE	$1,029.70	$1,471.00	$947.32	71% above	30%
Ultrasound of the abdomen, complete inpatient CPT 76700 HCHG RAD US ABDOMEN COMPLETE	$998.90	$1,427.00	$918.99	—	30%
Ultrasound of the abdomen, complete inpatient CPT 76700 HCHG RAD US ABDOMEN COMPLETE PORTABLE	$1,029.70	$1,471.00	$947.32	—	30%
Ultrasound of the scrotum and testicles CPT 76870 HCHG RAD US SCROTUM	$742.70	$1,061.00	$683.28	58% above	30%
Ultrasound of the scrotum and testicles CPT 76870 HCHG RAD US SCROTUM PORTABLE	$774.20	$1,106.00	$712.26	65% above	30%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HCHG RAD US SCROTUM	$742.70	$1,061.00	$683.28	—	30%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HCHG RAD US SCROTUM PORTABLE	$774.20	$1,106.00	$712.26	—	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HCHG RAD US NECK OR HEAD SOFT TISSUE	$742.70	$1,061.00	$683.28	63% above	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HCHG RAD US NECK OR HEAD SOFT TISSUE	$742.70	$1,061.00	$683.28	—	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HCHG RAD XRAY UPPER GI	$429.10	$613.00	$394.77	34% above	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HCHG RAD XRAY UPPER GI	$429.10	$613.00	$394.77	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HCHG RAD US DUPLEX SCAN EXTREMITY UNI OR LTD STUDY	$819.70	$1,171.00	$754.12	49% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HCHG RAD US DUPLEX SCAN EXTREMITY UNI OR LTD STUDY PORTABLE	$851.20	$1,216.00	$783.10	54% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HCHG RAD US DUPLEX SCAN EXTREMITY UNI OR LTD STUDY	$819.70	$1,171.00	$754.12	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HCHG RAD US DUPLEX SCAN EXTREMITY UNI OR LTD STUDY PORTABLE	$851.20	$1,216.00	$783.10	—	30%
Wrist X-ray, complete, 3 or more views CPT 73110 HCHG RAD XRAY WRIST THREE VIEWS OR MORE	$295.40	$422.00	$271.77	32% above	30%
Wrist X-ray, complete, 3 or more views CPT 73110 HCHG RAD XRAY WRIST THREE VIEWS OR MORE PORTABLE	$328.30	$469.00	$302.04	47% above	30%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HCHG RAD XRAY WRIST THREE VIEWS OR MORE	$295.40	$422.00	$271.77	—	30%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HCHG RAD XRAY WRIST THREE VIEWS OR MORE PORTABLE	$328.30	$469.00	$302.04	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HCHG RAD XRAY HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS	$295.40	$422.00	$271.77	7% above	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HCHG RAD XRAY HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS PORTABLE	$326.20	$466.00	$300.10	18% above	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HCHG RAD XRAY HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS	$295.40	$422.00	$271.77	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HCHG RAD XRAY HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS PORTABLE	$326.20	$466.00	$300.10	—	30%
X-ray of the abdomen, 1 view CPT 74018 HCHG RAD XRAY ABDOMEN SINGLE AP VIEW	$222.60	$318.00	$204.79	6% above	30%
X-ray of the abdomen, 1 view CPT 74018 HCHG RAD XRAY ABDOMEN SINGLE AP VIEW PORTABLE	$255.50	$365.00	$235.06	21% above	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 HCHG RAD XRAY ABDOMEN SINGLE AP VIEW	$222.60	$318.00	$204.79	—	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 HCHG RAD XRAY ABDOMEN SINGLE AP VIEW PORTABLE	$255.50	$365.00	$235.06	—	30%
X-ray of the ankle, 2 views CPT 73600 HCHG RAD XRAY ANKLE 2 VIEWS	$255.50	$365.00	$235.06	56% above	30%
X-ray of the ankle, 2 views CPT 73600 HCHG RAD XRAY ANKLE 2 VIEWS PORTABLE	$288.40	$412.00	$265.33	76% above	30%
X-ray of the ankle, 2 views inpatient CPT 73600 HCHG RAD XRAY ANKLE 2 VIEWS	$255.50	$365.00	$235.06	—	30%
X-ray of the ankle, 2 views inpatient CPT 73600 HCHG RAD XRAY ANKLE 2 VIEWS PORTABLE	$288.40	$412.00	$265.33	—	30%
X-ray of the finger(s), 2 or more views CPT 73140 HCHG RAD XRAY FINGER TWO VIEWS OR MORE	$255.50	$365.00	$235.06	31% above	30%
X-ray of the finger(s), 2 or more views CPT 73140 HCHG RAD XRAY FINGER TWO VIEWS OR MORE PORTABLE	$288.40	$412.00	$265.33	48% above	30%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HCHG RAD XRAY FINGER TWO VIEWS OR MORE	$255.50	$365.00	$235.06	—	30%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HCHG RAD XRAY FINGER TWO VIEWS OR MORE PORTABLE	$288.40	$412.00	$265.33	—	30%
X-ray of the foot, 2 views CPT 73620 HCHG RAD XRAY FOOT 2 VIEWS	$255.50	$365.00	$235.06	51% above	30%
X-ray of the foot, 2 views CPT 73620 HCHG RAD XRAY FOOT 2 VIEWS LIMITED	$255.50	$365.00	$235.06	51% above	30%
X-ray of the foot, 2 views CPT 73620 HCHG RAD XRAY FOOT 2 VIEWS PORTABLE LIMITED	$288.40	$412.00	$265.33	70% above	30%
X-ray of the foot, 2 views CPT 73620 HCHG RAD XRAY FOOT 2 VIEWS PORTABLE	$288.40	$412.00	$265.33	70% above	30%
X-ray of the foot, 2 views inpatient CPT 73620 HCHG RAD XRAY FOOT 2 VIEWS	$255.50	$365.00	$235.06	—	30%
X-ray of the foot, 2 views inpatient CPT 73620 HCHG RAD XRAY FOOT 2 VIEWS LIMITED	$255.50	$365.00	$235.06	—	30%
X-ray of the foot, 2 views inpatient CPT 73620 HCHG RAD XRAY FOOT 2 VIEWS PORTABLE	$288.40	$412.00	$265.33	—	30%
X-ray of the foot, 2 views inpatient CPT 73620 HCHG RAD XRAY FOOT 2 VIEWS PORTABLE LIMITED	$288.40	$412.00	$265.33	—	30%
X-ray of the foot, complete, 3 or more views CPT 73630 HCHG RAD XRAY FOOT COMPLETE MINIMUM OF 3 VIEWS	$295.40	$422.00	$271.77	35% above	30%
X-ray of the foot, complete, 3 or more views CPT 73630 HCHG RAD XRAY FOOT COMPLETE MINIMUM OF 3 VIEWS PORTABLE	$328.30	$469.00	$302.04	50% above	30%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HCHG RAD XRAY FOOT COMPLETE MINIMUM OF 3 VIEWS	$295.40	$422.00	$271.77	—	30%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HCHG RAD XRAY FOOT COMPLETE MINIMUM OF 3 VIEWS PORTABLE	$328.30	$469.00	$302.04	—	30%
X-ray of the hand, 3 or more views CPT 73130 HCHG RAD XRAY HAND 3 VIEWS OR MORE	$295.40	$422.00	$271.77	35% above	30%
X-ray of the hand, 3 or more views inpatient CPT 73130 HCHG RAD XRAY HAND 3 VIEWS OR MORE	$295.40	$422.00	$271.77	—	30%
X-ray of the knee, 1 or 2 views CPT 73560 HCHG RAD XRAY KNEE 1 OR 2 VIEWS	$255.50	$365.00	$235.06	36% above	30%
X-ray of the knee, 1 or 2 views CPT 73560 HCHG RAD XRAY KNEE 1 OR 2 VIEWS PORTABLE	$288.40	$412.00	$265.33	53% above	30%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HCHG RAD XRAY KNEE 1 OR 2 VIEWS	$255.50	$365.00	$235.06	—	30%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HCHG RAD XRAY KNEE 1 OR 2 VIEWS PORTABLE	$288.40	$412.00	$265.33	—	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HCHG RAD XRAY LUMBOSACRAL SPINE 2 OR 3 VIEWS	$255.50	$365.00	$235.06	3% below	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HCHG RAD XRAY LUMBOSACRAL SPINE 2 OR 3 VIEWS PORTABLE	$288.40	$412.00	$265.33	10% above	30%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HCHG RAD XRAY LUMBOSACRAL SPINE 2 OR 3 VIEWS	$255.50	$365.00	$235.06	—	30%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HCHG RAD XRAY LUMBOSACRAL SPINE 2 OR 3 VIEWS PORTABLE	$288.40	$412.00	$265.33	—	30%
X-ray of the lower back, 4 or more views CPT 72110 HCHG RAD XRAY LUMBOSACRAL MINIMUM OF 4 VIEWS	$340.20	$486.00	$312.98	1% below	30%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HCHG RAD XRAY LUMBOSACRAL MINIMUM OF 4 VIEWS	$340.20	$486.00	$312.98	—	30%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HCHG RAD XRAY SPINE THORACIC 2 VIEWS	$255.50	$365.00	$235.06	1% below	30%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HCHG RAD XRAY SPINE THORACIC 2 VIEWS	$255.50	$365.00	$235.06	—	30%
X-ray of the nasal bones, 3 or more views CPT 70160 HCHG RAD XRAY NASAL BONES COMPLETE MINIMUM OF THREE VIEWS	$295.40	$422.00	$271.77	35% above	30%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HCHG RAD XRAY NASAL BONES COMPLETE MINIMUM OF THREE VIEWS	$295.40	$422.00	$271.77	—	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HCHG RAD XRAY SPINE CERVICAL 2 OR 3 VIEWS	$295.40	$422.00	$271.77	19% above	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HCHG RAD XRAY SPINE CERVICAL 2 OR 3 VIEWS PORTABLE	$328.30	$469.00	$302.04	32% above	30%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HCHG RAD XRAY SPINE CERVICAL 2 OR 3 VIEWS	$295.40	$422.00	$271.77	—	30%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HCHG RAD XRAY SPINE CERVICAL 2 OR 3 VIEWS PORTABLE	$328.30	$469.00	$302.04	—	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 HCHG RAD XRAY PELVIS 1 OR 2 VIEWS	$222.60	$318.00	$204.79	2% above	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 HCHG RAD XRAY PELVIS 1 OR 2 VIEWS PORTABLE	$254.80	$364.00	$234.42	17% above	30%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HCHG RAD XRAY PELVIS 1 OR 2 VIEWS	$222.60	$318.00	$204.79	—	30%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HCHG RAD XRAY PELVIS 1 OR 2 VIEWS PORTABLE	$254.80	$364.00	$234.42	—	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HCHG RAD XRAY SACRUM AND COCCYX TWO VIEWS OR MORE	$255.50	$365.00	$235.06	13% above	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HCHG RAD XRAY SACRUM AND COCCYX TWO VIEWS OR MORE	$255.50	$365.00	$235.06	—	30%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HCHG ALT (SGPT)	$59.50	$85.00	$54.74	29% above	30%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HCHG ALT (SGPT)	$59.50	$85.00	$54.74	—	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 HCHG AST (SGOT)	$59.50	$85.00	$54.74	31% above	30%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HCHG AST (SGOT)	$59.50	$85.00	$54.74	—	30%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HCHG GENERAL LAB 8007401 LCC	$200.90	$287.00	$184.83	11% below	30%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HCHG GENERAL LAB 8007400	$200.90	$287.00	$184.83	11% below	30%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HCHG GENERAL LAB 8007400	$200.90	$287.00	$184.83	—	30%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HCHG GENERAL LAB 8007401 LCC	$200.90	$287.00	$184.83	—	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HCHG ALLERGEN LC	$25.20	$36.00	$23.18	66% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HCHG RAST IN-HOUSE	$25.20	$36.00	$23.18	66% above	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HCHG ALLERGEN LC	$25.20	$36.00	$23.18	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HCHG RAST IN-HOUSE	$25.20	$36.00	$23.18	—	30%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HCHG CCP ANTIBODY IGG	$57.40	$82.00	$52.81	37% above	30%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HCHG CCP ANTIBODY IGG	$57.40	$82.00	$52.81	—	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HCHG ANA	$44.80	$64.00	$41.22	1% above	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HCHG ANA	$44.80	$64.00	$41.22	—	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HCHG BRAIN NATRIURETIC PEPTIDE	$102.90	$147.00	$94.67	24% below	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HCHG PRO BNP	$102.90	$147.00	$94.67	24% below	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HCHG PRO-BNP	$102.90	$147.00	$94.67	24% below	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HCHG BRAIN NATRIURETIC PEPTIDE	$102.90	$147.00	$94.67	—	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HCHG PRO BNP	$102.90	$147.00	$94.67	—	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HCHG PRO-BNP	$102.90	$147.00	$94.67	—	30%
Basic metabolic panel (blood test) CPT 80048 HCHG BASIC METABOLIC RTR	$236.60	$338.00	$217.67	141% above	30%
Basic metabolic panel (blood test) CPT 80048 HCHG BASIC METABOLIC PANEL	$236.60	$338.00	$217.67	141% above	30%
Basic metabolic panel (blood test) inpatient CPT 80048 HCHG BASIC METABOLIC RTR	$236.60	$338.00	$217.67	—	30%
Basic metabolic panel (blood test) inpatient CPT 80048 HCHG BASIC METABOLIC PANEL	$236.60	$338.00	$217.67	—	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HCHG TISSUE LEVEL IV	$56.70	$81.00	$52.16	46% below	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HCHG CELL BLOCK	$56.70	$81.00	$52.16	46% below	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HCHG CELL BLOCK	$56.70	$81.00	$52.16	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HCHG TISSUE LEVEL IV	$56.70	$81.00	$52.16	—	30%
Blood culture for bacteria CPT 87040 HCHG BLOOD CULTURE-BACTEC	$69.30	$99.00	$63.76	36% below	30%
Blood culture for bacteria inpatient CPT 87040 HCHG BLOOD CULTURE-BACTEC	$69.30	$99.00	$63.76	—	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HCHG VENIPUNCTURE	$21.00	$30.00	$19.32	1% above	30%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HCHG VENIPUNCTURE	$21.00	$30.00	$19.32	—	30%
Blood glucose (sugar) test CPT 82947 HCHG GLUCOSE	$27.30	$39.00	$25.12	35% below	30%
Blood glucose (sugar) test CPT 82947 HCHG GLUCOSE POCT	$27.30	$39.00	$25.12	35% below	30%
Blood glucose (sugar) test CPT 82947 HCHG FASTING GLUCOSE	$27.30	$39.00	$25.12	35% below	30%
Blood glucose (sugar) test CPT 82947 HCHG GLUCOSE TOLERANCE FASTING	$27.30	$39.00	$25.12	35% below	30%
Blood glucose (sugar) test inpatient CPT 82947 HCHG GLUCOSE POCT	$27.30	$39.00	$25.12	—	30%
Blood glucose (sugar) test inpatient CPT 82947 HCHG GLUCOSE	$27.30	$39.00	$25.12	—	30%
Blood glucose (sugar) test inpatient CPT 82947 HCHG FASTING GLUCOSE	$27.30	$39.00	$25.12	—	30%
Blood glucose (sugar) test inpatient CPT 82947 HCHG GLUCOSE TOLERANCE FASTING	$27.30	$39.00	$25.12	—	30%
Blood lead test CPT 83655 HCHG LEAD, BLOOD LC	$96.60	$138.00	$88.87	210% above	30%
Blood lead test CPT 83655 HCHG LEAD HEAVY METALS PROFILE II, BLOOD LC	$96.60	$138.00	$88.87	210% above	30%
Blood lead test inpatient CPT 83655 HCHG LEAD HEAVY METALS PROFILE II, BLOOD LC	$96.60	$138.00	$88.87	—	30%
Blood lead test inpatient CPT 83655 HCHG LEAD, BLOOD LC	$96.60	$138.00	$88.87	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCHG GENERAL LAB 8470300	$80.50	$115.00	$74.06	16% above	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCHG GENERAL LAB 8470300	$80.50	$115.00	$74.06	—	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HCHG CORD ABO GROUP	$30.80	$44.00	$28.34	41% below	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HCHG ABO GROUP	$30.80	$44.00	$28.34	41% below	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HCHG ARC-ABO TYPE	$30.80	$44.00	$28.34	41% below	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HCHG ARC-ABO TYPE	$30.80	$44.00	$28.34	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HCHG ABO GROUP	$30.80	$44.00	$28.34	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HCHG CORD ABO GROUP	$30.80	$44.00	$28.34	—	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HCHG C-REACTIVE PROTEIN	$60.90	$87.00	$56.03	12% above	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HCHG C-REACTIVE PROTEIN	$60.90	$87.00	$56.03	—	30%
C. difficile toxin gene test (stool PCR) CPT 87493 HCHG CLOSTRIDIUM DIFF TOXIN PCR	$98.70	$141.00	$90.80	26% below	30%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HCHG CLOSTRIDIUM DIFF TOXIN PCR	$98.70	$141.00	$90.80	—	30%
CA 19-9 blood test (tumor marker) CPT 86301 HCHG CA 19-9	$224.70	$321.00	$206.72	121% above	30%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HCHG CA 19-9	$224.70	$321.00	$206.72	—	30%
CA-125 blood test (ovarian cancer marker) CPT 86304 HCHG CA 125	$191.80	$274.00	$176.46	89% above	30%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HCHG CA 125	$191.80	$274.00	$176.46	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HCHG COVID 19 NAA LC	$59.50	$85.00	$54.74	50% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HCHG COVID 19 MML	$120.40	$172.00	$110.77	at median	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HCHG COVID 19 NAA LC	$59.50	$85.00	$54.74	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HCHG COVID 19 MML	$120.40	$172.00	$110.77	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HCHG GENERAL LAB 8749100	$95.20	$136.00	$87.58	3% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HCHG GENERAL LAB 8749102	$95.20	$136.00	$87.58	3% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HCHG GENERAL LAB 8749100	$95.20	$136.00	$87.58	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HCHG GENERAL LAB 8749102	$95.20	$136.00	$87.58	—	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HCHG LIPID PANEL	$93.10	$133.00	$85.65	1% above	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HCHG LIPID PANEL LCC	$93.10	$133.00	$85.65	1% above	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HCHG LIPID PANEL LCC	$93.10	$133.00	$85.65	—	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HCHG LIPID PANEL	$93.10	$133.00	$85.65	—	30%
Complete blood count (CBC) with differential CPT 85025 HCHG CBC W/DIFF	$78.40	$112.00	$72.13	6% below	30%
Complete blood count (CBC) with differential inpatient CPT 85025 HCHG CBC W/DIFF	$78.40	$112.00	$72.13	—	30%
Complete blood count (CBC), no differential CPT 85027 HCHG CBC	$39.20	$56.00	$36.06	40% below	30%
Complete blood count (CBC), no differential inpatient CPT 85027 HCHG CBC	$39.20	$56.00	$36.06	—	30%
Comprehensive metabolic panel (blood test) CPT 80053 HCHG COMPREHENSIVE METABOLIC PANE	$423.50	$605.00	$389.62	348% above	30%
Comprehensive metabolic panel (blood test) CPT 80053 HCHG COMP METABOLIC RTR	$423.50	$605.00	$389.62	348% above	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HCHG COMPREHENSIVE METABOLIC PANE	$423.50	$605.00	$389.62	—	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HCHG COMP METABOLIC RTR	$423.50	$605.00	$389.62	—	30%
D-dimer blood test (blood clot marker) CPT 85379 HCHG D-DIMER QUANT	$173.60	$248.00	$159.71	72% above	30%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HCHG D-DIMER QUANT	$173.60	$248.00	$159.71	—	30%
DHEA sulfate (DHEA-S) blood test CPT 82627 HCHG DHEA-SULFATE	$105.00	$150.00	$96.60	82% above	30%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HCHG DHEA-SULFATE	$105.00	$150.00	$96.60	—	30%
Estradiol blood test CPT 82670 HCHG ESTRADIOL SERUM	$122.50	$175.00	$112.70	85% above	30%
Estradiol blood test inpatient CPT 82670 HCHG ESTRADIOL SERUM	$122.50	$175.00	$112.70	—	30%
FSH (follicle-stimulating hormone) test CPT 83001 HCHG FSH-SERUM	$96.60	$138.00	$88.87	29% above	30%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HCHG FSH-SERUM	$96.60	$138.00	$88.87	—	30%
Fecal calprotectin (stool inflammation test) CPT 83993 HCHG CALPROTECTIN, FECAL LC	$281.40	$402.00	$258.89	217% above	30%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HCHG CALPROTECTIN, FECAL LC	$281.40	$402.00	$258.89	—	30%
Ferritin blood test (iron stores) CPT 82728 HCHG FERRITIN	$72.80	$104.00	$66.98	18% below	30%
Ferritin blood test (iron stores) inpatient CPT 82728 HCHG FERRITIN	$72.80	$104.00	$66.98	—	30%
Folate (folic acid) blood test CPT 82746 HCHG FOLIC ACID LCC	$106.40	$152.00	$97.89	33% above	30%
Folate (folic acid) blood test CPT 82746 HCHG FOLIC ACID	$106.40	$152.00	$97.89	33% above	30%
Folate (folic acid) blood test inpatient CPT 82746 HCHG FOLIC ACID LCC	$106.40	$152.00	$97.89	—	30%
Folate (folic acid) blood test inpatient CPT 82746 HCHG FOLIC ACID	$106.40	$152.00	$97.89	—	30%
Free T3 thyroid hormone test CPT 84481 HCHG T3,FREE LCC	$72.10	$103.00	$66.33	2% below	30%
Free T3 thyroid hormone test CPT 84481 HCHG T3, FREE	$72.10	$103.00	$66.33	2% below	30%
Free T3 thyroid hormone test inpatient CPT 84481 HCHG T3, FREE	$72.10	$103.00	$66.33	—	30%
Free T3 thyroid hormone test inpatient CPT 84481 HCHG T3,FREE LCC	$72.10	$103.00	$66.33	—	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HCHG T4, FREE	$39.90	$57.00	$36.71	41% below	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HCHG T4,FREE LCC	$39.90	$57.00	$36.71	41% below	30%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HCHG T4,FREE LCC	$39.90	$57.00	$36.71	—	30%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HCHG T4, FREE	$39.90	$57.00	$36.71	—	30%
Free testosterone test CPT 84402 HCHG TESTOSTERONE FREE LC	$116.20	$166.00	$106.90	86% above	30%
Free testosterone test inpatient CPT 84402 HCHG TESTOSTERONE FREE LC	$116.20	$166.00	$106.90	—	30%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HCHG GENERAL HEALTH PANEL AFFILIATE ONLY	$536.90	$767.00	$493.95	111% above	30%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HCHG GENERAL HEALTH PANEL AFFILIATE ONLY	$536.90	$767.00	$493.95	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HCHG GLUCOSE, GESTATIONAL	$24.50	$35.00	$22.54	42% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HCHG GLUCOSE 2 HOUR	$24.50	$35.00	$22.54	42% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HCHG GLUCOSE 2 HOUR	$24.50	$35.00	$22.54	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HCHG GLUCOSE, GESTATIONAL	$24.50	$35.00	$22.54	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HCHG GENERAL LAB 8759100	$106.40	$152.00	$97.89	26% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HCHG GENERAL LAB 8759103	$106.40	$152.00	$97.89	26% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HCHG GENERAL LAB 8759103	$106.40	$152.00	$97.89	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HCHG GENERAL LAB 8759100	$106.40	$152.00	$97.89	—	30%
H. pylori antibody blood test CPT 86677 HCHG HELICOBACTER PYLORI IGG AFFILIATE ONLY	$166.60	$238.00	$153.27	42% above	30%
H. pylori antibody blood test inpatient CPT 86677 HCHG HELICOBACTER PYLORI IGG AFFILIATE ONLY	$166.60	$238.00	$153.27	—	30%
H. pylori stool antigen test CPT 87338 HCHG H. PYLORI ANTIGEN, STOOL	$63.70	$91.00	$58.60	40% below	30%
H. pylori stool antigen test inpatient CPT 87338 HCHG H. PYLORI ANTIGEN, STOOL	$63.70	$91.00	$58.60	—	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HCHG GENERAL LAB 8753600	$368.90	$527.00	$339.39	221% above	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HCHG GENERAL LAB 8753600	$368.90	$527.00	$339.39	—	30%
HIV-1 and HIV-2 antibody test CPT 86703 HCHG GENERAL LAB 8670301	$113.40	$162.00	$104.33	71% above	30%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HCHG GENERAL LAB 8670301	$113.40	$162.00	$104.33	—	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HCHG GENERAL LAB 8738900	$113.40	$162.00	$104.33	79% above	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HCHG GENERAL LAB 8738900	$113.40	$162.00	$104.33	—	30%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HCHG GENERAL LAB 8762400	$151.90	$217.00	$139.75	18% above	30%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HCHG GENERAL LAB 8762400	$151.90	$217.00	$139.75	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HCHG HEMOGLOBIN A1C	$39.90	$57.00	$36.71	29% below	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HCHG HEMOGLOBIN A1C	$39.90	$57.00	$36.71	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HCHG GENERAL LAB 8670600	$95.90	$137.00	$88.23	46% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HCHG GENERAL LAB 8670600	$95.90	$137.00	$88.23	—	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HCHG GENERAL LAB 8734000	$65.80	$94.00	$60.54	23% above	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HCHG HBSAG LCC	$65.80	$94.00	$60.54	23% above	30%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HCHG GENERAL LAB 8734000	$65.80	$94.00	$60.54	—	30%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HCHG HBSAG LCC	$65.80	$94.00	$60.54	—	30%
Hepatitis C antibody blood test (screening) CPT 86803 HCHG GENERAL LAB 8680300	$113.40	$162.00	$104.33	42% above	30%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCHG GENERAL LAB 8680300	$113.40	$162.00	$104.33	—	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCHG GENERAL LAB 8752200	$247.80	$354.00	$227.98	100% above	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCHG GENERAL LAB 87522 LCC	$247.80	$354.00	$227.98	100% above	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCHG GENERAL LAB 8752200	$247.80	$354.00	$227.98	—	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCHG GENERAL LAB 87522 LCC	$247.80	$354.00	$227.98	—	30%
Herpes blood test, HSV-1 antibody CPT 86695 HCHG GENERAL LAB 8669500	$42.00	$60.00	$38.64	9% below	30%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HCHG GENERAL LAB 8669500	$42.00	$60.00	$38.64	—	30%
Herpes blood test, HSV-2 antibody CPT 86696 HCHG GENERAL LAB 8669600	$42.00	$60.00	$38.64	25% below	30%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HCHG GENERAL LAB 8669600	$42.00	$60.00	$38.64	—	30%
High-sensitivity CRP (hs-CRP) test CPT 86141 HCHG HIGH SENS CRP	$117.60	$168.00	$108.19	66% above	30%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HCHG HIGH SENS CRP	$117.60	$168.00	$108.19	—	30%
Homocysteine blood test CPT 83090 HCHG HOMOCYSTEINE, CARDIAC	$221.90	$317.00	$204.15	147% above	30%
Homocysteine blood test inpatient CPT 83090 HCHG HOMOCYSTEINE, CARDIAC	$221.90	$317.00	$204.15	—	30%
Insulin blood test CPT 83525 HCHG INSULIN	$69.30	$99.00	$63.76	27% above	30%
Insulin blood test inpatient CPT 83525 HCHG INSULIN	$69.30	$99.00	$63.76	—	30%
Iron blood test (serum iron) CPT 83540 HCHG IRON	$51.80	$74.00	$47.66	1% above	30%
Iron blood test (serum iron) inpatient CPT 83540 HCHG IRON	$51.80	$74.00	$47.66	—	30%
Iron-binding capacity (TIBC) test CPT 83550 HCHG IRON BINDING CAPACITY (IBC)	$73.50	$105.00	$67.62	14% above	30%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HCHG IRON BINDING CAPACITY (IBC)	$73.50	$105.00	$67.62	—	30%
Kidney function blood test panel CPT 80069 HCHG RENAL FUNCTION PANEL	$434.70	$621.00	$399.92	310% above	30%
Kidney function blood test panel inpatient CPT 80069 HCHG RENAL FUNCTION PANEL	$434.70	$621.00	$399.92	—	30%
LH (luteinizing hormone) test CPT 83002 HCHG LUTEINIZING HORMONE	$99.40	$142.00	$91.45	22% above	30%
LH (luteinizing hormone) test inpatient CPT 83002 HCHG LUTEINIZING HORMONE	$99.40	$142.00	$91.45	—	30%
Lipase blood test (pancreas enzyme) CPT 83690 HCHG LIPASE	$56.70	$81.00	$52.16	4% below	30%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HCHG LIPASE	$56.70	$81.00	$52.16	—	30%
Liver function blood test panel CPT 80076 HCHG HEPATIC FUNCTION PANEL	$81.20	$116.00	$74.70	20% below	30%
Liver function blood test panel inpatient CPT 80076 HCHG HEPATIC FUNCTION PANEL	$81.20	$116.00	$74.70	—	30%
Lyme disease antibody test CPT 86618 HCHG LYME (FIA) POLYVALENT	$40.60	$58.00	$37.35	28% below	30%
Lyme disease antibody test inpatient CPT 86618 HCHG LYME (FIA) POLYVALENT	$40.60	$58.00	$37.35	—	30%
Magnesium blood test CPT 83735 HCHG MAGNESIUM BLOOD	$42.00	$60.00	$38.64	35% above	30%
Magnesium blood test inpatient CPT 83735 HCHG MAGNESIUM BLOOD	$42.00	$60.00	$38.64	—	30%
Measles (rubeola) antibody test CPT 86765 HCHG RUBEOLA IMMUNITY	$119.70	$171.00	$110.12	228% above	30%
Measles (rubeola) antibody test CPT 86765 HCHG RUBEOLA ANTIBODIES, IGM LC	$119.70	$171.00	$110.12	228% above	30%
Measles (rubeola) antibody test inpatient CPT 86765 HCHG RUBEOLA ANTIBODIES, IGM LC	$119.70	$171.00	$110.12	—	30%
Measles (rubeola) antibody test inpatient CPT 86765 HCHG RUBEOLA IMMUNITY	$119.70	$171.00	$110.12	—	30%
Mono test (heterophile antibody, Monospot) CPT 86308 HCHG HETEROPHILE	$56.00	$80.00	$51.52	9% above	30%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HCHG HETEROPHILE	$56.00	$80.00	$51.52	—	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HCHG PSA-DIAGNOSTIC	$83.30	$119.00	$76.64	4% above	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HCHG PSA-DIAGNOSTIC	$83.30	$119.00	$76.64	—	30%
Pap test (liquid-based, automated screening with review) CPT 88175 HCHG IMAGED THIN PREP PAP DIAGNOSTIC	$66.50	$95.00	$61.18	22% below	30%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HCHG IMAGED THIN PREP PAP DIAGNOSTIC	$66.50	$95.00	$61.18	—	30%
Parathyroid hormone (PTH) blood test CPT 83970 HCHG PTH INTACT	$241.50	$345.00	$222.18	106% above	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HCHG PTH INTACT	$241.50	$345.00	$222.18	—	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HCHG ACTIVATED PTT	$47.60	$68.00	$43.79	15% below	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HCHG PTT-LA SCREEN	$47.60	$68.00	$43.79	15% below	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HCHG ACTIVATED PTT	$47.60	$68.00	$43.79	—	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HCHG PTT-LA SCREEN	$47.60	$68.00	$43.79	—	30%
Progesterone blood test CPT 84144 HCHG PROGESTERONE LCC	$104.30	$149.00	$95.96	24% above	30%
Progesterone blood test CPT 84144 HCHG PROGESTERONE BLOOD	$104.30	$149.00	$95.96	24% above	30%
Progesterone blood test inpatient CPT 84144 HCHG PROGESTERONE BLOOD	$104.30	$149.00	$95.96	—	30%
Progesterone blood test inpatient CPT 84144 HCHG PROGESTERONE LCC	$104.30	$149.00	$95.96	—	30%
Prolactin blood test CPT 84146 HCHG PROLACTIN LCC	$93.10	$133.00	$85.65	43% above	30%
Prolactin blood test CPT 84146 HCHG PROLACTIN	$93.10	$133.00	$85.65	43% above	30%
Prolactin blood test inpatient CPT 84146 HCHG PROLACTIN	$93.10	$133.00	$85.65	—	30%
Prolactin blood test inpatient CPT 84146 HCHG PROLACTIN LCC	$93.10	$133.00	$85.65	—	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HCHG PROTHOMBIN TIME	$33.60	$48.00	$30.91	11% above	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HCHG INR POCT	$33.60	$48.00	$30.91	11% above	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HCHG INR POCT	$33.60	$48.00	$30.91	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HCHG PROTHOMBIN TIME	$33.60	$48.00	$30.91	—	30%
Rapid flu test (influenza antigen) CPT 87804 HCHG INFLUENZA A&B	$82.60	$118.00	$75.99	41% above	30%
Rapid flu test (influenza antigen) inpatient CPT 87804 HCHG INFLUENZA A&B	$82.60	$118.00	$75.99	—	30%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HCHG RAPID STREP A THROAT-SAT	$27.30	$39.00	$25.12	49% below	30%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HCHG RAPID STREP A THROAT-SAT	$27.30	$39.00	$25.12	—	30%
Rheumatoid factor (RF) test CPT 86431 HCHG RA QUANT	$53.20	$76.00	$48.94	10% above	30%
Rheumatoid factor (RF) test inpatient CPT 86431 HCHG RA QUANT	$53.20	$76.00	$48.94	—	30%
Rubella antibody test (immunity check) CPT 86762 HCHG RUBELLA IMMUNE STATUS	$80.50	$115.00	$74.06	70% above	30%
Rubella antibody test (immunity check) inpatient CPT 86762 HCHG RUBELLA IMMUNE STATUS	$80.50	$115.00	$74.06	—	30%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HCHG SED RATE	$9.10	$13.00	$8.37	76% below	30%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HCHG SED RATE	$9.10	$13.00	$8.37	—	30%
Stool ova and parasites exam CPT 87177 HCHG O&P EXAM LC	$112.00	$160.00	$103.04	218% above	30%
Stool ova and parasites exam inpatient CPT 87177 HCHG O&P EXAM LC	$112.00	$160.00	$103.04	—	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HCHG OCCULT BLOOD, IFOBT	$43.40	$62.00	$39.93	25% below	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HCHG OCCULT BLOOD, IFOBT	$43.40	$62.00	$39.93	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HCHG GENERAL LAB 8659200	$82.60	$118.00	$75.99	179% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HCHG GENERAL LAB 8659201	$82.60	$118.00	$75.99	179% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HCHG GENERAL LAB 8659203	$82.60	$118.00	$75.99	179% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HCHG GENERAL LAB 8659200	$82.60	$118.00	$75.99	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HCHG GENERAL LAB 8659201	$82.60	$118.00	$75.99	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HCHG GENERAL LAB 8659203	$82.60	$118.00	$75.99	—	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HCHG QUANTIFERON TB GOLD PLUS	$98.70	$141.00	$90.80	18% below	30%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HCHG QUANTIFERON TB GOLD PLUS	$98.70	$141.00	$90.80	—	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HCHG TESTOSTERONE TOTAL LCC	$114.10	$163.00	$104.97	82% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HCHG TESTOSTERONE	$114.10	$163.00	$104.97	82% above	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HCHG TESTOSTERONE	$114.10	$163.00	$104.97	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HCHG TESTOSTERONE TOTAL LCC	$114.10	$163.00	$104.97	—	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 HCHG THY PEROXIDASE ABY	$64.40	$92.00	$59.25	22% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 HCHG LIVER-KIDNEY MICROSOMAL AB LC	$64.40	$92.00	$59.25	22% above	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HCHG THY PEROXIDASE ABY	$64.40	$92.00	$59.25	—	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HCHG LIVER-KIDNEY MICROSOMAL AB LC	$64.40	$92.00	$59.25	—	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HCHG CONGENITAL HYPOTHYROIDISM	$79.10	$113.00	$72.77	15% below	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HCHG TSH	$79.10	$113.00	$72.77	15% below	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HCHG TSH	$79.10	$113.00	$72.77	—	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HCHG CONGENITAL HYPOTHYROIDISM	$79.10	$113.00	$72.77	—	30%
Trichomonas test (NAAT) CPT 87661 HCHG GENERAL LAB 8766103	$32.20	$46.00	$29.62	36% below	30%
Trichomonas test (NAAT) CPT 87661 HCHG GENERAL LAB 8766100	$32.20	$46.00	$29.62	36% below	30%
Trichomonas test (NAAT) inpatient CPT 87661 HCHG GENERAL LAB 8766100	$32.20	$46.00	$29.62	—	30%
Trichomonas test (NAAT) inpatient CPT 87661 HCHG GENERAL LAB 8766103	$32.20	$46.00	$29.62	—	30%
Uric acid blood test CPT 84550 HCHG URIC ACID	$104.30	$149.00	$95.96	134% above	30%
Uric acid blood test inpatient CPT 84550 HCHG URIC ACID	$104.30	$149.00	$95.96	—	30%
Urinalysis with microscope exam, automated CPT 81001 HCHG URINALYSIS COMPLETE	$67.90	$97.00	$62.47	37% above	30%
Urinalysis with microscope exam, automated CPT 81001 HCHG UA COMPLETE RTR	$67.90	$97.00	$62.47	37% above	30%
Urinalysis with microscope exam, automated inpatient CPT 81001 HCHG URINALYSIS COMPLETE	$67.90	$97.00	$62.47	—	30%
Urinalysis with microscope exam, automated inpatient CPT 81001 HCHG UA COMPLETE RTR	$67.90	$97.00	$62.47	—	30%
Urinalysis without microscope exam, automated CPT 81003 HCHG PH URINE	$21.00	$30.00	$19.32	18% below	30%
Urinalysis without microscope exam, automated CPT 81003 HCHG PROTEIN QUAL URINE	$54.60	$78.00	$50.23	114% above	30%
Urinalysis without microscope exam, automated CPT 81003 HCHG URINALYSIS	$54.60	$78.00	$50.23	114% above	30%
Urinalysis without microscope exam, automated CPT 81003 HCHG UA MULTI	$54.60	$78.00	$50.23	114% above	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HCHG PH URINE	$21.00	$30.00	$19.32	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HCHG URINALYSIS	$54.60	$78.00	$50.23	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HCHG UA MULTI	$54.60	$78.00	$50.23	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HCHG PROTEIN QUAL URINE	$54.60	$78.00	$50.23	—	30%
Urine culture for bacteria, with colony count CPT 87086 HCHG URINE CULTURE	$54.60	$78.00	$50.23	at median	30%
Urine culture for bacteria, with colony count inpatient CPT 87086 HCHG URINE CULTURE	$54.60	$78.00	$50.23	—	30%
Urine pregnancy test, read by color change CPT 81025 HCHG GENERAL LAB 8102500	$72.80	$104.00	$66.98	85% above	30%
Urine pregnancy test, read by color change inpatient CPT 81025 HCHG GENERAL LAB 8102500	$72.80	$104.00	$66.98	—	30%
Vitamin B12 (cobalamin) blood test CPT 82607 HCHG VITAMIN B-12	$76.30	$109.00	$70.20	10% below	30%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HCHG VITAMIN B-12	$76.30	$109.00	$70.20	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HCHG 25-HYDROXY VITAMIN D (D2+D3 FRACTIONATED) LC	$73.50	$105.00	$67.62	24% below	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HCHG VITAMIN D TOTAL	$73.50	$105.00	$67.62	24% below	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HCHG 25-HYDROXY VITAMIN D (D2+D3 FRACTIONATED) LC	$73.50	$105.00	$67.62	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HCHG VITAMIN D TOTAL	$73.50	$105.00	$67.62	—	30%
Zinc blood test CPT 84630 HCHG ZINC, PLASMA OR SERUM LC	$103.60	$148.00	$95.31	244% above	30%
Zinc blood test inpatient CPT 84630 HCHG ZINC, PLASMA OR SERUM LC	$103.60	$148.00	$95.31	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCHG GENERAL LAB 8470202	$142.80	$204.00	$131.38	55% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCHG GENERAL LAB 8470201	$142.80	$204.00	$131.38	55% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCHG GENERAL LAB 8470208	$142.80	$204.00	$131.38	55% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCHG GENERAL LAB 8470201	$142.80	$204.00	$131.38	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCHG GENERAL LAB 8470208	$142.80	$204.00	$131.38	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCHG GENERAL LAB 8470202	$142.80	$204.00	$131.38	—	30%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Cardioversion, elective (restoring heart rhythm) CPT 92960 HCHG CARDIOVERSION ELECTIVE, EXTERNAL	$417.20	$596.00	$383.82	57% below	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HCHG CARDIOVERSION ELECTIVE, EXTERNAL	$417.20	$596.00	$383.82	—	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HCHG CIRCUMCISION W REGIONAL BLOCK	$183.40	$262.00	$168.73	25% below	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HCHG CIRCUMCISION W REGIONAL BLOCK	$183.40	$262.00	$168.73	—	30%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HCHG XR INJ EPIDURAL CERVICAL OR THORACIC SPINE W GUIDE	$852.60	$1,218.00	$784.39	15% below	30%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HCHG RAD INJ EPIDURAL CERVICAL OR THORACIC W GUIDE	$852.60	$1,218.00	$784.39	15% below	30%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HCHG RAD INJ EPIDURAL CERVICAL OR THORACIC W GUIDE	$852.60	$1,218.00	$784.39	—	30%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HCHG XR INJ EPIDURAL CERVICAL OR THORACIC SPINE W GUIDE	$852.60	$1,218.00	$784.39	—	30%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HCHG XR INJ FACET LUMBAR OR SACRAL SINGLE LEV	$852.60	$1,218.00	$784.39	35% below	30%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HCHG RAD INJ FACET JOINT LUMBAR/SACRAL ONE LEVEL W GUIDE	$852.60	$1,218.00	$784.39	35% below	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HCHG XR INJ FACET LUMBAR OR SACRAL SINGLE LEV	$852.60	$1,218.00	$784.39	—	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HCHG RAD INJ FACET JOINT LUMBAR/SACRAL ONE LEVEL W GUIDE	$852.60	$1,218.00	$784.39	—	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HCHG XR INJ HYSTEROSALPINGOGRAM	$149.10	$213.00	$137.17	51% below	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HCHG RAD INJ HYSTEROSALPINGOGRAM W CATHETERIZATION	$149.10	$213.00	$137.17	51% below	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HCHG XR INJ HYSTEROSALPINGOGRAM	$149.10	$213.00	$137.17	—	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HCHG RAD INJ HYSTEROSALPINGOGRAM W CATHETERIZATION	$149.10	$213.00	$137.17	—	30%
Incision and drainage of a simple or single skin abscess CPT 10060 HCHG RAD DRAIN SUBCUTANEOUS ABSCESS	$194.60	$278.00	$179.03	32% below	30%
Incision and drainage of a simple or single skin abscess CPT 10060 HCHG US DRAIN SUBCUTANEOUS ABSCESS	$194.60	$278.00	$179.03	32% below	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HCHG US DRAIN SUBCUTANEOUS ABSCESS	$194.60	$278.00	$179.03	—	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HCHG RAD DRAIN SUBCUTANEOUS ABSCESS	$194.60	$278.00	$179.03	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HCHG RAD ARTHROCENTESIS ASPIRATION INJECTION MAJOR JOINT BURSA	$297.50	$425.00	$273.70	18% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HCHG XR ARTHROCENTESIS MAJOR JOINT OR BURSA	$297.50	$425.00	$273.70	18% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HCHG RAD ARTHROCENTESIS ASPIRATION INJECTION MAJOR JOINT BURSA	$297.50	$425.00	$273.70	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HCHG XR ARTHROCENTESIS MAJOR JOINT OR BURSA	$297.50	$425.00	$273.70	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HCHG XR ARTHROCENTESIS INTERMEDIATE JOINT OR BURSA	$297.50	$425.00	$273.70	3% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HCHG RAD ARTHROCENTESIS ASPIRATION INJECTION INTERM JOINT BURSA	$297.50	$425.00	$273.70	3% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HCHG XR ARTHROCENTESIS INTERMEDIATE JOINT OR BURSA	$297.50	$425.00	$273.70	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HCHG RAD ARTHROCENTESIS ASPIRATION INJECTION INTERM JOINT BURSA	$297.50	$425.00	$273.70	—	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HCHG RAD ARTHROCENTESIS ASPIRATION SMALL JOINT OR BURSA	$216.30	$309.00	$199.00	33% below	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HCHG RAD ARTHROCENTESIS ASPIRATION SMALL JOINT OR BURSA	$216.30	$309.00	$199.00	—	30%
Lower-back epidural injection, with imaging guidance CPT 62323 HCHG CT INJ EPIDURAL LUMBAR OR SACRAL W GUIDE	$852.60	$1,218.00	$784.39	13% below	30%
Lower-back epidural injection, with imaging guidance CPT 62323 HCHG RAD INJ EPIDURAL LUMBAR OR SACRAL W GUIDE	$852.60	$1,218.00	$784.39	13% below	30%
Lower-back epidural injection, with imaging guidance CPT 62323 HCHG XR INJ EPIDURAL LUMBAR OR SACRAL W GUIDE	$852.60	$1,218.00	$784.39	13% below	30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HCHG CT INJ EPIDURAL LUMBAR OR SACRAL W GUIDE	$852.60	$1,218.00	$784.39	—	30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HCHG RAD INJ EPIDURAL LUMBAR OR SACRAL W GUIDE	$852.60	$1,218.00	$784.39	—	30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HCHG XR INJ EPIDURAL LUMBAR OR SACRAL W GUIDE	$852.60	$1,218.00	$784.39	—	30%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HCHG RAD INJ TRANS EPIDURAL LUMBAR/SACRAL ONE LEVEL W GUIDE	$852.60	$1,218.00	$784.39	34% below	30%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HCHG XR INJ TRANSFORAMINAL LUMBAR OR SACRAL SINGLE LEV	$852.60	$1,218.00	$784.39	34% below	30%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HCHG XR INJ TRANSFORAMINAL LUMBAR OR SACRAL SINGLE LEV	$852.60	$1,218.00	$784.39	—	30%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HCHG RAD INJ TRANS EPIDURAL LUMBAR/SACRAL ONE LEVEL W GUIDE	$852.60	$1,218.00	$784.39	—	30%
Occipital nerve block (injection for headaches) CPT 64405 HCHG XR INJ NERVE BLOCK OCCIPITAL NERVE	$303.10	$433.00	$278.85	49% below	30%
Occipital nerve block (injection for headaches) CPT 64405 HCHG RAD INJ ANES AGENT STEROID OCCIPITAL NERVE	$303.10	$433.00	$278.85	49% below	30%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HCHG XR INJ NERVE BLOCK OCCIPITAL NERVE	$303.10	$433.00	$278.85	—	30%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HCHG RAD INJ ANES AGENT STEROID OCCIPITAL NERVE	$303.10	$433.00	$278.85	—	30%
Paracentesis with imaging guidance CPT 49083 HCHG RAD PARACENTESIS ABDOMEN WITH IMAGING	$1,146.60	$1,638.00	$1,054.87	31% above	30%
Paracentesis with imaging guidance CPT 49083 HCHG US PARACENTESIS ABDOMEN WITH IMAGING	$1,146.60	$1,638.00	$1,054.87	31% above	30%
Paracentesis with imaging guidance inpatient CPT 49083 HCHG US PARACENTESIS ABDOMEN WITH IMAGING	$1,146.60	$1,638.00	$1,054.87	—	30%
Paracentesis with imaging guidance inpatient CPT 49083 HCHG RAD PARACENTESIS ABDOMEN WITH IMAGING	$1,146.60	$1,638.00	$1,054.87	—	30%
Prostate biopsy CPT 55700 HCHG US BIOPSY PROSTATE	$402.50	$575.00	$370.30	68% below	30%
Prostate biopsy CPT 55700 HCHG RAD BIOPSY PROSTATE NEEDLE OR PUNCH SNGL OR MULTI	$402.50	$575.00	$370.30	68% below	30%
Prostate biopsy inpatient CPT 55700 HCHG RAD BIOPSY PROSTATE NEEDLE OR PUNCH SNGL OR MULTI	$402.50	$575.00	$370.30	—	30%
Prostate biopsy inpatient CPT 55700 HCHG US BIOPSY PROSTATE	$402.50	$575.00	$370.30	—	30%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HCHG RAD DSTR NROLYTC AGNT PARVERTEB FACET SNGL LMBR/SACRAL	$1,060.50	$1,515.00	$975.66	50% below	30%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HCHG RAD DSTR NROLYTC AGNT PARVERTEB FACET SNGL LMBR/SACRAL	$1,060.50	$1,515.00	$975.66	—	30%
Thoracentesis with imaging guidance CPT 32555 HCHG US THORACENTESIS PLEURAL SPACE	$947.10	$1,353.00	$871.33	4% above	30%
Thoracentesis with imaging guidance CPT 32555 HCHG RAD THORACENTESIS PLEURAL SPACE NEEDLE OR CATHETER	$947.10	$1,353.00	$871.33	4% above	30%
Thoracentesis with imaging guidance inpatient CPT 32555 HCHG US THORACENTESIS PLEURAL SPACE	$947.10	$1,353.00	$871.33	—	30%
Thoracentesis with imaging guidance inpatient CPT 32555 HCHG RAD THORACENTESIS PLEURAL SPACE NEEDLE OR CATHETER	$947.10	$1,353.00	$871.33	—	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HCHG RAD BIOPSY BREAST INC MARKER 1ST LESION W US GUIDE	$1,316.70	$1,881.00	$1,211.36	14% below	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HCHG RAD BIOPSY BREAST INC MARKER 1ST LESION W US GUIDE	$1,316.70	$1,881.00	$1,211.36	—	30%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HCHG BLOOD/BLOOD PRODUCT ADMIN PER UNIT	$1,080.10	$1,543.00	$993.69	51% above	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HCHG BLOOD/BLOOD PRODUCT ADMIN PER UNIT	$1,080.10	$1,543.00	$993.69	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HCHG RC AIRWAY INHALATION TX MDI VENT	$90.30	$129.00	$83.08	23% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HCHG RC AIRWAY INHALATION TX MDI/DPI	$90.30	$129.00	$83.08	23% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HCHG RC AIRWAY INHALATION TX EZPAP W NEB	$90.30	$129.00	$83.08	23% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HCHG RC AIRWAY INHALATION TX	$90.30	$129.00	$83.08	23% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HCHG RC SPUTUM INDUCTION	$90.30	$129.00	$83.08	23% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HCHG RC AIRWAY INHALATION TX IPPB	$90.30	$129.00	$83.08	23% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC AIRWAY INHALATION TX MDI/DPI	$90.30	$129.00	$83.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC AIRWAY INHALATION TX EZPAP W NEB	$90.30	$129.00	$83.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC SPUTUM INDUCTION	$90.30	$129.00	$83.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC AIRWAY INHALATION TX MDI VENT	$90.30	$129.00	$83.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC AIRWAY INHALATION TX IPPB	$90.30	$129.00	$83.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC AIRWAY INHALATION TX	$90.30	$129.00	$83.08	—	30%
Chemotherapy IV infusion, first hour CPT 96413 HCHG CHEMO IV ADMIN INITIAL HOUR	$245.00	$350.00	$225.40	52% below	30%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HCHG CHEMO IV ADMIN INITIAL HOUR	$245.00	$350.00	$225.40	—	30%
Critical care, first 30 to 74 minutes CPT 99291 PR CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN	$375.20	$536.00	—	76% below	30%
Critical care, first 30 to 74 minutes CPT 99291 HCHG ED CRITICAL CARE LEVEL VI	$2,198.00	$3,140.00	$2,022.16	42% above	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HCHG EKG 12LEAD TRACING ONLY WO REPORT/INTERP	$133.70	$191.00	$123.00	22% below	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HCHG EKG 12LEAD TRACING ONLY WO REPORT/INTERP	$133.70	$191.00	$123.00	—	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP	$102.20	$146.00	—	46% below	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED LVL 1 HCHG	$208.60	$298.00	$191.91	10% above	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM	$188.30	$269.00	—	24% below	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED LVL 2 HCHG	$564.20	$806.00	$519.06	128% above	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 PR EMERGENCY DEPARTMENT VISIT LOW MDM	$236.60	$338.00	—	43% below	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED LVL 3 HCHG	$727.30	$1,039.00	$669.12	74% above	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 PR EMERGENCY DEPARTMENT VISIT MODERATE MDM	$281.40	$402.00	—	56% below	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED LVL 4 HCHG	$1,022.00	$1,460.00	$940.24	61% above	30%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 PR EMERGENCY DEPARTMENT VISIT HIGH MDM	$329.00	$470.00	—	65% below	30%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED LVL 5 HCHG	$1,309.00	$1,870.00	$1,204.28	38% above	30%
Exercise stress test, tracing only, the hospital charge CPT 93017 HCHG RAD CV STRESS TEST EXERCISE OR PHARM TRACE ONLY	$286.30	$409.00	$263.40	60% below	30%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HCHG RAD CV STRESS TEST EXERCISE OR PHARM TRACE ONLY	$286.30	$409.00	$263.40	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HCHG IV INFUSION HYDRATION INITIAL 31-60 MIN	$216.30	$309.00	$199.00	21% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HCHG ED IV INFUSION HYDRATION INITIAL 31-60 MIN	$305.20	$436.00	$280.78	12% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HCHG IV INFUSION HYDRATION INITIAL 31-60 MIN	$216.30	$309.00	$199.00	—	30%
IV infusion of a medicine, first hour CPT 96365 HCHG IV INF THERAPY/DX/PROPH INITIAL HR	$255.50	$365.00	$235.06	22% below	30%
IV infusion of a medicine, first hour CPT 96365 HCHG ED IV INF THERAPY/DX/PROPH INITIAL HR	$398.30	$569.00	$366.44	22% above	30%
IV infusion of a medicine, first hour inpatient CPT 96365 HCHG IV INF THERAPY/DX/PROPH INITIAL HR	$255.50	$365.00	$235.06	—	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HCHG ED INJECTION SQ/IM	$49.00	$70.00	$45.08	37% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HCHG INJECTION SQ/IM	$112.00	$160.00	$103.04	45% above	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HCHG INJECTION SQ/IM	$112.00	$160.00	$103.04	—	30%
Neuromuscular re-education, 15 minutes CPT 97112 HCHG PT NEUROMUSCULAR RE-ED XU	$129.50	$185.00	$119.14	79% above	30%
Neuromuscular re-education, 15 minutes CPT 97112 HCHG PT NEUROMUSCULAR RE-ED 15MIN	$129.50	$185.00	$119.14	79% above	30%
Neuromuscular re-education, 15 minutes CPT 97112 HCHG OT NEUROMUSCULAR RE-ED 15MIN	$129.50	$185.00	$119.14	79% above	30%
Neuromuscular re-education, 15 minutes CPT 97112 HCHG PT NEUROMUSCULAR RE-ED XE	$129.50	$185.00	$119.14	79% above	30%
Neuromuscular re-education, 15 minutes CPT 97112 HCHG OT NEUROMUSCULAR RE-ED XE	$129.50	$185.00	$119.14	79% above	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG OT NEUROMUSCULAR RE-ED 15MIN	$129.50	$185.00	$119.14	—	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG OT NEUROMUSCULAR RE-ED XE	$129.50	$185.00	$119.14	—	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG PT NEUROMUSCULAR RE-ED XU	$129.50	$185.00	$119.14	—	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG PT NEUROMUSCULAR RE-ED XE	$129.50	$185.00	$119.14	—	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG PT NEUROMUSCULAR RE-ED 15MIN	$129.50	$185.00	$119.14	—	30%
Occupational therapy evaluation, low complexity CPT 97165 HCHG OT EVAL LOW COMPLEXITY	$243.60	$348.00	$224.11	44% above	30%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HCHG OT EVAL LOW COMPLEXITY	$243.60	$348.00	$224.11	—	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HCHG PT EVAL HIGH COMPLEXITY XU	$243.60	$348.00	$224.11	22% above	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HCHG PT EVAL HIGH COMPLEXITY	$243.60	$348.00	$224.11	22% above	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HCHG PT EVAL HIGH COMPLEXITY XE	$243.60	$348.00	$224.11	22% above	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HCHG PT EVAL HIGH COMPLEXITY FOOT ORTHOTIC FL ONLY	$339.50	$485.00	$312.34	70% above	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HCHG PT LYMPHEDEMA EVAL HIGH COMPLEXITY FL ONLY	$374.50	$535.00	$344.54	87% above	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HCHG PT EVAL HIGH COMPLEXITY XE	$243.60	$348.00	$224.11	—	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HCHG PT EVAL HIGH COMPLEXITY XU	$243.60	$348.00	$224.11	—	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HCHG PT EVAL HIGH COMPLEXITY	$243.60	$348.00	$224.11	—	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HCHG PT EVAL HIGH COMPLEXITY FOOT ORTHOTIC FL ONLY	$339.50	$485.00	$312.34	—	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HCHG PT LYMPHEDEMA EVAL HIGH COMPLEXITY FL ONLY	$374.50	$535.00	$344.54	—	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HCHG PT EVAL LOW COMPLEXITY XU	$243.60	$348.00	$224.11	45% above	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HCHG PT EVAL LOW COMPLEXITY XS	$243.60	$348.00	$224.11	45% above	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HCHG PT EVAL LOW COMPLEXITY	$243.60	$348.00	$224.11	45% above	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HCHG PT EVAL LOW COMPLEXITY XP	$243.60	$348.00	$224.11	45% above	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HCHG PT EVAL LOW COMPLEXITY XE	$243.60	$348.00	$224.11	45% above	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HCHG PT EVAL LOW COMPLEXITY FOOT ORTHOTIC FL ONLY	$339.50	$485.00	$312.34	101% above	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HCHG PT LYMPHEDEMA EVAL LOW COMPLEXITY FL ONLY	$374.50	$535.00	$344.54	122% above	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG PT EVAL LOW COMPLEXITY XP	$243.60	$348.00	$224.11	—	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG PT EVAL LOW COMPLEXITY XS	$243.60	$348.00	$224.11	—	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG PT EVAL LOW COMPLEXITY XE	$243.60	$348.00	$224.11	—	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG PT EVAL LOW COMPLEXITY XU	$243.60	$348.00	$224.11	—	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG PT EVAL LOW COMPLEXITY	$243.60	$348.00	$224.11	—	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG PT EVAL LOW COMPLEXITY FOOT ORTHOTIC FL ONLY	$339.50	$485.00	$312.34	—	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG PT LYMPHEDEMA EVAL LOW COMPLEXITY FL ONLY	$374.50	$535.00	$344.54	—	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HCHG PT EVAL MOD COMPLEXITY	$243.60	$348.00	$224.11	31% above	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HCHG PT EVAL MOD COMPLEXITY XU	$243.60	$348.00	$224.11	31% above	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HCHG PT EVAL MOD COMPLEXITY XE	$243.60	$348.00	$224.11	31% above	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HCHG PT EVAL MOD COMPLEXITY FOOT ORTHOTIC FL ONLY	$339.50	$485.00	$312.34	82% above	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HCHG PT LYMPHEDEMA EVAL MOD COMPLEXITY FL ONLY	$374.50	$535.00	$344.54	101% above	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HCHG PT EVAL MOD COMPLEXITY	$243.60	$348.00	$224.11	—	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HCHG PT EVAL MOD COMPLEXITY XU	$243.60	$348.00	$224.11	—	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HCHG PT EVAL MOD COMPLEXITY XE	$243.60	$348.00	$224.11	—	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HCHG PT EVAL MOD COMPLEXITY FOOT ORTHOTIC FL ONLY	$339.50	$485.00	$312.34	—	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HCHG PT LYMPHEDEMA EVAL MOD COMPLEXITY FL ONLY	$374.50	$535.00	$344.54	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HCHG OT MANUAL THERAPY XE	$141.40	$202.00	$130.09	68% above	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HCHG PT MANUAL THERAPY 15MIN	$141.40	$202.00	$130.09	68% above	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HCHG OT MANUAL THERAPY 15MIN	$141.40	$202.00	$130.09	68% above	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HCHG PT MANUAL THERAPY XE	$141.40	$202.00	$130.09	68% above	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HCHG PT MANUAL THERAPY XU	$141.40	$202.00	$130.09	68% above	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG OT MANUAL THERAPY 15MIN	$141.40	$202.00	$130.09	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG OT MANUAL THERAPY XE	$141.40	$202.00	$130.09	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG PT MANUAL THERAPY XU	$141.40	$202.00	$130.09	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG PT MANUAL THERAPY 15MIN	$141.40	$202.00	$130.09	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG PT MANUAL THERAPY XE	$141.40	$202.00	$130.09	—	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG PT THERAPEUTIC EXERCISE XE	$126.00	$180.00	$115.92	39% above	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG OT THERAPEUTIC EXERCISE 15MIN	$126.00	$180.00	$115.92	39% above	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG PT THERAPEUTIC EXERCISE XU	$126.00	$180.00	$115.92	39% above	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG OT THERAPEUTIC EXERCISE XU	$126.00	$180.00	$115.92	39% above	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG OT THERAPEUTIC EXERCISE XE	$126.00	$180.00	$115.92	39% above	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG PT THERAPEUTIC EXERCISE 15MIN	$126.00	$180.00	$115.92	39% above	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG PT THERAPEUTIC EXERCISE 15MIN	$126.00	$180.00	$115.92	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG OT THERAPEUTIC EXERCISE XU	$126.00	$180.00	$115.92	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG PT THERAPEUTIC EXERCISE XE	$126.00	$180.00	$115.92	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG OT THERAPEUTIC EXERCISE XE	$126.00	$180.00	$115.92	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG PT THERAPEUTIC EXERCISE XU	$126.00	$180.00	$115.92	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG OT THERAPEUTIC EXERCISE 15MIN	$126.00	$180.00	$115.92	—	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HCHG EST PT FAC VISIT LEVEL III	$412.30	$589.00	$379.32	305% above	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HCHG EST PT FAC VISIT LEVEL IV	$821.10	$1,173.00	$755.41	527% above	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HCHG EST PT FAC VISIT LEVEL II	$207.20	$296.00	$190.62	148% above	30%
Speech and language evaluation CPT 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP	$286.30	$409.00	$263.40	11% below	30%
Speech and language evaluation inpatient CPT 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP	$286.30	$409.00	$263.40	—	30%
Speech therapy session, individual CPT 92507 HCHG SLP INDIV TX COMMUNICATION	$243.60	$348.00	$224.11	15% above	30%
Speech therapy session, individual inpatient CPT 92507 HCHG SLP INDIV TX COMMUNICATION	$243.60	$348.00	$224.11	—	30%
Spirometry (breathing test) CPT 94010 HCHG SPIROMETRY INCOMPLETE	$108.50	$155.00	$99.82	30% below	30%
Spirometry (breathing test) CPT 94010 HCHG PFT SPIROMETRY-LAB	$108.50	$155.00	$99.82	30% below	30%
Spirometry (breathing test) CPT 94010 HCHG SPIROMETRY BEDSIDE	$108.50	$155.00	$99.82	30% below	30%
Spirometry (breathing test) inpatient CPT 94010 HCHG PFT SPIROMETRY-LAB	$108.50	$155.00	$99.82	—	30%
Spirometry (breathing test) inpatient CPT 94010 HCHG SPIROMETRY BEDSIDE	$108.50	$155.00	$99.82	—	30%
Spirometry (breathing test) inpatient CPT 94010 HCHG SPIROMETRY INCOMPLETE	$108.50	$155.00	$99.82	—	30%
Spirometry before and after a bronchodilator CPT 94060 HCHG BRONCHOSPASM EVAL-BEDSIDE	$253.40	$362.00	$233.13	11% below	30%
Spirometry before and after a bronchodilator CPT 94060 HCHG PFT BRONCHOSPASM EVAL-LAB	$253.40	$362.00	$233.13	11% below	30%
Spirometry before and after a bronchodilator inpatient CPT 94060 HCHG PFT BRONCHOSPASM EVAL-LAB	$253.40	$362.00	$233.13	—	30%
Spirometry before and after a bronchodilator inpatient CPT 94060 HCHG BRONCHOSPASM EVAL-BEDSIDE	$253.40	$362.00	$233.13	—	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 HCHG PT THERAPEUTIC ACTIVITIES XE	$129.50	$185.00	$119.14	67% above	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 HCHG OT THERAPEUTIC ACTIVITIES XP	$129.50	$185.00	$119.14	67% above	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 HCHG OT THERAPEUTIC ACTIVITIES XU	$129.50	$185.00	$119.14	67% above	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 HCHG PT THERAPEUTIC ACTIVITIES XU	$129.50	$185.00	$119.14	67% above	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 HCHG OT THERAPEUTIC ACTIVITY 15MIN	$129.50	$185.00	$119.14	67% above	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 HCHG PT THERAPEUTIC ACTIVITY 15MIN	$129.50	$185.00	$119.14	67% above	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 HCHG OT THERAPEUTIC ACTIVITIES XE	$129.50	$185.00	$119.14	67% above	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG PT THERAPEUTIC ACTIVITIES XU	$129.50	$185.00	$119.14	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG OT THERAPEUTIC ACTIVITIES XP	$129.50	$185.00	$119.14	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG PT THERAPEUTIC ACTIVITIES XE	$129.50	$185.00	$119.14	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG OT THERAPEUTIC ACTIVITIES XE	$129.50	$185.00	$119.14	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG OT THERAPEUTIC ACTIVITY 15MIN	$129.50	$185.00	$119.14	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG PT THERAPEUTIC ACTIVITY 15MIN	$129.50	$185.00	$119.14	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG OT THERAPEUTIC ACTIVITIES XU	$129.50	$185.00	$119.14	—	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HCHG PHLEBOTOMY THERAPEUTIC	$123.20	$176.00	$113.34	42% below	30%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HCHG PHLEBOTOMY THERAPEUTIC	$123.20	$176.00	$113.34	—	30%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 varicella virus live vaccine (PF) 1,350 unit/0.5 mL Susr 1 Each VIAL	$307.23	$438.90	$282.65	27% above	30%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 varicella virus live vaccine (PF) 1,350 unit/0.5 mL Susr 1 Each VIAL	$307.23	$438.90	$282.65	—	30%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 hepatitis A-hepatitis B vaccine 720 ELISA unit- 20 mcg/mL Syrg 1 mL SYRINGE	$222.06	$317.23	$204.30	53% above	30%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 hepatitis A-hepatitis B vaccine 720 ELISA unit- 20 mcg/mL Syrg 1 mL SYRINGE	$222.06	$317.23	$204.30	—	30%
Hepatitis A vaccine, adult dose CPT 90632 hepatitis A virus vaccine PF 1,440 ELISA unit/mL Syrg 1 mL SYRINGE	$144.52	$206.46	$132.96	38% above	30%
Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A virus vaccine PF 1,440 ELISA unit/mL Syrg 1 mL SYRINGE	$144.52	$206.46	$132.96	—	30%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B vaccine adult (PF) 20 mcg/mL Syrg 1 mL SYRINGE	$151.45	$216.35	$139.33	35% above	30%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B vaccine adult (PF) 20 mcg/mL Syrg 1 mL SYRINGE	$151.45	$216.35	$139.33	—	30%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles,mumps,rubella vaccine (PF) 10exp3.4-4.2- 3.3CCID50/0.5mL Susr 1 Each VIAL	$159.31	$227.58	$146.56	26% above	30%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles,mumps,rubella vaccine (PF) 10exp3.4-4.2- 3.3CCID50/0.5mL Susr 1 Each VIAL	$159.31	$227.58	$146.56	—	30%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 respiratory syncytial virus vaccine, RSV 120 mcg/0.5 mL Solr 1 Each VIAL	$991.20	$1,416.00	$911.90	291% above	30%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 respiratory syncytial virus vaccine, RSV 120 mcg/0.5 mL Solr 1 Each VIAL	$991.20	$1,416.00	$911.90	—	30%
Rabies vaccine, one dose CPT 90675 rabies vaccine, pcec PF 2.5 unit/1mL Susr 1 Each KIT	$695.37	$993.38	$639.74	26% above	30%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, pcec PF 2.5 unit/1mL Susr 1 Each KIT	$695.37	$993.38	$639.74	—	30%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 varicella-zoster PF 50 mcg/0.5 mL Susr 1 Each KIT	$288.23	$411.76	$265.17	22% above	30%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 varicella-zoster PF 50 mcg/0.5 mL Susr 1 Each KIT	$288.23	$411.76	$265.17	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HCHG IMMUN ADMIN IM/SQ ONE VACCINE (SGL/COMBO)	$28.00	$40.00	$25.76	31% below	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HCHG IMMUN ADMIN IM/SQ ONE VACCINE (SGL/COMBO)	$28.00	$40.00	$25.76	—	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HCHG IMMUN ADMIN IM/SQ EA ADDL (SGL/COMBO)	$28.00	$40.00	$25.76	10% above	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HCHG IMMUN ADMIN IM/SQ EA ADDL (SGL/COMBO)	$28.00	$40.00	$25.76	—	30%

Source file: https://www.weliahealth.org/wp-content/uploads/welia-charges.csv