Hospital San Jose-Sunnyvale-Santa Clara, CA

El Camino Hospital

El Camino Hospital in Mountain View, CA publishes cash prices for 323 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 California median for 240 of 318 procedures and above it for 77. By typical cash price it ranks #79 of 226 California hospitals and #2 of 7 hospitals in the San Jose, CA area, cheapest first. Select a procedure to compare it with other hospitals nearby.

2500 Grant Road, Mountain View, CA 94040,815 Pollard Road, Los Gatos, CA 95032,2590 Grant Road, Mountain View, CA 94040,355 Dardanelli Lane, Los Gatos, CA 95032 Collected Sep 22, 2026 Source price file Check a bill from this hospital (650) 940-7000

Acute care hospital Government-owned hospital Emergency department CMS star rating 4 of 5 CCN 050308 · CMS hospital register NPI 1093712374

Financial assistance

Public hospital: ask for its charity care or sliding-scale discount

El Camino Hospital is government-owned (CMS register). The federal financial assistance rules for nonprofit hospitals do not always apply to public ones, but many public hospitals run charity care or sliding-scale discounts for uninsured and low-income patients. Ask the billing office for its financial assistance or charity care policy and application before you pay. Letters you can copy.

State law

This state limits hospital bills for lower-income patients

California law (Health and Safety Code §127405): if you are uninsured or have high medical costs and your family income is at or below 400% of the federal poverty level, a hospital may not expect you to pay more than it would expect from Medicare or Medi-Cal, whichever is greater. That can be less than the cash prices below; ask the hospital for its discount payment policy. A separate physician fee may still apply. Other states' laws.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN W/WO CONTRAST	$3,549.75	$14,199.00	—	25% above	75%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN W/WO CONTRAST	$3,549.75	$14,199.00	—	—	75%
Abdominal X-ray, 2 views CPT 74019 HC RADIOLOGIC EXAMINATION,ABDOMEN 2 VIEWS	$375.00	$1,500.00	—	13% below	75%
Abdominal X-ray, 2 views inpatient CPT 74019 HC RADIOLOGIC EXAMINATION,ABDOMEN 2 VIEWS	$375.00	$1,500.00	—	—	75%
Ankle X-ray, complete, 3 or more views CPT 73610 HC ANKLE MIN 3 VIEWS	$456.50	$1,826.00	—	11% below	75%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC ANKLE MIN 3 VIEWS	$456.50	$1,826.00	—	—	75%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC US PHYS DOP ABI & WAVEFORMS	$259.50	$1,038.00	—	53% below	75%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC US PHYS DOP ABI & WAVEFORMS	$259.50	$1,038.00	—	—	75%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY W/O CONTRAST	$1,608.75	$6,435.00	—	29% below	75%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREMITY W/O CONTRAST	$1,608.75	$6,435.00	—	—	75%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC ESOPHOGRAM	$595.25	$2,381.00	—	2% below	75%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC ESOPHOGRAM	$595.25	$2,381.00	—	—	75%
Bone scan, whole body (nuclear medicine) CPT 78306 HC BONE SCAN	$2,573.50	$10,294.00	—	21% above	75%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC BONE SCAN	$2,573.50	$10,294.00	—	—	75%
Breast ultrasound, complete, one breast CPT 76641 HC US BREAST COMPLETE	$451.75	$1,807.00	—	36% below	75%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST COMPLETE	$451.75	$1,807.00	—	—	75%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST LIMITED	$363.25	$1,453.00	—	32% below	75%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST LIMITED	$363.25	$1,453.00	—	—	75%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CT ANGI ABDM/PELVIS W/WO CONTRAST	$5,984.25	$23,937.00	—	11% above	75%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CT ANGI ABDM/PELVIS W/WO CONTRAST	$5,984.25	$23,937.00	—	—	75%
CT angiography (CTA) of the head CPT 70496 HC CT ANGIO HEAD W/WO CONTRAST	$4,423.00	$17,692.00	—	48% above	75%
CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIO HEAD W/WO CONTRAST	$4,423.00	$17,692.00	—	—	75%
CT angiography (CTA) of the neck CPT 70498 HC CT ANGIO NECK W/WO CONTRAST	$4,491.75	$17,967.00	—	52% above	75%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIO NECK W/WO CONTRAST	$4,491.75	$17,967.00	—	—	75%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIO CHEST W/CONTRAST	$4,437.75	$17,751.00	—	29% above	75%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIO CHEST W/CONTRAST	$4,437.75	$17,751.00	—	—	75%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CT ANGIO HEART W/3D IMAGING	$1,844.75	$7,379.00	—	32% below	75%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CT ANGIO HEART W/3D IMAGING	$1,844.75	$7,379.00	—	—	75%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT CALCIUM SCORING	$122.74	$490.98	—	67% below	75%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT CALCIUM SCORING	$122.74	$490.98	—	—	75%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABDOMEN + PELVIS W/O CONT	$4,102.50	$16,410.00	—	28% above	75%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABDOMEN + PELVIS W/O CONT	$4,102.50	$16,410.00	—	—	75%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN + PELVIS W/CONT	$4,632.75	$18,531.00	—	12% above	75%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN + PELVIS W/CONT	$4,632.75	$18,531.00	—	—	75%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN + PELVIS W/WO CONT	$5,228.50	$20,914.00	—	11% above	75%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABDOMEN + PELVIS W/WO CONT	$5,228.50	$20,914.00	—	—	75%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W/CONTRAST	$1,961.50	$7,846.00	—	22% below	75%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W/CONTRAST	$1,961.50	$7,846.00	—	—	75%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN W/O CONTRAST	$1,493.75	$5,975.00	—	22% below	75%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN W/O CONTRAST	$1,493.75	$5,975.00	—	—	75%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT FACIAL W/O CONTRAST	$2,264.00	$9,056.00	—	4% above	75%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT FACIAL W/O CONTRAST	$2,264.00	$9,056.00	—	—	75%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD SCAN W/O CONTRAST	$1,209.25	$4,837.00	—	47% below	75%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD SCAN W/O CONTRAST	$1,209.25	$4,837.00	—	—	75%
CT scan of the head with contrast CPT 70460 HC CT HEAD SCAN W/CONTRAST	$1,735.00	$6,940.00	—	36% below	75%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD SCAN W/CONTRAST	$1,735.00	$6,940.00	—	—	75%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD SCAN COMPLETE	$2,073.75	$8,295.00	—	33% below	75%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD SCAN COMPLETE	$2,073.75	$8,295.00	—	—	75%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT L SPINE-COMPLETE	$990.00	$3,960.00	—	65% below	75%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT L SPINE-COMPLETE	$990.00	$3,960.00	—	—	75%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT C SPINE-COMPLETE	$2,228.25	$8,913.00	—	23% below	75%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT C SPINE-COMPLETE	$2,228.25	$8,913.00	—	—	75%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W/CONTRAST	$2,570.75	$10,283.00	—	1% above	75%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W/CONTRAST	$2,570.75	$10,283.00	—	—	75%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 HC US VASCULAR STUDY HEAD	$585.25	$2,341.00	—	52% below	75%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 HC US VASCULAR STUDY HEAD	$585.25	$2,341.00	—	—	75%
Chest CT scan without and with contrast CPT 71270 HC CT THORAX W/WO CONTR	$3,204.50	$12,818.00	—	2% below	75%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT THORAX W/WO CONTR	$3,204.50	$12,818.00	—	—	75%
Chest X-ray, 2 views CPT 71046 HC RADIOLOGIC EXAMINATION,CHEST 2 VIEWS	$298.75	$1,195.00	—	27% below	75%
Chest X-ray, 2 views inpatient CPT 71046 HC RADIOLOGIC EXAMINATION,CHEST 2 VIEWS	$298.75	$1,195.00	—	—	75%
Chest X-ray, single view CPT 71045 HC RADIOLOGIC EXAMINATION,CHEST,SINGLE VIEW	$211.75	$847.00	—	42% below	75%
Chest X-ray, single view inpatient CPT 71045 HC RADIOLOGIC EXAMINATION,CHEST,SINGLE VIEW	$211.75	$847.00	—	—	75%
Collarbone (clavicle) X-ray, complete CPT 73000 HC CLAVICLE	$401.00	$1,604.00	—	17% below	75%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC CLAVICLE	$401.00	$1,604.00	—	—	75%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US EXAM ABDO BACK WALL COMP	$647.75	$2,591.00	—	24% below	75%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US EXAM ABDO BACK WALL COMP	$647.75	$2,591.00	—	—	75%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC BONE DENSITY, AXIAL SKELETON	$248.25	$993.00	—	51% below	75%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC BONE DENSITY, AXIAL SKELETON	$248.25	$993.00	—	—	75%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC BONE DENSITY, PERIPHERAL	$100.75	$403.00	—	64% below	75%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC BONE DENSITY, PERIPHERAL	$100.75	$403.00	—	—	75%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US PREG UTERUS >14 WKS FETAL DET	$765.50	$3,062.00	—	15% below	75%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US PREG UTERUS >14 WKS FETAL DET	$765.50	$3,062.00	—	—	75%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX W/O CONTRAST	$1,110.50	$4,442.00	—	45% below	75%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX W/O CONTRAST	$1,110.50	$4,442.00	—	—	75%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W/CONTRAST	$2,931.50	$11,726.00	—	2% above	75%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX W/CONTRAST	$2,931.50	$11,726.00	—	—	75%
Diagnostic mammogram, both breasts both sides CPT 77066 HC DIAGNOSTIC MAMMOGRAPHY, INCLUDING CAD WHEN PERFORMED, BILATERAL	$301.25	$1,205.00	—	—	75%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DIAGNOSTIC MAMMOGRAPHY, INCLUDING CAD WHEN PERFORMED, BILATERAL	$301.25	$1,205.00	—	—	75%
Diagnostic mammogram, one breast one side CPT 77065 HC DIAGNOSTIC MAMMOGRAPHY, INCLUDING CAD WHEN PERFOMED, UNILATERAL	$237.50	$950.00	—	37% below	75%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC DIAGNOSTIC MAMMOGRAPHY, INCLUDING CAD WHEN PERFOMED, UNILATERAL	$237.50	$950.00	—	—	75%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUP SCAN LOW EXTR ART/BI	$555.00	$2,220.00	—	—	75%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUP SCAN LOW EXTR ART/BI	$555.00	$2,220.00	—	—	75%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUP SCAN EXTREM VEINS BI	$924.25	$3,697.00	—	—	75%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUP SCAN EXTREM VEINS BI	$924.25	$3,697.00	—	—	75%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC TTE W/DOPPLER, COMPLETE	$3,246.50	$12,986.00	—	21% above	75%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC TTE W/DOPPLER, COMPLETE	$3,246.50	$12,986.00	—	—	75%
Elbow X-ray, 2 views CPT 73070 HC ELBOW LTD AP & LATERAL	$368.75	$1,475.00	—	7% below	75%
Elbow X-ray, 2 views inpatient CPT 73070 HC ELBOW LTD AP & LATERAL	$368.75	$1,475.00	—	—	75%
Elbow X-ray, complete, 3 or more views CPT 73080 HC ELBOW MIN 3 VIEWS	$442.00	$1,768.00	—	9% below	75%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC ELBOW MIN 3 VIEWS	$442.00	$1,768.00	—	—	75%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT HEAD W/O CONTRAST HI-RES	$3,511.75	$14,047.00	—	53% above	75%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT HEAD W/O CONTRAST HI-RES	$3,511.75	$14,047.00	—	—	75%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC FACIAL BONES MIN 3 VIEWS	$371.00	$1,484.00	—	25% below	75%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC FACIAL BONES MIN 3 VIEWS	$371.00	$1,484.00	—	—	75%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC FOREARM	$391.00	$1,564.00	—	9% below	75%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC FOREARM	$391.00	$1,564.00	—	—	75%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC HEPATOBILIARY SYS IMAGE INCLD GAL	$737.75	$2,951.00	—	59% below	75%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC HEPATOBILIARY SYS IMAGE INCLD GAL	$737.75	$2,951.00	—	—	75%
Hand X-ray, 2 views CPT 73120 HC HAND LIMITED 2 VIEWS	$470.00	$1,880.00	—	15% above	75%
Hand X-ray, 2 views inpatient CPT 73120 HC HAND LIMITED 2 VIEWS	$470.00	$1,880.00	—	—	75%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC HEEL CALCANEUS MIN 2 VIEWS	$349.75	$1,399.00	—	1% below	75%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC HEEL CALCANEUS MIN 2 VIEWS	$349.75	$1,399.00	—	—	75%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STUDY UNATTENDED SIMULTANEOUS RECORD HRT RATE & O2 SAT EFFORT	$280.50	$1,122.00	—	63% below	75%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STUDY UNATTENDED SIMULTANEOUS RECORD HRT RATE & O2 SAT EFFORT	$280.50	$1,122.00	—	—	75%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMNOGRAPHY C-PAP	$3,862.50	$15,450.00	—	6% above	75%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMNOGRAPHY C-PAP	$3,862.50	$15,450.00	—	—	75%
Knee X-ray, 3 views CPT 73562 HC KNEE MIN 3 VIEWS	$447.50	$1,790.00	—	3% below	75%
Knee X-ray, 3 views inpatient CPT 73562 HC KNEE MIN 3 VIEWS	$447.50	$1,790.00	—	—	75%
Knee X-ray, complete, 4 or more views CPT 73564 HC PATELLA OBL/TUNNEL/PAT/STAND	$589.75	$2,359.00	—	1% above	75%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC PATELLA OBL/TUNNEL/PAT/STAND	$589.75	$2,359.00	—	—	75%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY W/O CONTRAST	$986.25	$3,945.00	—	54% below	75%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTREMITY W/O CONTRAST	$986.25	$3,945.00	—	—	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMINAL REAL TIME W/IMAGE LIMITED	$783.00	$3,132.00	—	6% below	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMINAL REAL TIME W/IMAGE LIMITED	$783.00	$3,132.00	—	—	75%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US EXTREMITY NON-VASCULAR LTD	$505.75	$2,023.00	—	7% below	75%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US EXTREMITY NON-VASCULAR LTD	$505.75	$2,023.00	—	—	75%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT THORAX, LOW DOSE FOR LUNG CANCER SCREENING, WITHOUT CONTRAST	$116.36	$465.43	—	67% below	75%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT THORAX, LOW DOSE FOR LUNG CANCER SCREENING, WITHOUT CONTRAST	$116.36	$465.43	—	—	75%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC TIBIA/FIBULA AP AND LATERAL	$441.25	$1,765.00	—	2% above	75%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC TIBIA/FIBULA AP AND LATERAL	$441.25	$1,765.00	—	—	75%
MR angiography (MRA) of the head without contrast CPT 70544 HC MR ANGIO HEAD WO CONTRAST	$3,438.50	$13,754.00	—	19% above	75%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MR ANGIO HEAD WO CONTRAST	$3,438.50	$13,754.00	—	—	75%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST W/WO CONTRAST, BILATERAL	$2,430.25	$9,721.00	—	—	75%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 HC MRI BREAST W/WO CONTRAST, BILATERAL	$2,430.25	$9,721.00	—	—	75%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY JOINT	$1,949.00	$7,796.00	—	36% below	75%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXTREMITY JOINT	$1,949.00	$7,796.00	—	—	75%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY JOINT WO/W CONTRAST	$2,565.50	$10,262.00	—	44% below	75%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXTREMITY JOINT WO/W CONTRAST	$2,565.50	$10,262.00	—	—	75%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN W/O CONTRAST	$1,542.50	$6,170.00	—	45% below	75%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN W/O CONTRAST	$1,542.50	$6,170.00	—	—	75%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W/WO CON	$4,399.00	$17,596.00	—	1% above	75%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN W/WO CON	$4,399.00	$17,596.00	—	—	75%
MRI of the brain, no contrast dye CPT 70551 HC MRI HEAD W/O CONT	$2,608.00	$10,432.00	—	10% below	75%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI HEAD W/O CONT	$2,608.00	$10,432.00	—	—	75%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI HEAD W/WO CONTRAST	$4,326.50	$17,306.00	—	at median	75%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI HEAD W/WO CONTRAST	$4,326.50	$17,306.00	—	—	75%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST	$2,825.25	$11,301.00	—	8% below	75%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST	$2,825.25	$11,301.00	—	—	75%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMB SPINE W/WO CON	$4,569.50	$18,278.00	—	1% above	75%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMB SPINE W/WO CON	$4,569.50	$18,278.00	—	—	75%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O CONTRAST	$1,747.50	$6,990.00	—	40% below	75%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THORACIC SPINE W/O CONTRAST	$1,747.50	$6,990.00	—	—	75%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERV SPINE W/WO CON	$4,261.50	$17,046.00	—	4% below	75%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERV SPINE W/WO CON	$4,261.50	$17,046.00	—	—	75%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O CONTRAST	$2,977.50	$11,910.00	—	1% below	75%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O CONTRAST	$2,977.50	$11,910.00	—	—	75%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W/WO CONTRAST	$4,178.00	$16,712.00	—	1% above	75%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS W/WO CONTRAST	$4,178.00	$16,712.00	—	—	75%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS W/O CONTRAST	$1,412.75	$5,651.00	—	45% below	75%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS W/O CONTRAST	$1,412.75	$5,651.00	—	—	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXTREMITY JOINT W/O CONTRAST	$1,856.00	$7,424.00	—	29% below	75%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPER EXTREMITY JOINT W/O CONTRAST	$1,856.00	$7,424.00	—	—	75%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC C-SPINE, 4 VIEWS	$675.50	$2,702.00	—	5% above	75%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC C-SPINE, 4 VIEWS	$675.50	$2,702.00	—	—	75%
Neck soft tissue CT scan with contrast CPT 70491 HC CT NECK W/CONTRAST	$2,944.50	$11,778.00	—	8% above	75%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT NECK W/CONTRAST	$2,944.50	$11,778.00	—	—	75%
Neck soft tissue CT scan without contrast CPT 70490 HC CT NECK W/O CONTRAST	$2,220.50	$8,882.00	—	5% above	75%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT NECK W/O CONTRAST	$2,220.50	$8,882.00	—	—	75%
Neck soft tissue X-ray CPT 70360 HC NECK-SOFT TISSUES	$386.75	$1,547.00	—	19% above	75%
Neck soft tissue X-ray inpatient CPT 70360 HC NECK-SOFT TISSUES	$386.75	$1,547.00	—	—	75%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC HEART SCAN SPECT MULTIPL	$3,575.75	$14,303.00	—	12% below	75%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC HEART SCAN SPECT MULTIPL	$3,575.75	$14,303.00	—	—	75%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET CT SKULL TO MID-THIGH	$2,394.25	$9,577.00	—	67% below	75%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC PET CT SKULL TO MID-THIGH	$2,394.25	$9,577.00	—	—	75%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS W/O CONTRAST	$1,229.25	$4,917.00	—	37% below	75%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS W/O CONTRAST	$1,229.25	$4,917.00	—	—	75%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIS SCAN-LIMITED	$347.00	$1,388.00	—	36% below	75%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIS SCAN-LIMITED	$347.00	$1,388.00	—	—	75%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIC SURVEY	$785.75	$3,143.00	—	16% below	75%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIC SURVEY	$785.75	$3,143.00	—	—	75%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US PREG UTERUS >14 WKS	$951.00	$3,804.00	—	10% above	75%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US PREG UTERUS >14 WKS	$951.00	$3,804.00	—	—	75%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US PREGNANT UTERUS, <14 WKS	$636.25	$2,545.00	—	18% below	75%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US PREGNANT UTERUS, <14 WKS	$636.25	$2,545.00	—	—	75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US PREGNANT UTERUS, LIMITED OBED	$541.75	$2,167.00	—	10% below	75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US PREGNANT UTERUS, LIMITED	$541.75	$2,167.00	—	10% below	75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US PREGNANT UTERUS, LIMITED	$541.75	$2,167.00	—	—	75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US PREGNANT UTERUS, LIMITED OBED	$541.75	$2,167.00	—	—	75%
Rib X-ray, one side, 2 views one side CPT 71100 HC RIBS UNILATERAL 2 VIEWS	$435.75	$1,743.00	—	6% below	75%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC RIBS UNILATERAL 2 VIEWS	$435.75	$1,743.00	—	—	75%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC RIBS W/PA CHEST	$455.00	$1,820.00	—	26% below	75%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC RIBS W/PA CHEST	$455.00	$1,820.00	—	—	75%
Screening mammogram, both breasts both sides CPT 77067 HC SCREENING MAMMOGRAPHY,BILATERAL (2 VIEW STUDY EACH BREAST) INCLUDING CAD WHEN PERFORMED	$219.50	$878.00	—	—	75%
Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCREENING MAMMOGRAPHY,BILATERAL (2 VIEW STUDY EACH BREAST) INCLUDING CAD WHEN PERFORMED	$219.50	$878.00	—	—	75%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC SHOULDER MIN 2 VIEWS	$481.50	$1,926.00	—	13% below	75%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC SHOULDER MIN 2 VIEWS	$481.50	$1,926.00	—	—	75%
Sinus X-ray, complete, 3 or more views CPT 70220 HC SINUSES MIN 3 VIEWS	$496.75	$1,987.00	—	9% above	75%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC SINUSES MIN 3 VIEWS	$496.75	$1,987.00	—	—	75%
Skull X-ray, fewer than 4 views CPT 70250 HC SKULL LTD LESS THAN 4 VIEWS	$253.25	$1,013.00	—	38% below	75%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC SKULL LTD LESS THAN 4 VIEWS	$253.25	$1,013.00	—	—	75%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAPHY SLEEP STAGING 4+	$3,379.25	$13,517.00	—	31% below	75%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAPHY SLEEP STAGING 4+	$3,379.25	$13,517.00	—	—	75%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC STRESS TTE COMPLETE	$2,156.75	$8,627.00	—	32% below	75%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC STRESS TTE COMPLETE	$2,156.75	$8,627.00	—	—	75%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$339.00	$1,356.00	—	49% below	75%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$339.00	$1,356.00	—	—	75%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-RAY EXAM OF FEMUR 2+ VIEWS	$173.75	$695.00	—	57% below	75%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC X-RAY EXAM OF FEMUR 2+ VIEWS	$173.75	$695.00	—	—	75%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT T SPINE-COMPLETE	$1,022.25	$4,089.00	—	64% below	75%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT T SPINE-COMPLETE	$1,022.25	$4,089.00	—	—	75%
Toe X-ray, 2 or more views CPT 73660 HC TOE(S)	$288.25	$1,153.00	—	13% below	75%
Toe X-ray, 2 or more views inpatient CPT 73660 HC TOE(S)	$288.25	$1,153.00	—	—	75%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL STUDY	$648.25	$2,593.00	—	10% below	75%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL STUDY	$648.25	$2,593.00	—	—	75%
Transvaginal ultrasound during pregnancy CPT 76817 HC US PREGNANT UTERUS, TRANSVAGINAL	$541.75	$2,167.00	—	19% below	75%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US PREGNANT UTERUS, TRANSVAGINAL	$541.75	$2,167.00	—	—	75%
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMEN-GENERAL SURVEY	$1,035.50	$4,142.00	—	5% below	75%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMEN-GENERAL SURVEY	$1,035.50	$4,142.00	—	—	75%
Ultrasound of the scrotum and testicles CPT 76870 HC SONOGRM SCROT/GENITALIA	$867.75	$3,471.00	—	3% below	75%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC SONOGRM SCROT/GENITALIA	$867.75	$3,471.00	—	—	75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC THYROID SONOGRAM	$889.00	$3,556.00	—	7% above	75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC THYROID SONOGRAM	$889.00	$3,556.00	—	—	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY	$338.75	$1,355.00	—	45% below	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY	$338.75	$1,355.00	—	—	75%
Upper arm X-ray (humerus), 2 views CPT 73060 HC HUMERUS MIN 2 VIEWS	$418.00	$1,672.00	—	2% below	75%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC HUMERUS MIN 2 VIEWS	$418.00	$1,672.00	—	—	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC DUP SCAN EXTREM VEINS LTD	$1,109.75	$4,439.00	—	23% above	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC DUP SCAN EXTREM VEINS LTD	$1,109.75	$4,439.00	—	—	75%
Wrist X-ray, 2 views CPT 73100 HC WRIST LTD AP & LATERAL	$389.25	$1,557.00	—	at median	75%
Wrist X-ray, 2 views inpatient CPT 73100 HC WRIST LTD AP & LATERAL	$389.25	$1,557.00	—	—	75%
Wrist X-ray, complete, 3 or more views CPT 73110 HC WRIST MIN 3 VIEWS	$432.00	$1,728.00	—	14% below	75%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC WRIST MIN 3 VIEWS	$432.00	$1,728.00	—	—	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VIEWS	$148.25	$593.00	—	63% below	75%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VIEWS	$148.25	$593.00	—	—	75%
X-ray of the abdomen, 1 view CPT 74018 HC RADIOLOGIC EXAMINATION,ABDOMEN 1 VIEW	$129.00	$516.00	—	58% below	75%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC RADIOLOGIC EXAMINATION,ABDOMEN 1 VIEW	$129.00	$516.00	—	—	75%
X-ray of the ankle, 2 views CPT 73600 HC ANKLE LTD AP AND LATERAL	$207.75	$831.00	—	47% below	75%
X-ray of the ankle, 2 views inpatient CPT 73600 HC ANKLE LTD AP AND LATERAL	$207.75	$831.00	—	—	75%
X-ray of the finger(s), 2 or more views CPT 73140 HC FINGER(S)	$309.75	$1,239.00	—	15% below	75%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC FINGER(S)	$309.75	$1,239.00	—	—	75%
X-ray of the foot, 2 views CPT 73620 HC FOOT LTD AP & LATERAL	$210.25	$841.00	—	48% below	75%
X-ray of the foot, 2 views inpatient CPT 73620 HC FOOT LTD AP & LATERAL	$210.25	$841.00	—	—	75%
X-ray of the foot, complete, 3 or more views CPT 73630 HC FOOT MIN 3 VIEWS	$475.75	$1,903.00	—	4% below	75%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC FOOT MIN 3 VIEWS	$475.75	$1,903.00	—	—	75%
X-ray of the hand, 3 or more views CPT 73130 HC HAND MIN 3 VIEWS	$568.75	$2,275.00	—	12% above	75%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC HAND MIN 3 VIEWS	$568.75	$2,275.00	—	—	75%
X-ray of the knee, 1 or 2 views CPT 73560 HC KNEE LTD AP AND LATERAL	$355.00	$1,420.00	—	11% below	75%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC KNEE LTD AP AND LATERAL	$355.00	$1,420.00	—	—	75%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC L SPINE AP/LAT	$405.75	$1,623.00	—	14% below	75%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC L SPINE AP/LAT	$405.75	$1,623.00	—	—	75%
X-ray of the lower back, 4 or more views CPT 72110 HC L-S SPINE +/OBLIQUE VIEWS	$462.00	$1,848.00	—	29% below	75%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC L-S SPINE +/OBLIQUE VIEWS	$462.00	$1,848.00	—	—	75%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC T-SPINE,2 VIEWS	$382.50	$1,530.00	—	17% below	75%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC T-SPINE,2 VIEWS	$382.50	$1,530.00	—	—	75%
X-ray of the nasal bones, 3 or more views CPT 70160 HC NASAL BONES MIN 3 VIEWS	$413.00	$1,652.00	—	4% below	75%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC NASAL BONES MIN 3 VIEWS	$413.00	$1,652.00	—	—	75%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC C SPINE AP/LAT	$481.75	$1,927.00	—	7% above	75%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC C SPINE AP/LAT	$481.75	$1,927.00	—	—	75%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC PELVIS	$313.50	$1,254.00	—	19% below	75%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC PELVIS	$313.50	$1,254.00	—	—	75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC SACRUM AND COCCYX	$517.50	$2,070.00	—	10% above	75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC SACRUM AND COCCYX	$517.50	$2,070.00	—	—	75%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs California	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALT (SGPT)	$30.75	$123.00	—	29% below	75%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC ALT (SGPT)	$30.75	$123.00	—	—	75%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC SGOT-ENZYM	$45.75	$183.00	—	1% above	75%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC SGOT-ENZYM	$45.75	$183.00	—	—	75%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS ACUTE PANEL	$152.25	$609.00	—	44% below	75%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS ACUTE PANEL	$152.25	$609.00	—	—	75%
Albumin blood test CPT 82040 HC ALBUMIN,SERUM(QUANT)	$21.75	$87.00	—	13% below	75%
Albumin blood test inpatient CPT 82040 HC ALBUMIN,SERUM(QUANT)	$21.75	$87.00	—	—	75%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ALK P TASE	$14.75	$59.00	—	60% below	75%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ALK P TASE	$14.75	$59.00	—	—	75%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGENS ZONE 14*3	$157.62	$630.50	—	3052% above	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGENS ZONE 14*3	$157.62	$630.50	—	—	75%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA FETOPROTEIN CA	$15.25	$61.00	—	80% below	75%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA FETOPROTEIN CA	$15.25	$61.00	—	—	75%
Ammonia blood test CPT 82140 HC AMMONIA BL	$62.00	$248.00	—	66% below	75%
Ammonia blood test inpatient CPT 82140 HC AMMONIA BL	$62.00	$248.00	—	—	75%
Amylase blood test CPT 82150 HC 123110 AMYLASE ISOENZYM 2/2*3	$5.90	$23.62	—	88% below	75%
Amylase blood test CPT 82150 HC AMYLASE	$47.50	$190.00	—	7% below	75%
Amylase blood test inpatient CPT 82150 HC 123110 AMYLASE ISOENZYM 2/2*3	$5.90	$23.62	—	—	75%
Amylase blood test inpatient CPT 82150 HC AMYLASE	$47.50	$190.00	—	—	75%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC BNP	$102.50	$410.00	—	45% below	75%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC BNP	$102.50	$410.00	—	—	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION A	$151.00	$604.00	—	25% above	75%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION A	$151.00	$604.00	—	—	75%
Basic metabolic panel (blood test) CPT 80048 HC CHEM BASIC	$287.25	$1,149.00	—	49% above	75%
Basic metabolic panel (blood test) inpatient CPT 80048 HC CHEM BASIC	$287.25	$1,149.00	—	—	75%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN; TOTAL	$27.50	$110.00	—	39% below	75%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN; TOTAL	$27.50	$110.00	—	—	75%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC 31150065 PATH EXM-COMPL-LV4 *5	$44.89	$179.55	—	65% below	75%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC G&M PROSTATE BIOPSY 10-20 SPECIME	$272.50	$1,090.00	—	110% above	75%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC RC 312 HISTOLOGY-LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION	$272.50	$1,090.00	—	110% above	75%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC RC 314 BIOPSY-LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION	$272.50	$1,090.00	—	110% above	75%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC 31150065 PATH EXM-COMPL-LV4 *5	$44.89	$179.55	—	—	75%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC RC 312 HISTOLOGY-LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION	$272.50	$1,090.00	—	—	75%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC RC 314 BIOPSY-LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION	$272.50	$1,090.00	—	—	75%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC G&M PROSTATE BIOPSY 10-20 SPECIME	$272.50	$1,090.00	—	—	75%
Blood culture for bacteria CPT 87040 HC CULT BLOOD	$405.75	$1,623.00	—	49% above	75%
Blood culture for bacteria inpatient CPT 87040 HC CULT BLOOD	$405.75	$1,623.00	—	—	75%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC PHLEBOTOMY/VENIPUNCTURE	$6.50	$26.00	—	69% below	75%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC PHLEBOTOMY/VENIPUNCTURE	$6.50	$26.00	—	—	75%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE	$114.00	$456.00	—	204% above	75%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE, POCT-EPOC	$114.00	$456.00	—	204% above	75%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE	$114.00	$456.00	—	—	75%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE, POCT-EPOC	$114.00	$456.00	—	—	75%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC SERUM PREG TEST	$271.00	$1,084.00	—	70% above	75%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC SERUM PREG TEST	$271.00	$1,084.00	—	—	75%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING, ABO	$94.75	$379.00	—	8% below	75%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING, ABO	$94.75	$379.00	—	—	75%
Blood urea nitrogen (BUN) test CPT 84520 HC BUN	$29.75	$119.00	—	10% below	75%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC BUN	$29.75	$119.00	—	—	75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN	$41.75	$167.00	—	23% below	75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN	$41.75	$167.00	—	—	75%
C. difficile toxin gene test (stool PCR) CPT 87493 HC C-DIFF TOXIN, BY PCR	$152.00	$608.00	—	1% below	75%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC C-DIFF TOXIN, BY PCR	$152.00	$608.00	—	—	75%
CA 19-9 blood test (tumor marker) CPT 86301 HC CA 19-9	$13.25	$53.00	—	73% below	75%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC CA 19-9	$13.25	$53.00	—	—	75%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC CA 125	$19.75	$79.00	—	86% below	75%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC CA 125	$19.75	$79.00	—	—	75%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC 139900 LABCORP - COVID-19	$12.83	$51.31	—	86% below	75%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC POCT SARS-COV2 LIAT	$50.00	$200.00	—	47% below	75%
COVID-19 PCR test (SARS-CoV-2 lab test) one side CPT 87635 HC ECH LOS GATOS KIT RAPID SARS-COV-2 RT-PCR 2019 NOVEL CORONA VIRUS	$86.50	$346.00	—	9% below	75%
COVID-19 PCR test (SARS-CoV-2 lab test) one side CPT 87635 HC ECH RAPID SARS-COV-2 RT-PCR 2019 NOVEL CORONA VIRUS	$86.50	$346.00	—	9% below	75%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC 139900 LABCORP - COVID-19	$12.83	$51.31	—	—	75%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC POCT SARS-COV2 LIAT	$50.00	$200.00	—	—	75%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient one side CPT 87635 HC ECH RAPID SARS-COV-2 RT-PCR 2019 NOVEL CORONA VIRUS	$86.50	$346.00	—	—	75%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient one side CPT 87635 HC ECH LOS GATOS KIT RAPID SARS-COV-2 RT-PCR 2019 NOVEL CORONA VIRUS	$86.50	$346.00	—	—	75%
Calcium blood test, total CPT 82310 HC CALCIUM	$108.75	$435.00	—	78% above	75%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM	$108.75	$435.00	—	—	75%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CEA	$37.50	$150.00	—	55% below	75%
Carcinoembryonic antigen (CEA) test CPT 82378 HC PANCREATIC CYST FLUID CEA	$37.50	$150.00	—	55% below	75%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CEA	$37.50	$150.00	—	—	75%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC PANCREATIC CYST FLUID CEA	$37.50	$150.00	—	—	75%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER	$52.00	$208.00	—	69% above	75%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER	$52.00	$208.00	—	—	75%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PROFILE	$64.25	$257.00	—	37% below	75%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PROFILE	$64.25	$257.00	—	—	75%
Complete blood count (CBC) with differential CPT 85025 HC CBC, WITH AUTO DIFFERENTIAL	$61.50	$246.00	—	44% below	75%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC, WITH AUTO DIFFERENTIAL	$61.50	$246.00	—	—	75%
Complete blood count (CBC), no differential CPT 85027 HC CBC, WITHOUT DIFFERENTIAL (HEMOGRAM)	$52.50	$210.00	—	40% below	75%
Complete blood count (CBC), no differential inpatient CPT 85027 HC CBC, WITHOUT DIFFERENTIAL (HEMOGRAM)	$52.50	$210.00	—	—	75%
Comprehensive metabolic panel (blood test) CPT 80053 HC CHEM COMPREHENSIVE	$345.25	$1,381.00	—	35% above	75%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC CHEM COMPREHENSIVE	$345.25	$1,381.00	—	—	75%
Cortisol blood test, total CPT 82533 HC CORTISOL	$91.25	$365.00	—	5% below	75%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL	$91.25	$365.00	—	—	75%
Creatine kinase (CK) blood test, total CPT 82550 HC CPK-ENZYME	$28.00	$112.00	—	68% below	75%
Creatine kinase (CK) blood test, total CPT 82550 HC CPK-ENZYME 91	$28.00	$112.00	—	68% below	75%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CPK-ENZYME 91	$28.00	$112.00	—	—	75%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CPK-ENZYME	$28.00	$112.00	—	—	75%
Creatinine blood test CPT 82565 HC CREATININE POCT-EPOC	$116.25	$465.00	—	151% above	75%
Creatinine blood test CPT 82565 HC CREATININE	$116.25	$465.00	—	151% above	75%
Creatinine blood test inpatient CPT 82565 HC CREATININE	$116.25	$465.00	—	—	75%
Creatinine blood test inpatient CPT 82565 HC CREATININE POCT-EPOC	$116.25	$465.00	—	—	75%
D-dimer blood test (blood clot marker) CPT 85379 HC D-DIMER	$250.25	$1,001.00	—	74% above	75%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC D-DIMER	$250.25	$1,001.00	—	—	75%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC 701106 SYNTHETIC CANNABINOIDS SCREEN W/RFLX CONFIRM LC#701106	$11.25	$45.00	—	82% below	75%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC 738792 Y-HYDROXYBUTYRIC ACID SCREEN UA	$16.41	$65.63	—	74% below	75%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC LC 791750 KRATOM (MITRAGYNINE) SCREEN UA	$20.00	$80.00	—	68% below	75%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN BLOOD SEND OUT	$80.75	$323.00	—	30% above	75%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC SCVMC DRUG OF ABUSE RAPID SCREEN, URINE	$90.00	$360.00	—	45% above	75%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN URINE NEONATE SENTOUT/SCVMC*	$90.00	$360.00	—	45% above	75%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC SCVMC CANNABINOIDS SCREEN, URINE	$90.00	$360.00	—	45% above	75%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN URINE - SCVMC*	$90.00	$360.00	—	45% above	75%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC LAB5166 SCVMC DRUG SCREEN URINE, NEONATE, CANNABINOIDS *8	$90.00	$360.00	—	45% above	75%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS	$437.75	$1,751.00	—	606% above	75%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC 701106 SYNTHETIC CANNABINOIDS SCREEN W/RFLX CONFIRM LC#701106	$11.25	$45.00	—	—	75%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC 738792 Y-HYDROXYBUTYRIC ACID SCREEN UA	$16.41	$65.63	—	—	75%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC LC 791750 KRATOM (MITRAGYNINE) SCREEN UA	$20.00	$80.00	—	—	75%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG SCREEN BLOOD SEND OUT	$80.75	$323.00	—	—	75%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC LAB5166 SCVMC DRUG SCREEN URINE, NEONATE, CANNABINOIDS *8	$90.00	$360.00	—	—	75%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG SCREEN URINE NEONATE SENTOUT/SCVMC*	$90.00	$360.00	—	—	75%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC SCVMC CANNABINOIDS SCREEN, URINE	$90.00	$360.00	—	—	75%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG SCREEN URINE - SCVMC*	$90.00	$360.00	—	—	75%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC SCVMC DRUG OF ABUSE RAPID SCREEN, URINE	$90.00	$360.00	—	—	75%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS	$437.75	$1,751.00	—	—	75%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL	$127.75	$511.00	—	52% above	75%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTE PANEL	$127.75	$511.00	—	—	75%
Estradiol blood test CPT 82670 HC ESTRADIOL; TOTAL	$88.00	$352.00	—	2% above	75%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL; TOTAL	$88.00	$352.00	—	—	75%
FSH (follicle-stimulating hormone) test CPT 83001 HC FSH	$88.25	$353.00	—	13% below	75%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC FSH	$88.25	$353.00	—	—	75%
Fecal calprotectin (stool inflammation test) CPT 83993 HC 123255 CALPROTECTIN FECAL*3	$22.81	$91.25	—	69% below	75%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC 123255 CALPROTECTIN FECAL*3	$22.81	$91.25	—	—	75%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN	$51.75	$207.00	—	51% below	75%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN	$51.75	$207.00	—	—	75%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN ASSAY	$56.00	$224.00	—	58% below	75%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN ASSAY	$56.00	$224.00	—	—	75%
Folate (folic acid) blood test CPT 82746 HC FOLATE	$45.75	$183.00	—	58% below	75%
Folate (folic acid) blood test inpatient CPT 82746 HC FOLATE	$45.75	$183.00	—	—	75%
Free T3 thyroid hormone test CPT 84481 HC FREE T3	$49.00	$196.00	—	40% below	75%
Free T3 thyroid hormone test inpatient CPT 84481 HC FREE T3	$49.00	$196.00	—	—	75%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC FREE T4	$43.00	$172.00	—	37% below	75%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC FREE T4	$43.00	$172.00	—	—	75%
Free testosterone test CPT 84402 HC FREE TESTOSTERONE	$16.25	$65.00	—	41% below	75%
Free testosterone test inpatient CPT 84402 HC FREE TESTOSTERONE	$16.25	$65.00	—	—	75%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC G.GLUT.TRANSPEPTIDASE	$84.50	$338.00	—	86% above	75%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC G.GLUT.TRANSPEPTIDASE	$84.50	$338.00	—	—	75%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)	$51.00	$204.00	—	2% below	75%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)	$51.00	$204.00	—	—	75%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE; TOLERANCE TEST (GTT), 3 SPECIMENS (INCLUDES GLUCOSE)	$38.00	$152.00	—	72% below	75%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE; TOLERANCE TEST (GTT), 3 SPECIMENS (INCLUDES GLUCOSE)	$38.00	$152.00	—	—	75%
H. pylori stool antigen test CPT 87338 HC H. PYLORI ANTIGEN, STOOL	$12.25	$49.00	—	85% below	75%
H. pylori stool antigen test inpatient CPT 87338 HC H. PYLORI ANTIGEN, STOOL	$12.25	$49.00	—	—	75%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV GENOSURE PLUS GENOTYPING*3	$87.75	$351.00	—	13% below	75%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV GENOSURE PLUS GENOTYPING*3	$87.75	$351.00	—	—	75%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV 1/2, RAPID	$59.75	$239.00	—	2% above	75%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV 1/2, RAPID	$59.75	$239.00	—	—	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 ANTIGEN W/ HIV 1 & 2 ANTIBODY, RAPID	$67.50	$270.00	—	23% below	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HUMAN IMMUNODEFICIENCY VIRUS (HIV) FOR AG/AB 4TH GENERATION	$67.50	$270.00	—	23% below	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HUMAN IMMUNODEFICIENCY VIRUS (HIV) FOR AG/AB 4TH GENERATION	$67.50	$270.00	—	—	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV-1 ANTIGEN W/ HIV 1 & 2 ANTIBODY, RAPID	$67.50	$270.00	—	—	75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN A1C	$43.00	$172.00	—	34% below	75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HEMOGLOBIN A1C	$43.00	$172.00	—	—	75%
Hemoglobin blood test CPT 85018 HC POCT HEMOGLOBIN - AVOX (2 OF 2)	$17.25	$69.00	—	57% below	75%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN	$17.25	$69.00	—	57% below	75%
Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN	$17.25	$69.00	—	—	75%
Hemoglobin blood test inpatient CPT 85018 HC POCT HEMOGLOBIN - AVOX (2 OF 2)	$17.25	$69.00	—	—	75%
Hepatitis B core antibody test (total) CPT 86704 HC HEPATITIS B CORE AB	$24.25	$97.00	—	31% below	75%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEPATITIS B CORE AB	$24.25	$97.00	—	—	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE ANTIBODY (HBSAB)	$96.25	$385.00	—	127% above	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURFACE ANTIBODY (HBSAB)	$96.25	$385.00	—	—	75%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC HEPATITIS B SUR ANTIGEN	$44.00	$176.00	—	39% below	75%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC HEPATITIS B SUR ANTIGEN	$44.00	$176.00	—	—	75%
Hepatitis C antibody blood test (screening) CPT 86803 HC HCV ABY	$104.25	$417.00	—	90% above	75%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HCV ABY	$104.25	$417.00	—	—	75%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN, HIGH SENSITIVITY (HSCRP) NEONATAL	$27.25	$109.00	—	54% below	75%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC CRP, HIGH SENSITIVITY	$27.25	$109.00	—	54% below	75%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN, HIGH SENSITIVITY (HSCRP) NEONATAL	$27.25	$109.00	—	—	75%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC CRP, HIGH SENSITIVITY	$27.25	$109.00	—	—	75%
Homocysteine blood test CPT 83090 HC HOMOCYSTEINE	$34.00	$136.00	—	55% below	75%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTEINE	$34.00	$136.00	—	—	75%
Iron blood test (serum iron) CPT 83540 HC IRON, SERUM	$34.00	$136.00	—	42% below	75%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON, SERUM	$34.00	$136.00	—	—	75%
Iron-binding capacity (TIBC) test CPT 83550 HC TIBC	$40.25	$161.00	—	45% below	75%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC TIBC	$40.25	$161.00	—	—	75%
Kidney function blood test panel CPT 80069 HC RENAL PANEL	$67.75	$271.00	—	52% below	75%
Kidney function blood test panel inpatient CPT 80069 HC RENAL PANEL	$67.75	$271.00	—	—	75%
LH (luteinizing hormone) test CPT 83002 HC LH	$103.50	$414.00	—	at median	75%
LH (luteinizing hormone) test inpatient CPT 83002 HC LH	$103.50	$414.00	—	—	75%
Lactate (lactic acid) blood test CPT 83605 HC LACTIC ACID	$176.25	$705.00	—	32% above	75%
Lactate (lactic acid) blood test CPT 83605 HC LACTATE POCT-EPOC	$176.25	$705.00	—	32% above	75%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTIC ACID	$176.25	$705.00	—	—	75%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTATE POCT-EPOC	$176.25	$705.00	—	—	75%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE DEHYDROGENASE (LD), (LDH)	$26.25	$105.00	—	26% below	75%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE DEHYDROGENASE (LD), (LDH)	$26.25	$105.00	—	—	75%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE	$200.00	$800.00	—	107% above	75%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE	$200.00	$800.00	—	—	75%
Liver function blood test panel CPT 80076 HC LIVER PANEL	$56.75	$227.00	—	62% below	75%
Liver function blood test panel inpatient CPT 80076 HC LIVER PANEL	$56.75	$227.00	—	—	75%
Lyme disease antibody test CPT 86618 HC LYME AB WEST BLOT*3	$7.50	$30.00	—	65% below	75%
Lyme disease antibody test inpatient CPT 86618 HC LYME AB WEST BLOT*3	$7.50	$30.00	—	—	75%
Magnesium blood test CPT 83735 HC MAGNESIUM	$189.00	$756.00	—	202% above	75%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM	$189.00	$756.00	—	—	75%
Measles (rubeola) antibody test CPT 86765 HC MEASLES	$48.25	$193.00	—	54% above	75%
Measles (rubeola) antibody test inpatient CPT 86765 HC MEASLES	$48.25	$193.00	—	—	75%
Mono test (heterophile antibody, Monospot) CPT 86308 HC MONOSPOT	$172.25	$689.00	—	68% above	75%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC MONOSPOT	$172.25	$689.00	—	—	75%
Mumps immunity blood test CPT 86735 HC MUMPS, IGG	$51.50	$206.00	—	221% above	75%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS, IGG	$51.50	$206.00	—	—	75%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC FREE PSA	$16.00	$64.00	—	73% below	75%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC FREE PSA	$16.00	$64.00	—	—	75%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA	$61.00	$244.00	—	2% above	75%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA	$61.00	$244.00	—	—	75%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC VAGINAL PAP SMEAR BY THIN PREP	$39.75	$159.00	—	56% below	75%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC VAGINAL PAP SMEAR BY THIN PREP	$39.75	$159.00	—	—	75%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE)	$170.00	$680.00	—	55% above	75%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE) 91	$170.00	$680.00	—	55% above	75%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE)	$170.00	$680.00	—	—	75%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE) 91	$170.00	$680.00	—	—	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC 31102493 LABACLPTT THROMBOPLASTIN PTT *5	$7.09	$28.35	—	89% below	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT INHIBITOR SCREEN, 5 MIN NORM PTT (1:1 INCUBATED MIX W/ NP) *5 4/6	$7.61	$30.45	—	88% below	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT INHIBITOR SCREEN, APTT PTTINH THROMPLAS *5 1/6	$7.61	$30.45	—	88% below	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT	$114.75	$459.00	—	84% above	75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC 31102493 LABACLPTT THROMBOPLASTIN PTT *5	$7.09	$28.35	—	—	75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT INHIBITOR SCREEN, 5 MIN NORM PTT (1:1 INCUBATED MIX W/ NP) *5 4/6	$7.61	$30.45	—	—	75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT INHIBITOR SCREEN, APTT PTTINH THROMPLAS *5 1/6	$7.61	$30.45	—	—	75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT	$114.75	$459.00	—	—	75%
Phosphorus (phosphate) blood test CPT 84100 HC PHOSPHOROUS	$103.25	$413.00	—	37% above	75%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC PHOSPHOROUS	$103.25	$413.00	—	—	75%
Potassium blood test CPT 84132 HC POTASSIUM, POCT-EPOC	$125.75	$503.00	—	72% above	75%
Potassium blood test CPT 84132 HC POTASSIUM	$125.75	$503.00	—	72% above	75%
Potassium blood test inpatient CPT 84132 HC POTASSIUM	$125.75	$503.00	—	—	75%
Potassium blood test inpatient CPT 84132 HC POTASSIUM, POCT-EPOC	$125.75	$503.00	—	—	75%
Progesterone blood test CPT 84144 HC PROGESTERONE	$81.00	$324.00	—	2% below	75%
Progesterone blood test inpatient CPT 84144 HC PROGESTERONE	$81.00	$324.00	—	—	75%
Prolactin blood test CPT 84146 HC PROLACTIN	$56.00	$224.00	—	48% below	75%
Prolactin blood test inpatient CPT 84146 HC PROLACTIN	$56.00	$224.00	—	—	75%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PT INHIBITOR SCREEN, PROTHROMBIN TIME *5 1/3	$4.72	$18.90	—	91% below	75%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PRO TIME	$36.75	$147.00	—	33% below	75%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PT INHIBITOR SCREEN, PROTHROMBIN TIME *5 1/3	$4.72	$18.90	—	—	75%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PRO TIME	$36.75	$147.00	—	—	75%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP SCREEN, GRP A POCT	$128.25	$513.00	—	19% above	75%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC RAPID STREP GRP A SCREEN	$128.25	$513.00	—	19% above	75%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP SCREEN, GRP A	$128.25	$513.00	—	19% above	75%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREP SCREEN, GRP A POCT	$128.25	$513.00	—	—	75%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC RAPID STREP GRP A SCREEN	$128.25	$513.00	—	—	75%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREP SCREEN, GRP A	$128.25	$513.00	—	—	75%
Rh blood typing CPT 86901 HC BCP ABO/RH INCL DU INDICATED 2/2	$5.25	$21.00	—	91% below	75%
Rh blood typing CPT 86901 HC LS015 VIT ABO/RH INCL DU INDICATED 2/2	$5.50	$22.00	—	90% below	75%
Rh blood typing CPT 86901 HC BLOOD TYPING, RH(D)	$60.25	$241.00	—	8% above	75%
Rh blood typing inpatient CPT 86901 HC BCP ABO/RH INCL DU INDICATED 2/2	$5.25	$21.00	—	—	75%
Rh blood typing inpatient CPT 86901 HC LS015 VIT ABO/RH INCL DU INDICATED 2/2	$5.50	$22.00	—	—	75%
Rh blood typing inpatient CPT 86901 HC BLOOD TYPING, RH(D)	$60.25	$241.00	—	—	75%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA TOTAL ABY	$63.50	$254.00	—	25% above	75%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA TOTAL ABY	$63.50	$254.00	—	—	75%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SED RATE AUTO	$20.50	$82.00	—	63% below	75%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SED RATE AUTO	$20.50	$82.00	—	—	75%
Sodium blood test CPT 84295 HC SODIUM, POCT-EPOC	$175.75	$703.00	—	168% above	75%
Sodium blood test CPT 84295 HC SODIUM	$175.75	$703.00	—	168% above	75%
Sodium blood test inpatient CPT 84295 HC SODIUM	$175.75	$703.00	—	—	75%
Sodium blood test inpatient CPT 84295 HC SODIUM, POCT-EPOC	$175.75	$703.00	—	—	75%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD	$19.50	$78.00	—	50% below	75%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD POCT	$19.50	$78.00	—	50% below	75%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD POCT	$19.50	$78.00	—	—	75%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD	$19.50	$78.00	—	—	75%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC 182949 OCCULT PL,FECAL,IMMUNASSAY*3	$7.50	$30.00	—	85% below	75%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC 182949 OCCULT PL,FECAL,IMMUNASSAY*3	$7.50	$30.00	—	—	75%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC TREPONEMA, EIA	$22.00	$88.00	—	36% above	75%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC TREPONEMA, EIA	$22.00	$88.00	—	—	75%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC QUANTIFERON TB	$176.50	$706.00	—	108% above	75%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC QUANTIFERON TB	$176.50	$706.00	—	—	75%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$16.75	$67.00	—	58% below	75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL	$16.75	$67.00	—	—	75%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH	$72.50	$290.00	—	22% below	75%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH	$72.50	$290.00	—	—	75%
Total cholesterol blood test CPT 82465 HC CHOLESTEROL	$22.25	$89.00	—	47% below	75%
Total cholesterol blood test inpatient CPT 82465 HC CHOLESTEROL	$22.25	$89.00	—	—	75%
Total triiodothyronine (T3) blood test CPT 84480 HC T3 RIA	$44.50	$178.00	—	43% below	75%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC T3 RIA	$44.50	$178.00	—	—	75%
Transferrin blood test CPT 84466 HC TRANSFERRIN	$29.75	$119.00	—	45% below	75%
Transferrin blood test inpatient CPT 84466 HC TRANSFERRIN	$29.75	$119.00	—	—	75%
Triglycerides blood test CPT 84478 HC TRIGLICERIDES	$41.50	$166.00	—	1% above	75%
Triglycerides blood test inpatient CPT 84478 HC TRIGLICERIDES	$41.50	$166.00	—	—	75%
Troponin test, quantitative CPT 84484 HC TROPONIN 91	$260.50	$1,042.00	—	45% above	75%
Troponin test, quantitative CPT 84484 HC TROPONIN	$260.50	$1,042.00	—	45% above	75%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN	$260.50	$1,042.00	—	—	75%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN 91	$260.50	$1,042.00	—	—	75%
Uric acid blood test CPT 84550 HC URIC ACID; BLOOD	$29.00	$116.00	—	56% below	75%
Uric acid blood test inpatient CPT 84550 HC URIC ACID; BLOOD	$29.00	$116.00	—	—	75%
Urinalysis with microscope exam, automated CPT 81001 HC UA W/MICROSCOPIC	$167.25	$669.00	—	102% above	75%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC UA W/MICROSCOPIC	$167.25	$669.00	—	—	75%
Urinalysis without microscope exam, automated CPT 81003 HC UROGRAM, POCT-STATUS	$107.00	$428.00	—	91% above	75%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS, BY DIP STICK OR TABLET REAGENT	$107.00	$428.00	—	91% above	75%
Urinalysis without microscope exam, automated CPT 81003 HC UROGRAM	$107.00	$428.00	—	91% above	75%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC UROGRAM	$107.00	$428.00	—	—	75%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS, BY DIP STICK OR TABLET REAGENT	$107.00	$428.00	—	—	75%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC UROGRAM, POCT-STATUS	$107.00	$428.00	—	—	75%
Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS, BY DIP STICK OR TABLET REAGENT	$6.00	$24.00	—	82% below	75%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINALYSIS, BY DIP STICK OR TABLET REAGENT	$6.00	$24.00	—	—	75%
Urine culture for bacteria, with colony count CPT 87086 HC CULT URINE	$149.75	$599.00	—	7% above	75%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULT URINE	$149.75	$599.00	—	—	75%
Urine microalbumin (albumin) test CPT 82043 HC ALBUMIN; URINE, MICROALBUMIN, QUANTITATIVE	$24.00	$96.00	—	35% below	75%
Urine microalbumin (albumin) test inpatient CPT 82043 HC ALBUMIN; URINE, MICROALBUMIN, QUANTITATIVE	$24.00	$96.00	—	—	75%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B12	$47.25	$189.00	—	50% below	75%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B12	$47.25	$189.00	—	—	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D-25 HYDROXY	$31.00	$124.00	—	52% below	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D-25 HYDROXY	$31.00	$124.00	—	—	75%
Zinc blood test CPT 84630 HC ZINC RBC*3	$6.25	$25.00	—	43% below	75%
Zinc blood test inpatient CPT 84630 HC ZINC RBC*3	$6.25	$25.00	—	—	75%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG BETA SUB UNIT	$173.00	$692.00	—	3% below	75%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG BETA SUB UNIT	$173.00	$692.00	—	—	75%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Cardiac catheterization with coronary angiogram one side CPT 93458 HC CORONARY W LHC W/WO LT VGRAM	$14,176.50	$56,706.00	—	10% above	75%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 HC CORONARY W LHC W/WO LT VGRAM	$14,176.50	$56,706.00	—	—	75%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION	$924.75	$3,699.00	—	52% below	75%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION PACU	$924.75	$3,699.00	—	52% below	75%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION	$924.75	$3,699.00	—	—	75%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION PACU	$924.75	$3,699.00	—	—	75%
Catheter ablation for atrial fibrillation CPT 93656 HC EP TX ATRIAL FIB PULM VEIN ISOLAT	$34,165.50	$136,662.00	—	2% above	75%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC EP TX ATRIAL FIB PULM VEIN ISOLAT	$34,165.50	$136,662.00	—	—	75%
Coronary stent placement, one artery CPT 92928 HC PRQ CARD STENT W ANGIO SGL ART	$15,014.00	$60,056.00	—	at median	75%
Coronary stent placement, one artery inpatient CPT 92928 HC PRQ CARD STENT W ANGIO SGL ART	$15,014.00	$60,056.00	—	—	75%
Cystoscopy with ureteral stent placement CPT 52332 HC CYSTOURETHROSCOPY W/INSERT INDWELLING URETERAL STENT (GIBBONS OR DBLE J TYPE)	$2,331.75	$9,327.00	—	69% below	75%
Cystoscopy with ureteral stent placement inpatient CPT 52332 HC CYSTOURETHROSCOPY W/INSERT INDWELLING URETERAL STENT (GIBBONS OR DBLE J TYPE)	$2,331.75	$9,327.00	—	—	75%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV	$980.75	$3,923.00	—	52% below	75%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV	$980.75	$3,923.00	—	—	75%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC INJ HYSTEROSALPINGOGRAM	$401.00	$1,604.00	—	36% below	75%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC INJ HYSTEROSALPINGOGRAM	$401.00	$1,604.00	—	—	75%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC DRAIN INJEXT MAJOR JOINT BURSA	$695.25	$2,781.00	—	27% below	75%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC DRAIN INJEXT MAJOR JOINT BURSA	$695.25	$2,781.00	—	—	75%
Left heart catheterization, diagnostic one side CPT 93452 HC LHC W/WO LT VGRAM	$5,185.75	$20,743.00	—	48% below	75%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC LHC W/WO LT VGRAM	$5,185.75	$20,743.00	—	—	75%
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJECTION DX/THER SBST INTRLMRN LMBR/SAC W/ IMAGING GUIDANCE	$1,014.25	$4,057.00	—	54% below	75%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJECTION DX/THER SBST INTRLMRN LMBR/SAC W/ IMAGING GUIDANCE	$1,014.25	$4,057.00	—	—	75%
Lower-back epidural injection, without imaging guidance CPT 62322 HC INJECTION DX/THER SBST INTRLMNR LMBR/SAC W/O IMAGING GUIDANCE	$903.50	$3,614.00	—	50% below	75%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC INJECTION DX/THER SBST INTRLMNR LMBR/SAC W/O IMAGING GUIDANCE	$903.50	$3,614.00	—	—	75%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJECT ANESTHETIC STEROID L/S EPI	$1,249.50	$4,998.00	—	39% below	75%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJECT ANESTHETIC STEROID L/S EPI	$1,249.50	$4,998.00	—	—	75%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXCISION B9 LESION INCLUDING MARGINS 0.5CM OR LESS	$705.50	$2,822.00	—	47% below	75%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXCISION B9 LESION INCLUDING MARGINS 0.5CM OR LESS	$705.50	$2,822.00	—	—	75%
Paracentesis with imaging guidance CPT 49083 HC ABDOMINAL PARACENTESIS W/IMAGING	$698.25	$2,793.00	—	62% below	75%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABDOMINAL PARACENTESIS W/IMAGING	$698.25	$2,793.00	—	—	75%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC LUMBAR PUNCTURE	$1,118.75	$4,475.00	—	15% below	75%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC LUMBAR PUNCTURE	$1,118.75	$4,475.00	—	—	75%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS W IMAGING GUIDANCE	$1,148.75	$4,595.00	—	44% below	75%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS W IMAGING GUIDANCE	$1,148.75	$4,595.00	—	—	75%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$432.00	$1,728.00	—	32% below	75%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$432.00	$1,728.00	—	—	75%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US GUIDE (CATHLAB)	$2,083.75	$8,335.00	—	35% below	75%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US GUIDE (CATHLAB)	$2,083.75	$8,335.00	—	—	75%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 HC CYSTO/URETERO W/LITHOTRIPSY INDWELL STENT INSRT	$4,371.75	$17,487.00	—	64% below	75%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 HC CYSTO/URETERO W/LITHOTRIPSY INDWELL STENT INSRT	$4,371.75	$17,487.00	—	—	75%
Vein ablation, radiofrequency, first vein CPT 36475 HC ENDOVENOUS RF 1ST VEIN	$2,215.75	$8,863.00	—	74% below	75%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC ENDOVENOUS RF 1ST VEIN	$2,215.75	$8,863.00	—	—	75%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION OBED	$320.75	$1,283.00	—	63% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION	$320.75	$1,283.00	—	63% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION PREOP	$320.75	$1,283.00	—	63% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION ENDO	$320.75	$1,283.00	—	63% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION PACU	$320.75	$1,283.00	—	63% below	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION	$320.75	$1,283.00	—	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION OBED	$320.75	$1,283.00	—	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION PREOP	$320.75	$1,283.00	—	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION ENDO	$320.75	$1,283.00	—	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION PACU	$320.75	$1,283.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC IPV TREATMENT SUBSEQUENT	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC SPUTUM INDUCTION SUB PULMONARY	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC MDI INITIAL	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC MDI SUBSEQUENT	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC IPPB INITIAL TX	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC SPUTUM INDUCTION INITIAL	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC HAND NEB INITIAL	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC HHN W/PEAK FLOW INITIAL	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC HHN W/PEAK FLOW SUBSEQUENT	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC IPV TREATMENT INITIAL	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC SPUTUM INDUCTION INITIAL PULMONARY	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC HAND NEB SUB	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC ULTRA NEB INITIAL	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AEROSOL TX SUBSEQUENT	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AEROSOL TX INITIAL	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC ULTRA NEB SUBSEQUENT	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC SPUTUM INDUCTION SUB	$182.25	$729.00	—	44% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC MDI INITIAL	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC HAND NEB INITIAL	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC SPUTUM INDUCTION SUB PULMONARY	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC HHN W/PEAK FLOW INITIAL	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC HHN W/PEAK FLOW SUBSEQUENT	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC SPUTUM INDUCTION SUB	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC HAND NEB SUB	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC ULTRA NEB INITIAL	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC SPUTUM INDUCTION INITIAL	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC ULTRA NEB SUBSEQUENT	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC IPV TREATMENT INITIAL	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC IPPB INITIAL TX	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC MDI SUBSEQUENT	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AEROSOL TX INITIAL	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AEROSOL TX SUBSEQUENT	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC SPUTUM INDUCTION INITIAL PULMONARY	$182.25	$729.00	—	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC IPV TREATMENT SUBSEQUENT	$182.25	$729.00	—	—	75%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO INFUSION,INITIAL,UP TO 1 HR	$717.75	$2,871.00	—	18% below	75%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO INFUSION,INITIAL,UP TO 1 HR	$717.75	$2,871.00	—	—	75%
Critical care, first 30 to 74 minutes CPT 99291 HC EMERGNCY SVC-CRITICAL 1ST 74 MIN	$4,212.50	$16,850.00	—	23% below	75%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC EMERGNCY SVC-CRITICAL 1ST 74 MIN	$4,212.50	$16,850.00	—	—	75%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG REGULAR AWAKE AND DROWSY-HOSPITAL	$527.50	$2,110.00	—	49% below	75%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG REGULAR AWAKE AND DROWSY-HOSPITAL	$527.50	$2,110.00	—	—	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG - HOSPITAL	$499.50	$1,998.00	—	48% above	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC EKG - HOSPITAL	$499.50	$1,998.00	—	—	75%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY	$561.50	$2,246.00	—	77% below	75%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY	$561.50	$2,246.00	—	—	75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC EMERGENCY SERVICE-LEVEL 1	$389.00	$1,556.00	—	8% below	75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC EMERGENCY SERVICE-LEVEL 1	$389.00	$1,556.00	—	—	75%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC EMERGENCY SERVICE-LEVEL 2	$700.75	$2,803.00	—	20% below	75%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC EMERGENCY SERVICE-LEVEL 2	$700.75	$2,803.00	—	—	75%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC EMERGENCY SERVICE-LEVEL 3	$1,210.25	$4,841.00	—	19% below	75%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC EMERGENCY SERVICE-LEVEL 3	$1,210.25	$4,841.00	—	—	75%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC EMERGENCY SERVICE-LEVEL 4	$1,984.50	$7,938.00	—	27% below	75%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC EMERGENCY SERVICE-LEVEL 4	$1,984.50	$7,938.00	—	—	75%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC EMERGENCY SERVICE-LEVEL 5	$2,862.50	$11,450.00	—	19% below	75%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC EMERGENCY SERVICE-LEVEL 5	$2,862.50	$11,450.00	—	—	75%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIOVASCULAR STRESS TEST	$716.75	$2,867.00	—	49% below	75%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CARDIOVASCULAR STRESS TEST	$716.75	$2,867.00	—	—	75%
Family therapy with the patient, 50 minutes CPT 90847 HC CLN-PSY THER FAMILY 50MIN W/ PT	$138.25	$553.00	—	60% below	75%
Family therapy with the patient, 50 minutes CPT 90847 HC PSY THER FAMILY 50 MIN W/ PT	$138.25	$553.00	—	60% below	75%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC PSY THER FAMILY 50 MIN W/ PT	$138.25	$553.00	—	—	75%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC CLN-PSY THER FAMILY 50MIN W/ PT	$138.25	$553.00	—	—	75%
Family therapy without the patient, 50 minutes CPT 90846 HC CLN-PSY THER FAMILY 50MIN W/O PT	$118.00	$472.00	—	66% below	75%
Family therapy without the patient, 50 minutes CPT 90846 HC PSY THER FAMILY 50 MIN W/O PT	$118.00	$472.00	—	66% below	75%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC PSY THER FAMILY 50 MIN W/O PT	$118.00	$472.00	—	—	75%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC CLN-PSY THER FAMILY 50MIN W/O PT	$118.00	$472.00	—	—	75%
Group psychotherapy session CPT 90853 HC PSYCHOTHERAPY GROUP	$70.50	$282.00	—	75% below	75%
Group psychotherapy session CPT 90853 HC ASPIRE SKILLS AC GROUP	$70.50	$282.00	—	75% below	75%
Group psychotherapy session CPT 90853 HC SHC-PSYCHOTHERAPY GROUP	$70.50	$282.00	—	75% below	75%
Group psychotherapy session CPT 90853 HC CLN-PSYCHOTHERAPY GROUP	$70.50	$282.00	—	75% below	75%
Group psychotherapy session inpatient CPT 90853 HC CLN-PSYCHOTHERAPY GROUP	$70.50	$282.00	—	—	75%
Group psychotherapy session inpatient CPT 90853 HC PSYCHOTHERAPY GROUP	$70.50	$282.00	—	—	75%
Group psychotherapy session inpatient CPT 90853 HC ASPIRE SKILLS AC GROUP	$70.50	$282.00	—	—	75%
Group psychotherapy session inpatient CPT 90853 HC SHC-PSYCHOTHERAPY GROUP	$70.50	$282.00	—	—	75%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC INFUSION,HYDRATION,INIT,31-60 MIN	$456.75	$1,827.00	—	8% below	75%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC INFUSION,HYDRATION,INIT,31-60 MIN OBED	$456.75	$1,827.00	—	8% below	75%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC INFUSION,HYDRATION,INIT,31-60 MIN	$456.75	$1,827.00	—	—	75%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC INFUSION,HYDRATION,INIT,31-60 MIN OBED	$456.75	$1,827.00	—	—	75%
IV infusion of a medicine, first hour CPT 96365 HC INFUSION,INITIAL,UP TO 1 HR	$476.00	$1,904.00	—	19% below	75%
IV infusion of a medicine, first hour CPT 96365 HC INFUSION,INITIAL,UP TO 1 HR OBED	$476.00	$1,904.00	—	19% below	75%
IV infusion of a medicine, first hour inpatient CPT 96365 HC INFUSION,INITIAL,UP TO 1 HR	$476.00	$1,904.00	—	—	75%
IV infusion of a medicine, first hour inpatient CPT 96365 HC INFUSION,INITIAL,UP TO 1 HR OBED	$476.00	$1,904.00	—	—	75%
IV push of a medicine, first drug CPT 96374 HC INJECTION IV PUSH, SINGLE/INITIAL	$324.75	$1,299.00	—	8% below	75%
IV push of a medicine, first drug CPT 96374 HC INJECTION IV PUSH, SINGLE/INITIAL OBED	$324.75	$1,299.00	—	8% below	75%
IV push of a medicine, first drug inpatient CPT 96374 HC INJECTION IV PUSH, SINGLE/INITIAL OBED	$324.75	$1,299.00	—	—	75%
IV push of a medicine, first drug inpatient CPT 96374 HC INJECTION IV PUSH, SINGLE/INITIAL	$324.75	$1,299.00	—	—	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECTION IM/SQ OBED	$139.75	$559.00	—	22% below	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECTION IM/SQ	$139.75	$559.00	—	22% below	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJECTION IM/SQ	$139.75	$559.00	—	—	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJECTION IM/SQ OBED	$139.75	$559.00	—	—	75%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSY DIAGNOSTIC EVALUATION	$210.25	$841.00	—	45% below	75%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC CD DIAGNOSTIC EVALUATION	$210.25	$841.00	—	45% below	75%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC OATS-PSYCH DIAGNOSTIC EVALUATION	$210.25	$841.00	—	45% below	75%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC CLN-PSYCHIATRIC DIAGNOSTIC EVALUATION	$210.25	$841.00	—	45% below	75%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC CLN-PSYCHIATRIC DIAGNOSTIC EVALUATION	$210.25	$841.00	—	—	75%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC CD DIAGNOSTIC EVALUATION	$210.25	$841.00	—	—	75%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PSY DIAGNOSTIC EVALUATION	$210.25	$841.00	—	—	75%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC OATS-PSYCH DIAGNOSTIC EVALUATION	$210.25	$841.00	—	—	75%
Neuromuscular re-education, 15 minutes CPT 97112 HC OT PROC NEUROMUSC REED 15M	$62.75	$251.00	—	51% below	75%
Neuromuscular re-education, 15 minutes CPT 97112 HC PT PROC NEUROMUSC REED 15M	$62.75	$251.00	—	51% below	75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC OT PROC NEUROMUSC REED 15M	$62.75	$251.00	—	—	75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC PT PROC NEUROMUSC REED 15M	$62.75	$251.00	—	—	75%
New patient office visit, about 30 minutes CPT 99203 HC E&M, NEW PT, LOW, 30-44 MIN	$109.00	$436.00	—	49% below	75%
New patient office visit, about 30 minutes inpatient CPT 99203 HC E&M, NEW PT, LOW, 30-44 MIN	$109.00	$436.00	—	—	75%
New patient office visit, about 45 minutes CPT 99204 HC E&M, NEW PT, MODERATE, 45-59 MIN	$170.00	$680.00	—	30% below	75%
New patient office visit, about 45 minutes inpatient CPT 99204 HC E&M, NEW PT, MODERATE, 45-59 MIN	$170.00	$680.00	—	—	75%
New patient office visit, about 60 minutes CPT 99205 HC E&M, NEW PT, HIGH, 60-74 MIN	$198.75	$795.00	—	42% below	75%
New patient office visit, about 60 minutes inpatient CPT 99205 HC E&M, NEW PT, HIGH, 60-74 MIN	$198.75	$795.00	—	—	75%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC E&M, NEW PT, STRAIGHTFORWARD, 15-29 MIN	$86.75	$347.00	—	38% below	75%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC E&M, NEW PT, STRAIGHTFORWARD, 15-29 MIN	$86.75	$347.00	—	—	75%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MNT INITIAL INDIVIDUAL EACH 15 MINS PDC	$85.25	$341.00	—	14% below	75%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MNT-INITIAL, INDIV, EA 15 MINS	$85.25	$341.00	—	14% below	75%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MNT INITIAL INDIVIDUAL EACH 15 MINS PDC	$85.25	$341.00	—	—	75%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MNT-INITIAL, INDIV, EA 15 MINS	$85.25	$341.00	—	—	75%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEXITY 30 MINS	$135.50	$542.00	—	48% below	75%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEXITY 30 MINS	$135.50	$542.00	—	—	75%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEXITY 45 MINS	$178.00	$712.00	—	55% below	75%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEXITY 45 MINS	$178.00	$712.00	—	—	75%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEXITY 20 MINS	$121.00	$484.00	—	49% below	75%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEXITY 20 MINS	$121.00	$484.00	—	—	75%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MODERATE COMPLEXITY 30 MINS	$163.75	$655.00	—	54% below	75%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MODERATE COMPLEXITY 30 MINS	$163.75	$655.00	—	—	75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC PT PROC MANUAL THERAPY 15M	$66.25	$265.00	—	45% below	75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC OT PROC MANUAL THERAPY 15M	$66.25	$265.00	—	45% below	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC PT PROC MANUAL THERAPY 15M	$66.25	$265.00	—	—	75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC OT PROC MANUAL THERAPY 15M	$66.25	$265.00	—	—	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PT PROC THERPTC EXERCISE 15M	$58.00	$232.00	—	55% below	75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT PROC THERPTC EXERCISE 15M	$58.00	$232.00	—	55% below	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC PT PROC THERPTC EXERCISE 15M	$58.00	$232.00	—	—	75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC OT PROC THERPTC EXERCISE 15M	$58.00	$232.00	—	—	75%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HC PSYCH TST EVAL BY MD, INCL INTERP, DATA, CLIN DECISION MAKING, TRTMNT PLAN AND REPORT;FIRST HR	$229.25	$917.00	—	66% below	75%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 HC PSYCH TST EVAL BY MD, INCL INTERP, DATA, CLIN DECISION MAKING, TRTMNT PLAN AND REPORT;FIRST HR	$229.25	$917.00	—	—	75%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC PSY THERAPY, CRISIS, FIRST 60 MINS	$199.75	$799.00	—	42% below	75%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PSY THERAPY, CRISIS, FIRST 60 MINS	$199.75	$799.00	—	—	75%
Psychotherapy session, 30 minutes CPT 90832 HC PSY THERAPY 30MIN W/PT AND/OR FAM	$202.75	$811.00	—	36% below	75%
Psychotherapy session, 30 minutes CPT 90832 HC CLN-PSYCHOTHERAPY 30MIN W/PT	$202.75	$811.00	—	36% below	75%
Psychotherapy session, 30 minutes CPT 90832 HC CD THERAPY 30MIN W/PT	$202.75	$811.00	—	36% below	75%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSY THERAPY 30MIN W/PT AND/OR FAM	$202.75	$811.00	—	—	75%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC CD THERAPY 30MIN W/PT	$202.75	$811.00	—	—	75%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC CLN-PSYCHOTHERAPY 30MIN W/PT	$202.75	$811.00	—	—	75%
Psychotherapy session, 45 minutes CPT 90834 HC THERAPY 45 MIN W/PT	$217.25	$869.00	—	32% below	75%
Psychotherapy session, 45 minutes CPT 90834 HC PSY THERAPY 45MIN W/PT	$217.25	$869.00	—	32% below	75%
Psychotherapy session, 45 minutes CPT 90834 HC CD THERAPY 45MIN W/PT	$217.25	$869.00	—	32% below	75%
Psychotherapy session, 45 minutes CPT 90834 HC CLN-PSYCHOTHERAPY 45MIN W/PT	$217.25	$869.00	—	32% below	75%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSY THERAPY 45MIN W/PT	$217.25	$869.00	—	—	75%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC CD THERAPY 45MIN W/PT	$217.25	$869.00	—	—	75%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC THERAPY 45 MIN W/PT	$217.25	$869.00	—	—	75%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC CLN-PSYCHOTHERAPY 45MIN W/PT	$217.25	$869.00	—	—	75%
Psychotherapy session, 60 minutes CPT 90837 HC CLN-PSYCHOTHERAPY 60MIN W/PT	$237.25	$949.00	—	35% below	75%
Psychotherapy session, 60 minutes CPT 90837 HC PSY THERAPY 60MIN W/PT	$237.25	$949.00	—	35% below	75%
Psychotherapy session, 60 minutes CPT 90837 HC CD THERAPY 60MIN W/PT	$237.25	$949.00	—	35% below	75%
Psychotherapy session, 60 minutes CPT 90837 HC THERAPY 60 MIN W/PT	$237.25	$949.00	—	35% below	75%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSY THERAPY 60MIN W/PT	$237.25	$949.00	—	—	75%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC THERAPY 60 MIN W/PT	$237.25	$949.00	—	—	75%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC CD THERAPY 60MIN W/PT	$237.25	$949.00	—	—	75%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC CLN-PSYCHOTHERAPY 60MIN W/PT	$237.25	$949.00	—	—	75%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC SMOKING CESSATION COUNSELING 3-10 MINUTE	$25.75	$103.00	—	65% below	75%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC SMOKING CESSATION COUNSELING 3-10 MINUTE	$25.75	$103.00	—	—	75%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC E&M, EST PT, HIGH, 40-54 MIN	$143.25	$573.00	—	43% below	75%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC E&M, EST PT, HIGH, 40-54 MIN	$143.25	$573.00	—	—	75%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC E&M, EST PT, LOW, 20-29 MIN	$75.00	$300.00	—	48% below	75%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC E&M, EST PT, LOW, 20-29 MIN	$75.00	$300.00	—	—	75%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC E&M, EST PT, MODERATE, 30-39 MIN	$93.25	$373.00	—	54% below	75%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC E&M, EST PT, MODERATE, 30-39 MIN	$93.25	$373.00	—	—	75%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC E&M, EST PT, STRAIGHTFORWARD, 10-19 MIN	$50.75	$203.00	—	56% below	75%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC E&M, EST PT, STRAIGHTFORWARD, 10-19 MIN	$50.75	$203.00	—	—	75%
Speech and language evaluation CPT 92523 HC SPEECH SOUND LANG COMPREHENSION	$191.25	$765.00	—	58% below	75%
Speech and language evaluation inpatient CPT 92523 HC SPEECH SOUND LANG COMPREHENSION	$191.25	$765.00	—	—	75%
Speech therapy session, individual CPT 92507 HC SPEECH THERAPY	$157.00	$628.00	—	43% below	75%
Speech therapy session, individual inpatient CPT 92507 HC SPEECH THERAPY	$157.00	$628.00	—	—	75%
Spirometry (breathing test) CPT 94010 HC SPIROMETRY-SIMPLE	$195.50	$782.00	—	49% below	75%
Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY-SIMPLE	$195.50	$782.00	—	—	75%
Spirometry before and after a bronchodilator CPT 94060 HC SPIROMETRY PRE/POST DILATOR	$676.00	$2,704.00	—	16% below	75%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC SPIROMETRY PRE/POST DILATOR	$676.00	$2,704.00	—	—	75%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC PT PROC THERAPEUTIC ACTIVITY 15M	$87.00	$348.00	—	37% below	75%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC OT PROC THERAPEUTIC ACT 15M	$87.00	$348.00	—	37% below	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC OT PROC THERAPEUTIC ACT 15M	$87.00	$348.00	—	—	75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC PT PROC THERAPEUTIC ACTIVITY 15M	$87.00	$348.00	—	—	75%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY, THERAPEUTIC	$274.00	$1,096.00	—	15% below	75%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY, THERAPEUTIC	$274.00	$1,096.00	—	—	75%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs California	Off list
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 diphtheria-tetanus-polio-haemophilus B vaccine per 0.5 mL	$205.27	$821.08	—	1% below	75%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 diphtheria-tetanus-polio-haemophilus B vaccine per 0.5 mL	$205.27	$821.08	—	—	75%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza vaccine trivalent 45 mcg (15 mcg x 3)/0.5 mL syringe 0.5 mL Syringe	$24.77	$99.09	—	42% below	75%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza vaccine trivalent 45 mcg (15 mcg x 3)/0.5 mL syringe 0.5 mL Syringe	$24.77	$99.09	—	—	75%
Hepatitis A vaccine, adult dose CPT 90632 hepatitis A vaccine 50 unit/mL syringe 1 mL Syringe	$129.94	$519.78	—	7% below	75%
Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A vaccine 50 unit/mL syringe 1 mL Syringe	$129.94	$519.78	—	—	75%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B virus vacc.rec(PF) 20 mcg/mL syringe 1 mL Syringe	$43.21	$172.83	—	65% below	75%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B virus vaccine PF 20 mcg/mL suspension 1 mL Vial	$91.94	$367.74	—	25% below	75%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B virus vacc.rec(PF) 20 mcg/mL syringe 1 mL Syringe	$43.21	$172.83	—	—	75%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B virus vaccine PF 20 mcg/mL suspension 1 mL Vial	$91.94	$367.74	—	—	75%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 hepatitis B virus vacc.rec(PF) per 0.5 mL	$20.64	$82.56	—	64% below	75%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 hepatitis B virus vacc.rec(PF) per 0.5 mL	$20.64	$82.56	—	—	75%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 haemophilus B polysac-tetanus toxoid (ActHIB) per 0.5 mL	$23.94	$95.75	—	43% below	75%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 haemophilus B polysac-tetanus toxoid (ActHIB) per 0.5 mL	$23.94	$95.75	—	—	75%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 influenza vaccine trivalent high dose 180 mcg/0.5 mL syringe 0.5 mL Syringe	$106.69	$426.77	—	15% below	75%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 influenza vaccine trivalent high dose 180 mcg/0.5 mL syringe 0.5 mL Syringe	$106.69	$426.77	—	—	75%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles/Mumps/Rubella Vaccine 0.5 mL	$155.94	$623.76	—	11% above	75%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Measles/Mumps/Rubella Vaccine 0.5 mL	$155.94	$623.76	—	—	75%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal conjugate vaccine (A component, 2 of 2) 10 mcg /0.5 mL (final) recon soln 1 each Vial	$206.64	$826.58	—	21% below	75%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal conjugate vaccine (C,Y,W-135 component, 1 of 2) 5 mcg x 3/ 0.5 mL (final) recon soln 1 each Vial	$206.64	$826.58	—	21% below	75%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 meningococcal conjugate vaccine (C,Y,W-135 component, 1 of 2) 5 mcg x 3/ 0.5 mL (final) recon soln 1 each Vial	$206.64	$826.58	—	—	75%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 meningococcal conjugate vaccine (A component, 2 of 2) 10 mcg /0.5 mL (final) recon soln 1 each Vial	$206.64	$826.58	—	—	75%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-4C), 2 dose schedule, for intramuscular use	$322.87	$1,291.49	—	27% below	75%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-4C), 2 dose schedule, for intramuscular use	$322.87	$1,291.49	—	—	75%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate 0.5 mL syringe 0.5 mL Syringe	$477.95	$1,911.80	—	8% below	75%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conjugate 0.5 mL syringe 0.5 mL Syringe	$477.95	$1,911.80	—	—	75%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 nirsevimab-alip 100 mg/mL syringe 1 mL Syringe	$923.23	$3,692.93	—	2% below	75%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 nirsevimab-alip 100 mg/mL syringe 1 mL Syringe	$923.23	$3,692.93	—	—	75%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 nirsevimab-alip 50 mg/0.5 mL syringe 0.5 mL Syringe	$923.23	$3,692.93	—	5% below	75%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 nirsevimab-alip 50 mg/0.5 mL syringe 0.5 mL Syringe	$923.23	$3,692.93	—	—	75%
Rabies vaccine, one dose CPT 90675 rabies vacc,human diploid (PF) per 1 mL	$803.82	$3,215.29	—	14% above	75%
Rabies vaccine, one dose inpatient CPT 90675 rabies vacc,human diploid (PF) per 1 mL	$803.82	$3,215.29	—	—	75%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus and diphther. tox (PF) per 0.5 mL	$73.19	$292.76	—	10% below	75%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus and diphther. tox (PF) per 0.5 mL	$73.19	$292.76	—	—	75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus-diphtheria-pertussis,acell per 0.5 mL	$69.50	$278.00	—	40% below	75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 diphth,pertus(acell),tetanus per 0.5 mL	$70.66	$282.64	—	39% below	75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus-diphtheria-pertussis,acell per 0.5 mL	$69.50	$278.00	—	—	75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 diphth,pertus(acell),tetanus per 0.5 mL	$70.66	$282.64	—	—	75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE	$59.50	$238.00	—	43% below	75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN INFLUENZA VIRUS VAC	$59.50	$238.00	—	43% below	75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN HEPATITIS B VACCINE	$59.50	$238.00	—	43% below	75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMIN INJ 1 VACCINE	$59.50	$238.00	—	43% below	75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN HEPATITIS B VACCINE	$59.50	$238.00	—	—	75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN INFLUENZA VIRUS VAC	$59.50	$238.00	—	—	75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE	$59.50	$238.00	—	—	75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMIN INJ 1 VACCINE	$59.50	$238.00	—	—	75%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMIN EA ADD VACCINE	$42.50	$170.00	—	47% below	75%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADMIN EA ADD VACCINE	$42.50	$170.00	—	—	75%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://www.elcaminohealth.org/sites/default/files/2026-05/943167314_el-camino-hospital_standardcharges.json