SelfPayRates
Hospital Vincennes, IN

Good Samaritan Hosptial

Good Samaritan Hosptial in Vincennes, IN publishes cash prices for 378 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Indiana median for 186 of 366 procedures and above it for 174. By typical cash price it ranks #36 of 89 Indiana hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

520 S. 7th Street Collected Sep 29, 2026 Source price file (812) 882-5220

Acute care hospital Emergency department CMS star rating 2 of 5 CCN 150042 · CMS hospital register NPI 1225032881

Scans and imaging

ProcedureCash price List priceInsurers payvs IndianaOff list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN W&W/O CONTRAST $1,749.60 $2,916.00 $1,458.00–$2,916.00 37% above 40%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN W&W/O CONTRAST $1,749.60 $2,916.00 $1,696.53–$2,916.00 — 40%
Abdominal X-ray, 2 views CPT 74019 HC XR ABDOMEN 2 VIEWS $331.80 $553.00 $276.50–$553.00 23% above 40%
Abdominal X-ray, 2 views inpatient CPT 74019 HC XR ABDOMEN 2 VIEWS $331.80 $553.00 $321.74–$553.00 — 40%
Ankle X-ray, complete, 3 or more views CPT 73610 HC XR ANKLE COMPLETE 3+ VIEWS $249.00 $415.00 $207.50–$415.00 27% above 40%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC XR ANKLE COMPLETE 3+ VIEWS $249.00 $415.00 $241.45–$415.00 — 40%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC DOPPLER ARTERIAL EXTREMITY LIMITED BILAT $694.80 $1,158.00 $579.00–$1,158.00 — 40%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC CARD DOPPLER ARTERIAL EXTREMITY LIMITED BILAT $694.80 $1,158.00 $579.00–$1,158.00 — 40%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC CARD DOPPLER ARTERIAL EXTREMITY LIMITED BILAT $694.80 $1,158.00 $673.72–$1,158.00 — 40%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY W/O CONTRAST $804.00 $1,340.00 $670.00–$1,340.00 at median 40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREMITY W/O CONTRAST $804.00 $1,340.00 $779.61–$1,340.00 — 40%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC XR EXAM ESOPHAGUS 1CNTRST $402.00 $670.00 $335.00–$670.00 14% below 40%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC XR EXAM ESOPHAGUS 1CNTRST $402.00 $670.00 $389.81–$670.00 — 40%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE WHOLE BODY $1,620.00 $2,700.00 $1,350.00–$2,700.00 2% above 40%
Breast ultrasound, complete, one breast one side CPT 76641 HC US BREAST COMPLETE UNILATERAL $312.60 $521.00 $260.50–$521.00 28% below 40%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC US BREAST LIMITED UNILATERAL $326.40 $544.00 $272.00–$544.00 1% above 40%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CTA ABD/PELVIS W/WO CONTRAST POST $1,607.40 $2,679.00 $1,339.50–$2,679.00 15% below 40%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CTA ABD/PELVIS W/WO CONTRAST POST $1,607.40 $2,679.00 $1,558.64–$2,679.00 — 40%
CT angiography (CTA) of the head CPT 70496 HC CTA HEAD W&W/O CONTRAST $1,505.40 $2,509.00 $1,254.50–$2,509.00 18% above 40%
CT angiography (CTA) of the head inpatient CPT 70496 HC CTA HEAD W&W/O CONTRAST $1,505.40 $2,509.00 $1,459.74–$2,509.00 — 40%
CT angiography (CTA) of the neck CPT 70498 HC CTA NECK W&W/O CONTRAST $1,476.00 $2,460.00 $1,230.00–$2,460.00 21% above 40%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CTA NECK W&W/O CONTRAST $1,476.00 $2,460.00 $1,431.23–$2,460.00 — 40%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CTA CHEST (NONCORONARY) W AND/OR W/O CONTRAST $1,652.40 $2,754.00 $1,377.00–$2,754.00 31% above 40%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CTA CHEST (NONCORONARY) W AND/OR W/O CONTRAST $1,652.40 $2,754.00 $1,602.28–$2,754.00 — 40%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CORONARY ARTERIES W CALCIUM SCORING $1,335.00 $2,225.00 $1,112.50–$2,225.00 60% above 40%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CORONARY ARTERIES WO CALCIUM SCORING $1,335.00 $2,225.00 $1,112.50–$2,225.00 60% above 40%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC VASCULAR SCREENING CARDIAC SCORING $59.40 $99.00 $49.50–$99.00 71% below 40%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CARDIAC SCORING $162.60 $271.00 $135.50–$271.00 21% below 40%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CARDIAC SCORING $162.60 $271.00 $157.67–$271.00 — 40%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABDOMEN & PELVIS W/O CONTRAST $1,841.40 $3,069.00 $1,534.50–$3,069.00 76% above 40%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABDOMEN & PELVIS W/O CONTRAST $1,841.40 $3,069.00 $1,785.54–$3,069.00 — 40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN AND PELVIS WITH CONTRAST $2,459.40 $4,099.00 $2,049.50–$4,099.00 63% above 40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN AND PELVIS WITH CONTRAST $2,459.40 $4,099.00 $2,384.80–$4,099.00 — 40%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN & PELVIS W&W/O CONTRAST 1+ REGIONS $2,493.00 $4,155.00 $2,077.50–$4,155.00 45% above 40%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABDOMEN & PELVIS W&W/O CONTRAST 1+ REGIONS $2,493.00 $4,155.00 $2,417.38–$4,155.00 — 40%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W/CONTRAST $1,536.60 $2,561.00 $1,280.50–$2,561.00 44% above 40%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W/CONTRAST $1,536.60 $2,561.00 $1,489.99–$2,561.00 — 40%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN W/O CONTRAST $1,020.60 $1,701.00 $850.50–$1,701.00 21% above 40%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN W/O CONTRAST $1,020.60 $1,701.00 $989.64–$1,701.00 — 40%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL W/O CONTRAST $1,130.40 $1,884.00 $942.00–$1,884.00 36% above 40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL W/O CONTRAST $1,130.40 $1,884.00 $1,096.11–$1,884.00 — 40%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN W/O CONTRAST $869.40 $1,449.00 $724.50–$1,449.00 10% above 40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN W/O CONTRAST $869.40 $1,449.00 $843.03–$1,449.00 — 40%
CT scan of the head with contrast CPT 70460 HC CT HEAD/BRAIN W/CONTRAST $929.40 $1,549.00 $774.50–$1,549.00 7% above 40%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD/BRAIN W/CONTRAST $929.40 $1,549.00 $901.21–$1,549.00 — 40%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD/BRAIN W&W/O CONTRAST $1,501.20 $2,502.00 $1,251.00–$2,502.00 44% above 40%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD/BRAIN W&W/O CONTRAST $1,501.20 $2,502.00 $1,455.66–$2,502.00 — 40%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE W/O CONTRAST $1,080.60 $1,801.00 $900.50–$1,801.00 22% above 40%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE W/O CONTRAST $1,080.60 $1,801.00 $1,047.82–$1,801.00 — 40%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL SPINE W/O CONTRAST $1,062.00 $1,770.00 $885.00–$1,770.00 27% above 40%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT CERVICAL SPINE W/O CONTRAST $1,062.00 $1,770.00 $1,029.79–$1,770.00 — 40%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUPLEX EXTRACRANIAL/CAROTID BILAT $807.00 $1,345.00 $672.50–$1,345.00 — 40%
Chest CT scan without and with contrast CPT 71270 HC CT THORAX DIAG W&W/O CONTRAST $1,422.60 $2,371.00 $1,185.50–$2,371.00 34% above 40%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT THORAX DIAG W&W/O CONTRAST $1,422.60 $2,371.00 $1,379.45–$2,371.00 — 40%
Chest X-ray, 2 views CPT 71046 HC XR CHEST 2 VIEWS $204.00 $340.00 $170.00–$340.00 2% below 40%
Chest X-ray, 2 views inpatient CPT 71046 HC XR CHEST 2 VIEWS $204.00 $340.00 $197.81–$340.00 — 40%
Chest X-ray, single view CPT 71045 HC XR CHEST 1 VIEW $162.00 $270.00 $135.00–$270.00 at median 40%
Chest X-ray, single view inpatient CPT 71045 HC XR CHEST 1 VIEW $162.00 $270.00 $157.09–$270.00 — 40%
Collarbone (clavicle) X-ray, complete CPT 73000 HC XR CLAVICLE COMPLETE $213.60 $356.00 $178.00–$356.00 11% above 40%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC XR CLAVICLE COMPLETE $213.60 $356.00 $207.12–$356.00 — 40%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITIONEAL COMPLETE $655.20 $1,092.00 $546.00–$1,092.00 28% above 40%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC XR BONE DENSITY DUAL ENERGY (DXA) AXIAL $361.20 $602.00 $301.00–$602.00 24% above 40%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC XR BONE DENSITY DUAL ENERGY (DEXA) APPENDICULAR $154.80 $258.00 $129.00–$258.00 7% above 40%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US PREGNANCY DETAILED SINGLE/FIRST GEST $684.60 $1,141.00 $570.50–$1,141.00 23% above 40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT LOW DOSE LUNG DIAGNOSTIC - FOLLOW UP $923.40 $1,539.00 $769.50–$1,539.00 11% above 40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX DIAG W/O CONTRAST $923.40 $1,539.00 $769.50–$1,539.00 11% above 40%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX DIAG W/O CONTRAST $923.40 $1,539.00 $895.39–$1,539.00 — 40%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX DIAG W/CONTRAST $1,165.80 $1,943.00 $971.50–$1,943.00 27% above 40%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX DIAG W/CONTRAST $1,165.80 $1,943.00 $1,130.44–$1,943.00 — 40%
Diagnostic mammogram, both breasts both sides CPT 77066 HC MAMMOGRAM DIAGNOSTIC BILATERAL W/DIGITAL IMAGES W CAD $352.20 $587.00 $293.50–$587.00 — 40%
Diagnostic mammogram, one breast one side CPT 77065 HC MAMMOGRAM DIAGNOSTIC UNILATERAL W/DIGITAL IMAGES W CAD $265.80 $443.00 $221.50–$443.00 19% above 40%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUPLEX ARTERIAL LOWER EXTREMITY BILAT $418.20 $697.00 $348.50–$697.00 — 40%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC CARD DUPLEX ARTERIAL LOWER EXTREMITY BILAT $418.20 $697.00 $348.50–$697.00 — 40%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC CARD DUPLEX ARTERIAL LOWER EXTREMITY BILAT $418.20 $697.00 $405.51–$697.00 — 40%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC CARD DUPLEX VENOUS EXTREMITY BILAT $965.40 $1,609.00 $804.50–$1,609.00 — 40%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUPLEX VENOUS EXTREMITY BILAT $965.40 $1,609.00 $804.50–$1,609.00 — 40%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC CARD DUPLEX VENOUS EXTREMITY BILAT $965.40 $1,609.00 $936.12–$1,609.00 — 40%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO COMPLETE $1,827.60 $3,046.00 $1,523.00–$3,046.00 11% above 40%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO COMPLETE $1,827.60 $3,046.00 $1,772.16–$3,046.00 — 40%
Elbow X-ray, 2 views CPT 73070 HC XR ELBOW 2 VIEWS $213.60 $356.00 $178.00–$356.00 28% above 40%
Elbow X-ray, 2 views inpatient CPT 73070 HC XR ELBOW 2 VIEWS $213.60 $356.00 $207.12–$356.00 — 40%
Elbow X-ray, complete, 3 or more views CPT 73080 HC XR ELBOW COMPLETE 3+ VIEWS $231.60 $386.00 $193.00–$386.00 9% below 40%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC XR ELBOW COMPLETE 3+ VIEWS $231.60 $386.00 $224.57–$386.00 — 40%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT/SELLA/FOSSA/EAR W/O CONTRAST $1,086.00 $1,810.00 $905.00–$1,810.00 34% above 40%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT/SELLA/FOSSA/EAR W/O CONTRAST $1,086.00 $1,810.00 $1,053.06–$1,810.00 — 40%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC XR FACIAL BONES COMPLETE 3+ VIEWS $315.60 $526.00 $263.00–$526.00 16% above 40%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC XR FACIAL BONES COMPLETE 3+ VIEWS $315.60 $526.00 $306.03–$526.00 — 40%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC XR FOREARM 2 VIEWS $213.60 $356.00 $178.00–$356.00 15% above 40%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC XR FOREARM 2 VIEWS $213.60 $356.00 $207.12–$356.00 — 40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBILIARY SYSTEM IMAGING INC GALLBLADDER $1,114.20 $1,857.00 $928.50–$1,857.00 15% below 40%
Hand X-ray, 2 views CPT 73120 HC XR HAND 2 VIEWS $289.80 $483.00 $241.50–$483.00 69% above 40%
Hand X-ray, 2 views inpatient CPT 73120 HC XR HAND 2 VIEWS $289.80 $483.00 $281.01–$483.00 — 40%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC XR CALCANEUS 2+ VIEWS $213.60 $356.00 $178.00–$356.00 1% below 40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC XR CALCANEUS 2+ VIEWS $213.60 $356.00 $207.12–$356.00 — 40%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC HST UNATTENDED W/ TYPE III PORTABLE MONITOR $460.80 $768.00 $384.00–$768.00 12% above 40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND SPLY $2,828.70 $4,714.50 $2,357.25–$4,714.50 15% below 40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND CPAP $2,828.70 $4,714.50 $2,357.25–$4,714.50 15% below 40%
Knee X-ray, 3 views CPT 73562 HC XR KNEE 3 VIEWS $276.60 $461.00 $230.50–$461.00 21% above 40%
Knee X-ray, 3 views inpatient CPT 73562 HC XR KNEE 3 VIEWS $276.60 $461.00 $268.21–$461.00 — 40%
Knee X-ray, complete, 4 or more views CPT 73564 HC XR KNEE COMPLETE 4+ VIEWS $298.20 $497.00 $248.50–$497.00 14% above 40%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC XR KNEE COMPLETE 4+ VIEWS $298.20 $497.00 $289.15–$497.00 — 40%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY W/O CONTRAST $944.40 $1,574.00 $787.00–$1,574.00 20% above 40%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTREMITY W/O CONTRAST $944.40 $1,574.00 $915.75–$1,574.00 — 40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED $684.00 $1,140.00 $570.00–$1,140.00 50% above 40%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US EXTREMITY NON VASCULAR LIMITED ANATOMIC SPEC $468.00 $780.00 $390.00–$780.00 55% above 40%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC LOW DOSE LUNG CT SCREENING $891.60 $1,486.00 $743.00–$1,486.00 363% above 40%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC XR TIBIA/FIBULA 2 VIEWS $213.60 $356.00 $178.00–$356.00 8% above 40%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC XR TIBIA/FIBULA 2 VIEWS $213.60 $356.00 $207.12–$356.00 — 40%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD W/O CONTRAST $1,931.40 $3,219.00 $1,609.50–$3,219.00 79% above 40%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA HEAD W/O CONTRAST $1,931.40 $3,219.00 $1,872.81–$3,219.00 — 40%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY JOINT W/O CONTRAST $1,789.20 $2,982.00 $1,491.00–$2,982.00 74% above 40%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXTREMITY JOINT W/O CONTRAST $1,789.20 $2,982.00 $1,734.93–$2,982.00 — 40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY JOINT W&W/O CONTRAST $2,354.40 $3,924.00 $1,962.00–$3,924.00 63% above 40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXTREMITY JOINT W&W/O CONTRAST $2,354.40 $3,924.00 $2,282.98–$3,924.00 — 40%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN W/O CONTRAST $1,800.60 $3,001.00 $1,500.50–$3,001.00 69% above 40%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN W/O CONTRAST $1,800.60 $3,001.00 $1,745.98–$3,001.00 — 40%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W&W/O CONTRAST $2,515.20 $4,192.00 $2,096.00–$4,192.00 59% above 40%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN W&W/O CONTRAST $2,515.20 $4,192.00 $2,438.91–$4,192.00 — 40%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN W/O CONTRAST $1,804.20 $3,007.00 $1,503.50–$3,007.00 74% above 40%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN W/O CONTRAST $1,804.20 $3,007.00 $1,749.47–$3,007.00 — 40%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W&W/O CONTRAST $2,644.20 $4,407.00 $2,203.50–$4,407.00 92% above 40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W&W/O CONTRAST $2,644.20 $4,407.00 $2,563.99–$4,407.00 — 40%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST $1,763.40 $2,939.00 $1,469.50–$2,939.00 70% above 40%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST $1,763.40 $2,939.00 $1,709.91–$2,939.00 — 40%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W&W/O CONTRAST $2,359.20 $3,932.00 $1,966.00–$3,932.00 61% above 40%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMBAR SPINE W&W/O CONTRAST $2,359.20 $3,932.00 $2,287.64–$3,932.00 — 40%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O CONTRAST $1,775.40 $2,959.00 $1,479.50–$2,959.00 73% above 40%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THORACIC SPINE W/O CONTRAST $1,775.40 $2,959.00 $1,721.55–$2,959.00 — 40%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W&W/O CONTRAST $2,314.80 $3,858.00 $1,929.00–$3,858.00 58% above 40%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERVICAL SPINE W&W/O CONTRAST $2,314.80 $3,858.00 $2,244.58–$3,858.00 — 40%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O CONTRAST $1,816.80 $3,028.00 $1,514.00–$3,028.00 74% above 40%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O CONTRAST $1,816.80 $3,028.00 $1,761.69–$3,028.00 — 40%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W&W/O CONTRAST $3,040.80 $5,068.00 $2,534.00–$5,068.00 109% above 40%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS W&W/O CONTRAST $3,040.80 $5,068.00 $2,948.56–$5,068.00 — 40%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS W/O CONTRAST $1,724.40 $2,874.00 $1,437.00–$2,874.00 60% above 40%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS W/O CONTRAST $1,724.40 $2,874.00 $1,672.09–$2,874.00 — 40%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXTREMITY JOINT W/O CONTRAST $1,789.20 $2,982.00 $1,491.00–$2,982.00 68% above 40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPER EXTREMITY JOINT W/O CONTRAST $1,789.20 $2,982.00 $1,734.93–$2,982.00 — 40%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC XR CERVICAL SPINE 4 OR 5 VIEWS $330.00 $550.00 $275.00–$550.00 5% below 40%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC XR CERVICAL SPINE 4 OR 5 VIEWS $330.00 $550.00 $319.99–$550.00 — 40%
Neck soft tissue CT scan with contrast CPT 70491 HC CT NECK W/CONTRAST $1,048.20 $1,747.00 $873.50–$1,747.00 7% above 40%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT NECK W/CONTRAST $1,048.20 $1,747.00 $1,016.40–$1,747.00 — 40%
Neck soft tissue CT scan without contrast CPT 70490 HC CT NECK W/O CONTRAST $942.60 $1,571.00 $785.50–$1,571.00 13% above 40%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT NECK W/O CONTRAST $942.60 $1,571.00 $914.01–$1,571.00 — 40%
Neck soft tissue X-ray CPT 70360 HC XR NECK SOFT TISSUE $238.80 $398.00 $199.00–$398.00 38% above 40%
Neck soft tissue X-ray inpatient CPT 70360 HC XR NECK SOFT TISSUE $238.80 $398.00 $231.56–$398.00 — 40%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM MYOCARDIAL PERFUSION MULTIPLE SPECT $3,672.60 $6,121.00 $3,060.50–$6,121.00 2% below 40%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET W/CT TUMOR IMAGING SKULL TO MID-THIGH $3,697.80 $6,163.00 $3,081.50–$6,163.00 9% below 40%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC HC NM PET-CT PROSTATE $3,697.80 $6,163.00 $3,081.50–$6,163.00 9% below 40%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS W/O CONTRAST $924.00 $1,540.00 $770.00–$1,540.00 11% above 40%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS W/O CONTRAST $924.00 $1,540.00 $895.97–$1,540.00 — 40%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIS NON OB LIMITED $363.60 $606.00 $303.00–$606.00 9% above 40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIS NON OB $496.80 $828.00 $414.00–$828.00 8% above 40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US PREGNANCY > 14 WEEKS SINGLE/FIRST GEST $508.20 $847.00 $423.50–$847.00 8% below 40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US PREGNANCY < 14 WEEKS SINGLE/FIRST GEST $415.20 $692.00 $346.00–$692.00 18% below 40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US PREGNANCY 1 OR MORE FETUSES LIMITED $338.40 $564.00 $282.00–$564.00 13% below 40%
Rib X-ray, one side, 2 views one side CPT 71100 HC XR RIBS UNILATERAL 2 VIEWS $259.20 $432.00 $216.00–$432.00 27% above 40%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC XR RIBS UNILATERAL 2 VIEWS $259.20 $432.00 $251.34–$432.00 — 40%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 HC XR RIBS UNILATERAL W/CHEST 3+ VIEWS $352.80 $588.00 $294.00–$588.00 45% above 40%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 HC XR RIBS UNILATERAL W/CHEST 3+ VIEWS $352.80 $588.00 $342.10–$588.00 — 40%
Screening mammogram, both breasts both sides CPT 77067 HC MAMMOGRAM SCREENING BILATERAL W/DIGITAL IMAGES W CAD $321.60 $536.00 $268.00–$536.00 — 40%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC XR SHOULDER COMPLETE 2+ VIEWS $245.40 $409.00 $204.50–$409.00 17% above 40%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC XR SHOULDER COMPLETE 2+ VIEWS $245.40 $409.00 $237.96–$409.00 — 40%
Sinus X-ray, complete, 3 or more views CPT 70220 HC XR SINUSES COMPLETE 3+ VIEWS $292.20 $487.00 $243.50–$487.00 3% above 40%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC XR SINUSES COMPLETE 3+ VIEWS $292.20 $487.00 $283.34–$487.00 — 40%
Skull X-ray, fewer than 4 views CPT 70250 HC XR SKULL < 4 VIEWS $213.00 $355.00 $177.50–$355.00 9% below 40%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC XR SKULL < 4 VIEWS $213.00 $355.00 $206.54–$355.00 — 40%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND $2,640.00 $4,400.00 $2,200.00–$4,400.00 5% below 40%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC ECHO REST & STRESS $1,543.20 $2,572.00 $1,286.00–$2,572.00 14% below 40%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC ECHO REST & STRESS $1,543.20 $2,572.00 $1,496.39–$2,572.00 — 40%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC XR EXAM SWLNG FUNCJ CNTRST STUDY $378.60 $631.00 $315.50–$631.00 3% above 40%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC XR EXAM SWLNG FUNCJ CNTRST STUDY $378.60 $631.00 $367.12–$631.00 — 40%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC XR FEMUR MIN 2 VIEWS $213.00 $355.00 $177.50–$355.00 6% above 40%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC XR FEMUR MIN 2 VIEWS $213.00 $355.00 $206.54–$355.00 — 40%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT THORACIC SPINE W/O CONTRAST $1,023.60 $1,706.00 $853.00–$1,706.00 17% above 40%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT THORACIC SPINE W/O CONTRAST $1,023.60 $1,706.00 $992.55–$1,706.00 — 40%
Toe X-ray, 2 or more views CPT 73660 HC XR TOE(S) 2+ VIEWS $211.80 $353.00 $176.50–$353.00 43% above 40%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL $442.80 $738.00 $369.00–$738.00 9% above 40%
Transvaginal ultrasound during pregnancy CPT 76817 HC US PREGNANCY TRANSVAGINAL $315.00 $525.00 $262.50–$525.00 15% below 40%
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMEN COMPLETE $706.80 $1,178.00 $589.00–$1,178.00 35% above 40%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM $480.60 $801.00 $400.50–$801.00 13% above 40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US SOFT TISSUE HEAD/NECK $632.40 $1,054.00 $527.00–$1,054.00 48% above 40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC XR EXAM UPR GI TRC 1CNTRST $469.20 $782.00 $391.00–$782.00 10% below 40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC XR EXAM UPR GI TRC 1CNTRST $469.20 $782.00 $454.97–$782.00 — 40%
Upper arm X-ray (humerus), 2 views CPT 73060 HC XR HUMERUS 2+ VIEWS $213.60 $356.00 $178.00–$356.00 11% above 40%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XR HUMERUS 2+ VIEWS $213.60 $356.00 $207.12–$356.00 — 40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUPLEX VENOUS EXTREMITY UNILATERAL/LIMITED $656.40 $1,094.00 $547.00–$1,094.00 1% above 40%
Wrist X-ray, 2 views CPT 73100 HC XR WRIST 2 VIEWS $255.00 $425.00 $212.50–$425.00 62% above 40%
Wrist X-ray, 2 views inpatient CPT 73100 HC XR WRIST 2 VIEWS $255.00 $425.00 $247.26–$425.00 — 40%
Wrist X-ray, complete, 3 or more views CPT 73110 HC XR WRIST COMPLETE 3+ VIEWS $285.00 $475.00 $237.50–$475.00 12% above 40%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC XR WRIST COMPLETE 3+ VIEWS $285.00 $475.00 $276.36–$475.00 — 40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC XR HIP UNILATERAL W/PELVIS 2-3 VIEWS $343.20 $572.00 $286.00–$572.00 28% above 40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC XR HIP UNILATERAL W/PELVIS 2-3 VIEWS $343.20 $572.00 $332.79–$572.00 — 40%
X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN 1 VIEW $238.80 $398.00 $199.00–$398.00 7% above 40%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN 1 VIEW $238.80 $398.00 $231.56–$398.00 — 40%
X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 2 VIEWS $210.00 $350.00 $175.00–$350.00 31% above 40%
X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 2 VIEWS $210.00 $350.00 $203.63–$350.00 — 40%
X-ray of the finger(s), 2 or more views CPT 73140 HC XR FINGER(S) 2+ VIEWS $248.40 $414.00 $207.00–$414.00 59% above 40%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XR FINGER(S) 2+ VIEWS $248.40 $414.00 $240.87–$414.00 — 40%
X-ray of the foot, 2 views CPT 73620 HC XR FOOT 2 VIEWS $265.80 $443.00 $221.50–$443.00 62% above 40%
X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 2 VIEWS $265.80 $443.00 $257.74–$443.00 — 40%
X-ray of the foot, complete, 3 or more views CPT 73630 HC XR FOOT COMPLETE 3+ VIEWS $216.60 $361.00 $180.50–$361.00 8% above 40%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC XR FOOT COMPLETE 3+ VIEWS $216.60 $361.00 $210.03–$361.00 — 40%
X-ray of the hand, 3 or more views CPT 73130 HC XR HAND COMPLETE 3+ VIEWS $295.80 $493.00 $246.50–$493.00 47% above 40%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC XR HAND COMPLETE 3+ VIEWS $295.80 $493.00 $286.83–$493.00 — 40%
X-ray of the knee, 1 or 2 views CPT 73560 HC XR KNEE 1 OR 2 VIEWS $245.40 $409.00 $204.50–$409.00 18% above 40%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC XR KNEE 1 OR 2 VIEWS $245.40 $409.00 $237.96–$409.00 — 40%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XR LUMBAR SPINE 2 OR 3 VIEWS $267.60 $446.00 $223.00–$446.00 6% above 40%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC XR LUMBAR SPINE 2 OR 3 VIEWS $267.60 $446.00 $259.48–$446.00 — 40%
X-ray of the lower back, 4 or more views CPT 72110 HC XR LUMBAR SPINE 4+ VIEWS $403.20 $672.00 $336.00–$672.00 16% above 40%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC XR LUMBAR SPINE 4+ VIEWS $403.20 $672.00 $390.97–$672.00 — 40%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC XR THORACIC SPINE 2 VIEWS $270.00 $450.00 $225.00–$450.00 13% above 40%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC XR THORACIC SPINE 2 VIEWS $270.00 $450.00 $261.81–$450.00 — 40%
X-ray of the nasal bones, 3 or more views CPT 70160 HC XR NASAL BONES COMPLETE 3+ VIEWS $270.00 $450.00 $225.00–$450.00 32% above 40%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC XR NASAL BONES COMPLETE 3+ VIEWS $270.00 $450.00 $261.81–$450.00 — 40%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC XR CERVICAL SPINE 2 OR 3 VIEWS $273.60 $456.00 $228.00–$456.00 9% above 40%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC XR CERVICAL SPINE 2 OR 3 VIEWS $273.60 $456.00 $265.30–$456.00 — 40%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC XR PELVIS 1 OR 2 VIEWS $240.00 $400.00 $200.00–$400.00 22% above 40%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC XR PELVIS 1 OR 2 VIEWS $240.00 $400.00 $232.72–$400.00 — 40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XR SACRUM/COCCYX 2+ VIEWS $235.20 $392.00 $196.00–$392.00 7% above 40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC XR SACRUM/COCCYX 2+ VIEWS $235.20 $392.00 $228.07–$392.00 — 40%

Lab tests

ProcedureCash price List priceInsurers payvs IndianaOff list
ACTH blood test CPT 82024 HC ACTH B $165.00 $275.00 $137.50–$275.00 37% below 40%
ACTH blood test inpatient CPT 82024 HC ACTH B $165.00 $275.00 $160.00–$275.00 — 40%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALT SGPT B $49.20 $82.00 $41.00–$82.00 76% above 40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC ALT SGPT B $49.20 $82.00 $47.71–$82.00 — 40%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC AST SGOT B $49.20 $82.00 $41.00–$82.00 70% above 40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC AST SGOT B $49.20 $82.00 $47.71–$82.00 — 40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS PANEL ACUTE $249.60 $416.00 $208.00–$416.00 21% below 40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS PANEL ACUTE $249.60 $416.00 $242.03–$416.00 — 40%
Albumin blood test CPT 82040 HC ALBUMIN MS PROFILE $13.20 $22.00 $11.00–$22.00 43% below 40%
Albumin blood test CPT 82040 HC ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD $48.00 $80.00 $40.00–$80.00 108% above 40%
Albumin blood test CPT 82040 HC ALBUMIN B $48.60 $81.00 $40.50–$81.00 110% above 40%
Albumin blood test inpatient CPT 82040 HC ALBUMIN MS PROFILE $13.20 $22.00 $12.80–$22.00 — 40%
Albumin blood test inpatient CPT 82040 HC ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD $48.00 $80.00 $46.54–$80.00 — 40%
Albumin blood test inpatient CPT 82040 HC ALBUMIN B $48.60 $81.00 $47.13–$81.00 — 40%
Aldosterone blood test CPT 82088 HC ALDOSTERONE 24 HR URINE $166.80 $278.00 $139.00–$278.00 19% below 40%
Aldosterone blood test CPT 82088 HC ALDOSTERONE BLOOD $166.80 $278.00 $139.00–$278.00 19% below 40%
Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE 24 HR URINE $166.80 $278.00 $161.74–$278.00 — 40%
Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE BLOOD $166.80 $278.00 $161.74–$278.00 — 40%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ALKALINE PHOSPHATASE $49.20 $82.00 $41.00–$82.00 51% above 40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ALKALINE PHOSPHATASE $49.20 $82.00 $47.71–$82.00 — 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, EGWTP $5.40 $9.00 $4.50–$9.00 72% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC HOUSE DUST MITES D.F. IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC BOX ELD MAPLE S IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC OAK IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC CAT EPITHELIUM IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC WHITE ASH IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC WALNUT TREE IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC TIMOHTY GRASS IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC EASTERN SYCAMORE IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC WALNUT-FOOD IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC CHESNUT SWEET IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALTERNARIA TENUIS IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ASPERGILLUS FUMIGATUS IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC RED SORREL IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC BURMUDA GRASS IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC SILVER BIRCH IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC CLADOSPORIUM IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC COCKROACH IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC SHORT RAGWEED IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ROUGH PIGWEED IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC PENICILLIUM IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC MUGWORT IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC MOUNTAIN CEDAR IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ELM IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC DOG DANDER IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC HOUSE DUST MITES D.P. IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC COTTONWOOD IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC OAT IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC TOMATO IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC EGG IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC MILK IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC CODFISH IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC WHEAT IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC CORN-FOOD IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC PEANUT IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC SOYBEAN IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC CRAB IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC SHRIMP IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC PORK IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC BEEF IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC TUNA IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC STRAWBERRY IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC CARROT IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ORANGE IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC WHITE POTATO IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC BAKER'S YEAST IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC APPLE IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC SESAME SEED IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC HAZELNUT-FOOD IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC BRAZIL NUT IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALMOND IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC PECAN-FOOD IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC CASHEW IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD PISTACHIO IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC PINE NUT IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC WILLOW IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC SWEET VERNAL GRASS IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC RED TOP IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ORCHARD GRASS IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC MEADOW FESCUE IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC LAMBS QUARTER IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC JUNE GRASS IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC HELMINTHOSPORIUM HALODES IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC HOUSE DUST GREER LAB IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC GIANT RAGWEED IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC GOOSE FEATHERS IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC GOLDENROD IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ENGLISH PLANTAIN IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC DUCK FEATHERS IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC DANDELION IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC CHICKEN FEATHERS IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC CANDIDA ALBICANS MONILIA IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC COCKLEBUR IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC BEECH IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC SCALLOP IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC GLUTEN IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC EGG WHITE IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC MULBERRY IGE $14.40 $24.00 $12.00–$24.00 25% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC CANDIDA ALBICANS IGE $18.00 $30.00 $15.00–$30.00 6% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC IMMUNOGLOBULIN E, S $32.40 $54.00 $27.00–$54.00 69% above 40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC GALACTOSE-ALPHA-1,3-IGE $51.00 $85.00 $42.50–$85.00 166% above 40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, EGWTP $5.40 $9.00 $5.24–$9.00 — 40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE $14.40 $24.00 $13.96–$24.00 — 40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC CANDIDA ALBICANS IGE $18.00 $30.00 $17.45–$30.00 — 40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC GALACTOSE-ALPHA-1,3-IGE $51.00 $85.00 $49.45–$85.00 — 40%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC AFP TUMOR MARKER $71.40 $119.00 $59.50–$119.00 30% below 40%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC AFP MATERNAL $71.40 $119.00 $59.50–$119.00 30% below 40%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC AFP TUMOR MARKER $71.40 $119.00 $69.23–$119.00 — 40%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC AFP MATERNAL $71.40 $119.00 $69.23–$119.00 — 40%
Ammonia blood test CPT 82140 HC AMMONIUM, 24HR, U $60.60 $101.00 $50.50–$101.00 50% below 40%
Ammonia blood test CPT 82140 HC AMMONIA B $65.40 $109.00 $54.50–$109.00 46% below 40%
Ammonia blood test inpatient CPT 82140 HC AMMONIUM, 24HR, U $60.60 $101.00 $58.76–$101.00 — 40%
Ammonia blood test inpatient CPT 82140 HC AMMONIA B $65.40 $109.00 $63.42–$109.00 — 40%
Amylase blood test CPT 82150 HC AMYLASE BODY FLUID $19.80 $33.00 $16.50–$33.00 61% below 40%
Amylase blood test CPT 82150 HC AMYLASE B $68.40 $114.00 $57.00–$114.00 35% above 40%
Amylase blood test inpatient CPT 82150 HC AMYLASE BODY FLUID $19.80 $33.00 $19.20–$33.00 — 40%
Amylase blood test inpatient CPT 82150 HC AMYLASE B $68.40 $114.00 $66.33–$114.00 — 40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CYCLIC CITRUL PEPTIDE AB IGG $80.40 $134.00 $67.00–$134.00 52% above 40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CYCLIC CITRUL PEPTIDE AB IGG $80.40 $134.00 $77.96–$134.00 — 40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC SCLERODERMA COMP PROFILE $34.80 $58.00 $29.00–$58.00 42% below 40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANA BODY FLUID $53.40 $89.00 $44.50–$89.00 11% below 40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANA SCREEN $183.60 $306.00 $153.00–$306.00 206% above 40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC SCLERODERMA COMP PROFILE $34.80 $58.00 $33.74–$58.00 — 40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANA BODY FLUID $53.40 $89.00 $51.78–$89.00 — 40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANA SCREEN $183.60 $306.00 $178.03–$306.00 — 40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC BN PEPTIDE BNP $171.60 $286.00 $143.00–$286.00 1% above 40%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC BN PEPTIDE BNP $171.60 $286.00 $166.39–$286.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE CSF $61.80 $103.00 $51.50–$103.00 34% below 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE MISC $61.80 $103.00 $51.50–$103.00 34% below 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE OTHR SPECIMN AEROBIC $61.80 $103.00 $51.50–$103.00 34% below 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE BRONCH BRUSH $74.40 $124.00 $62.00–$124.00 20% below 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE EAR $76.20 $127.00 $63.50–$127.00 18% below 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE GENITAL TRACT $79.20 $132.00 $66.00–$132.00 15% below 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE SPUTUM $87.60 $146.00 $73.00–$146.00 6% below 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE VAGINAL $93.60 $156.00 $78.00–$156.00 at median 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE BRONCH WASH $93.60 $156.00 $78.00–$156.00 at median 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE BODY FLUID $93.60 $156.00 $78.00–$156.00 at median 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE NOSE AND THROAT $93.60 $156.00 $78.00–$156.00 at median 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE IV CATH TIP $183.60 $306.00 $153.00–$306.00 97% above 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE EYE $183.60 $306.00 $153.00–$306.00 97% above 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE CSF $61.80 $103.00 $59.93–$103.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE OTHR SPECIMN AEROBIC $61.80 $103.00 $59.93–$103.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE MISC $61.80 $103.00 $59.93–$103.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE BRONCH BRUSH $74.40 $124.00 $72.14–$124.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE EAR $76.20 $127.00 $73.89–$127.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE GENITAL TRACT $79.20 $132.00 $76.80–$132.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE SPUTUM $87.60 $146.00 $84.94–$146.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE VAGINAL $93.60 $156.00 $90.76–$156.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE NOSE AND THROAT $93.60 $156.00 $90.76–$156.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE BODY FLUID $93.60 $156.00 $90.76–$156.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE BRONCH WASH $93.60 $156.00 $90.76–$156.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE IV CATH TIP $183.60 $306.00 $178.03–$306.00 — 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE EYE $183.60 $306.00 $178.03–$306.00 — 40%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PROF CHEM8 $74.40 $124.00 $62.00–$124.00 8% below 40%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PROF CHEM8 $74.40 $124.00 $72.14–$124.00 — 40%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL $49.80 $83.00 $41.50–$83.00 48% above 40%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN BF $79.20 $132.00 $66.00–$132.00 136% above 40%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL $49.80 $83.00 $48.29–$83.00 — 40%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN BF $79.20 $132.00 $76.80–$132.00 — 40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC RENAL PATH LEVEL IV WET TISSUE $223.80 $373.00 $186.50–$373.00 14% below 40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC BONE MARROW CLOT $334.20 $557.00 $278.50–$557.00 29% above 40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC RENAL PATH LEVEL IV WET TISSUE $223.80 $373.00 $217.01–$373.00 — 40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC BONE MARROW CLOT $334.20 $557.00 $324.06–$557.00 — 40%
Blood culture for bacteria CPT 87040 HC CULTURE BLOOD $121.20 $202.00 $101.00–$202.00 7% below 40%
Blood culture for bacteria inpatient CPT 87040 HC CULTURE BLOOD $121.20 $202.00 $117.52–$202.00 — 40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE $11.40 $19.00 $9.50–$19.00 32% below 40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE $11.40 $19.00 $11.05–$19.00 — 40%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE B $33.00 $55.00 $27.50–$55.00 23% above 40%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE BLOOD RESP $34.20 $57.00 $28.50–$57.00 27% above 40%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE B $33.00 $55.00 $32.00–$55.00 — 40%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE BLOOD RESP $34.20 $57.00 $33.16–$57.00 — 40%
Blood lead test CPT 83655 HC LEAD OCCUP EXPOS $23.40 $39.00 $19.50–$39.00 67% below 40%
Blood lead test CPT 83655 HC LEAD 24HR URINE $64.20 $107.00 $53.50–$107.00 10% below 40%
Blood lead test CPT 83655 HC LEAD WHOLE BLOOD $96.00 $160.00 $80.00–$160.00 35% above 40%
Blood lead test inpatient CPT 83655 HC LEAD OCCUP EXPOS $23.40 $39.00 $22.69–$39.00 — 40%
Blood lead test inpatient CPT 83655 HC LEAD 24HR URINE $64.20 $107.00 $62.25–$107.00 — 40%
Blood lead test inpatient CPT 83655 HC LEAD WHOLE BLOOD $96.00 $160.00 $93.09–$160.00 — 40%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC HCG QUALITATIVE $71.40 $119.00 $59.50–$119.00 7% below 40%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC HCG SERUM PREGNANCY $71.40 $119.00 $59.50–$119.00 7% below 40%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC HCG QUALITATIVE $71.40 $119.00 $69.23–$119.00 — 40%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC ABO TYPING $109.20 $182.00 $91.00–$182.00 112% above 40%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC ABO TYPING $109.20 $182.00 $105.89–$182.00 — 40%
Blood urea nitrogen (BUN) test CPT 84520 HC BUN B $49.80 $83.00 $41.50–$83.00 108% above 40%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC BUN B $49.80 $83.00 $48.29–$83.00 — 40%
C-peptide blood test CPT 84681 HC C PEPTIDE $87.00 $145.00 $72.50–$145.00 34% below 40%
C-peptide blood test inpatient CPT 84681 HC C PEPTIDE $87.00 $145.00 $84.36–$145.00 — 40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C REACTIVE PROTEIN $65.40 $109.00 $54.50–$109.00 7% below 40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C REACTIVE PROTEIN $65.40 $109.00 $63.42–$109.00 — 40%
C. difficile toxin gene test (stool PCR) CPT 87493 HC CLOSTRIDIUM BY PCR $226.80 $378.00 $189.00–$378.00 67% above 40%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC CLOSTRIDIUM BY PCR $226.80 $378.00 $219.92–$378.00 — 40%
CA 19-9 blood test (tumor marker) CPT 86301 HC CARBOHYDRATE ANTIGEN 19 9 $106.80 $178.00 $89.00–$178.00 27% below 40%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC CARBOHYDRATE ANTIGEN 19 9 $106.80 $178.00 $103.56–$178.00 — 40%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC CA 125 ANTIGEN $133.20 $222.00 $111.00–$222.00 19% below 40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC CA 125 ANTIGEN $133.20 $222.00 $129.16–$222.00 — 40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID; 2 (SARS-COV-2), AMPLIFIED PROBE TECHNIQUE $61.80 $103.00 $51.50–$103.00 42% below 40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID; 2 (SARS-COV-2), AMPLIFIED PROBE TECHNIQUE $61.80 $103.00 $59.93–$103.00 — 40%
Calcium blood test, total CPT 82310 HC CALCIUM B $49.80 $83.00 $41.50–$83.00 83% above 40%
Calcium blood test, total CPT 82310 HC CALCIUM URINE RANDOM $49.80 $83.00 $41.50–$83.00 83% above 40%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM URINE RANDOM $49.80 $83.00 $48.29–$83.00 — 40%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM B $49.80 $83.00 $48.29–$83.00 — 40%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CEA CARCINOEMBRYONIC ANTIGEN $116.40 $194.00 $97.00–$194.00 8% below 40%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CEA CARCINOEMBRYONIC ANTIGEN $116.40 $194.00 $112.87–$194.00 — 40%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER IGM $33.00 $55.00 $27.50–$55.00 68% below 40%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER IGG $33.00 $55.00 $27.50–$55.00 68% below 40%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER AB IGG IGM $67.20 $112.00 $56.00–$112.00 34% below 40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER IGM $33.00 $55.00 $32.00–$55.00 — 40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER IGG $33.00 $55.00 $32.00–$55.00 — 40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER AB IGG IGM $67.20 $112.00 $65.16–$112.00 — 40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC C TRACHOMATIS $89.40 $149.00 $74.50–$149.00 12% below 40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC C TRACHOMATIS $89.40 $149.00 $86.69–$149.00 — 40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PROFILE CORONARY RISK $129.60 $216.00 $108.00–$216.00 17% above 40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PROFILE CORONARY RISK $129.60 $216.00 $125.67–$216.00 — 40%
Complete blood count (CBC) with differential CPT 85025 HC CBC W AUTO DIFF $60.00 $100.00 $50.00–$100.00 49% above 40%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC W AUTO DIFF $60.00 $100.00 $58.18–$100.00 — 40%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METABOLIC PROFILE $114.60 $191.00 $95.50–$191.00 12% above 40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHENSIVE METABOLIC PROFILE $114.60 $191.00 $111.12–$191.00 — 40%
Cortisol blood test, total CPT 82533 HC CORTISOL B $78.60 $131.00 $65.50–$131.00 18% below 40%
Cortisol blood test, total CPT 82533 HC CORTISOL, SALIVA $130.20 $217.00 $108.50–$217.00 36% above 40%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL B $78.60 $131.00 $76.22–$131.00 — 40%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL, SALIVA $130.20 $217.00 $126.25–$217.00 — 40%
Creatine kinase (CK) blood test, total CPT 82550 HC CK CPK CREATINE PHOSPHOKINASE $49.20 $82.00 $41.00–$82.00 27% above 40%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CK CPK CREATINE PHOSPHOKINASE $49.20 $82.00 $47.71–$82.00 — 40%
Creatinine blood test CPT 82565 HC CREATININE B $48.00 $80.00 $40.00–$80.00 67% above 40%
Creatinine blood test CPT 82565 HC CREATININE BLOOD POC $48.00 $80.00 $40.00–$80.00 67% above 40%
Creatinine blood test inpatient CPT 82565 HC CREATININE BLOOD POC $48.00 $80.00 $46.54–$80.00 — 40%
Creatinine blood test inpatient CPT 82565 HC CREATININE B $48.00 $80.00 $46.54–$80.00 — 40%
Cytomegalovirus (CMV) antibody test CPT 86644 HC CMV ABS IGG $33.00 $55.00 $27.50–$55.00 58% below 40%
Cytomegalovirus (CMV) antibody test CPT 86644 HC TORCH CMV IGG $33.00 $55.00 $27.50–$55.00 58% below 40%
Cytomegalovirus (CMV) antibody test CPT 86644 HC CMV IGG AND IGM $52.80 $88.00 $44.00–$88.00 32% below 40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC CMV ABS IGG $33.00 $55.00 $32.00–$55.00 — 40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC TORCH CMV IGG $33.00 $55.00 $32.00–$55.00 — 40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC CMV IGG AND IGM $52.80 $88.00 $51.20–$88.00 — 40%
D-dimer blood test (blood clot marker) CPT 85379 HC DIMER QUANTITATIVE $73.20 $122.00 $61.00–$122.00 40% below 40%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC DIMER QUANTITATIVE $73.20 $122.00 $70.98–$122.00 — 40%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DHEA SULFATE $130.80 $218.00 $109.00–$218.00 15% below 40%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DHEA SULFATE $130.80 $218.00 $126.83–$218.00 — 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN SUBOXONE $27.00 $45.00 $22.50–$45.00 76% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG 7 DOT CHAIN OF CUSTODY $28.20 $47.00 $23.50–$47.00 75% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC CONTROLLED SUBSTANCE MONITORING, U $59.40 $99.00 $49.50–$99.00 47% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST, PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES $67.50 $112.50 $56.25–$112.50 40% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC BARBITURATES/COCAINE/THC $72.60 $121.00 $60.50–$121.00 36% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC MEPHEDRONE & METHYLONE, URINE $80.40 $134.00 $67.00–$134.00 29% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC 17 PANEL HAIR DRUG SCRN REF $84.00 $140.00 $70.00–$140.00 26% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC GHB SCREEN, UR $84.60 $141.00 $70.50–$141.00 25% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN 7 MEDICAL $86.40 $144.00 $72.00–$144.00 24% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC KETAMINE AND METABOLITE SCREEN,P $87.00 $145.00 $72.50–$145.00 23% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC ANABOLIC STEROIDS; 1 OR 2 $89.40 $149.00 $74.50–$149.00 21% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC GABAPENTINE URINE $99.60 $166.00 $83.00–$166.00 12% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC BUPRENORPHINE CONFIRMATION $100.20 $167.00 $83.50–$167.00 11% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC ETHYL GLUCURONIDE SCREEN WITH REFLEX, RANDOM URINE $102.00 $170.00 $85.00–$170.00 10% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC HYPOGLYCEMIC AGENT SCREEN S $108.00 $180.00 $90.00–$180.00 4% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC AMPHETAMINES ANALYSIS, S $109.80 $183.00 $91.50–$183.00 3% below 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC FENTANYL AND METABOLITES, URINE $114.00 $190.00 $95.00–$190.00 1% above 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC FENTANYL SCREEN W/REFLEX,U $114.60 $191.00 $95.50–$191.00 1% above 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC FENTANYL URINE IMMUNOASSAY $117.60 $196.00 $98.00–$196.00 4% above 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUGS OF ABUSE 10 PANEL, S $125.40 $209.00 $104.50–$209.00 11% above 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG ABUSE SURVEY W CONFIRM, 9P $133.20 $222.00 $111.00–$222.00 18% above 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC SYNTHETIC CANABINOIDS SCR UR $138.00 $230.00 $115.00–$230.00 22% above 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC AIT DRUG SCREEN URINE $194.40 $324.00 $162.00–$324.00 72% above 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC SEDATIVE HYPNOTIC PANEL UR $209.40 $349.00 $174.50–$349.00 85% above 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN, PRESCRIPTION/OTC $210.00 $350.00 $175.00–$350.00 86% above 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC CONTROLLED SUBSTANCE MONITORING, U $59.40 $99.00 $57.60–$99.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC BARBITURATES/COCAINE/THC $72.60 $121.00 $70.40–$121.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC MEPHEDRONE & METHYLONE, URINE $80.40 $134.00 $77.96–$134.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC GHB SCREEN, UR $84.60 $141.00 $82.03–$141.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC KETAMINE AND METABOLITE SCREEN,P $87.00 $145.00 $84.36–$145.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC ANABOLIC STEROIDS; 1 OR 2 $89.40 $149.00 $86.69–$149.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC GABAPENTINE URINE $99.60 $166.00 $96.58–$166.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC BUPRENORPHINE CONFIRMATION $100.20 $167.00 $97.16–$167.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC ETHYL GLUCURONIDE SCREEN WITH REFLEX, RANDOM URINE $102.00 $170.00 $98.91–$170.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC HYPOGLYCEMIC AGENT SCREEN S $108.00 $180.00 $104.72–$180.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC AMPHETAMINES ANALYSIS, S $109.80 $183.00 $106.47–$183.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC FENTANYL AND METABOLITES, URINE $114.00 $190.00 $110.54–$190.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC FENTANYL SCREEN W/REFLEX,U $114.60 $191.00 $111.12–$191.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC FENTANYL URINE IMMUNOASSAY $117.60 $196.00 $114.03–$196.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUGS OF ABUSE 10 PANEL, S $125.40 $209.00 $121.60–$209.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG ABUSE SURVEY W CONFIRM, 9P $133.20 $222.00 $129.16–$222.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC SYNTHETIC CANABINOIDS SCR UR $138.00 $230.00 $133.81–$230.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC AIT DRUG SCREEN URINE $194.40 $324.00 $188.50–$324.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC SEDATIVE HYPNOTIC PANEL UR $209.40 $349.00 $203.05–$349.00 — 40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG SCREEN, PRESCRIPTION/OTC $210.00 $350.00 $203.63–$350.00 — 40%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTES NA K CL C02 $86.40 $144.00 $72.00–$144.00 34% above 40%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTES POC $86.40 $144.00 $72.00–$144.00 34% above 40%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTES NA K CL C02 $86.40 $144.00 $83.78–$144.00 — 40%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTES POC $86.40 $144.00 $83.78–$144.00 — 40%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EPSTEIN BARR VIRAL CAPSID ANTGN IGM $45.00 $75.00 $37.50–$75.00 47% below 40%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EPSTEIN BARR VIRAL CAPSID ANTGN IGG $45.00 $75.00 $37.50–$75.00 47% below 40%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EPSTEIN BARR VIRUS PANEL $59.40 $99.00 $49.50–$99.00 30% below 40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EPSTEIN BARR VIRAL CAPSID ANTGN IGM $45.00 $75.00 $43.64–$75.00 — 40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EPSTEIN BARR VIRAL CAPSID ANTGN IGG $45.00 $75.00 $43.64–$75.00 — 40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EPSTEIN BARR VIRUS PANEL $59.40 $99.00 $57.60–$99.00 — 40%
Estradiol blood test CPT 82670 HC ESTRADIOL B $132.00 $220.00 $110.00–$220.00 at median 40%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL B $132.00 $220.00 $128.00–$220.00 — 40%
FSH (follicle-stimulating hormone) test CPT 83001 HC FSH FOLLICLE STIM HORMONE $99.00 $165.00 $82.50–$165.00 23% below 40%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC FSH FOLLICLE STIM HORMONE $99.00 $165.00 $96.00–$165.00 — 40%
Fecal calprotectin (stool inflammation test) CPT 83993 HC CALPROTECTIN FECAL $70.80 $118.00 $59.00–$118.00 60% below 40%
Fecal calprotectin (stool inflammation test) CPT 83993 HC CALPROTECTIN, F $153.00 $255.00 $127.50–$255.00 15% below 40%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC CALPROTECTIN FECAL $70.80 $118.00 $68.65–$118.00 — 40%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC CALPROTECTIN, F $153.00 $255.00 $148.36–$255.00 — 40%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN $96.60 $161.00 $80.50–$161.00 24% above 40%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN $96.60 $161.00 $93.67–$161.00 — 40%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN B $109.20 $182.00 $91.00–$182.00 73% above 40%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN B $109.20 $182.00 $105.89–$182.00 — 40%
Folate (folic acid) blood test CPT 82746 HC FOLATE $75.00 $125.00 $62.50–$125.00 2% below 40%
Folate (folic acid) blood test inpatient CPT 82746 HC FOLATE $75.00 $125.00 $72.72–$125.00 — 40%
Free T3 thyroid hormone test CPT 84481 HC FREE T3 $190.20 $317.00 $158.50–$317.00 27% above 40%
Free T3 thyroid hormone test inpatient CPT 84481 HC FREE T3 $190.20 $317.00 $184.43–$317.00 — 40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC FREE T4 $75.00 $125.00 $62.50–$125.00 7% below 40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC FREE T4 $75.00 $125.00 $72.72–$125.00 — 40%
Free testosterone test CPT 84402 HC TESTOSTERONE FREE $81.00 $135.00 $67.50–$135.00 3% below 40%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GGT GAMMA GLUTAMYL TRANSPE $49.80 $83.00 $41.50–$83.00 47% above 40%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GGT GAMMA GLUTAMYL TRANSPE $49.80 $83.00 $48.29–$83.00 — 40%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE 1HR 75G COLA $40.20 $67.00 $33.50–$67.00 3% below 40%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE 1 HOUR PC 50G GLUCOLA $40.20 $67.00 $33.50–$67.00 3% below 40%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE 2 HOUR PC 75G GLUC $40.20 $67.00 $33.50–$67.00 3% below 40%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE 1HR 75G COLA $40.20 $67.00 $38.98–$67.00 — 40%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE 2 HOUR PC 75G GLUC $40.20 $67.00 $38.98–$67.00 — 40%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE 1 HOUR PC 50G GLUCOLA $40.20 $67.00 $38.98–$67.00 — 40%
Glucose tolerance test, 3 samples CPT 82951 HC LACTOSE TOLERANCE 120 $86.40 $144.00 $72.00–$144.00 17% above 40%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE 0 $146.40 $244.00 $122.00–$244.00 98% above 40%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC LACTOSE TOLERANCE 120 $86.40 $144.00 $83.78–$144.00 — 40%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE 0 $146.40 $244.00 $141.96–$244.00 — 40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N GONORRHOEAE $171.00 $285.00 $142.50–$285.00 72% above 40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N GONORRHOEAE $171.00 $285.00 $165.81–$285.00 — 40%
H. pylori antibody blood test CPT 86677 HC HELCOBACTER PYLORI POC $54.00 $90.00 $45.00–$90.00 46% below 40%
H. pylori antibody blood test CPT 86677 HC H PYLORI AB IGA $54.00 $90.00 $45.00–$90.00 46% below 40%
H. pylori antibody blood test inpatient CPT 86677 HC HELCOBACTER PYLORI POC $54.00 $90.00 $52.36–$90.00 — 40%
H. pylori antibody blood test inpatient CPT 86677 HC H PYLORI AB IGA $54.00 $90.00 $52.36–$90.00 — 40%
H. pylori stool antigen test CPT 87338 HC HELICOBACTOR PYLORI AG $93.60 $156.00 $78.00–$156.00 25% below 40%
H. pylori stool antigen test CPT 87338 HC H PILORI ANTIGEN $93.60 $156.00 $78.00–$156.00 25% below 40%
H. pylori stool antigen test inpatient CPT 87338 HC HELICOBACTOR PYLORI AG $93.60 $156.00 $90.76–$156.00 — 40%
H. pylori stool antigen test inpatient CPT 87338 HC H PILORI ANTIGEN $93.60 $156.00 $90.76–$156.00 — 40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV-1 QUANT & REVERSE TRANSCRP $148.80 $248.00 $124.00–$248.00 60% below 40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC VIRAL LOAD HIV $379.20 $632.00 $316.00–$632.00 1% above 40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV-1 QUANT & REVERSE TRANSCRP $148.80 $248.00 $144.29–$248.00 — 40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC VIRAL LOAD HIV $379.20 $632.00 $367.70–$632.00 — 40%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV ANTIBODY 1 PLUS 2 $89.40 $149.00 $74.50–$149.00 51% above 40%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV ANTIBODY 1 PLUS 2 $89.40 $149.00 $86.69–$149.00 — 40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HGB A1C $51.60 $86.00 $43.00–$86.00 23% below 40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCATED HEMOGLOBIN $63.60 $106.00 $53.00–$106.00 5% below 40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HGB A1C $51.60 $86.00 $50.03–$86.00 — 40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCATED HEMOGLOBIN $63.60 $106.00 $61.67–$106.00 — 40%
Hemoglobin blood test CPT 85018 HC HGB $21.60 $36.00 $18.00–$36.00 16% above 40%
Hemoglobin blood test inpatient CPT 85018 HC HGB $21.60 $36.00 $20.94–$36.00 — 40%
Hepatitis B core antibody test (total) CPT 86704 HC HEP B CORE ATB TOTAL $44.40 $74.00 $37.00–$74.00 35% below 40%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEP B CORE ATB TOTAL $44.40 $74.00 $43.05–$74.00 — 40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE ANTIBO $65.40 $109.00 $54.50–$109.00 at median 40%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURFACE ANTIBO $65.40 $109.00 $63.42–$109.00 — 40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC HEPATITIS B SURFACE ANTIGEN $49.80 $83.00 $41.50–$83.00 18% below 40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC HEPATITIS B SURFACE ANTIGEN $49.80 $83.00 $48.29–$83.00 — 40%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY $105.60 $176.00 $88.00–$176.00 4% above 40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY $105.60 $176.00 $102.40–$176.00 — 40%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C RNA QUANT BY PCR $366.60 $611.00 $305.50–$611.00 66% above 40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C RNA QUANT BY PCR $366.60 $611.00 $355.48–$611.00 — 40%
Herpes blood test, HSV-1 antibody CPT 86695 HC HSV TYPE1 G SPEC IGG $49.20 $82.00 $41.00–$82.00 4% below 40%
Herpes blood test, HSV-1 antibody CPT 86695 HC ASH FIBROSURE $330.60 $551.00 $275.50–$551.00 543% above 40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HSV TYPE1 G SPEC IGG $49.20 $82.00 $47.71–$82.00 — 40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC ASH FIBROSURE $330.60 $551.00 $320.57–$551.00 — 40%
Herpes blood test, HSV-2 antibody CPT 86696 HC HSV TYPE2 G SPEC IGG $72.00 $120.00 $60.00–$120.00 1% below 40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HSV TYPE2 G SPEC IGG $72.00 $120.00 $69.82–$120.00 — 40%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC CRP HIGH SENSITIVE $63.60 $106.00 $53.00–$106.00 14% below 40%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC CRP HIGH SENSITIVE $63.60 $106.00 $61.67–$106.00 — 40%
Homocysteine blood test CPT 83090 HC HOMOCYSTEINE B $130.80 $218.00 $109.00–$218.00 1% above 40%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTEINE B $130.80 $218.00 $126.83–$218.00 — 40%
Insulin blood test CPT 83525 HC INSULIN RANDOM $93.60 $156.00 $78.00–$156.00 23% above 40%
Insulin blood test inpatient CPT 83525 HC INSULIN RANDOM $93.60 $156.00 $90.76–$156.00 — 40%
Iron blood test (serum iron) CPT 83540 HC IRON B $49.80 $83.00 $41.50–$83.00 4% above 40%
Iron blood test (serum iron) CPT 83540 HC IRON TISSUE $54.00 $90.00 $45.00–$90.00 12% above 40%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON B $49.80 $83.00 $48.29–$83.00 — 40%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON TISSUE $54.00 $90.00 $52.36–$90.00 — 40%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON AND IRON BIND CAP $33.60 $56.00 $28.00–$56.00 25% below 40%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON AND IRON BIND CAP $33.60 $56.00 $32.58–$56.00 — 40%
Kidney function blood test panel CPT 80069 HC RENAL PROFILE $47.40 $79.00 $39.50–$79.00 55% below 40%
Kidney function blood test panel inpatient CPT 80069 HC RENAL PROFILE $47.40 $79.00 $45.96–$79.00 — 40%
LH (luteinizing hormone) test CPT 83002 HC LH LUTEINIZING HORMONE $100.20 $167.00 $83.50–$167.00 29% below 40%
LH (luteinizing hormone) test inpatient CPT 83002 HC LH LUTEINIZING HORMONE $100.20 $167.00 $97.16–$167.00 — 40%
Lactate (lactic acid) blood test CPT 83605 HC LACTIC ACID CSF $27.00 $45.00 $22.50–$45.00 70% below 40%
Lactate (lactic acid) blood test CPT 83605 HC LACTIC ACID $88.20 $147.00 $73.50–$147.00 2% below 40%
Lactate (lactic acid) blood test CPT 83605 HC LACTATE POC $88.20 $147.00 $73.50–$147.00 2% below 40%
Lactate (lactic acid) blood test one side CPT 83605 HC RT VENOUS LACTATE $88.20 $147.00 $73.50–$147.00 2% below 40%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTIC ACID CSF $27.00 $45.00 $26.18–$45.00 — 40%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTIC ACID $88.20 $147.00 $85.52–$147.00 — 40%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTATE POC $88.20 $147.00 $85.52–$147.00 — 40%
Lactate (lactic acid) blood test inpatient one side CPT 83605 HC RT VENOUS LACTATE $88.20 $147.00 $85.52–$147.00 — 40%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH B $46.80 $78.00 $39.00–$78.00 10% above 40%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH BODY FLUID $46.80 $78.00 $39.00–$78.00 10% above 40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH BODY FLUID $46.80 $78.00 $45.38–$78.00 — 40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH B $46.80 $78.00 $45.38–$78.00 — 40%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE FLUID $28.80 $48.00 $24.00–$48.00 68% below 40%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE B $88.20 $147.00 $73.50–$147.00 1% below 40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE FLUID $28.80 $48.00 $27.93–$48.00 — 40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE B $88.20 $147.00 $85.52–$147.00 — 40%
Liver function blood test panel CPT 80076 HC LIVER HEPATIC PROFILE $46.20 $77.00 $38.50–$77.00 56% below 40%
Liver function blood test panel inpatient CPT 80076 HC LIVER HEPATIC PROFILE $46.20 $77.00 $44.80–$77.00 — 40%
Lyme disease antibody test CPT 86618 HC LYME IGM/IGG, WCS,EIA, S $30.60 $51.00 $25.50–$51.00 76% below 40%
Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY $94.20 $157.00 $78.50–$157.00 26% below 40%
Lyme disease antibody test CPT 86618 HC ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) $166.20 $277.00 $138.50–$277.00 30% above 40%
Lyme disease antibody test inpatient CPT 86618 HC LYME IGM/IGG, WCS,EIA, S $30.60 $51.00 $29.67–$51.00 — 40%
Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE ANTIBODY $94.20 $157.00 $91.34–$157.00 — 40%
Lyme disease antibody test inpatient CPT 86618 HC ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) $166.20 $277.00 $161.16–$277.00 — 40%
Magnesium blood test CPT 83735 HC MAGNESIUM RDM U $25.80 $43.00 $21.50–$43.00 44% below 40%
Magnesium blood test CPT 83735 HC MAGNESIUM, FECES $40.80 $68.00 $34.00–$68.00 12% below 40%
Magnesium blood test CPT 83735 HC MAGNESIUM B $54.60 $91.00 $45.50–$91.00 18% above 40%
Magnesium blood test CPT 83735 HC MAGNESIUM 24 HR URINE $58.20 $97.00 $48.50–$97.00 26% above 40%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM RDM U $25.80 $43.00 $25.02–$43.00 — 40%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM, FECES $40.80 $68.00 $39.56–$68.00 — 40%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM B $54.60 $91.00 $52.94–$91.00 — 40%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM 24 HR URINE $58.20 $97.00 $56.43–$97.00 — 40%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA ANTIBODY MEASLES $70.20 $117.00 $58.50–$117.00 14% below 40%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA ANTIBODY MEASLES $70.20 $117.00 $68.07–$117.00 — 40%
Mono test (heterophile antibody, Monospot) CPT 86308 HC MONO $54.00 $90.00 $45.00–$90.00 35% below 40%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC MONO $54.00 $90.00 $52.36–$90.00 — 40%
Mumps immunity blood test CPT 86735 HC MUMPS ANTIBODY IGM $33.00 $55.00 $27.50–$55.00 57% below 40%
Mumps immunity blood test CPT 86735 HC MUMPS ANTIBODY IGG $74.40 $124.00 $62.00–$124.00 3% below 40%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS ANTIBODY IGM $33.00 $55.00 $32.00–$55.00 — 40%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS ANTIBODY IGG $74.40 $124.00 $72.14–$124.00 — 40%
Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL $349.80 $583.00 $291.50–$583.00 5% above 40%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA FREE $60.60 $101.00 $50.50–$101.00 13% below 40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PSA FREE $60.60 $101.00 $58.76–$101.00 — 40%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA DIAGNOSTIC $90.60 $151.00 $75.50–$151.00 13% above 40%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CYTO PAP THIN LAYER C/V MANUAL DIAG $87.00 $145.00 $72.50–$145.00 24% above 40%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC CYTO PAP THIN LAYER C/V MANUAL DIAG $87.00 $145.00 $84.36–$145.00 — 40%
Parathyroid hormone (PTH) blood test CPT 83970 HC PTH INTACT SURGERY USE ONLY $143.40 $239.00 $119.50–$239.00 27% below 40%
Parathyroid hormone (PTH) blood test CPT 83970 HC PTH WITH CALCIUM $183.60 $306.00 $153.00–$306.00 6% below 40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PTH INTACT SURGERY USE ONLY $143.40 $239.00 $139.05–$239.00 — 40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PTH WITH CALCIUM $183.60 $306.00 $178.03–$306.00 — 40%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC LUPUS ANTICOAGULANT $34.20 $57.00 $28.50–$57.00 32% below 40%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC APTT B $80.40 $134.00 $67.00–$134.00 59% above 40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC LUPUS ANTICOAGULANT $34.20 $57.00 $33.16–$57.00 — 40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC APTT B $80.40 $134.00 $77.96–$134.00 — 40%
Phosphorus (phosphate) blood test CPT 84100 HC PHOSPHOROUS, FECES $27.60 $46.00 $23.00–$46.00 7% below 40%
Phosphorus (phosphate) blood test CPT 84100 HC PHOSPHOURS $51.00 $85.00 $42.50–$85.00 71% above 40%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC PHOSPHOROUS, FECES $27.60 $46.00 $26.76–$46.00 — 40%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC PHOSPHOURS $51.00 $85.00 $49.45–$85.00 — 40%
Potassium blood test CPT 84132 HC POTASSIUM B $49.80 $83.00 $41.50–$83.00 75% above 40%
Potassium blood test inpatient CPT 84132 HC POTASSIUM B $49.80 $83.00 $48.29–$83.00 — 40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC CELL-FREE DNA PRENATAL SCREEN $971.40 $1,619.00 $809.50–$1,619.00 15% above 40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC CELL-FREE DNA PRENATAL SCREEN $971.40 $1,619.00 $941.93–$1,619.00 — 40%
Progesterone blood test CPT 84144 HC PROGESTERONE $106.20 $177.00 $88.50–$177.00 23% below 40%
Progesterone blood test inpatient CPT 84144 HC PROGESTERONE $106.20 $177.00 $102.98–$177.00 — 40%
Prolactin blood test CPT 84146 HC PROLACTIN B $113.40 $189.00 $94.50–$189.00 13% above 40%
Prolactin blood test inpatient CPT 84146 HC PROLACTIN B $113.40 $189.00 $109.96–$189.00 — 40%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME POC $38.40 $64.00 $32.00–$64.00 45% above 40%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME NON CLIA $52.80 $88.00 $44.00–$88.00 99% above 40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME POC $38.40 $64.00 $37.24–$64.00 — 40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME NON CLIA $52.80 $88.00 $51.20–$88.00 — 40%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC THROAT RAPID BETA STREP A ANTGN $33.00 $55.00 $27.50–$55.00 57% below 40%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC THROAT RAPID BETA STREP A ANTGN $33.00 $55.00 $32.00–$55.00 — 40%
Renin blood test CPT 84244 HC RENIN $126.60 $211.00 $105.50–$211.00 14% above 40%
Renin blood test inpatient CPT 84244 HC RENIN $126.60 $211.00 $122.76–$211.00 — 40%
Rh blood typing CPT 86901 HC RH TYPING $76.80 $128.00 $64.00–$128.00 97% above 40%
Rh blood typing inpatient CPT 86901 HC RH TYPING $76.80 $128.00 $74.47–$128.00 — 40%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR $43.80 $73.00 $36.50–$73.00 15% below 40%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR $43.80 $73.00 $42.47–$73.00 — 40%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA $48.60 $81.00 $40.50–$81.00 29% below 40%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA $48.60 $81.00 $47.13–$81.00 — 40%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SED RATE WESTERGREN $48.00 $80.00 $40.00–$80.00 24% above 40%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SED RATE WESTERGREN $48.00 $80.00 $46.54–$80.00 — 40%
Sodium blood test CPT 84295 HC SODIUM B $48.00 $80.00 $40.00–$80.00 31% above 40%
Sodium blood test inpatient CPT 84295 HC SODIUM B $48.00 $80.00 $46.54–$80.00 — 40%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITE FECES $90.60 $151.00 $75.50–$151.00 84% above 40%
Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITE FECES $90.60 $151.00 $87.85–$151.00 — 40%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC HEMOCCULT FPC/SC $27.60 $46.00 $23.00–$46.00 24% below 40%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECES $27.60 $46.00 $23.00–$46.00 24% below 40%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD SCREEN $183.60 $306.00 $153.00–$306.00 403% above 40%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC HEMOCCULT FPC/SC $27.60 $46.00 $26.76–$46.00 — 40%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD FECES $27.60 $46.00 $26.76–$46.00 — 40%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC OCCULT BLOOD FECAL BY IMMUNOASSAY $67.20 $112.00 $56.00–$112.00 25% above 40%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC OCCULT BLOOD FECAL BY IMMUNOASSAY $67.20 $112.00 $65.16–$112.00 — 40%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC NEUROSYPHILIS IGG AB INDEX WITH VDRL $15.00 $25.00 $12.50–$25.00 79% below 40%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC NEUROSYPHILIS IGG AB INDEX WITH VDRL $15.00 $25.00 $14.54–$25.00 — 40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC RPR QUALITATIVE $33.60 $56.00 $28.00–$56.00 18% below 40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC VDRL CSF $33.60 $56.00 $28.00–$56.00 18% below 40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC VDRL CSF $33.60 $56.00 $32.58–$56.00 — 40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC RPR QUALITATIVE $33.60 $56.00 $32.58–$56.00 — 40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC QUANTIFERON TB GOLD $163.20 $272.00 $136.00–$272.00 2% below 40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC QUANTIFERON TB GOLD $163.20 $272.00 $158.25–$272.00 — 40%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL $151.20 $252.00 $126.00–$252.00 31% above 40%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE FREE AND TOTAL $151.20 $252.00 $126.00–$252.00 31% above 40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE FREE AND TOTAL $151.20 $252.00 $146.61–$252.00 — 40%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC LIVER KIDNEY MICROSOME ABS IGG $43.20 $72.00 $36.00–$72.00 53% below 40%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC ANTI THYROID ANTIBODIES MI $97.80 $163.00 $81.50–$163.00 6% above 40%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC LIVER CYOSOL (LC-1) AUTOANTIBODIES $138.60 $231.00 $115.50–$231.00 50% above 40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC LIVER KIDNEY MICROSOME ABS IGG $43.20 $72.00 $41.89–$72.00 — 40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC ANTI THYROID ANTIBODIES MI $97.80 $163.00 $94.83–$163.00 — 40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC LIVER CYOSOL (LC-1) AUTOANTIBODIES $138.60 $231.00 $134.40–$231.00 — 40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH $97.20 $162.00 $81.00–$162.00 19% above 40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH $97.20 $162.00 $94.25–$162.00 — 40%
Total IgE blood test CPT 82785 HC IGE B $61.80 $103.00 $51.50–$103.00 18% below 40%
Total IgE blood test inpatient CPT 82785 HC IGE B $61.80 $103.00 $59.93–$103.00 — 40%
Total cholesterol blood test CPT 82465 HC CHOLESTEROL B $48.00 $80.00 $40.00–$80.00 52% above 40%
Total cholesterol blood test inpatient CPT 82465 HC CHOLESTEROL B $48.00 $80.00 $46.54–$80.00 — 40%
Total thyroxine (T4) blood test CPT 84436 HC T4 B $40.20 $67.00 $33.50–$67.00 15% below 40%
Total thyroxine (T4) blood test inpatient CPT 84436 HC T4 B $40.20 $67.00 $38.98–$67.00 — 40%
Total triiodothyronine (T3) blood test CPT 84480 HC T3 TOTAL TRIIODOTHYRONINE $112.80 $188.00 $94.00–$188.00 7% below 40%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC T3 TOTAL TRIIODOTHYRONINE $112.80 $188.00 $109.38–$188.00 — 40%
Transferrin blood test CPT 84466 HC TRANSFERRIN $66.00 $110.00 $55.00–$110.00 21% below 40%
Transferrin blood test inpatient CPT 84466 HC TRANSFERRIN $66.00 $110.00 $64.00–$110.00 — 40%
Trichomonas test (NAAT) CPT 87661 HC TRICHOMONAS VAGINALIS (TMA) $123.00 $205.00 $102.50–$205.00 29% above 40%
Trichomonas test (NAAT) inpatient CPT 87661 HC TRICHOMONAS VAGINALIS (TMA) $123.00 $205.00 $119.27–$205.00 — 40%
Triglycerides blood test CPT 84478 HC TRIGLYCERIDES $49.20 $82.00 $41.00–$82.00 37% above 40%
Triglycerides blood test CPT 84478 HC BODY FLUID TRIGLYCERIDE $138.60 $231.00 $115.50–$231.00 285% above 40%
Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDES $49.20 $82.00 $47.71–$82.00 — 40%
Triglycerides blood test inpatient CPT 84478 HC BODY FLUID TRIGLYCERIDE $138.60 $231.00 $134.40–$231.00 — 40%
Troponin test, quantitative CPT 84484 HC TROPONIN $104.40 $174.00 $87.00–$174.00 16% below 40%
Troponin test, quantitative CPT 84484 HC TROPONIN-T $104.40 $174.00 $87.00–$174.00 16% below 40%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN $104.40 $174.00 $101.23–$174.00 — 40%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN-T $104.40 $174.00 $101.23–$174.00 — 40%
Uric acid blood test CPT 84550 HC URIC ACID $48.00 $80.00 $40.00–$80.00 at median 40%
Uric acid blood test inpatient CPT 84550 HC URIC ACID $48.00 $80.00 $46.54–$80.00 — 40%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS W MICRO $211.20 $352.00 $176.00–$352.00 391% above 40%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS W MICRO $211.20 $352.00 $204.79–$352.00 — 40%
Urinalysis without microscope exam, automated CPT 81003 HC UA AUTO WITHOUT MICRO 81003 $19.80 $33.00 $16.50–$33.00 19% below 40%
Urinalysis without microscope exam, automated CPT 81003 HC GLUCOSE URINE $183.60 $306.00 $153.00–$306.00 649% above 40%
Urinalysis without microscope exam, automated CPT 81003 HC BILIRUBIN URINE $183.60 $306.00 $153.00–$306.00 649% above 40%
Urinalysis without microscope exam, automated CPT 81003 HC SPECIFIC GRAVITY URINE $183.60 $306.00 $153.00–$306.00 649% above 40%
Urinalysis without microscope exam, automated CPT 81003 HC PH URINE $183.60 $306.00 $153.00–$306.00 649% above 40%
Urinalysis without microscope exam, automated CPT 81003 HC KETONE URINE $183.60 $306.00 $153.00–$306.00 649% above 40%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC UA AUTO WITHOUT MICRO 81003 $19.80 $33.00 $19.20–$33.00 — 40%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC SPECIFIC GRAVITY URINE $183.60 $306.00 $178.03–$306.00 — 40%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC BILIRUBIN URINE $183.60 $306.00 $178.03–$306.00 — 40%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC GLUCOSE URINE $183.60 $306.00 $178.03–$306.00 — 40%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC KETONE URINE $183.60 $306.00 $178.03–$306.00 — 40%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC PH URINE $183.60 $306.00 $178.03–$306.00 — 40%
Urinalysis without microscope exam, manual CPT 81002 HC UA NONAUTO WITHOUT MICRO 81002 $12.00 $20.00 $10.00–$20.00 29% below 40%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC UA NONAUTO WITHOUT MICRO 81002 $12.00 $20.00 $11.64–$20.00 — 40%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE URINE $74.40 $124.00 $62.00–$124.00 69% above 40%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE BLADDER $93.60 $156.00 $78.00–$156.00 113% above 40%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE URINE $74.40 $124.00 $72.14–$124.00 — 40%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE BLADDER $93.60 $156.00 $90.76–$156.00 — 40%
Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN QUANTITATIVE URINE $82.80 $138.00 $69.00–$138.00 139% above 40%
Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN URINE $82.80 $138.00 $69.00–$138.00 139% above 40%
Urine microalbumin (albumin) test inpatient CPT 82043 HC MICROALBUMIN QUANTITATIVE URINE $82.80 $138.00 $80.29–$138.00 — 40%
Urine microalbumin (albumin) test inpatient CPT 82043 HC MICROALBUMIN URINE $82.80 $138.00 $80.29–$138.00 — 40%
Urine pregnancy test, read by color change CPT 81025 HC PREGNANCY TEST $40.80 $68.00 $34.00–$68.00 25% below 40%
Urine pregnancy test, read by color change CPT 81025 HC PREGNANCY TEST URINE $76.20 $127.00 $63.50–$127.00 40% above 40%
Urine pregnancy test, read by color change inpatient CPT 81025 HC PREGNANCY TEST $40.80 $68.00 $39.56–$68.00 — 40%
Urine pregnancy test, read by color change inpatient CPT 81025 HC PREGNANCY TEST URINE $76.20 $127.00 $73.89–$127.00 — 40%
Vitamin B12 (cobalamin) blood test CPT 82607 HC B12 $97.80 $163.00 $81.50–$163.00 29% above 40%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC B12 $97.80 $163.00 $94.83–$163.00 — 40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25-HYDROXYVITAMIN D2 AND D3 $73.20 $122.00 $61.00–$122.00 41% below 40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D 25 HYDROXY $162.60 $271.00 $135.50–$271.00 30% above 40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25-HYDROXYVITAMIN D2 AND D3 $73.20 $122.00 $70.98–$122.00 — 40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D 25 HYDROXY $162.60 $271.00 $157.67–$271.00 — 40%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC VITAMIN D 1 25 DEHYROXY $178.20 $297.00 $148.50–$297.00 1% above 40%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC VITAMIN D 1 25 DEHYROXY $178.20 $297.00 $172.79–$297.00 — 40%
Zinc blood test CPT 84630 HC ZINC BLOOD $68.40 $114.00 $57.00–$114.00 8% below 40%
Zinc blood test inpatient CPT 84630 HC ZINC BLOOD $68.40 $114.00 $66.33–$114.00 — 40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG QUANTITATIVE PREGNANCY $94.20 $157.00 $78.50–$157.00 19% above 40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG QUANTITATIVE PREGNANCY $94.20 $157.00 $91.34–$157.00 — 40%

Surgery and procedures

ProcedureCash price List priceInsurers payvs IndianaOff list
Botox injections for chronic migraine CPT 64615 HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE $448.80 $748.00 $374.00–$748.00 30% below 40%
Botox injections for chronic migraine inpatient CPT 64615 HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE $448.80 $748.00 $435.19–$748.00 — 40%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESION STEREOTACTIC $5,110.20 $8,517.00 $4,258.50–$8,517.00 113% above 40%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC CLOSED RX DIST FIBULA FX $153.60 $256.00 $128.00–$256.00 68% below 40%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC CLOSED RX METATARSAL FX $153.60 $256.00 $128.00–$256.00 71% below 40%
Cardiac catheterization with coronary angiogram CPT 93458 HC LHC W/WO LV ANGIO/CORONARY ANGIO $9,880.20 $16,467.00 $8,233.50–$16,467.00 at median 40%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 HC LHC W/WO LV ANGIO/CORONARY ANGIO $9,880.20 $16,467.00 $9,580.50–$16,467.00 — 40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTIVE EXTERNAL $1,008.00 $1,680.00 $840.00–$1,680.00 30% below 40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTIVE EXTERNAL $1,008.00 $1,680.00 $977.42–$1,680.00 — 40%
Carpal tunnel release, open surgery CPT 64721 HC NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL $850.50 $1,417.50 $708.75–$1,417.50 82% below 40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION W/REGIONL BLOCK $2,751.00 $4,585.00 $2,292.50–$4,585.00 303% above 40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC CIRCUMCISION W/REGIONL BLOCK $2,751.00 $4,585.00 $2,667.55–$4,585.00 — 40%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC CLOSED RX DIST RAD/ULNA FX $153.60 $256.00 $128.00–$256.00 73% below 40%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC PB 3DAY 52000 $414.00 $690.00 $401.44–$690.00 — 40%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT $127.20 $212.00 $106.00–$212.00 28% below 40%
Earwax removal with instruments, one ear one side CPT 69210 HC REMOVE CERUMEN IMPACTED REQUIRING INSTR UNILAT $103.80 $173.00 $86.50–$173.00 31% below 40%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT $315.60 $526.00 $306.03–$526.00 — 40%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC EPIDURAL NECK CHEST W/IMAGING $787.20 $1,312.00 $656.00–$1,312.00 26% below 40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ FACET JOINT LUMBAR OR SACRAL SINGLE LEVEL $1,149.00 $1,915.00 $957.50–$1,915.00 1% below 40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PV FACET JNT L/S 1 LEV $1,149.00 $1,915.00 $957.50–$1,915.00 1% below 40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ FACET JOINT LUMBAR OR SACRAL SINGLE LEVEL $1,149.00 $1,915.00 $1,114.15–$1,915.00 — 40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC HYSTEROSALPINGOGRAM $421.80 $703.00 $351.50–$703.00 46% above 40%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D ABSCESS SIMPLE $124.80 $208.00 $104.00–$208.00 75% below 40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC PB 3 DAY 10060 $178.20 $297.00 $172.79–$297.00 — 40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D ABSCESS SIMPLE $588.00 $980.00 $570.16–$980.00 — 40%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJECTION TENDON SHEATH $190.80 $318.00 $159.00–$318.00 65% below 40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCEN ASP/INJ JOINT/BURSA MAJOR W/O US $190.80 $318.00 $159.00–$318.00 55% below 40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENTESIS ASP/INJ JOINT/BURSA MAJOR $456.60 $761.00 $380.50–$761.00 7% above 40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHRO/ASP/INJ MAJOR JOINT/BURSA $466.20 $777.00 $388.50–$777.00 9% above 40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC PB 3 DAY 20610 $182.10 $303.50 $176.58–$303.50 — 40%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERTION DRUG IMPLANT DEVICE $189.60 $316.00 $158.00–$316.00 87% below 40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCEN ASP/INJ JOINT/BURSA INTERMEDIATE W/O US $190.80 $318.00 $159.00–$318.00 57% below 40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCENTESIS ASP/INJ JOINT/BURSA INTERMEDIATE $468.00 $780.00 $390.00–$780.00 6% above 40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ARTHROCENTESIS ASP/INJ JOINT/BURSA SMALL $190.80 $318.00 $159.00–$318.00 35% below 40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ARTHROCEN ASP/INJ JOINT/BURSA SMALL W/O US $456.60 $761.00 $380.50–$761.00 55% above 40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC REPAIR LAC INTERMED SCALP/AXIL/TRUNK <2.5CM $327.60 $546.00 $273.00–$546.00 50% below 40%
Left heart catheterization, diagnostic CPT 93452 HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I $7,012.20 $11,687.00 $5,843.50–$11,687.00 10% below 40%
Left heart catheterization, diagnostic inpatient CPT 93452 HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I $7,012.20 $11,687.00 $6,799.50–$11,687.00 — 40%
Lower-back epidural injection, with imaging guidance CPT 62323 HC EPIDURAL LUMBAR SACRAL W IMAGING $787.20 $1,312.00 $656.00–$1,312.00 39% below 40%
Lower-back epidural injection, without imaging guidance CPT 62322 HC EPIDURAL LUMBAR SACRAL WO IMAGING $655.20 $1,092.00 $546.00–$1,092.00 53% below 40%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC INJECT FORAMEN EPIDURAL L/S SINGLE LT $1,104.00 $1,840.00 $920.00–$1,840.00 34% below 40%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC INJECT FORAMEN EPIDURAL L/S SINGLE RT $1,104.00 $1,840.00 $920.00–$1,840.00 34% below 40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/< $440.40 $734.00 $367.00–$734.00 76% below 40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXC SKIN BENIGN <0.5 CM FACE FACIAL $433.80 $723.00 $361.50–$723.00 9% below 40%
Nail removal (partial or complete), one nail CPT 11730 HC AVULSION NAIL PLATE 1 NAIL $158.40 $264.00 $132.00–$264.00 60% below 40%
Occipital nerve block (injection for headaches) CPT 64405 HC NERVE BLOCK INJ OCCIPITAL $392.10 $653.50 $326.75–$653.50 35% below 40%
Pacemaker implant (dual chamber) CPT 33208 HC PPM INSERT DUAL W/FLUORO $12,136.80 $20,228.00 $10,114.00–$20,228.00 at median 40%
Paracentesis with imaging guidance CPT 49083 HC ABDOMINAL PARACENTESIS W IMAGING $1,400.40 $2,334.00 $1,167.00–$2,334.00 1% above 40%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABDOMINAL PARACENTESIS W IMAGING $1,400.40 $2,334.00 $1,357.92–$2,334.00 — 40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC REMOVAL OF NAIL BED $246.60 $411.00 $205.50–$411.00 64% below 40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC EXCISION NAIL & MATRIX $363.60 $606.00 $303.00–$606.00 47% below 40%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTRUCTION BY NEUROLYTIC AGENT LUMBAR SACRAL SINGLE $1,640.40 $2,734.00 $1,367.00–$2,734.00 46% below 40%
Removal of a breast lump, open surgery CPT 19120 HC EXCISION BREAST LESION $2,436.00 $4,060.00 $2,030.00–$4,060.00 47% below 40%
Removal of a foreign object under the skin, simple CPT 10120 HC INCISION/REMOVAL FOREIGN BODY SUBQ SIMPLE $252.60 $421.00 $210.50–$421.00 50% below 40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INCISION/REMOVAL FOREIGN BODY SUBQ SIMPLE $630.60 $1,051.00 $611.47–$1,051.00 — 40%
Short arm cast (elbow to hand) CPT 29075 HC SHORT ARM CAST APPLIC $174.00 $290.00 $145.00–$290.00 55% below 40%
Short arm splint (forearm and hand) CPT 29125 HC APPLY SPLINT SHORT ARM $100.80 $168.00 $84.00–$168.00 49% below 40%
Short leg cast (below the knee) CPT 29405 HC SHORT LEG CAST APPLIC $174.00 $290.00 $145.00–$290.00 54% below 40%
Short leg splint (calf to foot) CPT 29515 HC APPLY SPLINT SHORT LEG $100.80 $168.00 $84.00–$168.00 59% below 40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC REPAIR LAC SIMPLE SCALP/HAND/FT/GEN <2.5CM $232.80 $388.00 $194.00–$388.00 48% below 40%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BX SKIN SINGLE LESION $246.30 $410.50 $205.25–$410.50 46% below 40%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BIOPSY SINGLE LESION $252.60 $421.00 $210.50–$421.00 45% below 40%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC EXC SKIN MALIG <0.5 CM TRUNK ARM LEG $440.40 $734.00 $367.00–$734.00 1% below 40%
Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL OF SKIN TAGS, UP TO AND INCLUDING 15 LESIONS $124.80 $208.00 $104.00–$208.00 56% below 40%
Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL OF SKIN TAGS UP TO 15 $256.80 $428.00 $214.00–$428.00 9% below 40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC LUMBAR PUNCTURE DIAGNOSTIC $808.80 $1,348.00 $674.00–$1,348.00 21% below 40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC REPAIR LAC SIMPLE SCALP/HAND/FT/GEN 2.6-7.5CM $124.80 $208.00 $104.00–$208.00 69% below 40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC SIMPLE REPAIR OF SUPERFICIAL WOUND; 2.6 CM TO 7.5 CM $124.80 $208.00 $104.00–$208.00 69% below 40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC REPAIR LAC SIMPLE FACE/EAR/LIPS <2.5CM $237.60 $396.00 $198.00–$396.00 45% below 40%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGNTL BX SKIN SINGLE LESION $232.20 $387.00 $193.50–$387.00 45% below 40%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS W IMAGE GUIDANCE $390.30 $650.50 $325.25–$650.50 65% below 40%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS WITH IMAGE GUIDE $1,013.40 $1,689.00 $844.50–$1,689.00 8% below 40%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS WITH IMAGE GUIDE $1,013.40 $1,689.00 $982.66–$1,689.00 — 40%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS W IMAGE GUIDANCE $1,013.40 $1,689.00 $982.66–$1,689.00 — 40%
Trigger finger release surgery CPT 26055 HC TENDON SHEATH INCISION $878.40 $1,464.00 $732.00–$1,464.00 77% below 40%
Trigger finger release surgery inpatient CPT 26055 HC TENDON SHEATH INCISION $878.40 $1,464.00 $851.76–$1,464.00 — 40%
Trigger point injections, 1 or 2 muscles CPT 20552 HC TRIGGER PT 1-2 MUSCLE $190.80 $318.00 $159.00–$318.00 68% below 40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMAG $2,399.40 $3,999.00 $1,999.50–$3,999.00 5% above 40%
Vein ablation, radiofrequency, first vein CPT 36475 HC ABLATION RF SAPH FEM 1ST VEIN $5,760.00 $9,600.00 $4,800.00–$9,600.00 8% below 40%
Vein ablation, radiofrequency, first vein CPT 36475 HC RF ABLATION 1ST VEIN $5,760.00 $9,600.00 $4,800.00–$9,600.00 8% below 40%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC RF ABLATION 1ST VEIN $5,760.00 $9,600.00 $5,585.28–$9,600.00 — 40%
Wart removal, up to 14 warts CPT 17110 HC LESION DESTRUCTION UP TO 14 $210.00 $350.00 $175.00–$350.00 29% below 40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDE SKIN/SUBQ TISSUE 1ST 20 SQ CM $252.60 $421.00 $210.50–$421.00 68% below 40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC PB 3DAY 11042 $246.30 $410.50 $238.83–$410.50 — 40%

Doctor visits and therapy

ProcedureCash price List priceInsurers payvs IndianaOff list
Blood transfusion (giving blood or blood components) CPT 36430 HC TRANSFUSION BLOOD/BLOOD COMPONENTS $714.00 $1,190.00 $595.00–$1,190.00 21% below 40%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC TRANSFUSION BLOOD/BLOOD COMPONENTS $714.00 $1,190.00 $692.34–$1,190.00 — 40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHAL RX AIRWAY OBST/DX SPUTUM INDUCT NMDI $172.80 $288.00 $144.00–$288.00 53% above 40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHAL RX AIRWAY OBST/DX SPUTUM INDUCT INTRAPULM PERCUSS $172.80 $288.00 $144.00–$288.00 53% above 40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHAL RX AIRWAY OBST/DX SPUTUM INDUCT NEB $172.80 $288.00 $144.00–$288.00 53% above 40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHAL RX AIRWAY OBST/DX SPUTUM INDUCT EZ PAP $172.80 $288.00 $144.00–$288.00 53% above 40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHAL RX AIRWAY OBST/DX SPUTUM INDUCT INTRAPULM PERCUSS $172.80 $288.00 $167.56–$288.00 — 40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHAL RX AIRWAY OBST/DX SPUTUM INDUCT NMDI $172.80 $288.00 $167.56–$288.00 — 40%
Chemotherapy IV infusion, first hour CPT 96413 HC IV CHEMOTHERAPY INFUSION - INITIAL UP TO 1 HOUR $671.40 $1,119.00 $559.50–$1,119.00 1% below 40%
Critical care, first 30 to 74 minutes CPT 99291 HC ED CLASS V SERVICE $1,510.80 $2,518.00 $1,259.00–$2,518.00 24% below 40%
Critical care, first 30 to 74 minutes CPT 99291 HC CRITICAL CARE 30 - 74 MIN $1,510.80 $2,518.00 $1,259.00–$2,518.00 24% below 40%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE AND DROWSY $445.80 $743.00 $371.50–$743.00 35% below 40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG $196.80 $328.00 $164.00–$328.00 3% below 40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC EKG $196.80 $328.00 $190.83–$328.00 — 40%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ECT SEIZURE $307.80 $513.00 $256.50–$513.00 70% below 40%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ECT SEIZURE $307.80 $513.00 $298.46–$513.00 — 40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED RECHECKS $153.00 $255.00 $127.50–$255.00 22% below 40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED LEVEL 1 VISIT 99281 $153.00 $255.00 $127.50–$255.00 22% below 40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED CLASS I SERVICE $340.20 $567.00 $283.50–$567.00 16% below 40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED LEVEL 2 VISIT 99282 $340.20 $567.00 $283.50–$567.00 16% below 40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED LEVEL 3 VISIT 99283 $627.60 $1,046.00 $523.00–$1,046.00 9% below 40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED CLASS II SERVICE $627.60 $1,046.00 $523.00–$1,046.00 9% below 40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED LEVEL 4 VISIT 99284 $874.80 $1,458.00 $729.00–$1,458.00 26% below 40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED CLASS III SERVICE $874.80 $1,458.00 $729.00–$1,458.00 26% below 40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED LEVEL 5 VISIT 99285 $1,404.00 $2,340.00 $1,170.00–$2,340.00 20% below 40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED CLASS IV SERVICE $1,404.00 $2,340.00 $1,170.00–$2,340.00 20% below 40%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC STRESS TEST TREADML OR BIKE/PHARM $907.80 $1,513.00 $756.50–$1,513.00 15% above 40%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC STRESS TEST TREADML OR BIKE/PHARM $907.80 $1,513.00 $880.26–$1,513.00 — 40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV HYDRATION INFUSION - INITIAL 31 MINUTES TO 1 HOUR $290.40 $484.00 $242.00–$484.00 26% below 40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV HYDRATION INFUSION - INITIAL 31 MINUTES TO 1 HOUR $290.40 $484.00 $281.59–$484.00 — 40%
IV infusion of a medicine, first hour CPT 96365 HC IV THERAPEUTIC INFUSION - INITIAL UP TO 1 HOUR $355.20 $592.00 $296.00–$592.00 12% below 40%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV THERAPEUTIC INFUSION - INITIAL UP TO 1 HOUR $355.20 $592.00 $344.43–$592.00 — 40%
IV push of a medicine, first drug CPT 96374 HC IV THERAPEUTIC PUSH - INITIAL $164.40 $274.00 $137.00–$274.00 17% below 40%
IV push of a medicine, first drug inpatient CPT 96374 HC IV THERAPEUTIC PUSH - INITIAL $164.40 $274.00 $159.41–$274.00 — 40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECTION SQ/IM $93.60 $156.00 $78.00–$156.00 11% below 40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC IM/SC THERAPEUTIC ADMINISTRATION $96.60 $161.00 $80.50–$161.00 8% below 40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJECTION SQ/IM $93.60 $156.00 $90.76–$156.00 — 40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC IM/SC THERAPEUTIC ADMINISTRATION $96.60 $161.00 $93.67–$161.00 — 40%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PB 3DAY 90791 $135.00 $225.00 $130.90–$225.00 — 40%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NCS 7 OR 8 STUDIES $958.80 $1,598.00 $799.00–$1,598.00 15% above 40%
Neuromuscular re-education, 15 minutes CPT 97112 HC AT NEUROMUSCULAR RE ED 15 MIN $88.80 $148.00 $74.00–$148.00 20% above 40%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC AT NEUROMUSCULAR RE ED 15 MIN $88.80 $148.00 $86.11–$148.00 — 40%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MED NUTR THER 1ST INDIV EA 15 MIN $33.00 $55.00 $27.50–$55.00 4% below 40%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC AT MANUAL THERAPY 15 MIN $93.60 $156.00 $78.00–$156.00 13% above 40%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC AT MANUAL THERAPY 15 MIN $93.60 $156.00 $90.76–$156.00 — 40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC AT THERAPEUTIC EXERCISE 15 MIN $89.40 $149.00 $74.50–$149.00 23% above 40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC AT THERAPEUTIC EXERCISE 15 MIN $89.40 $149.00 $86.69–$149.00 — 40%
Psychiatric evaluation with medical services inpatient CPT 90792 HC PB 3DAY 90792 $135.00 $225.00 $130.90–$225.00 — 40%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC SMOKING CESSATION 3-10 MIN $49.50 $82.50 $41.25–$82.50 65% above 40%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HC OFFICE OP VISIT CONSULT 99243 $80.40 $134.00 $67.00–$134.00 63% below 40%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC OFFICE OP VISIT CONSULT 99244 $109.20 $182.00 $91.00–$182.00 57% below 40%
Spirometry (breathing test) CPT 94010 HC PFT SPIROMETRY WO BRONCHODILATOR $192.60 $321.00 $160.50–$321.00 27% below 40%
Spirometry (breathing test) CPT 94010 HC PFT SPIROMETRY WO BRONCHODILATOR BEDSIDE $192.60 $321.00 $160.50–$321.00 27% below 40%
Spirometry (breathing test) inpatient CPT 94010 HC PFT SPIROMETRY WO BRONCHODILATOR $192.60 $321.00 $186.76–$321.00 — 40%
Spirometry (breathing test) inpatient CPT 94010 HC PFT SPIROMETRY WO BRONCHODILATOR BEDSIDE $192.60 $321.00 $186.76–$321.00 — 40%
Spirometry before and after a bronchodilator CPT 94060 HC PFT SPIROMETRY W BRONCHODILATOR $413.40 $689.00 $344.50–$689.00 27% below 40%
Spirometry before and after a bronchodilator CPT 94060 HC PFT SPIROMETRY W BRONCHODILATOR BEDSIDE $413.40 $689.00 $344.50–$689.00 27% below 40%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC PFT SPIROMETRY W BRONCHODILATOR BEDSIDE $413.40 $689.00 $400.86–$689.00 — 40%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC PFT SPIROMETRY W BRONCHODILATOR $413.40 $689.00 $400.86–$689.00 — 40%
TMS (transcranial magnetic stimulation), first session with mapping CPT 90867 HC TMS TREATMENT INITAL $273.00 $455.00 $227.50–$455.00 — 40%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC AT THERAPEUTIC ACTIVITY 15 MIN $90.60 $151.00 $75.50–$151.00 38% above 40%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC AT THERAPEUTIC ACTIVITY 15 MIN $90.60 $151.00 $87.85–$151.00 — 40%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY THERAPEUTIC $139.80 $233.00 $116.50–$233.00 34% below 40%

Vaccines

ProcedureCash price List priceInsurers payvs IndianaOff list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 MRNA VACC (MODERNA) 50 MCG/0.5ML IM SUSP (WRAPPER) $216.60 $361.00 $180.50–$361.00 12% below 40%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID-19 MRNA VACC (MODERNA) 50 MCG/0.5ML IM SUSP (WRAPPER) $216.60 $361.00 $210.03–$361.00 — 40%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR $324.90 $541.50 $270.75–$541.50 21% below 40%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR $324.90 $541.50 $315.04–$541.50 — 40%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 15-23-5 LF-MCG/0.5 IM SUSP $123.60 $206.00 $103.00–$206.00 57% above 40%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 15-23-5 LF-MCG/0.5 IM SUSP $123.60 $206.00 $119.85–$206.00 — 40%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP-HEPATITIS B RECOMB-IPV IM SUSY $199.20 $332.00 $166.00–$332.00 10% above 40%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP-HEPATITIS B RECOMB-IPV IM SUSY $199.20 $332.00 $193.16–$332.00 — 40%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-IPV-HIB VACCINE IM SUSR $190.20 $317.00 $158.50–$317.00 20% below 40%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP-IPV-HIB VACCINE IM SUSR $190.20 $317.00 $184.43–$317.00 — 40%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 INFLUENZA VAC RECOMB HA (PF) 0.5 ML IM SOSY $155.10 $258.50 $129.25–$258.50 305% above 40%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 INFLUENZA VAC RECOMB HA (PF) 0.5 ML IM SOSY $155.10 $258.50 $150.40–$258.50 — 40%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY $17.10 $28.50 $14.25–$28.50 57% below 40%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY $17.10 $28.50 $16.58–$28.50 — 40%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSP $556.80 $928.00 $464.00–$928.00 12% below 40%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSY $556.80 $928.00 $464.00–$928.00 12% below 40%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSY $556.80 $928.00 $539.91–$928.00 — 40%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSP $556.80 $928.00 $539.91–$928.00 — 40%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 50 UNIT/ML IM SUSP (WRAPPER) $150.60 $251.00 $125.50–$251.00 12% below 40%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSY $161.10 $268.50 $134.25–$268.50 5% below 40%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE 50 UNIT/ML IM SUSP (WRAPPER) $150.60 $251.00 $146.03–$251.00 — 40%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSY $161.10 $268.50 $156.21–$268.50 — 40%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE 25 UNIT/0.5ML IM SUSP (WRAPPER) $158.10 $263.50 $131.75–$263.50 95% above 40%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSY $159.30 $265.50 $132.75–$265.50 97% above 40%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VACCINE 25 UNIT/0.5ML IM SUSP (WRAPPER) $158.10 $263.50 $153.30–$263.50 — 40%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSY $159.30 $265.50 $154.47–$265.50 — 40%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP (WRAPPER) $151.20 $252.00 $126.00–$252.00 14% below 40%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP (WRAPPER) $151.20 $252.00 $146.61–$252.00 — 40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP (WRAPPER) $115.50 $192.50 $96.25–$192.50 51% above 40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY $118.80 $198.00 $99.00–$198.00 56% above 40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP (WRAPPER) $115.50 $192.50 $112.00–$192.50 — 40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY $118.80 $198.00 $115.20–$198.00 — 40%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP $124.20 $207.00 $103.50–$207.00 92% above 40%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP $124.20 $207.00 $120.43–$207.00 — 40%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC 10 MCG IJ SOLR $54.60 $91.00 $45.50–$91.00 12% above 40%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR $59.10 $98.50 $49.25–$98.50 21% above 40%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC 10 MCG IJ SOLR $54.60 $91.00 $52.94–$91.00 — 40%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR $59.10 $98.50 $57.31–$98.50 — 40%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY $70.80 $118.00 $59.00–$118.00 61% below 40%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY $70.80 $118.00 $68.65–$118.00 — 40%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR $175.80 $293.00 $146.50–$293.00 33% below 40%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR $175.80 $293.00 $170.47–$293.00 — 40%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENING ACY&W-135 DIPHTH CONJ IM SOLN $251.70 $419.50 $209.75–$419.50 23% below 40%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENING ACY&W-135 DIPHTH CONJ IM SOLN $251.70 $419.50 $244.07–$419.50 — 40%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENING ACY&W-135 TETANUS CONJ IM SOLN $299.70 $499.50 $249.75–$499.50 8% below 40%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENING ACY&W-135 TETANUS CONJ IM SOLN $299.70 $499.50 $290.61–$499.50 — 40%
Meningococcal B vaccine (Trumenba) CPT 90621 MENINGOCOCCAL B VAC (RECOMB) IM SUSY $382.20 $637.00 $318.50–$637.00 7% below 40%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 MENINGOCOCCAL B VAC (RECOMB) IM SUSY $382.20 $637.00 $370.61–$637.00 — 40%
Mpox and smallpox vaccine (Jynneos), 2-dose schedule CPT 90611 SMALLPOX & MONKEYPOX VAC, LIVE 0.1 ML ID SUSP $475.20 $792.00 $396.00–$792.00 — 40%
Mpox and smallpox vaccine (Jynneos), 2-dose schedule inpatient CPT 90611 SMALLPOX & MONKEYPOX VAC, LIVE 0.1 ML ID SUSP $475.20 $792.00 $460.79–$792.00 — 40%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL 13-VAL CONJ VACC IM SUSP $383.10 $638.50 $319.25–$638.50 15% below 40%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL 13-VAL CONJ VACC IM SUSP $383.10 $638.50 $371.48–$638.50 — 40%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 PNEUMOCOCCAL 15-VAL CONJ VACC 0.5 ML IM SUSY $407.10 $678.50 $339.25–$678.50 19% below 40%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 PNEUMOCOCCAL 15-VAL CONJ VACC 0.5 ML IM SUSY $407.10 $678.50 $394.75–$678.50 — 40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY $210.90 $351.50 $175.75–$351.50 11% above 40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY $210.90 $351.50 $204.50–$351.50 — 40%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5ML IM SOSY $930.00 $1,550.00 $775.00–$1,550.00 18% below 40%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5ML IM SOSY $930.00 $1,550.00 $901.79–$1,550.00 — 40%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR $553.80 $923.00 $461.50–$923.00 32% below 40%
Rabies vaccine, one dose CPT 90675 RABIES VIRUS VACCINE, HDC IM SUSR $733.20 $1,222.00 $611.00–$1,222.00 10% below 40%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC IM SUSR $553.80 $923.00 $537.00–$923.00 — 40%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VIRUS VACCINE, HDC IM SUSR $733.20 $1,222.00 $710.96–$1,222.00 — 40%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTAVIRUS VACCINE LIVE ORAL PO SUSR $248.70 $414.50 $207.25–$414.50 81% above 40%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 ROTAVIRUS VACCINE LIVE ORAL PO SUSR $248.70 $414.50 $241.16–$414.50 — 40%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 2-2 LF/0.5ML IM SUSP $111.00 $185.00 $92.50–$185.00 3% below 40%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP $121.80 $203.00 $101.50–$203.00 6% above 40%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 2-2 LF/0.5ML IM SUSP $111.00 $185.00 $107.63–$185.00 — 40%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP $121.80 $203.00 $118.11–$203.00 — 40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP (WRAPPER) $135.30 $225.50 $112.75–$225.50 10% above 40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP (WRAPPER) $135.30 $225.50 $131.20–$225.50 — 40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC VACCINE ADMIN SINGLE $42.60 $71.00 $35.50–$71.00 34% below 40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC VACCINE ADMIN SINGLE $42.60 $71.00 $41.31–$71.00 — 40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC VACCINE ADMIN EA ADDL $40.20 $67.00 $33.50–$67.00 1% above 40%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC VACCINE ADMIN EA ADDL $40.20 $67.00 $38.98–$67.00 — 40%

Source file: https://www.gshvin.org/clientfiles/getfile/356001532_GoodSamaritan_standardcharges.csv