SelfPayRates
Hospital Phoenix-Mesa-Chandler, AZ

Dignity Health East Valley Rehabilitation Hospital

Dignity Health East Valley Rehabilitation Hospital in Gilbert, AZ publishes cash prices for 315 common procedures listed here, from its own machine-readable price file updated Mar 16, 2026. Select a procedure to compare it with other hospitals nearby.

1850 S. Santan Village Pkwy Gilbert AZ 85295 Collected Sep 22, 2026 Source price file Check a bill from this hospital

Some prices here are not compared

Dignity Health East Valley Rehabilitation Hospital is an inpatient rehabilitation hospital. Its price file also lists scans, lab tests and procedures, but these are generally provided to its own inpatients, not booked by outside patients, so they are not compared with other hospitals here. Only its physical, occupational and speech therapy prices are compared.

The price file shows no self-pay discount

For 956 of the 956 prices listed here, the cash price in Dignity Health East Valley Rehabilitation Hospital's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing. Other US hospitals whose cash price is their full list price.

Scans and imaging

ProcedureCash priceList priceInsurers payOff list
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/WO CONTRAST $11,624.00 $11,624.00 $11,624.00 —
Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN, 2 VIEWS $474.99 $474.99 $474.99 —
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 XRAY ANKLE, COMPLETE $280.77 $280.77 $280.77 —
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE 3 VIEWS LT $367.62 $367.62 $367.62 —
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE 3+ VIEWS LT $476.82 $476.82 $476.82 —
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE 3+ VIEWS RT $476.82 $476.82 $476.82 —
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE 3 VIEWS RT $1,295.00 $1,295.00 $1,295.00 —
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US EXT ARTERY SINGLE LEVEL BIL $557.45 $557.45 $557.45 —
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 TCPO2 SINGLE LEVEL $726.99 $726.99 $726.99 —
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPPER EXT W/O CONTRAST LT $342.33 $342.33 $342.33 —
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPP EXTREM WO CON RT $3,367.00 $3,367.00 $3,367.00 —
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPP EXTREM WO CON LT $3,367.00 $3,367.00 $3,367.00 —
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGUS $854.00 $854.00 $854.00 —
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE/JOINT WHOLE BODY $2,565.00 $2,565.00 $2,565.00 —
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST UNIL COMPLT $400.00 $400.00 $400.00 —
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE RT $400.00 $400.00 $400.00 —
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE LT $400.00 $400.00 $400.00 —
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST UNIL LIMITED $328.00 $328.00 $328.00 —
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED LT $328.00 $328.00 $328.00 —
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED RT $328.00 $328.00 $328.00 —
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ANGIO ABD/PELVIS W CON $4,846.00 $4,846.00 $4,846.00 —
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD WO/W CONTRAST $4,295.00 $4,295.00 $4,295.00 —
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK WO/W CONTRAST $4,520.00 $4,520.00 $4,520.00 —
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST (NONCORONARY) WO/W $2,645.00 $2,645.00 $2,645.00 —
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT ANGIO HRT/COR ART 3D W $3,361.00 $3,361.00 $3,361.00 —
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HRT EVAL COR CA WO CON $2,857.00 $2,857.00 $2,857.00 —
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS WO CONTRAST $767.55 $767.55 $767.55 —
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CONTRAST $7,749.00 $7,749.00 $7,749.00 —
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD & PELVIS W/WO CONTRAST $8,756.00 $8,756.00 $8,756.00 —
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST $5,734.00 $5,734.00 $5,734.00 —
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST $3,720.00 $3,720.00 $3,720.00 —
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CONTRAST $2,842.00 $2,842.00 $2,842.00 —
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT BRAIN/HEAD WO CONTRAST $238.53 $238.53 $238.53 —
CT scan of the head with contrast inpatient CPT 70460 CT BRAIN/HEAD W/CONTRAST $3,875.00 $3,875.00 $3,875.00 —
CT scan of the head without and with contrast inpatient CPT 70470 CT BRAIN/HEAD W/WO CONTRAST $4,567.00 $4,567.00 $4,567.00 —
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O CONTRAST $4,363.00 $4,363.00 $4,363.00 —
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O CONTRAST $4,494.00 $4,494.00 $4,494.00 —
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST $5,216.00 $5,216.00 $5,216.00 —
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID BILATERAL $1,266.12 $1,266.12 $1,266.12 —
Chest CT scan without and with contrast inpatient CPT 71270 CT THORAX W/WO CONTRAST $4,921.00 $4,921.00 $4,921.00 —
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS $358.02 $358.02 $358.02 —
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS FRONTAL & LAT $449.64 $449.64 $449.64 —
Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW $280.77 $280.77 $280.77 —
Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW FRONTAL $398.13 $398.13 $398.13 —
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 CLAVICLE X RAY $255.38 $255.38 $255.38 —
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE LT $280.77 $280.77 $280.77 —
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR CLAVICLE COMPLETE LT $348.75 $348.75 $348.75 —
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE RT $414.00 $414.00 $414.00 —
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR CLAVICLE COMPLETE RT $776.00 $776.00 $776.00 —
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL COMPLETE $851.34 $851.34 $851.34 —
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA BONE DENSITY HIP/PELV/SP $643.00 $643.00 $643.00 —
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 XR BONE DENSITYDXAAPEND $399.00 $399.00 $399.00 —
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA BONE DENSITY WRIST/HEEL $399.00 $399.00 $399.00 —
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US PREGDETL SNGL1ST GEST $461.00 $461.00 $461.00 —
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX W/O CONTRAST $2,197.00 $2,197.00 $2,197.00 —
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX W/CONTRAST $841.17 $841.17 $841.17 —
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMOGRAM DIAG BILATERAL $457.00 $457.00 $457.00 —
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US LOW EXT ART DUPLEX COMP BIL $1,525.50 $1,525.50 $1,525.50 —
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US EXT VEIN DUPLEX COMPLETE BI $1,217.31 $1,217.31 $1,217.31 —
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO 2-D&M-MODE W/DOPPLER $983.37 $983.37 $983.37 —
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US 2D ECHO DOPPLER/COLOR FLOW $1,396.89 $1,396.89 $1,396.89 —
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW AP/LAT LEFT $199.94 $199.94 $199.94 —
Elbow X-ray, 2 views inpatient one side CPT 73070 XR ELBOW 2 VIEWS RT $339.48 $339.48 $339.48 —
Elbow X-ray, 2 views inpatient one side CPT 73070 XR ELBOW 2 VIEWS LT $339.48 $339.48 $339.48 —
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW 2 VIEWS RT $423.12 $423.12 $423.12 —
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW 2 VIEWS LT $423.12 $423.12 $423.12 —
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW 3+ VIEWS RT $136.50 $136.50 $136.50 —
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW COMPLETE RIGHT $166.36 $166.36 $166.36 —
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW 3+ VIEWS LT $561.81 $561.81 $561.81 —
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR ELBOW 3 VIEWS LT $890.00 $890.00 $890.00 —
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR ELBOW 3 VIEWS RT $890.00 $890.00 $890.00 —
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT INTRACRANIAL STRUC WO CON $4,126.00 $4,126.00 $4,126.00 —
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES 3+ VIEWS $481.00 $481.00 $481.00 —
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 XRAY FOREARM $208.54 $208.54 $208.54 —
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM 2 VIEWS LT $410.00 $410.00 $410.00 —
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM 2 VIEWS RT $430.83 $430.83 $430.83 —
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR FOREARM 2 VIEWS LT $430.83 $430.83 $430.83 —
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR FOREARM 2 VIEWS RT $885.00 $885.00 $885.00 —
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY $2,305.00 $2,305.00 $2,305.00 —
Hand X-ray, 2 views inpatient CPT 73120 HAND 2 VIEWS $137.55 $137.55 $137.55 —
Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 VIEWS LT $348.75 $348.75 $348.75 —
Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 VIEWS RT $410.00 $410.00 $410.00 —
Hand X-ray, 2 views inpatient one side CPT 73120 XR HAND 2 VIEWS LT $440.40 $440.40 $440.40 —
Hand X-ray, 2 views inpatient one side CPT 73120 XR HAND 2 VIEWS RT $1,098.00 $1,098.00 $1,098.00 —
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 CALCANEUS 2 PLUS VIEW BILATER $95.76 $95.76 $95.76 —
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 CALCANEUS 2+ VIEWS LT $25.00 $25.00 $25.00 —
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 CALCANEUS 2+ VIEWS RT $409.00 $409.00 $409.00 —
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR CALCANEUS 2 VIEWS RT $703.00 $703.00 $703.00 —
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR CALCANEUS 2 VIEWS LT $703.00 $703.00 $703.00 —
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 PSS W 4/>P W CPAP >=6YRS $4,068.00 $4,068.00 $4,068.00 —
Knee X-ray, 3 views inpatient CPT 73562 KNEE EXAM MIN 3 VIEWS $199.91 $199.91 $199.91 —
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS RT $494.10 $494.10 $494.10 —
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS LT $505.35 $505.35 $505.35 —
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VIEWS RT $1,272.00 $1,272.00 $1,272.00 —
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VIEWS LT $1,272.00 $1,272.00 $1,272.00 —
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE 4 VIEWS LEFT $512.07 $512.07 $512.07 —
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR KNEE 4 VIEWS RT $544.11 $544.11 $544.11 —
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR KNEE 4 VIEWS LT $1,463.00 $1,463.00 $1,463.00 —
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOW EXTREMITY WO UNI $3,091.00 $3,091.00 $3,091.00 —
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER EXT W/O CONTRAST RT $639.69 $639.69 $639.69 —
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER EXT W/O CONTRAST LT $2,722.27 $2,722.27 $2,722.27 —
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED $649.01 $649.01 $649.01 —
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXTREM NONVASCULAR LTD $559.59 $559.59 $559.59 —
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXTREM LIMITED RT $109.02 $109.02 $109.02 —
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXTREM NONVAS LTD RT $314.00 $314.00 $314.00 —
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXTREM NONVAS LTD LT $314.00 $314.00 $314.00 —
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXTREM LIMITED LT $499.62 $499.62 $499.62 —
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 TIBIA/FIBULA 2 VIEWS $224.29 $224.29 $224.29 —
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 TIBIA/FIBULA RT $350.67 $350.67 $350.67 —
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 TIBIA/FIBULA LT $446.10 $446.10 $446.10 —
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR TIBIA & FIBULA 2 VW LT $810.00 $810.00 $810.00 —
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR TIBIA & FIBULA 2 VW RT $810.00 $810.00 $810.00 —
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD WITHOUT CONTRAST $3,580.00 $3,580.00 $3,580.00 —
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR LOW EXTREM JNT WO LT $6,131.00 $6,131.00 $6,131.00 —
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR LOW EXTREM JNT WO RT $6,131.00 $6,131.00 $6,131.00 —
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR LOW EXTREM JNT WO&W LT $10,361.00 $10,361.00 $10,361.00 —
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR LOW EXTREM JNT WO&W RT $10,361.00 $10,361.00 $10,361.00 —
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONT $4,303.00 $4,303.00 $4,303.00 —
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/WO CONTRAST $7,294.00 $7,294.00 $7,294.00 —
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST $1,029.87 $1,029.87 $1,029.87 —
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO CONTRAST $5,166.00 $5,166.00 $5,166.00 —
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE WO CONTRAST $813.60 $813.60 $813.60 —
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/WO CONTRAST $11,180.00 $11,180.00 $11,180.00 —
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC WO CONTRAST $3,044.00 $3,044.00 $3,044.00 —
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL W/WO CONTRAST $12,658.00 $12,658.00 $12,658.00 —
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL WO CONTRAST $7,490.00 $7,490.00 $7,490.00 —
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/WO CONTRAST $5,838.00 $5,838.00 $5,838.00 —
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST $8,757.00 $8,757.00 $8,757.00 —
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UP EXT JOINT W/O CONT LT $711.90 $711.90 $711.90 —
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UP EXT JOINT W/O CONT RT $711.90 $711.90 $711.90 —
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR UPP EXTREM JNT WO LT $3,540.00 $3,540.00 $3,540.00 —
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR UPP EXTREM JNT WO RT $3,540.00 $3,540.00 $3,540.00 —
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERVICAL SP 4+ VIEWS $337.72 $337.72 $337.72 —
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W/CONTRAST $3,450.00 $3,450.00 $3,450.00 —
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK WO CONT $2,829.00 $2,829.00 $2,829.00 —
Neck soft tissue X-ray inpatient CPT 70360 NECK SOFT TISSUE $514.00 $514.00 $514.00 —
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYOCARD PERF MULTI SPECT $7,002.00 $7,002.00 $7,002.00 —
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET TUMOR W/CT SKULL-MIDTHIGH $4,661.00 $4,661.00 $4,661.00 —
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST $2,595.00 $2,595.00 $2,595.00 —
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LIMITED OR FOLLOWUP $877.00 $877.00 $877.00 —
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE $1,290.00 $1,290.00 $1,290.00 —
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG UTERUS >14 WEEKS $844.00 $844.00 $844.00 —
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG UTERUS <14 WEEKS 1ST G $734.00 $734.00 $734.00 —
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREG UTERUS LIMITED $993.00 $993.00 $993.00 —
Rib X-ray, one side, 2 views inpatient CPT 71100 71100 RIBS UNI-LAT 2V $280.77 $280.77 $280.77 —
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNILATERAL 2 VIEWS RT $473.94 $473.94 $473.94 —
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNILATERAL 2 VIEWS LT $575.64 $575.64 $575.64 —
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR RIBS 2 VIEWS LT $940.00 $940.00 $940.00 —
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR RIBS 2 VIEWS RT $940.00 $940.00 $940.00 —
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS UNILATERAL W/PA CHEST LT $116.94 $116.94 $116.94 —
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XRAY UNILAT RIBS/CHEST $303.13 $303.13 $303.13 —
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS UNILATERAL W/PA CHEST RT $499.68 $499.68 $499.68 —
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR RIBS W CHEST 3 VWS LT $1,119.00 $1,119.00 $1,119.00 —
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR RIBS W CHEST 3 VWS RT $1,119.00 $1,119.00 $1,119.00 —
Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMOGRAM SCREEN BILATERAL $197.00 $197.00 $197.00 —
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 Shoulder Cmplt 2 Vws $280.57 $280.57 $280.57 —
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER 2+ VIEWS LT $352.92 $352.92 $352.92 —
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 2 VIEWS RT $444.66 $444.66 $444.66 —
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 2 VIEWS LT $444.66 $444.66 $444.66 —
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUS COMP MIN 3 VIEWS $895.00 $895.00 $895.00 —
Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL < 4 VIEWS $511.00 $511.00 $511.00 —
Sleep study in a lab (polysomnography) inpatient CPT 95810 PSS W 4/> PAR W TECH>=6YR $3,865.00 $3,865.00 $3,865.00 —
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 ECHO STR TEST COMP W ECG $1,768.00 $1,768.00 $1,768.00 —
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 SWALLOW FUNCTION W/VIDEORAD $854.00 $854.00 $854.00 —
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 FEMUR $258.56 $258.56 $258.56 —
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR FEMUR 2 VIEWS LT $280.77 $280.77 $280.77 —
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR FEMUR 2 VIEWS RT $367.29 $367.29 $367.29 —
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE W/O CONTRAST $3,553.00 $3,553.00 $3,553.00 —
Toe X-ray, 2 or more views inpatient one side CPT 73660 73660 RT TOE(S) 2VW MIN $174.78 $174.78 $174.78 —
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE(S) 2+ VIEWS RT $270.33 $270.33 $270.33 —
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE(S) 2+ VIEWS LT $280.77 $280.77 $280.77 —
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES 2 VIEWS RT $582.00 $582.00 $582.00 —
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES 2 VIEWS LT $582.00 $582.00 $582.00 —
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL $1,360.00 $1,360.00 $1,360.00 —
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREGNANT UTERUS TRANSVAGINA $1,142.00 $1,142.00 $1,142.00 —
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE $1,112.94 $1,112.94 $1,112.94 —
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM $1,217.00 $1,217.00 $1,217.00 —
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US HEAD/NECK SOFT TISSUE $839.49 $839.49 $839.49 —
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI STOMACH W/O KUB $513.00 $513.00 $513.00 —
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HUMERUS, 2 VIEWS $302.93 $302.93 $302.93 —
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR HUMERUS 2 VIEWS LT $280.77 $280.77 $280.77 —
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS 2+ VIEWS RT $450.06 $450.06 $450.06 —
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS 2+ VIEWS LT $450.06 $450.06 $450.06 —
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR HUMERUS 2 VIEWS RT $909.00 $909.00 $909.00 —
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 RAD US DUPLEX UP EX $614.57 $614.57 $614.57 —
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 RAD US DUPLEX UP EX LT $295.80 $295.80 $295.80 —
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 EXT VEIN DUPLEX STUDY LIMIT LT $837.90 $837.90 $837.90 —
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 EXT VEIN DUPLEX STUDY LIMIT RT $837.90 $837.90 $837.90 —
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US V DPLX VENOUS EXT LT $837.90 $837.90 $837.90 —
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US V DPLX VENOUS EXT RT $837.90 $837.90 $837.90 —
Wrist X-ray, 2 views inpatient CPT 73100 X-RAY WRIST 2 VIEWS $198.62 $198.62 $198.62 —
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST 2 VIEWS RT $94.68 $94.68 $94.68 —
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST 2 VIEWS LT $361.59 $361.59 $361.59 —
Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST 2 VIEWS RT $466.05 $466.05 $466.05 —
Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST 2 VIEWS LT $466.05 $466.05 $466.05 —
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 XRAY WRIST 3+ VIEWS $230.07 $230.07 $230.07 —
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3+ VIEWS RT $491.22 $491.22 $491.22 —
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3+ VIEWS LT $491.22 $491.22 $491.22 —
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST 3 VIEWS LT $1,122.00 $1,122.00 $1,122.00 —
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST 3 VIEWS RT $1,122.00 $1,122.00 $1,122.00 —
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HIP RGHT $365.48 $365.48 $365.48 —
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 Hip Unilate cmplt 2 Vws $550.50 $550.50 $550.50 —
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP 2+ VIEWS UNILATERAL RT $409.26 $409.26 $409.26 —
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP 2+ VIEWS UNILATERAL LT $428.91 $428.91 $428.91 —
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP W PEL 2-3 VIEWS LT $550.50 $550.50 $550.50 —
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP W PEL 2-3 VIEWS RT $550.50 $550.50 $550.50 —
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN SINGLE AP VIEW $430.14 $430.14 $430.14 —
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN, 1 VIEW $748.35 $748.35 $748.35 —
X-ray of the ankle, 2 views inpatient CPT 73600 XR ANKLE 2 VIEWS UNI $91.53 $91.53 $91.53 —
X-ray of the ankle, 2 views inpatient CPT 73600 73600 ANKLE AP&LAT 2V $307.06 $307.06 $307.06 —
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 VIEWS LT $456.42 $456.42 $456.42 —
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 VIEWS RT $456.42 $456.42 $456.42 —
X-ray of the finger(s), 2 or more views inpatient CPT 73140 X-RAY FINGERS 2 VIEW $207.47 $207.47 $207.47 —
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER(S) 2+ VIEWS LT $293.75 $293.75 $293.75 —
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGERS 2 VIEWS LT $743.00 $743.00 $743.00 —
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGERS 2 VIEWS RT $743.00 $743.00 $743.00 —
X-ray of the foot, 2 views inpatient CPT 73620 73620 FOOT AP&LAT 2V $280.77 $280.77 $280.77 —
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 VIEWS RT $424.47 $424.47 $424.47 —
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 VIEWS LT $424.47 $424.47 $424.47 —
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS LT $1,129.00 $1,129.00 $1,129.00 —
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS RT $1,129.00 $1,129.00 $1,129.00 —
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT COMPLETE RT $244.15 $244.15 $244.15 —
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT 3 VIEWS RT $358.02 $358.02 $358.02 —
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT 3+ VIEWS RT $459.24 $459.24 $459.24 —
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT 3+ VIEWS LT $459.24 $459.24 $459.24 —
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT 3 VIEWS LT $1,283.00 $1,283.00 $1,283.00 —
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND 3+ VIEWS LT $455.70 $455.70 $455.70 —
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND 3+ VIEWS RT $476.82 $476.82 $476.82 —
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND 3 VIEWS LT $1,277.00 $1,277.00 $1,277.00 —
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND 3 VIEWS RT $1,277.00 $1,277.00 $1,277.00 —
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 KNEE 1-2 VIEWS BILATERAL $191.40 $191.40 $191.40 —
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1-2 VIEWS RT $363.15 $363.15 $363.15 —
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1-2 VIEWS LT $469.20 $469.20 $469.20 —
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE 1 OR 2 VIEWS RT $1,081.00 $1,081.00 $1,081.00 —
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBOSACRAL SP 2-3 VIEWS $492.90 $492.90 $492.90 —
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBOSACRAL SP 4+ VIEWS $923.00 $923.00 $923.00 —
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SP 2 VIEWS $369.24 $369.24 $369.24 —
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES 3+ VIEWS $968.00 $968.00 $968.00 —
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SP 2 OR 3 VIEWS $280.77 $280.77 $280.77 —
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1-2 VIEWS $473.61 $473.61 $473.61 —
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM & COCCYX MIN 2+ VIEWS $90.51 $90.51 $90.51 —

Lab tests

ProcedureCash priceList priceInsurers payOff list
ACTH blood test inpatient CPT 82024 ACTH $133.82 $133.82 $133.82 —
ACTH blood test inpatient CPT 82024 ACTHB $183.40 $183.40 $183.40 —
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT (ALT) $18.36 $18.36 $18.36 —
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT $40.72 $40.72 $40.72 —
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT (AST) $17.94 $17.94 $17.94 —
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST $41.15 $41.15 $41.15 —
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL (ACUTE) $165.04 $165.04 $165.04 —
Albumin blood test inpatient CPT 82040 ALBUMIN SERUM $17.16 $17.16 $17.16 —
Albumin blood test inpatient CPT 82040 S/O IGG CSF INDEX $220.50 $220.50 $220.50 —
Albumin blood test inpatient CPT 82040 S/O OLIGO BAND PROF $220.50 $220.50 $220.50 —
Aldosterone blood test inpatient CPT 82088 S/O ALDOSTERONE SERUM $141.20 $141.20 $141.20 —
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE SERUM $549.15 $549.15 $549.15 —
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE, TOTAL $17.94 $17.94 $17.94 —
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 S/O ALK PHOS SRM/PLSM $25.20 $25.20 $25.20 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG PUMPK SEED IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY NUTMEG IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CAROB GUM IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY ANCHOVY IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WALLEYE PIKE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY HONEY IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GOAT MILK IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CILANTRO IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG BLACKBERRY IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG WEED SUNFLOWER $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLRG DOUGLAS FIR IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WHITEFISH IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY FLAXSEED IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TILAPIA IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY THYME IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SWORDFISH IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SOLE IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SAGE IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY RED SNAPP IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY RED DYE 4 IgE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG WEED CARELESS $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY HACKBERRY IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG BALD CYPRESS $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG BUMBLE BEE IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG CHAETOMIUM IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MINT IGE $24.15 $24.15 $24.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WEST RAGWEED $36.75 $36.75 $36.75 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CASHEW $36.75 $36.75 $36.75 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY BRAZIL NUT $36.75 $36.75 $36.75 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY HAZELNUT $36.75 $36.75 $36.75 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PISTACHIO $36.75 $36.75 $36.75 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PECAN $36.75 $36.75 $36.75 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG PENICILLM NOTA $47.25 $47.25 $47.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MITES D PTERO $47.25 $47.25 $47.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY EGG YOLK $47.25 $47.25 $47.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG ALTERNARIA ALT $47.25 $47.25 $47.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O STAPH AUREUS PANL $51.45 $51.45 $51.45 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GREEN BEAN $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLRG HOUS DUST STIER $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG ASPERGIL NIGER $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MACADAMIA NUT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG WEED SHEEP SOR $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG WEED SAGE/WOOD $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WEED NETTLE $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG WEED MARSH ELD $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG WEED KOCH/FIRE $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG WEED GOLDENROD $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG WEED DANDELION $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY RAGWEED GIANT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY RAGWEED FALSE $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG WEED COCKLEBUR $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE WILLOW $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE MULBERRY $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE WALNUT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG TREE VIRG OAK $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG TREE SWEET GUM $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE PRIVET $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG TREE WHIT PINE $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE PECAN $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG TREE MAPLE/BOX $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE ALDER $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE ACACIA $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG PARASITE ASCAR $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TOBACCO $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SUNFLOWER IGE $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG ISOCYANATE TDI $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG ISOCYANATE MDI $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG ISOCYANATE HDI $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG MOLD STEMPHYL $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG MOLD RHIZOPUS $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG MOLD PHOMA BET $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG MOLD MUCOR RAC $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG MOLD HELMINTHO $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MOLD FUSARIUM $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG MOLD EPICOCCUM $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MOLD CURVULAR $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MOLD CEPHALOS $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MOLD CANDIDA $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MOLD AUREOBAS $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY YELLOW JACKET $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY HORNET YELLOW $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY HORNET WHITE $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PAPER WASP $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TRICHOPHYTON $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY LEPIDOGLYPHUS $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG HONEYBEE VENOM $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY FIRE ANT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG GRASS SWEETVER $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRASS ORCHARD $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRASS BROME $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG GRASS BENT/RED $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRASS BAHIA $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WHEY IGE $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG WATERMELON IGE $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WALNUT IGE $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY VANILLA $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TEA $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SPINACH $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SESAME SEED $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PINE NUT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PEAR $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PEACH $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PEA $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PAPAYA $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY OYSTER $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY ONION $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MUSTARD $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY BLUE MUSSEL $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MUSHROOM $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY BETA LACTOGLO $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY ALPHA LACTALB $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG HONEYDEW/CANTA $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MANGO $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MACKEREL $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY LOBSTER $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY LIME IGE $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG LIMA/WHIT BEAN $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY LENTIL $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY LEMON $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY LAMB $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY KIWI $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY KIDNEY BEAN $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY HOPS $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY HALIBUT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRAPEFRUIT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GARLIC $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY FLOUNDER GULF $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY EGG WHOLE $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY EGGPLANT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY COFFEE $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY COCONUT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CLAM $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PEPPER CHILI $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CHICKPEA $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CHESTNUT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CHEESE MOLD $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CHEESE CHEDDR $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CELERY $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CASEIN $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY BROCCOLI $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY BLUEBERRY $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY BLACK PEPPER $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY BANANA $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY AVOCADO $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY APRICOT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY ALMOND $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG SHEEP EPITH/WL $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY RABBIT EPITH $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG PARAKEET FEATH $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MOUSE EPITHEL $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY HAMSTER EPITH $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GOOSE FEATHER $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY DOG DANDER $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CHICKEN FEATH $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PARAKEET DROP $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PENICILLIN V $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PENICILLIN G $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY AMPICILLIN $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY AMOXICILLIN $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRASS MEADOW $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG GRASS CULWHEAT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG GRASS CULT OAT $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG GRASS CULTCORN $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRASS CANARY $54.60 $54.60 $54.60 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY COCKROACH GER $55.65 $55.65 $55.65 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY APPLE $55.65 $55.65 $55.65 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GLUTEN $55.65 $55.65 $55.65 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SALMON $55.65 $55.65 $55.65 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TROUT $55.65 $55.65 $55.65 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY STRAWBERRY $55.65 $55.65 $55.65 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TURKEY $55.65 $55.65 $55.65 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE CEDAR $55.65 $55.65 $55.65 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE ASH $55.65 $55.65 $55.65 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY LATEX IGE $55.65 $55.65 $55.65 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WEED PIGWEED $55.65 $55.65 $55.65 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WEED SCALE $55.65 $55.65 $55.65 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG TREE MAPLE SUG $60.90 $60.90 $60.90 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG TREE ASPEN IGE $60.90 $60.90 $60.90 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG CUMIN SEED IGE $60.90 $60.90 $60.90 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY BLACK WILLOW $60.90 $60.90 $60.90 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY ARTICHOKE IGE $65.10 $65.10 $65.10 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRAPE $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MOLD ASPERGIL $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG GRASS JUN/KENT $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRASS JOHNSON $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLRG HOUS DUST GREER $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PEPPER BELL $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TUNA $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG HORSE HAIR/DND $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SOYBEAN $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY COW HAIR/DAND $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY NAVY BEAN $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN, IGE $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE OAK $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY RAGWEEG C/S $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG WEED ENGL PLAN $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WEED LAMB QRT $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WEED MUGWORT $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MALT $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY LETTUCE $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MOLD HORMODEN $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE ELM $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG TREE MOUN CEDR $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRASS TIMOTHY $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CRAB $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CABBAGE $66.15 $66.15 $66.15 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE SYCAMORE $67.20 $67.20 $67.20 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY ORANGE $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WEED THISTLE $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SHRIMP $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PORK $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CHICKEN $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WHEAT $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MITES $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRASS BERMUDA $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRASS RYE $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY RICE $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE MESQUITE $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY RYE $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY BEEF $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY BARLEY $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PEANUT $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TOMATO $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE OLIVE $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY OAT $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MILK COW $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY EGG WHITE $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CAT DANDER $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TREE COTTONWD $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGEY CORN $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CARROT $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CHOCOLATE $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CODFISH IGE $68.25 $68.25 $68.25 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG BLACKOLIVE IGG $107.10 $107.10 $107.10 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY ZUCCHINI IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY ACARUS SIRO $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY ALFALFA IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CYPRESS ARIZ $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CYPRESS ITAL $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY ASPARAGUS IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PARROT DROP $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG TREE GROUNDSEL $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRASS BARLEY $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY BASS BLACK $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY BAYBERRY IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CHERRY IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CLOVE IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CINNAMON $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CRANBERRY IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY CUCUMBER IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG D MICROCER IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG ETHYLENE OXIDE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY EUROGLYPHUS $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY FORMALDEHYDE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GINGER IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GLYCOPHAGUS $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GOAT EPITHEL $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GUINEA PIG EP $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY HADDOCK IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG TREE MELALEUCA $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MOSQUITO IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MOUSE URINE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY ORRIS ROOT $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG TREE PALM/QUEN $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PIG EPITH IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY PIGEON STOOL $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG TREE POPLAR WH $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY POPPY SEED $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERG PTHALIC ANHYDR $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY RASPBERRY IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY RAT EPITHIL $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY RAT URINE IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY REED POLLEN $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY GRASS SALT $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY MOLD STEMPHYL $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SUGARBEET IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SUGARCANE IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SQUASH SUMMER $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY SWEET POTATO $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY TYROPHAGUS $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY YAM IGE $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY WEED YEL DOCK $115.50 $115.50 $115.50 —
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 S/O ALLERGY ALPHA GAL IGE $186.90 $186.90 $186.90 —
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 S/O ALPHA FETOPROTEIN $546.00 $546.00 $546.00 —
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN, SERUM $546.00 $546.00 $546.00 —
Ammonia blood test inpatient CPT 82140 AMMONIA $50.48 $50.48 $50.48 —
Ammonia blood test inpatient CPT 82140 AMMONIA BLOOD $75.67 $75.67 $75.67 —
Amylase blood test inpatient CPT 82150 S/O AMYLASE $34.65 $34.65 $34.65 —
Amylase blood test inpatient CPT 82150 AMYLASE $55.65 $55.65 $55.65 —
Amylase blood test inpatient CPT 82150 S/O AMYLASE ISOENZYME $55.65 $55.65 $55.65 —
Amylase blood test inpatient CPT 82150 AMYLASE SERUM $55.94 $55.94 $55.94 —
Amylase blood test inpatient CPT 82150 AMYLASE URINE $129.15 $129.15 $129.15 —
Amylase blood test inpatient CPT 82150 AMYLASE PROFILE $129.15 $129.15 $129.15 —
Amylase blood test inpatient CPT 82150 AMYLASE FLD $129.15 $129.15 $129.15 —
Amylase blood test inpatient CPT 82150 S/O PANCREATIC FUNCT $131.25 $131.25 $131.25 —
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATD PEPTIDE AB $144.00 $144.00 $144.00 —
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 S/O ANA ANTINUCLEAR BLD $41.90 $41.90 $41.90 —
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 S/O SCLER ANA IGG IFA $48.30 $48.30 $48.30 —
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 S/O ANA REFLEX T $56.70 $56.70 $56.70 —
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA SCREEN $279.30 $279.30 $279.30 —
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-TYPE NATRIURETIC PEPTID $119.74 $119.74 $119.74 —
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP (B NATRIURETIC PEPTIDE) $136.04 $136.04 $136.04 —
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 S/O PROBNP NT $139.65 $139.65 $139.65 —
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-PRO BNP $152.61 $152.61 $152.61 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 NOCARDIA CULTURE $16.84 $16.84 $16.84 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 S/O CULT RESPIRATORY $28.45 $28.45 $28.45 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 S/O CULT WOUND $28.45 $28.45 $28.45 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 S/O CULT BODY FLUID $28.45 $28.45 $28.45 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE WOUND $70.18 $70.18 $70.18 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 WOUND CULTURE,AEROBIC $70.58 $70.58 $70.58 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, CATH-TIP $82.24 $82.24 $82.24 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE FLUID/OTHER (NON CSF) $85.48 $85.48 $85.48 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE- GENITAL $90.93 $90.93 $90.93 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE AEROBIC $109.90 $109.90 $109.90 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE- RESPIRATORY $115.57 $115.57 $115.57 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE- TISSUE $117.19 $117.19 $117.19 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE CSF $117.19 $117.19 $117.19 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE- EYE $117.33 $117.33 $117.33 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE- EAR $117.33 $117.33 $117.33 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE NARES $133.42 $133.42 $133.42 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 SOLUTION CULTURE $197.40 $197.40 $197.40 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 LEGIONELLA CULTURE $197.40 $197.40 $197.40 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 S/O CULT BONE MARROW $382.00 $382.00 $382.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULT CATHETER TIP $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULT EYE $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULT EAR $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULT CSF $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULT GENITAL $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULT BODY FLUID $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULT SPUTUM $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULT THROAT $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULT TISSUE $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BRONCH BRUSH $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE OTHER SOURCE $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULT UTERUS/PLACENTA $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BRONCH WASH $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULT NOSE/THROAT $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE NASAL PHARYN $510.00 $510.00 $510.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 S/O CULT GENITAL $528.00 $528.00 $528.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 S/O CULT CSF $528.00 $528.00 $528.00 —
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE-ROUTINE $535.50 $535.50 $535.50 —
Basic metabolic panel (blood test) inpatient CPT 80048 METABOLIC PANEL TOTAL CA $27.92 $27.92 $27.92 —
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL $61.87 $61.87 $61.87 —
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL $17.40 $17.40 $17.40 —
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOT $47.81 $47.81 $47.81 —
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN $98.19 $98.19 $98.19 —
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATH LEVEL IV $394.80 $394.80 $394.80 —
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 CELL BLOCK, INTERP COMPLETE $2,894.85 $2,894.85 $2,894.85 —
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD $35.76 $35.76 $35.76 —
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE $68.38 $68.38 $68.38 —
Blood culture for bacteria inpatient CPT 87040 CULTURE BACTERIA $122.96 $122.96 $122.96 —
Blood culture for bacteria inpatient CPT 87040 S/O CULT BLOOD $507.00 $507.00 $507.00 —
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE $10.40 $10.40 $10.40 —
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE FOR COLLECT $16.98 $16.98 $16.98 —
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE, QUANTITATIVE $13.62 $13.62 $13.62 —
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE BLOOD POC $28.35 $28.35 $28.35 —
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE,EXCEPT URINE $51.92 $51.92 $51.92 —
Blood glucose (sugar) test inpatient CPT 82947 GLUC BLOOD NOVA STAT STRIP $57.55 $57.55 $57.55 —
Blood lead test inpatient CPT 83655 S/O LEAD BLOOD VENOUS $622.65 $622.65 $622.65 —
Blood lead test inpatient CPT 83655 S/O LEAD URINE $622.65 $622.65 $622.65 —
Blood lead test inpatient CPT 83655 S/O HEAVY METALS4 BLD $622.65 $622.65 $622.65 —
Blood lead test inpatient CPT 83655 LEAD LEVEL $622.65 $622.65 $622.65 —
Blood lead test inpatient CPT 83655 S/O LEAD BLOOD CAPILLARY $622.65 $622.65 $622.65 —
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QUAL URINE $110.25 $110.25 $110.25 —
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG SERUM, QUALITATIVE $396.90 $396.90 $396.90 —
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO ONLY $37.98 $37.98 $37.98 —
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 TYPE AND SCREEN $80.00 $80.00 $80.00 —
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO & RH TYPE $84.00 $84.00 $84.00 —
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 PRENATAL PANEL $84.00 $84.00 $84.00 —
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 TYPE & CROSSMATCH $85.82 $85.82 $85.82 —
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO BLOOD TYPING $159.60 $159.60 $159.60 —
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING ABO $211.40 $211.40 $211.40 —
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 S/O ABO DISCREPANCY UBS $404.36 $404.36 $404.36 —
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN (UREANITROGEN) $13.69 $13.69 $13.69 —
Blood urea nitrogen (BUN) test inpatient CPT 84520 S/O UREA NITROGEN FLUID $23.10 $23.10 $23.10 —
Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITRO, FLUID $30.48 $30.48 $30.48 —
C-peptide blood test inpatient CPT 84681 C-PEPTIDE $361.20 $361.20 $361.20 —
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 S/O C-REACTIVE PROTEIN $21.00 $21.00 $21.00 —
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN $34.46 $34.46 $34.46 —
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN $265.65 $265.65 $265.65 —
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 S/O CLOS DIF TOX AMP PROB $122.99 $122.99 $122.99 —
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CLOSTRIDIUM DIFF TOXIN AM $167.54 $167.54 $167.54 —
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFFICILE AMP PROBE $275.00 $275.00 $275.00 —
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA-19-9 $72.10 $72.10 $72.10 —
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 ANTIBODY $416.85 $416.85 $416.85 —
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 NAA UNIT PERFORMED $120.00 $120.00 $120.00 —
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 CORONAVIRUS $161.63 $161.63 $161.63 —
Calcium blood test, total inpatient CPT 82310 CALCIUM SERUM $17.88 $17.88 $17.88 —
Calcium blood test, total inpatient CPT 82310 CALCIUM, MISC FLUID $22.14 $22.14 $22.14 —
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 S/O CARCINOEMBRYONC AG BF $74.55 $74.55 $74.55 —
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 S/O CARCINOEMBRYON AG FLD $106.05 $106.05 $106.05 —
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 S/O CARCINOEMBRYONIC AG $106.05 $106.05 $106.05 —
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA $113.87 $113.87 $113.87 —
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINOEMBRYONIC-(CEA) $429.45 $429.45 $429.45 —
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER ANTIBODY $121.80 $121.80 $121.80 —
Chickenpox (varicella) immunity blood test inpatient CPT 86787 S/O VARICELLA ZOST AB IGG $323.40 $323.40 $323.40 —
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 S/O CHLAMYDIA AMP PROBE $139.00 $139.00 $139.00 —
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 S/O CG TMA $141.00 $141.00 $141.00 —
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 S/O CHLAMYDIA TRACHOMATIS $141.00 $141.00 $141.00 —
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS(AMP) $142.80 $142.80 $142.80 —
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL $46.40 $46.40 $46.40 —
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 S/O LIPOPROFILE NMR $55.65 $55.65 $55.65 —
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE $92.46 $92.46 $92.46 —
Complete blood count (CBC) with differential inpatient CPT 85025 CBC, W/ AUTO DIFF $26.92 $26.92 $26.92 —
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/AUTO DIFF $46.32 $46.32 $46.32 —
Complete blood count (CBC), no differential inpatient CPT 85027 CBC, AUTO W/O DIFF $22.42 $22.42 $22.42 —
Complete blood count (CBC), no differential inpatient CPT 85027 AUTOMATED CBC $36.15 $36.15 $36.15 —
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL $34.85 $34.85 $34.85 —
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL $79.56 $79.56 $79.56 —
Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL $56.48 $56.48 $56.48 —
Cortisol blood test, total inpatient CPT 82533 S/O CORTISOL SALIVA $302.40 $302.40 $302.40 —
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK-TOTAL $22.55 $22.55 $22.55 —
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK TOTAL $34.02 $34.02 $34.02 —
Creatine kinase (CK) blood test, total inpatient CPT 82550 S/O CK ISOENZYMES $85.05 $85.05 $85.05 —
Creatinine blood test inpatient CPT 82565 CREATININE, BLOOD $17.75 $17.75 $17.75 —
Creatinine blood test inpatient CPT 82565 CREATININE SERU $66.50 $66.50 $66.50 —
Creatinine blood test inpatient CPT 82565 RESPIRATORY THERAPY 82565 $103.69 $103.69 $103.69 —
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV TITER $270.90 $270.90 $270.90 —
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGALOVIRUS IGG & IGM $288.75 $288.75 $288.75 —
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 S/O TORCH AB IGG $554.40 $554.40 $554.40 —
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV IGG ANTIBODY $554.40 $554.40 $554.40 —
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN-D-DIMER QUANT $35.27 $35.27 $35.27 —
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER ELISA $53.61 $53.61 $53.61 —
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S $391.65 $391.65 $391.65 —
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR $185.15 $185.15 $185.15 —
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCRN PRESUMP CLASS B $1,239.00 $1,239.00 $1,239.00 —
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL $342.30 $342.30 $342.30 —
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN BARR ANTIBODY VCA $87.15 $87.15 $87.15 —
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 S/O EBV VCA IGM $87.15 $87.15 $87.15 —
Estradiol blood test inpatient CPT 82670 ESTRADIOL $131.25 $131.25 $131.25 —
Estradiol blood test inpatient CPT 82670 S/O ESTRADIOL $1,135.05 $1,135.05 $1,135.05 —
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE STIMULATING HORMONE $865.20 $865.20 $865.20 —
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 S/O CALPROTECTIN FECAL $90.30 $90.30 $90.30 —
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN $47.23 $47.23 $47.23 —
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN $33.68 $33.68 $33.68 —
Fibrinogen blood test inpatient CPT 85384 PLATELET MAPPING $282.45 $282.45 $282.45 —
Fibrinogen blood test inpatient CPT 85384 TEG TEST $282.45 $282.45 $282.45 —
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID $50.94 $50.94 $50.94 —
Folate (folic acid) blood test inpatient CPT 82746 FOLATE SERUM $66.75 $66.75 $66.75 —
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE $58.70 $58.70 $58.70 —
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE (THYROXINE) $31.26 $31.26 $31.26 —
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE (FREE T4) $48.75 $48.75 $48.75 —
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROID FUNCTION PANEL $176.40 $176.40 $176.40 —
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE $49.35 $49.35 $49.35 —
Free testosterone test inpatient CPT 84402 S/O TESTOST FREE FEML/CHD $51.45 $51.45 $51.45 —
Free testosterone test inpatient CPT 84402 S/O TESTOSTERONE FREE $106.05 $106.05 $106.05 —
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT $50.04 $50.04 $50.04 —
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GAMMA GT (GGT) $278.25 $278.25 $278.25 —
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 POST GLUCOSE DOSE (GTT) $383.25 $383.25 $383.25 —
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOL - 3 SPECIMENS $237.30 $237.30 $237.30 —
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 S/O CG TMA $136.00 $136.00 $136.00 —
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 S/O NEISSERIA AMP PROBE $139.00 $139.00 $139.00 —
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE $159.50 $159.50 $159.50 —
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI AB $17.85 $17.85 $17.85 —
H. pylori antibody blood test inpatient CPT 86677 S/O H PYLORI AB IGM $59.85 $59.85 $59.85 —
H. pylori antibody blood test inpatient CPT 86677 S/O H PYLORI AB IGG $436.80 $436.80 $436.80 —
H. pylori stool antigen test inpatient CPT 87338 HELICOBACTER PYLORI, STOOL $156.45 $156.45 $156.45 —
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV VIRAL LOAD, QUANT (DNA) $353.85 $353.85 $353.85 —
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1&2 AB SCREEN $18.76 $18.76 $18.76 —
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV1 & HIV2, SINGLE ASSSAY $56.70 $56.70 $56.70 —
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 IA HIV1 AG W HIV1&HIV2 AB $83.43 $83.43 $83.43 —
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG W/HIV-1 & HIV-2 AB $123.91 $123.91 $123.91 —
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOHEMOGLOBIN (HGB A1) $33.64 $33.64 $33.64 —
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCO HGB $49.14 $49.14 $49.14 —
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN $8.21 $8.21 $8.21 —
Hemoglobin blood test inpatient CPT 85018 HGB $17.00 $17.00 $17.00 —
Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE ANTIBODY $271.95 $271.95 $271.95 —
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB $37.21 $37.21 $37.21 —
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG (HBSAG) $35.79 $35.79 $35.79 —
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB $49.44 $49.44 $49.44 —
Hepatitis C antibody blood test (screening) inpatient CPT 86803 S/O HEPATITIS C AB CIA $63.00 $63.00 $63.00 —
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C VIRUS AB RNA $148.44 $148.44 $148.44 —
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE 1 ABY $76.65 $76.65 $76.65 —
Herpes blood test, HSV-1 antibody inpatient CPT 86695 S/O HSV TYPE 1 GLYCO IGG $76.65 $76.65 $76.65 —
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE 2 ABY $84.00 $84.00 $84.00 —
Herpes blood test, HSV-2 antibody inpatient CPT 86696 S/O HSV TYPE 2 GLYCO IGG $84.00 $84.00 $84.00 —
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP HIGH SENSITIVITY $44.88 $44.88 $44.88 —
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP HIGH SENSITIVITY RISK $71.05 $71.05 $71.05 —
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP (HIGH SENSITIVITY) $115.50 $115.50 $115.50 —
Homocysteine blood test inpatient CPT 83090 S/O THROMBO RISK WRFX $175.35 $175.35 $175.35 —
Homocysteine blood test inpatient CPT 83090 HOMOCYSTINE $175.35 $175.35 $175.35 —
Insulin blood test inpatient CPT 83525 INSULIN $49.35 $49.35 $49.35 —
Insulin blood test inpatient CPT 83525 S/O INSULIN TOTAL $560.70 $560.70 $560.70 —
Iron blood test (serum iron) inpatient CPT 83540 IRON,SERUM,CHEMICAL $22.42 $22.42 $22.42 —
Iron blood test (serum iron) inpatient CPT 83540 IRON PANEL $34.19 $34.19 $34.19 —
Iron blood test (serum iron) inpatient CPT 83540 IRON SERUM $46.88 $46.88 $46.88 —
Iron blood test (serum iron) inpatient CPT 83540 S/O IRON LIVER $709.80 $709.80 $709.80 —
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY $219.45 $219.45 $219.45 —
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL $28.64 $28.64 $28.64 —
Kidney function blood test panel inpatient CPT 80069 RENAL PANEL $63.05 $63.05 $63.05 —
LH (luteinizing hormone) test inpatient CPT 83002 LUTEINIZING HORMONE $737.10 $737.10 $737.10 —
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID $40.09 $40.09 $40.09 —
Lactate (lactic acid) blood test inpatient CPT 83605 S/O LACTIC ACID BODY FLUD $52.50 $52.50 $52.50 —
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 S/O LD ISOENZYMES $17.85 $17.85 $17.85 —
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 S/O LDH TOTAL BODY FLUID $17.85 $17.85 $17.85 —
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH $20.93 $20.93 $20.93 —
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH FL $94.50 $94.50 $94.50 —
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE $23.88 $23.88 $23.88 —
Lipase blood test (pancreas enzyme) inpatient CPT 83690 S/O PANCREATIC FUNCT $131.25 $131.25 $131.25 —
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE, MISC FLUID $139.65 $139.65 $139.65 —
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL $28.31 $28.31 $28.31 —
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE TITER $605.85 $605.85 $605.85 —
Lyme disease antibody test inpatient CPT 86618 S/O BORRELIA BURG TTL CSF $637.35 $637.35 $637.35 —
Magnesium blood test inpatient CPT 83735 MAGNESIUM $23.22 $23.22 $23.22 —
Magnesium blood test inpatient CPT 83735 S/O MAGNESIUM RBC $30.45 $30.45 $30.45 —
Magnesium blood test inpatient CPT 83735 S/O URINE SUPERSAT $32.55 $32.55 $32.55 —
Magnesium blood test inpatient CPT 83735 S/O MAGNESIUM URINE $65.10 $65.10 $65.10 —
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ANTIBODY $95.55 $95.55 $95.55 —
Measles (rubeola) antibody test inpatient CPT 86765 S/O RUBEOLLA AB IGG $320.25 $320.25 $320.25 —
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 S/O HETEROPHILE AB W/RFLX $25.20 $25.20 $25.20 —
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODY SCREEN $182.70 $182.70 $182.70 —
Mumps immunity blood test inpatient CPT 86735 MUMPS ANTIBODY $76.65 $76.65 $76.65 —
Mumps immunity blood test inpatient CPT 86735 S/O MUMPS AB IGG $186.90 $186.90 $186.90 —
Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL $63.00 $63.00 $63.00 —
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PROSTATE SPECIFIC ATG (FREE) $228.90 $228.90 $228.90 —
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ATG (TOTAL) $63.72 $63.72 $63.72 —
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 S/O PSA FREE/TOTAL $76.65 $76.65 $76.65 —
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN $90.95 $90.95 $90.95 —
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA SCRN $135.45 $135.45 $135.45 —
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP SMEAR THIN PREP $163.80 $163.80 $163.80 —
Parathyroid hormone (PTH) blood test inpatient CPT 83970 S/O PTH INTACT W/CA GRAPH $143.03 $143.03 $143.03 —
Parathyroid hormone (PTH) blood test inpatient CPT 83970 INTACT PARATHYROID HORMON $162.99 $162.99 $162.99 —
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE $204.03 $204.03 $204.03 —
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARA THYROID INTACT C TERMINAL $295.64 $295.64 $295.64 —
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTRAOPERATIVE $296.10 $296.10 $296.10 —
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONES INTACT $355.95 $355.95 $355.95 —
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT $20.82 $20.82 $20.82 —
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 S/O INHIB ASSAY PTT WRFLX $21.00 $21.00 $21.00 —
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 S/O THROM RISK PTT $21.00 $21.00 $21.00 —
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 S/O INHIB ASSY PTT 1HR $21.00 $21.00 $21.00 —
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 S/O PTT-D HEPARIN RFLX $21.00 $21.00 $21.00 —
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 S/O THROMBO RISK WRFX $25.20 $25.20 $25.20 —
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 S/O LUPUS ANTICOAGULANT $25.20 $25.20 $25.20 —
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APTT $40.53 $40.53 $40.53 —
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHOROUS SERUM $16.42 $16.42 $16.42 —
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHATE INORG $26.50 $26.50 $26.50 —
Potassium blood test inpatient CPT 84132 POTASSIUM SERUM $16.50 $16.50 $16.50 —
Potassium blood test inpatient CPT 84132 POTASSIUM SERUM K $22.15 $22.15 $22.15 —
Progesterone blood test inpatient CPT 84144 PROGESTERONE $626.85 $626.85 $626.85 —
Prolactin blood test inpatient CPT 84146 PROLACTIN $79.80 $79.80 $79.80 —
Prolactin blood test inpatient CPT 84146 S/O MACROPROLACTIN $82.95 $82.95 $82.95 —
Prolactin blood test inpatient CPT 84146 S/O PROLACTIN ASSAY $819.00 $819.00 $819.00 —
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME $14.87 $14.87 $14.87 —
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 S/O THROMBO RISK WRFX $21.00 $21.00 $21.00 —
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 S/O LUPUS ANTICOAGULANT $21.00 $21.00 $21.00 —
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 S/O INHIB ASSAY PT W/RFLX $21.00 $21.00 $21.00 —
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 DIC SCREEN $59.85 $59.85 $59.85 —
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/PTT $77.70 $77.70 $77.70 —
Rapid flu test (influenza antigen) inpatient CPT 87804 INF AG DET BY IA INFLUENZA $111.30 $111.30 $111.30 —
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RAPID STREP $16.99 $16.99 $16.99 —
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 IMMUNOASSAY STREP A $57.28 $57.28 $57.28 —
Renin blood test inpatient CPT 84244 RENIN-PLASMA $76.20 $76.20 $76.20 —
Rh blood typing inpatient CPT 86901 S/O RH TYPE $34.65 $34.65 $34.65 —
Rh blood typing inpatient CPT 86901 RH TYPE ONLY $40.26 $40.26 $40.26 —
Rh blood typing inpatient CPT 86901 RH TYPING $81.07 $81.07 $81.07 —
Rh blood typing inpatient CPT 86901 S/O RH DISCREPANCY UBS $148.06 $148.06 $148.06 —
Rh blood typing inpatient CPT 86901 RH BLOOD TYPING $150.15 $150.15 $150.15 —
Rheumatoid factor (RF) test inpatient CPT 86431 S/O RHEUTAMOID FACTOR BLD $23.00 $23.00 $23.00 —
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR, QUANT $333.90 $333.90 $333.90 —
Rubella antibody test (immunity check) inpatient CPT 86762 S/O RUBELLA AB IGM $80.85 $80.85 $80.85 —
Rubella antibody test (immunity check) inpatient CPT 86762 S/O TORCH AB IGG $84.00 $84.00 $84.00 —
Rubella antibody test (immunity check) inpatient CPT 86762 S/O RUBELLA AB IGG $247.80 $247.80 $247.80 —
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODY $317.10 $317.10 $317.10 —
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE (AUTO) $9.36 $9.36 $9.36 —
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE $15.25 $15.25 $15.25 —
Sodium blood test inpatient CPT 84295 SODIUM SERUM $16.66 $16.66 $16.66 —
Stool ova and parasites exam inpatient CPT 87177 S/O OVA & PARASITES HCCL $62.00 $62.00 $62.00 —
Stool ova and parasites exam inpatient CPT 87177 S/O OVA & PARASIT FECL $63.00 $63.00 $63.00 —
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES $65.10 $65.10 $65.10 —
Stool ova and parasites exam inpatient CPT 87177 S/O OVA & PARASITES $68.00 $68.00 $68.00 —
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES $249.00 $249.00 $249.00 —
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 RESPIRATORY THERAPY 82270 $91.11 $91.11 $91.11 —
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD, FECAL $98.70 $98.70 $98.70 —
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD 1-3 DETERMIN $59.50 $59.50 $59.50 —
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 FECAL HGB IMMUNOASSAY $98.70 $98.70 $98.70 —
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 S/O TEPONEMA PALL IGG CSF $54.60 $54.60 $54.60 —
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM $150.15 $150.15 $150.15 —
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 S/O T PALLIDUM IGG TP-PA $156.45 $156.45 $156.45 —
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHIL VDRL/RPR QL $14.09 $14.09 $14.09 —
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR $141.75 $141.75 $141.75 —
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB GOLD $214.76 $214.76 $214.76 —
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 S/O TESTOSTERONE TOTAL $107.10 $107.10 $107.10 —
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL $122.85 $122.85 $122.85 —
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 S/O TESTOSTER FEMALE/CHLD $128.10 $128.10 $128.10 —
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 S/O LKM1 AB IGG $39.90 $39.90 $39.90 —
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 S/O LIVER/KIDNY MICROSOME $198.45 $198.45 $198.45 —
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODIES $255.15 $255.15 $255.15 —
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH $58.21 $58.21 $58.21 —
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID CASCADE $142.99 $142.99 $142.99 —
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH ULTRA SENSITIVE $201.00 $201.00 $201.00 —
Total IgE blood test inpatient CPT 82785 S/O STAPH AUREUS PANL $75.60 $75.60 $75.60 —
Total IgE blood test inpatient CPT 82785 S/O IMMUNOGLOBULIN E $94.50 $94.50 $94.50 —
Total IgE blood test inpatient CPT 82785 GAMMAGLOBULIN IGE $285.60 $285.60 $285.60 —
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL (TOTAL) $133.35 $133.35 $133.35 —
Total thyroxine (T4) blood test inpatient CPT 84436 T-4 TOTAL (THYROXINE) $23.80 $23.80 $23.80 —
Total thyroxine (T4) blood test inpatient CPT 84436 T4 $46.16 $46.16 $46.16 —
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 TOTAL $49.13 $49.13 $49.13 —
Transferrin blood test inpatient CPT 84466 TRANSFERRIN SERUM $44.22 $44.22 $44.22 —
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES $19.89 $19.89 $19.89 —
Triglycerides blood test inpatient CPT 84478 S/O VAP CHOLESTEROL $26.25 $26.25 $26.25 —
Troponin test, quantitative inpatient CPT 84484 TROPONIN (QUANTITATIVE) $43.21 $43.21 $43.21 —
Troponin test, quantitative inpatient CPT 84484 TROPONIN-I $84.32 $84.32 $84.32 —
Troponin test, quantitative inpatient CPT 84484 TROPONIN T (QUANTITATIVE) $114.27 $114.27 $114.27 —
Uric acid blood test inpatient CPT 84550 URIC ACID, BLOOD $15.67 $15.67 $15.67 —
Uric acid blood test inpatient CPT 84550 URIC ACID SERUM $37.31 $37.31 $37.31 —
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/MICROSCOPIC $10.98 $10.98 $10.98 —
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AND MICROSCOPI $20.57 $20.57 $20.57 —
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS NONAUTO W/MICROSCOP $46.95 $46.95 $46.95 —
Urinalysis without microscope exam, automated inpatient CPT 81003 UA AUTO W/O MICRO $7.80 $7.80 $7.80 —
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS MACRO ONLY $23.27 $23.27 $23.27 —
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O MICRO $48.30 $48.30 $48.30 —
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO W/O MICROSC $90.30 $90.30 $90.30 —
Urine culture for bacteria, with colony count inpatient CPT 87086 S/O CULT UR W/COLONY CNT $26.63 $26.63 $26.63 —
Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE $58.19 $58.19 $58.19 —
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE W/COLONY COUNT $627.90 $627.90 $627.90 —
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN 24 HOUR URINE $20.02 $20.02 $20.02 —
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN URINE QUANT $172.34 $172.34 $172.34 —
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST,VISUAL COLOR $9.04 $9.04 $9.04 —
Urine pregnancy test, read by color change inpatient CPT 81025 PREG URINE VISUAL $246.75 $246.75 $246.75 —
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12 $52.25 $52.25 $52.25 —
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 & FOLATE $127.49 $127.49 $127.49 —
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25 HYDROXY $102.56 $102.56 $102.56 —
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25-HYDROXY $117.55 $117.55 $117.55 —
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D, 1, 25-DIHYDROXY $133.40 $133.40 $133.40 —
Zinc blood test inpatient CPT 84630 ZINC $39.47 $39.47 $39.47 —
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 S/O MATERNAL SRM SCREEN $55.65 $55.65 $55.65 —
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 S/O BETA HCG QN TUMR MARK $58.80 $58.80 $58.80 —
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG SERUM, QUANTITATIVE $1,429.05 $1,429.05 $1,429.05 —

Surgery and procedures

ProcedureCash priceList priceInsurers payOff list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BX BREAST STEREO PERC 1ST $4,181.00 $4,181.00 $4,181.00 —
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 LESION PREMALIG DESTR 1ST $298.00 $298.00 $298.00 —
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 FACET JT/NRV L/S SNG INJ $824.00 $824.00 $824.00 —
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HYSTERO NS/CON INTRO $647.00 $647.00 $647.00 —
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE $574.00 $574.00 $574.00 —
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCEN ASP MAJOR JT WO $1,473.00 $1,473.00 $1,473.00 —
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCEN ASP INTER JT WO $1,237.00 $1,237.00 $1,237.00 —
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCEN ASP SMALL JT WO $265.00 $265.00 $265.00 —
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 ANES/STE EPI L/S SNGL INJ $4,011.00 $4,011.00 $4,011.00 —
Paracentesis with imaging guidance inpatient CPT 49083 PARACENTSIS ABD W IMAGING $1,475.00 $1,475.00 $1,475.00 —
Prostate biopsy inpatient CPT 55700 BIOPSY PROSTATE NDL/PUNCH $2,144.00 $2,144.00 $2,144.00 —
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE DIAGNOSTIC $475.57 $475.57 $475.57 —
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE DIAGNOSTC $1,874.00 $1,874.00 $1,874.00 —
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/IMG GD $2,006.10 $2,006.10 $2,006.10 —
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W IMAGING $2,568.00 $2,568.00 $2,568.00 —
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W IMAG BIL $2,898.00 $2,898.00 $2,898.00 —
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PT 1-2 MUSCL $1,213.00 $1,213.00 $1,213.00 —
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST US PERC 1ST $4,181.00 $4,181.00 $4,181.00 —
Vein ablation, radiofrequency, first vein inpatient CPT 36475 EXTRM VEIN ABLAT RF 1ST $20,040.00 $20,040.00 $20,040.00 —
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SUBQ TIS FIRST 20CM $919.60 $919.60 $919.60 —

Doctor visits and therapy

ProcedureCash priceList priceInsurers payOff list
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD/COMPONENT $993.00 $993.00 $993.00 —
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RESPIRATORY THERAPY 94640 $96.96 $96.96 $96.96 —
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT $99.75 $99.75 $99.75 —
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI $103.09 $103.09 $103.09 —
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL/VAPOR INHALE INITIAL $112.81 $112.81 $112.81 —
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB-INITIAL/EZPAP $131.89 $131.89 $131.89 —
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO VIA IV UP TO 1 HOUR $707.91 $707.91 $707.91 —
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG, AWAKE AND DROWSY $1,131.00 $1,131.00 $1,131.00 —
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG $489.80 $489.80 $489.80 —
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING ONLY (RAD) $225.00 $225.00 $225.00 —
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING ONLY $541.00 $541.00 $541.00 —
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVAS STR TEST W RX $1,590.00 $1,590.00 $1,590.00 —
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVAS STR TEST WO RX $1,590.00 $1,590.00 $1,590.00 —
IV infusion of a medicine, first hour inpatient CPT 96365 PRIMARY IV TPD EACH $481.40 $481.40 $481.40 —
IV push of a medicine, first drug inpatient CPT 96374 PRIMARY TPD INJ IV PUSH $56.35 $56.35 $56.35 —
IV push of a medicine, first drug inpatient CPT 96374 INJ TX/DX/PRO IVPUSH INIT $632.00 $632.00 $632.00 —
IV push of a medicine, first drug inpatient CPT 96374 INJ FOR MICROBUBBLE STUDY $632.00 $632.00 $632.00 —
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NERVE CONDUCT 7-8 STUDIES $229.00 $229.00 $229.00 —
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NCB EA NERVE MOTOR W FW 7-8 $5,924.96 $5,924.96 $5,924.96 —
New patient office visit, about 45 minutes inpatient CPT 99204 OP VISIT NEW PT LEVEL IV $1,849.05 $1,849.05 $1,849.05 —
New patient office visit, about 60 minutes inpatient CPT 99205 OP VISIT NEW PT LEVEL V $1,814.01 $1,814.01 $1,814.01 —
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 NUTRITIONAL CONS PER 15 MIN $54.24 $54.24 $54.24 —
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEXITY 60 MIN $212.70 $212.70 $212.70 —
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEXITY 45 MIN $348.45 $348.45 $348.45 —
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVALUATION LOW COMPLEXITY $296.18 $296.18 $296.18 —
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVALUATION MOD COMPLEXITY $309.30 $309.30 $309.30 —
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES $112.67 $112.67 $112.67 —
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 TRANSTRACHIAL FOLLOW UP $412.91 $412.91 $412.91 —
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OP VISIT EST PT LEVEL III $167.10 $167.10 $167.10 —
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OP VISIT EST PT LEVEL IV $730.66 $730.66 $730.66 —
Speech therapy session, individual inpatient CPT 92507 SPEECH/LANG THERAPY 30 MIN $155.14 $155.14 $155.14 —
Speech therapy session, individual inpatient CPT 92507 PASSY MUIR VALVE ASSIST $261.28 $261.28 $261.28 —
Speech therapy session, individual inpatient CPT 92507 SPEECH/LANGUAGE THER 60 MIN $292.66 $292.66 $292.66 —
Speech therapy session, individual inpatient CPT 92507 SPEECH/LANGUAGE THER 45 MIN $312.03 $312.03 $312.03 —
Spirometry (breathing test) inpatient CPT 94010 INCENTIVE SPIRO TX $174.71 $174.71 $174.71 —
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY/PFT SIMPLE $211.05 $211.05 $211.05 —
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHOSPASM EVALUATION $83.79 $83.79 $83.79 —
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHODIL RESPONSE-PRE & POST $83.79 $83.79 $83.79 —

Vaccines

ProcedureCash priceList priceInsurers payOff list
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIP-TET-AC PRT 0.5ML<7YIM $148.17 $148.17 $148.17 —
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HEP B VAC/DTAP/IPV0.5MLIM $504.72 $504.72 $504.72 —
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPAT A VACC 1440U 1ML IN $226.68 $226.68 $226.68 —
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEP A VACC 720U/0.5MLPDIM $206.04 $206.04 $206.04 —
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPAT B VACC 20MCG 1ML IN $186.30 $186.30 $186.30 —
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPAT B VACC 10MCG PEDIM $166.17 $166.17 $166.17 —
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HIB VACC PRP-OMP CONJ IM $163.05 $163.05 $163.05 —
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HIB VACCINE PRP-T CONJ IM $93.90 $93.90 $93.90 —
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES/MUMPS/RUBELLA VAC $202.11 $202.11 $202.11 —
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENING VAC ACYW PF0.5MLIM $422.25 $422.25 $422.25 —
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOC VACC 13 VALENT $972.39 $972.39 $972.39 —
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIO VACCINACTIVE 0.5M $196.65 $196.65 $196.65 —
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACC 2.5IU/ML 1ML $1,008.87 $1,008.87 $1,008.87 —
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TET/DIP PFVACC 0.5ML>=7YR $159.09 $159.09 $159.09 —
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP 0.5ML >=7YR IM $267.66 $267.66 $267.66 —
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://www.dignityhealthevrehabgilbert.com/docs/zirfdignityhealtheastvalleyrehabilitationhospitalgilbertlibraries/mar2026/473724879_dignity-health-east-valley-rehabilitation-hospital-gilbert_standardcharges.csv.zip