Hospital Spokane-Spokane Valley, WA

Prov Sacred Hrt Medical Center & Childs Hospital

Listed in its price file as “Providence Health And Services - Washington”.

Prov Sacred Hrt Medical Center & Childs Hospital in Spokane, WA publishes cash prices for 318 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 Washington median for 179 of 315 procedures and above it for 132. By typical cash price it ranks #14 of 58 Washington hospitals and #1 of 6 hospitals in the Spokane, WA area, cheapest first. Click a procedure to compare it with other hospitals nearby.

101 W 8th Ave, Spokane, WA 99204 Collected Sep 23, 2026 Source price file (509) 474-3131

Acute care hospital Emergency department CMS star rating 3 of 5 CCN 500054 · CMS hospital register NPI 1144471715

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Washington	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 HC XR ANKLE COMPLETE MIN 3 VIEWS	$67.20	$96.00	—	77% below	30%
Ankle X-ray, complete, 3 or more views CPT 73610 HC XR ANKLE COMPLETE MIN 3 VIEWS	$522.90	$747.00	—	79% above	30%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC XR ANKLE COMPLETE MIN 3 VIEWS	$522.90	$747.00	—	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$260.40	$372.00	—	15% below	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$1,202.60	$1,718.00	—	291% above	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$1,202.60	$1,718.00	—	—	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC XR ESOPHAGUS W CONTRAST	$376.60	$538.00	—	35% below	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC XR ESOPHAGUS W CONTRAST	$722.40	$1,032.00	—	25% above	30%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC XR ESOPHAGUS W CONTRAST	$722.40	$1,032.00	—	—	30%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE AND OR JOINT IMAGING WHOLE BODY CDM	$474.60	$678.00	—	68% below	30%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE AND OR JOINT IMAGING WHOLE BODY CDM	$2,190.30	$3,129.00	—	47% above	30%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE AND OR JOINT IMAGING WHOLE BODY CDM	$2,190.30	$3,129.00	—	—	30%
Breast ultrasound, complete, one breast CPT 76641 HC US BREAST UNI COMPLETE	$270.90	$387.00	—	37% below	30%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST UNI COMPLETE	$270.90	$387.00	—	—	30%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST UNI LIMITED	$270.90	$387.00	—	17% below	30%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US ED BREAST UNI LIMITED CDM	$270.90	$387.00	—	17% below	30%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST UNI LIMITED	$270.90	$387.00	—	—	30%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US ED BREAST UNI LIMITED CDM	$270.90	$387.00	—	—	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIOGRAPHY CHEST	$861.70	$1,231.00	—	62% below	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIOGRAPHY CHEST	$2,684.50	$3,835.00	—	18% above	30%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIOGRAPHY CHEST	$2,684.50	$3,835.00	—	—	30%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CCTA HEART ARTERIES/GRAFTS W/3D IMAGE W/ CONTRAST	$654.50	$935.00	—	41% below	30%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CCTA HEART ARTERIES/GRAFTS W/3D IMAGE W/ CONTRAST	$1,398.60	$1,998.00	—	27% above	30%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CCTA HEART ARTERIES/GRAFTS W/3D IMAGE W/ CONTRAST	$1,398.60	$1,998.00	—	—	30%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST	$65.80	$94.00	—	51% below	30%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST	$1,211.00	$1,730.00	—	811% above	30%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST	$1,211.00	$1,730.00	—	—	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD & PELVIS WO CONTRAST	$713.30	$1,019.00	—	66% below	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD & PELVIS WO CONTRAST	$2,584.40	$3,692.00	—	21% above	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD & PELVIS WO CONTRAST	$2,584.40	$3,692.00	—	—	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST	$1,150.80	$1,644.00	—	53% below	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST	$3,453.80	$4,934.00	—	41% above	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST	$3,453.80	$4,934.00	—	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN & PELVIS W & W/O CONTRAST	$3,759.00	$5,370.00	—	8% above	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN & PELVIS W & W/O CONTRAST	$3,798.20	$5,426.00	—	9% above	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABDOMEN & PELVIS W & W/O CONTRAST	$3,759.00	$5,370.00	—	—	30%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST	$734.30	$1,049.00	—	58% below	30%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST	$1,797.60	$2,568.00	—	3% above	30%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W CONTRAST	$1,797.60	$2,568.00	—	—	30%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CONTRAST	$373.80	$534.00	—	73% below	30%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CONTRAST	$1,330.00	$1,900.00	—	4% below	30%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN WO CONTRAST	$1,330.00	$1,900.00	—	—	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL W/O DYE LIMITED	$376.60	$538.00	—	61% below	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST	$376.60	$538.00	—	61% below	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST	$1,199.80	$1,714.00	—	25% above	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL W/O DYE LIMITED	$1,199.80	$1,714.00	—	25% above	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL W/O DYE LIMITED	$1,199.80	$1,714.00	—	—	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST	$1,199.80	$1,714.00	—	—	30%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN WO CONTRAST	$376.60	$538.00	—	68% below	30%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN WO CONTRAST	$1,151.50	$1,645.00	—	3% below	30%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN WO CONTRAST	$1,151.50	$1,645.00	—	—	30%
CT scan of the head with contrast CPT 70460 HC CT HEAD/BRAIN W CONTRAST	$739.90	$1,057.00	—	42% below	30%
CT scan of the head with contrast CPT 70460 HC CT HEAD/BRAIN W CONTRAST	$1,346.10	$1,923.00	—	6% above	30%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD/BRAIN W CONTRAST	$1,346.10	$1,923.00	—	—	30%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD/BRAIN W & W/O CONTRAST	$833.00	$1,190.00	—	43% below	30%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD/BRAIN W & W/O CONTRAST	$1,686.30	$2,409.00	—	15% above	30%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD/BRAIN W & W/O CONTRAST	$1,686.30	$2,409.00	—	—	30%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONTRAST	$373.80	$534.00	—	71% below	30%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONTRAST	$1,625.40	$2,322.00	—	27% above	30%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE WO CONTRAST	$1,625.40	$2,322.00	—	—	30%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT NECK SPINE WO CONTRAST	$376.60	$538.00	—	72% below	30%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT NECK SPINE WO CONTRAST	$1,497.30	$2,139.00	—	13% above	30%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT NECK SPINE WO CONTRAST	$1,497.30	$2,139.00	—	—	30%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST	$734.30	$1,049.00	—	58% below	30%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST	$1,779.40	$2,542.00	—	3% above	30%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST	$1,779.40	$2,542.00	—	—	30%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$366.80	$524.00	—	—	30%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$2,195.90	$3,137.00	—	—	30%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$2,195.90	$3,137.00	—	—	30%
Chest X-ray, 2 views CPT 71046 HC XR CHEST 2 VIEWS	$80.50	$115.00	—	70% below	30%
Chest X-ray, 2 views CPT 71046 HC XR CHEST 2 VIEWS	$455.00	$650.00	—	69% above	30%
Chest X-ray, 2 views inpatient CPT 71046 HC XR CHEST 2 VIEWS	$455.00	$650.00	—	—	30%
Chest X-ray, single view CPT 71045 HC XR CHEST 1 VIEW	$80.50	$115.00	—	65% below	30%
Chest X-ray, single view CPT 71045 HC XR CHEST PORTABLE 1 VIEW	$80.50	$115.00	—	65% below	30%
Chest X-ray, single view CPT 71045 HC XR CHEST 1 VIEW	$398.30	$569.00	—	75% above	30%
Chest X-ray, single view CPT 71045 HC XR CHEST PORTABLE 1 VIEW	$398.30	$569.00	—	75% above	30%
Chest X-ray, single view inpatient CPT 71045 HC XR CHEST PORTABLE 1 VIEW	$398.30	$569.00	—	—	30%
Chest X-ray, single view inpatient CPT 71045 HC XR CHEST 1 VIEW	$398.30	$569.00	—	—	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE	$205.10	$293.00	—	63% below	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE	$1,484.00	$2,120.00	—	170% above	30%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE	$1,484.00	$2,120.00	—	—	30%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US OB DETAILED SINGLE FETUS CDM	$291.20	$416.00	—	57% below	30%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US OB DETAILED SINGLE FETUS CDM	$2,485.00	$3,550.00	—	268% above	30%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US OB DETAILED SINGLE FETUS CDM	$2,485.00	$3,550.00	—	—	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX WO CONTRAST	$384.30	$549.00	—	72% below	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX W/O DYE F/U LUNG SCREENING	$1,393.00	$1,990.00	—	at median	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX WO CONTRAST	$1,434.30	$2,049.00	—	3% above	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX W/O DYE F/U LUNG SCREENING	$1,393.00	$1,990.00	—	—	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX WO CONTRAST	$1,434.30	$2,049.00	—	—	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W CONTRAST	$734.30	$1,049.00	—	60% below	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W CONTRAST	$2,305.10	$3,293.00	—	27% above	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX W CONTRAST	$2,305.10	$3,293.00	—	—	30%
Diagnostic mammogram, both breasts CPT 77066 HC MAMMO DIAG BIL W CAD	$160.30	$229.00	—	63% below	30%
Diagnostic mammogram, both breasts CPT 77066 HC MAMMO DIAG BIL W CAD	$580.30	$829.00	—	34% above	30%
Diagnostic mammogram, both breasts inpatient CPT 77066 HC MAMMO DIAG BIL W CAD	$580.30	$829.00	—	—	30%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$291.20	$416.00	—	—	30%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$2,639.70	$3,771.00	—	—	30%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$2,639.70	$3,771.00	—	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY	$294.00	$420.00	—	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY	$2,667.00	$3,810.00	—	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY	$2,667.00	$3,810.00	—	—	30%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO TTE 2D W DOPPLER COMPLETE	$1,407.70	$2,011.00	—	6% below	30%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO TTE 2D W DOPPLER COMPLETE	$1,407.70	$2,011.00	—	—	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBILIARY IMG WO PHARM	$494.20	$706.00	—	58% below	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBILIARY SYSTEM	$494.20	$706.00	—	58% below	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBILIARY IMG WO PHARM	$2,284.80	$3,264.00	—	94% above	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBILIARY SYSTEM	$2,284.80	$3,264.00	—	94% above	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM HEPATOBILIARY SYSTEM	$2,284.80	$3,264.00	—	—	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM HEPATOBILIARY IMG WO PHARM	$2,284.80	$3,264.00	—	—	30%
Knee X-ray, 3 views CPT 73562 HC XR KNEE 3 VIEWS	$70.70	$101.00	—	76% below	30%
Knee X-ray, 3 views CPT 73562 HC XR KNEE 3 VIEWS	$590.80	$844.00	—	101% above	30%
Knee X-ray, 3 views inpatient CPT 73562 HC XR KNEE 3 VIEWS	$590.80	$844.00	—	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED	$205.10	$293.00	—	57% below	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ED ABDOMEN LIMITED CDM	$1,024.80	$1,464.00	—	113% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED	$1,024.80	$1,464.00	—	113% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMEN LIMITED	$1,024.80	$1,464.00	—	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ED ABDOMEN LIMITED CDM	$1,024.80	$1,464.00	—	—	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM	$146.30	$209.00	—	35% below	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM	$146.30	$209.00	—	—	30%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST	$1,246.00	$1,780.00	—	25% below	30%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST	$2,683.80	$3,834.00	—	61% above	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST	$2,683.80	$3,834.00	—	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST	$2,022.30	$2,889.00	—	28% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST	$4,109.70	$5,871.00	—	47% above	30%
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	$4,109.70	$5,871.00	—	—	30%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN WO CONTRAST	$1,211.00	$1,730.00	—	29% below	30%
MRI of the abdomen without contrast CPT 74181 HC MRI MRCP ABDOMEN WO CONTRAST	$1,211.00	$1,730.00	—	29% below	30%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN WO CONTRAST	$2,998.10	$4,283.00	—	75% above	30%
MRI of the abdomen without contrast CPT 74181 HC MRI MRCP ABDOMEN WO CONTRAST	$2,998.10	$4,283.00	—	75% above	30%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN WO CONTRAST	$2,998.10	$4,283.00	—	—	30%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI MRCP ABDOMEN WO CONTRAST	$2,998.10	$4,283.00	—	—	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN WO & W CONTRAST	$2,081.80	$2,974.00	—	29% below	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN WO & W CONTRAST	$6,256.60	$8,938.00	—	112% above	30%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN WO & W CONTRAST	$6,256.60	$8,938.00	—	—	30%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN STEM W/O DYE	$1,505.00	$2,150.00	—	16% below	30%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN W/O DYE LIMITED	$1,546.30	$2,209.00	—	14% below	30%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN STEM W/O DYE	$2,482.90	$3,547.00	—	38% above	30%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN W/O DYE LIMITED	$1,546.30	$2,209.00	—	—	30%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN STEM W/O DYE	$2,482.90	$3,547.00	—	—	30%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/O & W/DYE	$2,513.70	$3,591.00	—	5% below	30%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/O & W/DYE	$4,224.50	$6,035.00	—	60% above	30%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W/O & W/DYE	$4,224.50	$6,035.00	—	—	30%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O DYE LIMITED	$924.70	$1,321.00	—	55% below	30%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O DYE	$1,246.00	$1,780.00	—	40% below	30%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O DYE	$2,968.70	$4,241.00	—	43% above	30%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O DYE LIMITED	$924.70	$1,321.00	—	—	30%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O DYE	$2,968.70	$4,241.00	—	—	30%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE	$2,081.80	$2,974.00	—	31% below	30%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE LIMITED	$2,576.00	$3,680.00	—	15% below	30%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE	$5,103.70	$7,291.00	—	68% above	30%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE LIMITED	$2,576.00	$3,680.00	—	—	30%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE	$5,103.70	$7,291.00	—	—	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O DYE	$1,211.00	$1,730.00	—	42% below	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O DYE LIMITED	$1,862.00	$2,660.00	—	11% below	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O DYE	$2,739.80	$3,914.00	—	30% above	30%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THORACIC SPINE W/O DYE LIMITED	$1,862.00	$2,660.00	—	—	30%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THORACIC SPINE W/O DYE	$2,739.80	$3,914.00	—	—	30%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE LIMITED	$1,155.70	$1,651.00	—	58% below	30%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE	$2,513.70	$3,591.00	—	9% below	30%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE	$3,794.00	$5,420.00	—	38% above	30%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE LIMITED	$1,155.70	$1,651.00	—	—	30%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE	$3,794.00	$5,420.00	—	—	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O DYE LIMITED	$641.90	$917.00	—	68% below	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O DYE	$1,460.90	$2,087.00	—	27% below	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O DYE	$2,366.00	$3,380.00	—	18% above	30%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O DYE LIMITED	$641.90	$917.00	—	—	30%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O DYE	$2,366.00	$3,380.00	—	—	30%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WO & W CONTRAST	$2,022.30	$2,889.00	—	33% below	30%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WO & W CONTRAST	$4,875.50	$6,965.00	—	60% above	30%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS WO & W CONTRAST	$4,875.50	$6,965.00	—	—	30%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST	$1,211.00	$1,730.00	—	33% below	30%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST	$2,473.10	$3,533.00	—	37% above	30%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS WO CONTRAST	$2,473.10	$3,533.00	—	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXTREMITY JOINT WO CONTRAST	$1,246.00	$1,780.00	—	31% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI JOINT UPR EXTREM W/O DYE LIMITED	$2,429.70	$3,471.00	—	35% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXTREMITY JOINT WO CONTRAST	$2,701.30	$3,859.00	—	50% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI JOINT UPR EXTREM W/O DYE LIMITED	$2,429.70	$3,471.00	—	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPER EXTREMITY JOINT WO CONTRAST	$2,701.30	$3,859.00	—	—	30%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM MYCARD PERFUS SPECT MULTIPLE	$1,528.10	$2,183.00	—	53% below	30%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM MYCARD PERFUS SPECT MULTIPLE	$7,074.20	$10,106.00	—	117% above	30%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM MYCARD PERFUS SPECT MULTIPLE	$7,074.20	$10,106.00	—	—	30%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET IMAGE W CT SKULL MID THIGH	$11,543.00	$16,490.00	—	175% above	30%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET IMAGE W CT SKULL MID THIGH	$13,110.30	$18,729.00	—	212% above	30%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC PET IMAGE W CT SKULL MID THIGH	$13,110.30	$18,729.00	—	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC LIMITED	$137.20	$196.00	—	64% below	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC FOLLICLE LIMITED	$137.20	$196.00	—	64% below	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC FOLLICLE LIMITED	$910.70	$1,301.00	—	140% above	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US ED EXAM PELVIC LIMITED CDM	$910.70	$1,301.00	—	140% above	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC LIMITED	$910.70	$1,301.00	—	140% above	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US EXAM PELVIC FOLLICLE LIMITED	$910.70	$1,301.00	—	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US ED EXAM PELVIC LIMITED CDM	$910.70	$1,301.00	—	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US EXAM PELVIC LIMITED	$910.70	$1,301.00	—	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIC NON-OB COMPLETE	$205.10	$293.00	—	62% below	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIC NON-OB COMPLETE	$1,535.80	$2,194.00	—	182% above	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIC NON-OB COMPLETE	$1,535.80	$2,194.00	—	—	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS	$205.10	$293.00	—	62% below	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS	$1,539.30	$2,199.00	—	183% above	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS	$1,539.30	$2,199.00	—	—	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby one side CPT 76801 HC US OB LT 14 WKS SINGLE FETUS CDM	$205.10	$293.00	—	57% below	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby one side CPT 76801 HC US OB LT 14 WKS SINGLE FETUS CDM	$1,373.40	$1,962.00	—	187% above	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient one side CPT 76801 HC US OB LT 14 WKS SINGLE FETUS CDM	$1,373.40	$1,962.00	—	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US OB LIMITED FETUS(S) CDM	$205.10	$293.00	—	48% below	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US OB LIMITED FETUS(S) CDM	$970.20	$1,386.00	—	144% above	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US ED OB LIMITED FETUS(S) CDM	$970.20	$1,386.00	—	144% above	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US ED OB LIMITED FETUS(S) CDM	$970.20	$1,386.00	—	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US OB LIMITED FETUS(S) CDM	$970.20	$1,386.00	—	—	30%
Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN BIL W CAD	$325.50	$465.00	—	4% below	30%
Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD	$325.50	$465.00	—	4% below	30%
Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD	$325.50	$465.00	—	—	30%
Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN BIL W CAD	$325.50	$465.00	—	—	30%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC XR SHOULDER COMPLETE MIN 2 VIEWS	$67.20	$96.00	—	76% below	30%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC XR SHOULDER COMPLETE MIN 2 VIEWS	$505.40	$722.00	—	81% above	30%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC XR SHOULDER COMPLETE MIN 2 VIEWS	$505.40	$722.00	—	—	30%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC ECHO STRESS W/INTERP REPT & MONITOR	$1,894.20	$2,706.00	—	92% above	30%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC ECHO STRESS W/INTERP REPT & MONITOR	$1,894.20	$2,706.00	—	—	30%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$71.40	$102.00	—	86% below	30%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$1,146.60	$1,638.00	—	120% above	30%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$1,146.60	$1,638.00	—	—	30%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON-OB	$205.10	$293.00	—	57% below	30%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON-OB	$1,089.20	$1,556.00	—	128% above	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON-OB	$1,089.20	$1,556.00	—	—	30%
Transvaginal ultrasound during pregnancy CPT 76817 HC US OB TRANSVAGINAL CDM	$205.10	$293.00	—	52% below	30%
Transvaginal ultrasound during pregnancy CPT 76817 HC US OB TRANSVAGINAL CDM	$1,115.10	$1,593.00	—	164% above	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US OB TRANSVAGINAL CDM	$1,115.10	$1,593.00	—	—	30%
Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE	$205.10	$293.00	—	68% below	30%
Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE	$1,633.80	$2,334.00	—	154% above	30%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US EXAM ABDOMEN COMPLETE	$1,633.80	$2,334.00	—	—	30%
Ultrasound of the scrotum and testicles CPT 76870 HC US EXAM SCROTUM & CONTENTS	$205.10	$293.00	—	62% below	30%
Ultrasound of the scrotum and testicles CPT 76870 HC US EXAM SCROTUM & CONTENTS	$1,152.90	$1,647.00	—	112% above	30%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US EXAM SCROTUM & CONTENTS	$1,152.90	$1,647.00	—	—	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US EXAM OF HEAD AND NECK	$205.10	$293.00	—	61% below	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US ED EXAM OF HEAD AND NECK CDM	$1,273.30	$1,819.00	—	141% above	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US EXAM OF HEAD AND NECK	$1,273.30	$1,819.00	—	141% above	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US EXAM OF HEAD AND NECK	$1,273.30	$1,819.00	—	—	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US ED EXAM OF HEAD AND NECK CDM	$1,273.30	$1,819.00	—	—	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC XR RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY CDM	$104.30	$149.00	—	85% below	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC XR RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY CDM	$1,498.00	$2,140.00	—	122% above	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC XR RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY CDM	$1,498.00	$2,140.00	—	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$207.20	$296.00	—	68% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$1,513.40	$2,162.00	—	136% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$1,513.40	$2,162.00	—	—	30%
Wrist X-ray, complete, 3 or more views CPT 73110 HC XR WRIST COMPLETE MIN 3 VIEWS	$67.20	$96.00	—	78% below	30%
Wrist X-ray, complete, 3 or more views CPT 73110 HC XR WRIST COMPLETE MIN 3 VIEWS	$524.30	$749.00	—	69% above	30%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC XR WRIST COMPLETE MIN 3 VIEWS	$524.30	$749.00	—	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC XR HIPS UNI W PELVIS WHEN PERFORMED 2-3 VIEWS	$67.20	$96.00	—	74% below	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC XR HIPS UNI W PELVIS WHEN PERFORMED 2-3 VIEWS	$571.20	$816.00	—	123% above	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC XR HIPS UNI W PELVIS WHEN PERFORMED 2-3 VIEWS	$571.20	$816.00	—	—	30%
X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN PORTABLE 1 VIEW	$41.30	$59.00	—	83% below	30%
X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN 1 VIEW	$41.30	$59.00	—	83% below	30%
X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN PORTABLE 1 VIEW	$495.60	$708.00	—	109% above	30%
X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN 1 VIEW	$495.60	$708.00	—	109% above	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN 1 VIEW	$495.60	$708.00	—	—	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN PORTABLE 1 VIEW	$495.60	$708.00	—	—	30%
X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 2 VIEWS	$67.20	$96.00	—	71% below	30%
X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 1 VIEW	$67.20	$96.00	—	71% below	30%
X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 2 VIEWS	$508.90	$727.00	—	122% above	30%
X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 1 VIEW	$508.90	$727.00	—	122% above	30%
X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 2 VIEWS	$508.90	$727.00	—	—	30%
X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 1 VIEW	$508.90	$727.00	—	—	30%
X-ray of the finger(s), 2 or more views CPT 73140 HC XR FINGERS(S) MIN 2 VIEWS	$67.20	$96.00	—	70% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 HC XR FINGERS(S) MIN 2 VIEWS	$401.10	$573.00	—	80% above	30%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XR FINGERS(S) MIN 2 VIEWS	$401.10	$573.00	—	—	30%
X-ray of the foot, 2 views CPT 73620 HC XR FOOT 2 VIEWS	$67.20	$96.00	—	73% below	30%
X-ray of the foot, 2 views CPT 73620 HC XR FOOT 1 VIEW	$67.20	$96.00	—	73% below	30%
X-ray of the foot, 2 views CPT 73620 HC XR FOOT 1 VIEW	$508.90	$727.00	—	106% above	30%
X-ray of the foot, 2 views CPT 73620 HC XR FOOT 2 VIEWS	$508.90	$727.00	—	106% above	30%
X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 2 VIEWS	$508.90	$727.00	—	—	30%
X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 1 VIEW	$508.90	$727.00	—	—	30%
X-ray of the foot, complete, 3 or more views CPT 73630 HC XR FOOT MIN 3 VIEWS	$67.20	$96.00	—	75% below	30%
X-ray of the foot, complete, 3 or more views CPT 73630 HC XR FOOT MIN 3 VIEWS	$511.00	$730.00	—	87% above	30%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC XR FOOT MIN 3 VIEWS	$511.00	$730.00	—	—	30%
X-ray of the hand, 3 or more views CPT 73130 HC XR HAND MIN 3 VIEWS	$67.20	$96.00	—	76% below	30%
X-ray of the hand, 3 or more views CPT 73130 HC XR HAND MIN 3 VIEWS	$524.30	$749.00	—	89% above	30%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC XR HAND MIN 3 VIEWS	$524.30	$749.00	—	—	30%
X-ray of the knee, 1 or 2 views CPT 73560 HC XR KNEE 1-2 VIEWS	$67.20	$96.00	—	73% below	30%
X-ray of the knee, 1 or 2 views CPT 73560 HC XR KNEE 1-2 VIEWS	$480.90	$687.00	—	94% above	30%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC XR KNEE 1-2 VIEWS	$480.90	$687.00	—	—	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS	$67.20	$96.00	—	79% below	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS	$580.30	$829.00	—	77% above	30%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS	$580.30	$829.00	—	—	30%
X-ray of the lower back, 4 or more views CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS	$104.30	$149.00	—	76% below	30%
X-ray of the lower back, 4 or more views CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS	$917.00	$1,310.00	—	108% above	30%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS	$917.00	$1,310.00	—	—	30%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC XR SPINE THORACIC 2 VIEWS	$67.20	$96.00	—	77% below	30%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC XR SPINE THORACIC 2 VIEWS	$534.80	$764.00	—	86% above	30%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC XR SPINE THORACIC 2 VIEWS	$534.80	$764.00	—	—	30%
X-ray of the nasal bones, 3 or more views CPT 70160 HC XR NASAL BONES MIN 3 VIEWS	$67.20	$96.00	—	73% below	30%
X-ray of the nasal bones, 3 or more views CPT 70160 HC XR NASAL BONES MIN 3 VIEWS	$536.20	$766.00	—	115% above	30%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC XR NASAL BONES MIN 3 VIEWS	$536.20	$766.00	—	—	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC XR SPINE CERVICAL 2 OR 3 VIEWS	$67.20	$96.00	—	78% below	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC XR SPINE CERVICAL 2 OR 3 VIEWS	$518.00	$740.00	—	66% above	30%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC XR SPINE CERVICAL 2 OR 3 VIEWS	$518.00	$740.00	—	—	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC XR PELVIS 1-2 VIEWS NO HIP VIEWS	$67.20	$96.00	—	74% below	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC XR PELVIS 1-2 VIEWS NO HIP VIEWS	$515.90	$737.00	—	97% above	30%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC XR PELVIS 1-2 VIEWS NO HIP VIEWS	$515.90	$737.00	—	—	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XR TAILBONE MIN 2 VIEWS	$67.20	$96.00	—	72% below	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XR TAILBONE MIN 2 VIEWS	$602.00	$860.00	—	147% above	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC XR TAILBONE MIN 2 VIEWS	$602.00	$860.00	—	—	30%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Washington	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC SGPT (ALT)	$31.50	$45.00	—	27% below	30%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALANINE AMINO (ALT) (SGPT)	$31.50	$45.00	—	27% below	30%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALANINE AMINO (ALT) (SGPT)	$45.50	$65.00	—	5% above	30%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC SGPT (ALT)	$45.50	$65.00	—	5% above	30%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC SGPT (ALT)	$45.50	$65.00	—	—	30%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC ALANINE AMINO (ALT) (SGPT)	$45.50	$65.00	—	—	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC SGOT (AST)	$30.80	$44.00	—	19% below	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC TRANSFERASE ASPARTATE AMINO AST SGOT	$30.80	$44.00	—	19% below	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC TRANSFERASE ASPARTATE AMINO AST SGOT	$45.50	$65.00	—	20% above	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC SGOT (AST)	$45.50	$65.00	—	20% above	30%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC TRANSFERASE ASPARTATE AMINO AST SGOT	$45.50	$65.00	—	—	30%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC SGOT (AST)	$45.50	$65.00	—	—	30%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS ACUTE PANEL	$151.90	$217.00	—	38% below	30%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS ACUTE PANEL	$151.90	$217.00	—	38% below	30%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS ACUTE PANEL	$151.90	$217.00	—	—	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE - IGE QUANT	$12.60	$18.00	—	51% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN PANEL RESPIRATORY RGN 17 CASCADE AND PACIFIC NW	$15.40	$22.00	—	40% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB	$43.40	$62.00	—	69% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE	$43.40	$62.00	—	69% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB	$48.30	$69.00	—	88% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE	$48.30	$69.00	—	88% above	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE - IGE QUANT	$12.60	$18.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN PANEL RESPIRATORY RGN 17 CASCADE AND PACIFIC NW	$15.40	$22.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE	$48.30	$69.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB	$48.30	$69.00	—	—	30%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CCP ANTIBODY	$57.40	$82.00	—	24% below	30%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY LAB	$57.40	$82.00	—	24% below	30%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CCP ANTIBODY	$105.00	$150.00	—	39% above	30%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY LAB	$105.00	$150.00	—	39% above	30%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY LAB	$57.40	$82.00	—	—	30%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CCP ANTIBODY	$57.40	$82.00	—	—	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA LAB	$97.30	$139.00	—	42% above	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES SCREEN - REFLEXIVE	$97.30	$139.00	—	42% above	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA	$97.30	$139.00	—	42% above	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES	$97.30	$139.00	—	42% above	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES	$109.90	$157.00	—	60% above	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA LAB	$109.90	$157.00	—	60% above	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA	$216.30	$309.00	—	215% above	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES SCREEN - REFLEXIVE	$216.30	$309.00	—	215% above	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES	$109.90	$157.00	—	—	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA LAB	$109.90	$157.00	—	—	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES SCREEN - REFLEXIVE	$216.30	$309.00	—	—	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA	$216.30	$309.00	—	—	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE	$188.30	$269.00	—	2% below	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE LAB	$188.30	$269.00	—	2% below	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE	$227.50	$325.00	—	18% above	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE LAB	$227.50	$325.00	—	18% above	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE LAB	$227.50	$325.00	—	—	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE	$227.50	$325.00	—	—	30%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL	$20.30	$29.00	—	72% below	30%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL	$103.60	$148.00	—	41% above	30%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL	$103.60	$148.00	—	—	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC PR 88305 TISSUE EXAM BY PATHOLOGIST	$64.40	$92.00	—	63% below	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC PR 88305 MUSCLE BIOPSY (OF PANL)	$64.40	$92.00	—	63% below	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC BIOPSY BONE MARROW INTERP	$262.50	$375.00	—	50% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB	$262.50	$375.00	—	50% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC CELL BLOCK	$262.50	$375.00	—	50% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC CELL BLOCK	$322.00	$460.00	—	84% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC BIOPSY BONE MARROW INTERP	$412.30	$589.00	—	136% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB	$464.80	$664.00	—	166% above	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC PR 88305 TISSUE EXAM BY PATHOLOGIST	$64.40	$92.00	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC PR 88305 MUSCLE BIOPSY (OF PANL)	$64.40	$92.00	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC CELL BLOCK	$322.00	$460.00	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC BIOPSY BONE MARROW INTERP	$412.30	$589.00	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB	$464.80	$664.00	—	—	30%
Blood culture for bacteria CPT 87040 HC BLOOD CULTURE FOR BACTERIA	$94.50	$135.00	—	34% below	30%
Blood culture for bacteria CPT 87040 HC BLOOD CULTURE FOR BACTERIA	$388.50	$555.00	—	170% above	30%
Blood culture for bacteria inpatient CPT 87040 HC BLOOD CULTURE FOR BACTERIA	$388.50	$555.00	—	—	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM	$16.80	$24.00	—	33% below	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM	$16.80	$24.00	—	33% below	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM	$60.90	$87.00	—	144% above	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM	$60.90	$87.00	—	144% above	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM	$60.90	$87.00	—	144% above	30%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM	$60.90	$87.00	—	—	30%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM	$60.90	$87.00	—	—	30%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM	$60.90	$87.00	—	—	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP	$22.40	$32.00	—	39% below	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE	$22.40	$32.00	—	39% below	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)	$22.40	$32.00	—	39% below	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE FASTING	$22.40	$32.00	—	39% below	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE SERUM EA ADDL/DAY	$22.40	$32.00	—	39% below	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE WHOLE BLOOD	$22.40	$32.00	—	39% below	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE SURGERY	$22.40	$32.00	—	39% below	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP	$45.50	$65.00	—	23% above	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)	$45.50	$65.00	—	23% above	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE FASTING	$45.50	$65.00	—	23% above	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE	$45.50	$65.00	—	23% above	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE SERUM EA ADDL/DAY	$45.50	$65.00	—	23% above	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE SERUM	$84.70	$121.00	—	129% above	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE SURGERY	$92.40	$132.00	—	150% above	30%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE WHOLE BLOOD	$99.40	$142.00	—	169% above	30%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)	$45.50	$65.00	—	—	30%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE SERUM EA ADDL/DAY	$45.50	$65.00	—	—	30%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE FASTING	$45.50	$65.00	—	—	30%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE	$45.50	$65.00	—	—	30%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP	$45.50	$65.00	—	—	30%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE SERUM	$84.70	$121.00	—	—	30%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE SURGERY	$92.40	$132.00	—	—	30%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE WHOLE BLOOD	$99.40	$142.00	—	—	30%
Blood lead test CPT 83655 HC ASSAY OF LEAD CDM	$67.20	$96.00	—	6% above	30%
Blood lead test CPT 83655 HC LEAD RANDOM URINE	$67.20	$96.00	—	6% above	30%
Blood lead test CPT 83655 HC LEAD-BLOOD(OSHA)	$67.20	$96.00	—	6% above	30%
Blood lead test CPT 83655 HC LEAD	$67.20	$96.00	—	6% above	30%
Blood lead test CPT 83655 HC LEAD BLOOD	$72.10	$103.00	—	13% above	30%
Blood lead test CPT 83655 HC ASSAY OF LEAD	$72.10	$103.00	—	13% above	30%
Blood lead test CPT 83655 HC HVY MET BLD - LEAD	$72.10	$103.00	—	13% above	30%
Blood lead test CPT 83655 HC HVY MET UR - LEAD	$72.10	$103.00	—	13% above	30%
Blood lead test CPT 83655 HC ASSAY OF LEAD LAB	$72.10	$103.00	—	13% above	30%
Blood lead test CPT 83655 HC LEAD	$82.60	$118.00	—	30% above	30%
Blood lead test CPT 83655 HC LEAD RANDOM URINE	$182.70	$261.00	—	187% above	30%
Blood lead test CPT 83655 HC LEAD-BLOOD(OSHA)	$182.70	$261.00	—	187% above	30%
Blood lead test CPT 83655 HC ASSAY OF LEAD CDM	$182.70	$261.00	—	187% above	30%
Blood lead test CPT 83655 HC ASSAY OF LEAD LAB	$196.00	$280.00	—	208% above	30%
Blood lead test CPT 83655 HC LEAD BLOOD	$196.00	$280.00	—	208% above	30%
Blood lead test CPT 83655 HC HVY MET BLD - LEAD	$196.00	$280.00	—	208% above	30%
Blood lead test CPT 83655 HC ASSAY OF LEAD	$196.00	$280.00	—	208% above	30%
Blood lead test CPT 83655 HC HVY MET UR - LEAD	$196.00	$280.00	—	208% above	30%
Blood lead test inpatient CPT 83655 HC LEAD	$82.60	$118.00	—	—	30%
Blood lead test inpatient CPT 83655 HC LEAD-BLOOD(OSHA)	$182.70	$261.00	—	—	30%
Blood lead test inpatient CPT 83655 HC ASSAY OF LEAD CDM	$182.70	$261.00	—	—	30%
Blood lead test inpatient CPT 83655 HC LEAD RANDOM URINE	$182.70	$261.00	—	—	30%
Blood lead test inpatient CPT 83655 HC LEAD BLOOD	$196.00	$280.00	—	—	30%
Blood lead test inpatient CPT 83655 HC HVY MET UR - LEAD	$196.00	$280.00	—	—	30%
Blood lead test inpatient CPT 83655 HC HVY MET BLD - LEAD	$196.00	$280.00	—	—	30%
Blood lead test inpatient CPT 83655 HC ASSAY OF LEAD	$196.00	$280.00	—	—	30%
Blood lead test inpatient CPT 83655 HC ASSAY OF LEAD LAB	$196.00	$280.00	—	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE CDM	$43.40	$62.00	—	41% below	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC CHORIONIC GONADOTROPIN QUAL	$43.40	$62.00	—	41% below	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE CDM	$233.80	$334.00	—	217% above	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC CHORIONIC GONADOTROPIN QUAL	$233.80	$334.00	—	217% above	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC CHORIONIC GONADOTROPIN QUAL	$233.80	$334.00	—	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE CDM	$233.80	$334.00	—	—	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO LAB	$27.30	$39.00	—	58% below	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO LAB	$125.30	$179.00	—	95% above	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO LAB	$125.30	$179.00	—	—	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN	$43.40	$62.00	—	22% below	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN LAB	$43.40	$62.00	—	22% below	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN	$142.80	$204.00	—	158% above	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN LAB	$142.80	$204.00	—	158% above	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN LAB	$142.80	$204.00	—	—	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN	$142.80	$204.00	—	—	30%
C. difficile toxin gene test (stool PCR) CPT 87493 HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE	$305.20	$436.00	—	77% above	30%
C. difficile toxin gene test (stool PCR) CPT 87493 HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB	$305.20	$436.00	—	77% above	30%
C. difficile toxin gene test (stool PCR) CPT 87493 HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB	$308.00	$440.00	—	79% above	30%
C. difficile toxin gene test (stool PCR) CPT 87493 HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE	$308.00	$440.00	—	79% above	30%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE	$305.20	$436.00	—	—	30%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB	$305.20	$436.00	—	—	30%
CA 19-9 blood test (tumor marker) CPT 86301 HC IMMUNOASSAY TUMOR CA 19-9	$166.60	$238.00	—	52% above	30%
CA 19-9 blood test (tumor marker) CPT 86301 HC IMMUNOASSAY TUMOR CA 19-9	$189.00	$270.00	—	72% above	30%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC IMMUNOASSAY TUMOR CA 19-9	$189.00	$270.00	—	—	30%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM	$166.60	$238.00	—	40% above	30%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM	$189.00	$270.00	—	58% above	30%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM	$189.00	$270.00	—	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB	$184.80	$264.00	—	65% above	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB	$184.80	$264.00	—	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS APTIMA2	$48.30	$69.00	—	62% below	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB	$48.30	$69.00	—	62% below	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ	$48.30	$69.00	—	62% below	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS PCR	$265.30	$379.00	—	109% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS PCR	$268.10	$383.00	—	111% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE	$305.20	$436.00	—	140% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB	$308.00	$440.00	—	142% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE	$308.00	$440.00	—	142% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB	$48.30	$69.00	—	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ	$48.30	$69.00	—	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACHOMATIS APTIMA2	$48.30	$69.00	—	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACHOMATIS PCR	$265.30	$379.00	—	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE	$305.20	$436.00	—	—	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL OF NMR	$37.80	$54.00	—	57% below	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PROFILE	$42.70	$61.00	—	51% below	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$42.70	$61.00	—	51% below	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL LAB	$42.70	$61.00	—	51% below	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL OF NMR	$44.80	$64.00	—	49% below	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL LAB	$51.10	$73.00	—	42% below	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PROFILE	$51.10	$73.00	—	42% below	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$51.10	$73.00	—	42% below	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL OF NMR	$44.80	$64.00	—	—	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL	$51.10	$73.00	—	—	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL LAB	$51.10	$73.00	—	—	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PROFILE	$51.10	$73.00	—	—	30%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$35.70	$51.00	—	45% below	30%
Complete blood count (CBC) with differential CPT 85025 HC CBC WITH DIFF AUTO	$35.70	$51.00	—	45% below	30%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB	$35.70	$51.00	—	45% below	30%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$96.60	$138.00	—	48% above	30%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB	$96.60	$138.00	—	48% above	30%
Complete blood count (CBC) with differential CPT 85025 HC CBC WITH DIFF AUTO	$96.60	$138.00	—	48% above	30%
Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB	$96.60	$138.00	—	—	30%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC WITH DIFF AUTO	$96.60	$138.00	—	—	30%
Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$96.60	$138.00	—	—	30%
Complete blood count (CBC), no differential CPT 85027 HC COMPLETE CBC AUTOMATED	$29.40	$42.00	—	41% below	30%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB	$29.40	$42.00	—	41% below	30%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED	$29.40	$42.00	—	41% below	30%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED	$94.50	$135.00	—	90% above	30%
Complete blood count (CBC), no differential CPT 85027 HC COMPLETE CBC AUTOMATED	$94.50	$135.00	—	90% above	30%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB	$94.50	$135.00	—	90% above	30%
Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB	$94.50	$135.00	—	—	30%
Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED	$94.50	$135.00	—	—	30%
Complete blood count (CBC), no differential inpatient CPT 85027 HC COMPLETE CBC AUTOMATED	$94.50	$135.00	—	—	30%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHEN METABOLIC PANEL	$27.30	$39.00	—	70% below	30%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHEN METABOLIC PANEL	$181.30	$259.00	—	99% above	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHEN METABOLIC PANEL	$181.30	$259.00	—	—	30%
D-dimer blood test (blood clot marker) CPT 85379 HC DDIMER QUANT	$46.90	$67.00	—	59% below	30%
D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN DEGRADATION QUANT	$46.90	$67.00	—	59% below	30%
D-dimer blood test (blood clot marker) CPT 85379 HC DDIMER QUANT	$151.90	$217.00	—	32% above	30%
D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN DEGRADATION QUANT	$151.90	$217.00	—	32% above	30%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC DDIMER QUANT	$151.90	$217.00	—	—	30%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC FIBRIN DEGRADATION QUANT	$151.90	$217.00	—	—	30%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE-SULFATE CDM	$123.90	$177.00	—	3% below	30%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE	$123.90	$177.00	—	3% below	30%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE	$373.10	$533.00	—	191% above	30%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE-SULFATE CDM	$373.10	$533.00	—	191% above	30%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DEHYDROEPIANDROSTERONE-SULFATE CDM	$373.10	$533.00	—	—	30%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DEHYDROEPIANDROSTERONE	$373.10	$533.00	—	—	30%
Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL LAB	$134.40	$192.00	—	at median	30%
Estradiol blood test CPT 82670 HC ESTRADIOL BY LC MS MS	$155.40	$222.00	—	15% above	30%
Estradiol blood test CPT 82670 HC ASSAY OF TOTAL ESTRADIOL CDM	$155.40	$222.00	—	15% above	30%
Estradiol blood test CPT 82670 HC ESTRADIOL	$155.40	$222.00	—	15% above	30%
Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL	$155.40	$222.00	—	15% above	30%
Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL LAB	$258.30	$369.00	—	91% above	30%
Estradiol blood test CPT 82670 HC ESTRADIOL	$297.50	$425.00	—	120% above	30%
Estradiol blood test CPT 82670 HC ASSAY OF TOTAL ESTRADIOL CDM	$297.50	$425.00	—	120% above	30%
Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL	$297.50	$425.00	—	120% above	30%
Estradiol blood test CPT 82670 HC ESTRADIOL BY LC MS MS	$297.50	$425.00	—	120% above	30%
Estradiol blood test inpatient CPT 82670 HC ASSAY OF ESTRADIOL LAB	$258.30	$369.00	—	—	30%
Estradiol blood test inpatient CPT 82670 HC ASSAY OF ESTRADIOL	$297.50	$425.00	—	—	30%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL	$297.50	$425.00	—	—	30%
Estradiol blood test inpatient CPT 82670 HC ASSAY OF TOTAL ESTRADIOL CDM	$297.50	$425.00	—	—	30%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL BY LC MS MS	$297.50	$425.00	—	—	30%
FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM	$96.60	$138.00	—	2% above	30%
FSH (follicle-stimulating hormone) test CPT 83001 HC FSH(FOLLICLE STIMULATE HORMONE)	$96.60	$138.00	—	2% above	30%
FSH (follicle-stimulating hormone) test CPT 83001 HC FSH(FOLLICLE STIMULATE HORMONE)	$227.50	$325.00	—	139% above	30%
FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM	$227.50	$325.00	—	139% above	30%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM	$227.50	$325.00	—	—	30%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC FSH(FOLLICLE STIMULATE HORMONE)	$227.50	$325.00	—	—	30%
Fecal calprotectin (stool inflammation test) CPT 83993 HC ASSAY OF CALPROTECTIN FECAL CDM	$211.40	$302.00	—	10% above	30%
Fecal calprotectin (stool inflammation test) CPT 83993 HC ASSAY OF CALPROTECTIN FECAL CDM	$211.40	$302.00	—	10% above	30%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC ASSAY OF CALPROTECTIN FECAL CDM	$211.40	$302.00	—	—	30%
Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN CDM	$76.30	$109.00	—	20% below	30%
Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN	$76.30	$109.00	—	20% below	30%
Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN CDM	$92.40	$132.00	—	3% below	30%
Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN	$92.40	$132.00	—	3% below	30%
Ferritin blood test (iron stores) inpatient CPT 82728 HC ASSAY OF FERRITIN CDM	$92.40	$132.00	—	—	30%
Ferritin blood test (iron stores) inpatient CPT 82728 HC ASSAY OF FERRITIN	$92.40	$132.00	—	—	30%
Folate (folic acid) blood test CPT 82746 HC BLOOD FOLIC ACID SERUM	$82.60	$118.00	—	17% below	30%
Folate (folic acid) blood test CPT 82746 HC ASSAY OF FOLIC ACID SERUM CDM	$82.60	$118.00	—	17% below	30%
Folate (folic acid) blood test CPT 82746 HC ASSAY OF FOLIC ACID SERUM CDM	$103.60	$148.00	—	4% above	30%
Folate (folic acid) blood test CPT 82746 HC BLOOD FOLIC ACID SERUM	$103.60	$148.00	—	4% above	30%
Folate (folic acid) blood test inpatient CPT 82746 HC ASSAY OF FOLIC ACID SERUM CDM	$103.60	$148.00	—	—	30%
Folate (folic acid) blood test inpatient CPT 82746 HC BLOOD FOLIC ACID SERUM	$103.60	$148.00	—	—	30%
Free T3 thyroid hormone test CPT 84481 HC FREE ASSAY (FT-3)	$42.70	$61.00	—	51% below	30%
Free T3 thyroid hormone test CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB	$42.70	$61.00	—	51% below	30%
Free T3 thyroid hormone test CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE CDM	$42.70	$61.00	—	51% below	30%
Free T3 thyroid hormone test CPT 84481 HC FREE ASSAY (FT-3)	$51.10	$73.00	—	41% below	30%
Free T3 thyroid hormone test CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE CDM	$51.10	$73.00	—	41% below	30%
Free T3 thyroid hormone test CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB	$276.50	$395.00	—	217% above	30%
Free T3 thyroid hormone test inpatient CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE CDM	$51.10	$73.00	—	—	30%
Free T3 thyroid hormone test inpatient CPT 84481 HC FREE ASSAY (FT-3)	$51.10	$73.00	—	—	30%
Free T3 thyroid hormone test inpatient CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB	$276.50	$395.00	—	—	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC THYROXINE FREE	$49.00	$70.00	—	24% below	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE CDM	$49.00	$70.00	—	24% below	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE LAB	$49.00	$70.00	—	24% below	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE CDM	$112.70	$161.00	—	74% above	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE LAB	$112.70	$161.00	—	74% above	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC THYROXINE FREE	$112.70	$161.00	—	74% above	30%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC ASSAY OF FREE THYROXINE CDM	$112.70	$161.00	—	—	30%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC ASSAY OF FREE THYROXINE LAB	$112.70	$161.00	—	—	30%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC THYROXINE FREE	$112.70	$161.00	—	—	30%
Free testosterone test CPT 84402 HC TESTOSTERONE FREE	$110.60	$158.00	—	13% below	30%
Free testosterone test CPT 84402 HC TESTOSTERONE FREE	$131.60	$188.00	—	3% above	30%
Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE FREE CDM	$142.10	$203.00	—	12% above	30%
Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE FREE LAB	$142.10	$203.00	—	12% above	30%
Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE FREE	$142.10	$203.00	—	12% above	30%
Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE FREE	$171.50	$245.00	—	35% above	30%
Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE FREE LAB	$171.50	$245.00	—	35% above	30%
Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE FREE CDM	$171.50	$245.00	—	35% above	30%
Free testosterone test inpatient CPT 84402 HC TESTOSTERONE FREE	$131.60	$188.00	—	—	30%
Free testosterone test inpatient CPT 84402 HC ASSAY OF TESTOSTERONE FREE CDM	$171.50	$245.00	—	—	30%
Free testosterone test inpatient CPT 84402 HC ASSAY OF TESTOSTERONE FREE	$171.50	$245.00	—	—	30%
Free testosterone test inpatient CPT 84402 HC ASSAY OF TESTOSTERONE FREE LAB	$171.50	$245.00	—	—	30%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PANEL	$147.70	$211.00	—	36% below	30%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC GENERAL HEALTH PANEL	$147.70	$211.00	—	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE POST GLUCOSE DOSE	$23.80	$34.00	—	36% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE TOL-1 HR-OB	$23.80	$34.00	—	36% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GESTATIONAL GLUCOSE 1 HOUR	$23.80	$34.00	—	36% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE POST GLUCOSE DOSE LAB	$23.80	$34.00	—	36% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE POST GLUCOSE DOSE	$49.00	$70.00	—	31% above	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE POST GLUCOSE DOSE LAB	$49.00	$70.00	—	31% above	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GESTATIONAL GLUCOSE 1 HOUR	$49.00	$70.00	—	31% above	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE TOL-1 HR-OB	$49.00	$70.00	—	31% above	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE POST GLUCOSE DOSE LAB	$49.00	$70.00	—	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE TOL-1 HR-OB	$49.00	$70.00	—	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE POST GLUCOSE DOSE	$49.00	$70.00	—	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GESTATIONAL GLUCOSE 1 HOUR	$49.00	$70.00	—	—	30%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE(3 SPEC)	$72.10	$103.00	—	2% above	30%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECIMENS	$72.10	$103.00	—	2% above	30%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECIMENS	$136.50	$195.00	—	93% above	30%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE(3 SPEC)	$185.50	$265.00	—	162% above	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECIMENS	$136.50	$195.00	—	—	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE(3 SPEC)	$185.50	$265.00	—	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ	$42.00	$60.00	—	67% below	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB	$48.30	$69.00	—	62% below	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.GONORRHOEAE DNA APTIMA2	$48.30	$69.00	—	62% below	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ	$268.10	$383.00	—	112% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM	$305.20	$436.00	—	142% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.GONORRHOEAE DNA AMPLIFIED PROBE	$305.20	$436.00	—	142% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC GC (AMP DNA PROBE)	$305.20	$436.00	—	142% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.GONORRHOEAE DNA AMPLIFIED PROBE	$308.00	$440.00	—	144% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM	$308.00	$440.00	—	144% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC GC (AMP DNA PROBE)	$308.00	$440.00	—	144% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB	$308.00	$440.00	—	144% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ	$42.00	$60.00	—	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB	$48.30	$69.00	—	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N.GONORRHOEAE DNA APTIMA2	$48.30	$69.00	—	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N.GONORRHOEAE DNA AMPLIFIED PROBE	$305.20	$436.00	—	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM	$305.20	$436.00	—	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC GC (AMP DNA PROBE)	$305.20	$436.00	—	—	30%
H. pylori antibody blood test CPT 86677 HC HELICOBACTER PYLORI	$49.00	$70.00	—	41% below	30%
H. pylori antibody blood test CPT 86677 HC ANTIBODY HELICOBACTER PYLORI CDM	$117.60	$168.00	—	41% above	30%
H. pylori antibody blood test CPT 86677 HC ANTIBODY HELICOBACTER PYLORI CDM	$131.60	$188.00	—	58% above	30%
H. pylori antibody blood test inpatient CPT 86677 HC HELICOBACTER PYLORI	$49.00	$70.00	—	—	30%
H. pylori antibody blood test inpatient CPT 86677 HC ANTIBODY HELICOBACTER PYLORI CDM	$131.60	$188.00	—	—	30%
H. pylori stool antigen test CPT 87338 HC IAAD IA HPYLORI STOOL CDM	$103.60	$148.00	—	26% below	30%
H. pylori stool antigen test CPT 87338 HC IAAD IA HPYLORI STOOL CDM	$106.40	$152.00	—	24% below	30%
H. pylori stool antigen test inpatient CPT 87338 HC IAAD IA HPYLORI STOOL CDM	$103.60	$148.00	—	—	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV VIRAL LOAD	$532.70	$761.00	—	40% above	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV-1 RNA BY BRANCHED DNA	$735.70	$1,051.00	—	93% above	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV STANDARD PCR	$735.70	$1,051.00	—	93% above	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV ULTRA SENSITIVE PCR	$747.60	$1,068.00	—	96% above	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV-1 RNA BY BRANCHED DNA	$747.60	$1,068.00	—	96% above	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV STANDARD PCR	$747.60	$1,068.00	—	96% above	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB	$747.60	$1,068.00	—	96% above	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV ULTRA SENSITIVE PCR	$1,124.90	$1,607.00	—	195% above	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB	$1,124.90	$1,607.00	—	195% above	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV VIRAL LOAD	$532.70	$761.00	—	—	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV-1 RNA BY BRANCHED DNA	$735.70	$1,051.00	—	—	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV STANDARD PCR	$735.70	$1,051.00	—	—	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV ULTRA SENSITIVE PCR	$1,124.90	$1,607.00	—	—	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB	$1,124.90	$1,607.00	—	—	30%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE	$109.90	$157.00	—	28% above	30%
HIV-1 and HIV-2 antibody test CPT 86703 HC RAPID HIV 1-2	$109.90	$157.00	—	28% above	30%
HIV-1 and HIV-2 antibody test CPT 86703 HC RAPID HIV 1-2	$124.60	$178.00	—	45% above	30%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE	$248.50	$355.00	—	189% above	30%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC RAPID HIV 1-2	$124.60	$178.00	—	—	30%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE	$248.50	$355.00	—	—	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC ANTI-HIV 1/2 AB & P24 AG	$139.30	$199.00	—	42% above	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB	$160.30	$229.00	—	64% above	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC ANTI-HIV 1/2 AB & P24 AG	$139.30	$199.00	—	—	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB	$160.30	$229.00	—	—	30%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB	$233.80	$334.00	—	64% above	30%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES	$233.80	$334.00	—	64% above	30%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB	$233.80	$334.00	—	—	30%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES	$233.80	$334.00	—	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C LAB	$56.00	$80.00	—	20% below	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C CDM	$56.00	$80.00	—	20% below	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C CDM	$103.60	$148.00	—	47% above	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C LAB	$103.60	$148.00	—	47% above	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C LAB	$103.60	$148.00	—	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C CDM	$103.60	$148.00	—	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB CDM	$86.80	$124.00	—	23% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB LAB	$86.80	$124.00	—	23% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEP B SURFACE ANTIBODY AB QUANT	$86.80	$124.00	—	23% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB LAB	$97.30	$139.00	—	37% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB CDM	$97.30	$139.00	—	37% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEP B SURFACE ANTIBODY AB QUANT	$233.10	$333.00	—	229% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB CDM	$97.30	$139.00	—	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB LAB	$97.30	$139.00	—	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEP B SURFACE ANTIBODY AB QUANT	$233.10	$333.00	—	—	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB	$90.30	$129.00	—	22% above	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM	$90.30	$129.00	—	22% above	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB	$94.50	$135.00	—	28% above	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM	$94.50	$135.00	—	28% above	30%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM	$90.30	$129.00	—	—	30%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB	$90.30	$129.00	—	—	30%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY CDM	$115.50	$165.00	—	34% above	30%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY	$115.50	$165.00	—	34% above	30%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY LAB	$115.50	$165.00	—	34% above	30%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY	$130.20	$186.00	—	51% above	30%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY CDM	$130.20	$186.00	—	51% above	30%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY LAB	$130.20	$186.00	—	51% above	30%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY LAB	$130.20	$186.00	—	—	30%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY CDM	$130.20	$186.00	—	—	30%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY	$130.20	$186.00	—	—	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION LAB	$328.30	$469.00	—	1% below	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM	$378.00	$540.00	—	14% above	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C RNA QUANTIFICATION	$378.00	$540.00	—	14% above	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEP C PCR (QUANT)	$378.00	$540.00	—	14% above	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C GENOTYPING EXTRACT	$378.00	$540.00	—	14% above	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C RNA BY BRANCH DNA	$378.00	$540.00	—	14% above	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION LAB	$532.70	$761.00	—	61% above	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C RNA QUANTIFICATION	$613.20	$876.00	—	86% above	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C RNA BY BRANCH DNA	$613.20	$876.00	—	86% above	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C GENOTYPING EXTRACT	$613.20	$876.00	—	86% above	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM	$613.20	$876.00	—	86% above	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEP C PCR (QUANT)	$908.60	$1,298.00	—	175% above	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION LAB	$532.70	$761.00	—	—	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C RNA BY BRANCH DNA	$613.20	$876.00	—	—	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C GENOTYPING EXTRACT	$613.20	$876.00	—	—	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM	$613.20	$876.00	—	—	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C RNA QUANTIFICATION	$613.20	$876.00	—	—	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEP C PCR (QUANT)	$908.60	$1,298.00	—	—	30%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX TEST - TYPE 1 IGG	$106.40	$152.00	—	54% above	30%
Herpes blood test, HSV-1 antibody CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 CDM	$106.40	$152.00	—	54% above	30%
Herpes blood test, HSV-1 antibody CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 LAB	$106.40	$152.00	—	54% above	30%
Herpes blood test, HSV-1 antibody CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 CDM	$144.20	$206.00	—	109% above	30%
Herpes blood test, HSV-1 antibody CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 LAB	$144.20	$206.00	—	109% above	30%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX TEST - TYPE 1 IGG	$144.20	$206.00	—	109% above	30%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 LAB	$144.20	$206.00	—	—	30%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES SIMPLEX TEST - TYPE 1 IGG	$144.20	$206.00	—	—	30%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 CDM	$144.20	$206.00	—	—	30%
Herpes blood test, HSV-2 antibody CPT 86696 HC ANTIBODY HERPES SMPLX TYPE 2 LAB	$156.10	$223.00	—	77% above	30%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TYPE 2	$156.10	$223.00	—	77% above	30%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TYPE 2 - TYPE 2 IGG	$156.10	$223.00	—	77% above	30%
Herpes blood test, HSV-2 antibody CPT 86696 HC ANTIBODY HERPES SMPLX TYPE 2 CDM	$156.10	$223.00	—	77% above	30%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TYPE 2 - TYPE 2 IGG	$210.70	$301.00	—	139% above	30%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TYPE 2	$210.70	$301.00	—	139% above	30%
Herpes blood test, HSV-2 antibody CPT 86696 HC ANTIBODY HERPES SMPLX TYPE 2 LAB	$210.70	$301.00	—	139% above	30%
Herpes blood test, HSV-2 antibody CPT 86696 HC ANTIBODY HERPES SMPLX TYPE 2 CDM	$210.70	$301.00	—	139% above	30%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX TYPE 2 - TYPE 2 IGG	$210.70	$301.00	—	—	30%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX TYPE 2	$210.70	$301.00	—	—	30%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC ANTIBODY HERPES SMPLX TYPE 2 CDM	$210.70	$301.00	—	—	30%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC ANTIBODY HERPES SMPLX TYPE 2 LAB	$210.70	$301.00	—	—	30%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM	$105.00	$150.00	—	42% above	30%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM	$193.20	$276.00	—	162% above	30%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM	$193.20	$276.00	—	—	30%
Homocysteine blood test CPT 83090 HC ASSAY OF HOMOCYSTEINE LAB	$95.20	$136.00	—	22% below	30%
Homocysteine blood test CPT 83090 HC ASSAY OF HOMOCYSTEINE LAB	$158.20	$226.00	—	30% above	30%
Homocysteine blood test inpatient CPT 83090 HC ASSAY OF HOMOCYSTEINE LAB	$158.20	$226.00	—	—	30%
Insulin blood test CPT 83525 HC ASSAY OF INSULIN TOTAL LAB	$65.10	$93.00	—	21% below	30%
Insulin blood test CPT 83525 HC ASSAY OF INSULIN TOTAL CDM	$65.10	$93.00	—	21% below	30%
Insulin blood test CPT 83525 HC INSULIN LEVEL ASSAY	$65.10	$93.00	—	21% below	30%
Insulin blood test CPT 83525 HC INSULIN TOTAL	$65.10	$93.00	—	21% below	30%
Insulin blood test CPT 83525 HC ASSAY OF INSULIN TOTAL CDM	$234.50	$335.00	—	184% above	30%
Insulin blood test CPT 83525 HC INSULIN TOTAL	$234.50	$335.00	—	184% above	30%
Insulin blood test CPT 83525 HC INSULIN LEVEL ASSAY	$234.50	$335.00	—	184% above	30%
Insulin blood test CPT 83525 HC ASSAY OF INSULIN TOTAL LAB	$234.50	$335.00	—	184% above	30%
Insulin blood test inpatient CPT 83525 HC ASSAY OF INSULIN TOTAL LAB	$234.50	$335.00	—	—	30%
Insulin blood test inpatient CPT 83525 HC INSULIN TOTAL	$234.50	$335.00	—	—	30%
Insulin blood test inpatient CPT 83525 HC INSULIN LEVEL ASSAY	$234.50	$335.00	—	—	30%
Insulin blood test inpatient CPT 83525 HC ASSAY OF INSULIN TOTAL CDM	$234.50	$335.00	—	—	30%
Iron blood test (serum iron) CPT 83540 HC IRON	$37.80	$54.00	—	20% below	30%
Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON CDM	$37.80	$54.00	—	20% below	30%
Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON	$37.80	$54.00	—	20% below	30%
Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON	$45.50	$65.00	—	3% below	30%
Iron blood test (serum iron) CPT 83540 HC IRON	$45.50	$65.00	—	3% below	30%
Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON CDM	$45.50	$65.00	—	3% below	30%
Iron blood test (serum iron) inpatient CPT 83540 HC ASSAY OF IRON CDM	$45.50	$65.00	—	—	30%
Iron blood test (serum iron) inpatient CPT 83540 HC ASSAY OF IRON	$45.50	$65.00	—	—	30%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON	$45.50	$65.00	—	—	30%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY CDM	$49.00	$70.00	—	18% below	30%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY LAB	$49.00	$70.00	—	18% below	30%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY LAB	$170.10	$243.00	—	184% above	30%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY CDM	$170.10	$243.00	—	184% above	30%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY CDM	$170.10	$243.00	—	—	30%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY LAB	$170.10	$243.00	—	—	30%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL CDM	$20.30	$29.00	—	73% below	30%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL CDM	$129.50	$185.00	—	70% above	30%
Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL CDM	$129.50	$185.00	—	—	30%
LH (luteinizing hormone) test CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE CDM	$97.30	$139.00	—	2% above	30%
LH (luteinizing hormone) test CPT 83002 HC LUTEINIZING HORMORE (LH)	$97.30	$139.00	—	2% above	30%
LH (luteinizing hormone) test CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE CDM	$180.60	$258.00	—	90% above	30%
LH (luteinizing hormone) test CPT 83002 HC LUTEINIZING HORMORE (LH)	$180.60	$258.00	—	90% above	30%
LH (luteinizing hormone) test inpatient CPT 83002 HC LUTEINIZING HORMORE (LH)	$180.60	$258.00	—	—	30%
LH (luteinizing hormone) test inpatient CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE CDM	$180.60	$258.00	—	—	30%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE	$39.90	$57.00	—	45% below	30%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE LAB	$39.90	$57.00	—	45% below	30%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE CDM	$39.90	$57.00	—	45% below	30%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE CDM	$48.30	$69.00	—	34% below	30%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE LAB	$48.30	$69.00	—	34% below	30%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE	$48.30	$69.00	—	34% below	30%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE CDM	$48.30	$69.00	—	—	30%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE LAB	$48.30	$69.00	—	—	30%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE	$48.30	$69.00	—	—	30%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL CDM	$20.30	$29.00	—	69% below	30%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL CDM	$77.70	$111.00	—	19% above	30%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL CDM	$77.70	$111.00	—	—	30%
Lyme disease antibody test CPT 86618 HC LYME (B.BURGDORFERI) AB CSF	$58.80	$84.00	—	34% below	30%
Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY - CSF	$58.80	$84.00	—	34% below	30%
Lyme disease antibody test CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI LYME DISEASE LAB	$125.30	$179.00	—	40% above	30%
Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY - IGG-IGM	$137.90	$197.00	—	54% above	30%
Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY	$137.90	$197.00	—	54% above	30%
Lyme disease antibody test CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI LYME DISEASE LAB	$172.90	$247.00	—	94% above	30%
Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY	$189.70	$271.00	—	112% above	30%
Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY - IGG-IGM	$189.70	$271.00	—	112% above	30%
Lyme disease antibody test inpatient CPT 86618 HC LYME (B.BURGDORFERI) AB CSF	$58.80	$84.00	—	—	30%
Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE ANTIBODY - CSF	$58.80	$84.00	—	—	30%
Lyme disease antibody test inpatient CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI LYME DISEASE LAB	$172.90	$247.00	—	—	30%
Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE ANTIBODY - IGG-IGM	$189.70	$271.00	—	—	30%
Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE ANTIBODY	$189.70	$271.00	—	—	30%
Magnesium blood test CPT 83735 HC MAGNESIUM QUANT URINE	$38.50	$55.00	—	27% below	30%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM	$38.50	$55.00	—	27% below	30%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM CDM	$38.50	$55.00	—	27% below	30%
Magnesium blood test CPT 83735 HC MAGNESIUM (24HR UR)	$38.50	$55.00	—	27% below	30%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM	$45.50	$65.00	—	13% below	30%
Magnesium blood test CPT 83735 HC MAGNESIUM (24HR UR)	$45.50	$65.00	—	13% below	30%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM CDM	$45.50	$65.00	—	13% below	30%
Magnesium blood test CPT 83735 HC MAGNESIUM QUANT URINE	$45.50	$65.00	—	13% below	30%
Magnesium blood test CPT 83735 HC MAGNESIUM RBC	$56.70	$81.00	—	8% above	30%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM QUANT URINE	$45.50	$65.00	—	—	30%
Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM	$45.50	$65.00	—	—	30%
Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM CDM	$45.50	$65.00	—	—	30%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM (24HR UR)	$45.50	$65.00	—	—	30%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM RBC	$56.70	$81.00	—	—	30%
Measles (rubeola) antibody test CPT 86765 HC ANTIBODY RUBEOLA CDM	$105.00	$150.00	—	46% above	30%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA ANTIBODY - IGG	$105.00	$150.00	—	46% above	30%
Measles (rubeola) antibody test CPT 86765 HC ANTIBODY RUBEOLA CDM	$181.30	$259.00	—	152% above	30%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA ANTIBODY - IGG	$181.30	$259.00	—	152% above	30%
Measles (rubeola) antibody test inpatient CPT 86765 HC ANTIBODY RUBEOLA CDM	$181.30	$259.00	—	—	30%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA ANTIBODY - IGG	$181.30	$259.00	—	—	30%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODIES	$43.40	$62.00	—	24% below	30%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODIES	$275.10	$393.00	—	384% above	30%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE ANTIBODIES	$275.10	$393.00	—	—	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA FREE	$108.50	$155.00	—	8% above	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$108.50	$155.00	—	8% above	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB	$108.50	$155.00	—	8% above	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$205.10	$293.00	—	104% above	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA FREE	$205.10	$293.00	—	104% above	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB	$205.10	$293.00	—	104% above	30%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB	$205.10	$293.00	—	—	30%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PSA FREE	$205.10	$293.00	—	—	30%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$205.10	$293.00	—	—	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL	$79.10	$113.00	—	29% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB	$107.10	$153.00	—	3% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATIC SPECIFIC AG	$108.50	$155.00	—	2% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM	$108.50	$155.00	—	2% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL	$149.80	$214.00	—	35% above	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB	$193.20	$276.00	—	74% above	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM	$196.00	$280.00	—	77% above	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATIC SPECIFIC AG	$196.00	$280.00	—	77% above	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL	$149.80	$214.00	—	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB	$193.20	$276.00	—	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATIC SPECIFIC AG	$196.00	$280.00	—	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM	$196.00	$280.00	—	—	30%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MN LAB	$193.20	$276.00	—	121% above	30%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS	$193.20	$276.00	—	121% above	30%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB	$193.20	$276.00	—	121% above	30%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS	$244.30	$349.00	—	179% above	30%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MN LAB	$244.30	$349.00	—	179% above	30%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB	$244.30	$349.00	—	179% above	30%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB	$193.20	$276.00	—	—	30%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS	$193.20	$276.00	—	—	30%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MN LAB	$193.20	$276.00	—	—	30%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC PAP SUREPATH DIAGNOSTIC	$188.30	$269.00	—	131% above	30%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN	$188.30	$269.00	—	131% above	30%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC PAP-THIN PREP SCREENING	$188.30	$269.00	—	131% above	30%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN	$247.10	$353.00	—	204% above	30%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC PAP SUREPATH DIAGNOSTIC	$247.10	$353.00	—	204% above	30%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC PAP-THIN PREP SCREENING	$247.10	$353.00	—	204% above	30%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN	$247.10	$353.00	—	—	30%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC PAP-THIN PREP SCREENING	$247.10	$353.00	—	—	30%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC PAP SUREPATH DIAGNOSTIC	$247.10	$353.00	—	—	30%
Parathyroid hormone (PTH) blood test CPT 83970 HC PTH C-TERMINAL	$228.20	$326.00	—	9% above	30%
Parathyroid hormone (PTH) blood test CPT 83970 HC PTH	$228.20	$326.00	—	9% above	30%
Parathyroid hormone (PTH) blood test CPT 83970 HC ASSAY OF PARATHORMONE LAB	$276.50	$395.00	—	32% above	30%
Parathyroid hormone (PTH) blood test CPT 83970 HC PTH INTACT	$276.50	$395.00	—	32% above	30%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE)	$276.50	$395.00	—	32% above	30%
Parathyroid hormone (PTH) blood test CPT 83970 HC PTH	$393.40	$562.00	—	87% above	30%
Parathyroid hormone (PTH) blood test CPT 83970 HC PTH C-TERMINAL	$592.90	$847.00	—	182% above	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC ASSAY OF PARATHORMONE LAB	$276.50	$395.00	—	—	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE)	$276.50	$395.00	—	—	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PTH INTACT	$276.50	$395.00	—	—	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PTH	$393.40	$562.00	—	—	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PTH C-TERMINAL	$592.90	$847.00	—	—	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL	$26.60	$38.00	—	35% below	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB	$26.60	$38.00	—	35% below	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT POST 60 MIN INCUBATION	$94.50	$135.00	—	130% above	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB	$121.80	$174.00	—	196% above	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL	$121.80	$174.00	—	196% above	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT POST 60 MIN INCUBATION	$94.50	$135.00	—	—	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL	$121.80	$174.00	—	—	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB	$121.80	$174.00	—	—	30%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS LAB	$929.60	$1,328.00	—	21% above	30%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS LAB	$929.60	$1,328.00	—	—	30%
Progesterone blood test CPT 84144 HC ASSAY OF PROGESTERONE CDM	$114.10	$163.00	—	17% above	30%
Progesterone blood test CPT 84144 HC ASSAY OF PROGESTERONE CDM	$137.90	$197.00	—	41% above	30%
Progesterone blood test inpatient CPT 84144 HC ASSAY OF PROGESTERONE CDM	$137.90	$197.00	—	—	30%
Prolactin blood test CPT 84146 HC ASSAY OF PROLACTIN CDM	$108.50	$155.00	—	3% above	30%
Prolactin blood test CPT 84146 HC ASSAY OF PROLACTIN CDM	$170.10	$243.00	—	62% above	30%
Prolactin blood test inpatient CPT 84146 HC ASSAY OF PROLACTIN CDM	$170.10	$243.00	—	—	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTIME	$18.20	$26.00	—	54% below	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME CDM	$18.20	$26.00	—	54% below	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME 85610	$18.20	$26.00	—	54% below	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME LAB	$18.20	$26.00	—	54% below	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME WHOLE BLOOD	$18.20	$26.00	—	54% below	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME	$18.20	$26.00	—	54% below	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME 85610	$69.30	$99.00	—	73% above	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME CDM	$69.30	$99.00	—	73% above	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC AC PROTIME	$69.30	$99.00	—	73% above	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME WHOLE BLOOD	$69.30	$99.00	—	73% above	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME	$69.30	$99.00	—	73% above	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME LAB	$69.30	$99.00	—	73% above	30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTIME	$69.30	$99.00	—	73% above	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC AC PROTIME	$69.30	$99.00	—	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME WHOLE BLOOD	$69.30	$99.00	—	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTIME	$69.30	$99.00	—	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME	$69.30	$99.00	—	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME 85610	$69.30	$99.00	—	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME LAB	$69.30	$99.00	—	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME CDM	$69.30	$99.00	—	—	30%
Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA A AND B SCREEN	$106.40	$152.00	—	58% above	30%
Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA A SCREEN	$118.30	$169.00	—	76% above	30%
Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA B SCREEN	$118.30	$169.00	—	76% above	30%
Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA A AND B SCREEN	$275.80	$394.00	—	311% above	30%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFLUENZA A SCREEN	$118.30	$169.00	—	—	30%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFLUENZA B SCREEN	$118.30	$169.00	—	—	30%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFLUENZA A AND B SCREEN	$275.80	$394.00	—	—	30%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB	$103.60	$148.00	—	44% above	30%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB	$106.40	$152.00	—	48% above	30%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB	$103.60	$148.00	—	—	30%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANTITATIVE LAB	$46.90	$67.00	—	17% above	30%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR	$46.90	$67.00	—	17% above	30%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANT	$46.90	$67.00	—	17% above	30%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR	$199.50	$285.00	—	399% above	30%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANT	$199.50	$285.00	—	399% above	30%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANTITATIVE LAB	$199.50	$285.00	—	399% above	30%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR	$199.50	$285.00	—	—	30%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR QUANTITATIVE LAB	$199.50	$285.00	—	—	30%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR QUANT	$199.50	$285.00	—	—	30%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY	$106.40	$152.00	—	54% above	30%
Rubella antibody test (immunity check) CPT 86762 HC ANTIBODY RUBELLA LAB	$106.40	$152.00	—	54% above	30%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY IGM	$106.40	$152.00	—	54% above	30%
Rubella antibody test (immunity check) CPT 86762 HC ANTIBODY RUBELLA CDM	$106.40	$152.00	—	54% above	30%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY	$183.40	$262.00	—	165% above	30%
Rubella antibody test (immunity check) CPT 86762 HC ANTIBODY RUBELLA LAB	$183.40	$262.00	—	165% above	30%
Rubella antibody test (immunity check) CPT 86762 HC ANTIBODY RUBELLA CDM	$183.40	$262.00	—	165% above	30%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY IGM	$183.40	$262.00	—	165% above	30%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA ANTIBODY	$183.40	$262.00	—	—	30%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA ANTIBODY IGM	$183.40	$262.00	—	—	30%
Rubella antibody test (immunity check) inpatient CPT 86762 HC ANTIBODY RUBELLA CDM	$183.40	$262.00	—	—	30%
Rubella antibody test (immunity check) inpatient CPT 86762 HC ANTIBODY RUBELLA LAB	$183.40	$262.00	—	—	30%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC RBC SED RATE AUTOMATED	$13.30	$19.00	—	57% below	30%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC RBC SED RATE AUTOMATED	$44.10	$63.00	—	42% above	30%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC RBC SED RATE AUTOMATED	$44.10	$63.00	—	—	30%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT LAB	$53.20	$76.00	—	27% below	30%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS	$60.90	$87.00	—	16% below	30%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT LAB	$239.40	$342.00	—	230% above	30%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS	$275.10	$393.00	—	279% above	30%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT LAB	$239.40	$342.00	—	—	30%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC SEMEN ANALYSIS	$275.10	$393.00	—	—	30%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES EXAM	$16.10	$23.00	—	74% below	30%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES SMEARS	$79.80	$114.00	—	30% above	30%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITED SMEARS W/MODIF	$196.70	$281.00	—	221% above	30%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES SMEARS	$257.60	$368.00	—	320% above	30%
Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITES EXAM	$16.10	$23.00	—	—	30%
Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITED SMEARS W/MODIF	$196.70	$281.00	—	—	30%
Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITES SMEARS	$257.60	$368.00	—	—	30%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM	$19.60	$28.00	—	34% below	30%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECES	$19.60	$28.00	—	34% below	30%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECES	$78.40	$112.00	—	164% above	30%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM	$78.40	$112.00	—	164% above	30%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM	$78.40	$112.00	—	—	30%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD FECES	$78.40	$112.00	—	—	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 CDM	$78.40	$112.00	—	5% above	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 CDM	$78.40	$112.00	—	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL RPR	$35.70	$51.00	—	20% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - CSF	$35.70	$51.00	—	20% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - VDRL	$35.70	$51.00	—	20% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL	$35.70	$51.00	—	20% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB	$35.70	$51.00	—	20% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - VDRL	$168.70	$241.00	—	467% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL RPR	$168.70	$241.00	—	467% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - CSF	$168.70	$241.00	—	467% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL	$168.70	$241.00	—	467% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB	$168.70	$241.00	—	467% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREP QUAL RPR	$168.70	$241.00	—	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - VDRL	$168.70	$241.00	—	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREP QUAL	$168.70	$241.00	—	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB	$168.70	$241.00	—	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - CSF	$168.70	$241.00	—	—	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB	$494.90	$707.00	—	138% above	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC QUANTIFERON TB GOLD	$494.90	$707.00	—	138% above	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM	$494.90	$707.00	—	138% above	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$494.90	$707.00	—	138% above	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$676.90	$967.00	—	226% above	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC QUANTIFERON TB GOLD	$676.90	$967.00	—	226% above	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB	$676.90	$967.00	—	226% above	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM	$676.90	$967.00	—	226% above	30%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB	$676.90	$967.00	—	—	30%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$676.90	$967.00	—	—	30%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM	$676.90	$967.00	—	—	30%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC QUANTIFERON TB GOLD	$676.90	$967.00	—	—	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE -TOTAL	$44.80	$64.00	—	62% below	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE-TOTAL	$44.80	$64.00	—	62% below	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$52.50	$75.00	—	56% below	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL LAB	$142.80	$204.00	—	21% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TOTAL TESTOSTERONE	$142.80	$204.00	—	21% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE	$142.80	$204.00	—	21% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$142.80	$204.00	—	21% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL CDM	$142.80	$204.00	—	21% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TOTAL TESTOSTERONE	$172.20	$246.00	—	45% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE	$172.20	$246.00	—	45% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL LAB	$172.20	$246.00	—	45% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL CDM	$209.30	$299.00	—	77% above	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE-TOTAL	$44.80	$64.00	—	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE -TOTAL	$44.80	$64.00	—	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL	$52.50	$75.00	—	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE	$172.20	$246.00	—	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL LAB	$172.20	$246.00	—	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TOTAL TESTOSTERONE	$172.20	$246.00	—	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL CDM	$209.30	$299.00	—	—	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EACH LAB	$117.60	$168.00	—	48% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODY	$117.60	$168.00	—	48% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EACH CDM	$117.60	$168.00	—	48% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EACH CDM	$131.60	$188.00	—	66% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODY	$131.60	$188.00	—	66% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EACH LAB	$131.60	$188.00	—	66% above	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES EACH CDM	$131.60	$188.00	—	—	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODY	$131.60	$188.00	—	—	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES EACH LAB	$131.60	$188.00	—	—	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH(THYROID STIMULATING HORMONE)	$95.20	$136.00	—	3% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB	$95.20	$136.00	—	3% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH	$95.20	$136.00	—	3% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE (TSH)	$95.20	$136.00	—	3% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC REFLEXIVE TSH	$95.20	$136.00	—	3% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH REFLEX TO FT4	$95.20	$136.00	—	3% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH REFLEXIVE	$95.20	$136.00	—	3% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC REFLEXIVE TSH	$112.70	$161.00	—	22% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH(THYROID STIMULATING HORMONE)	$112.70	$161.00	—	22% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH	$112.70	$161.00	—	22% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB	$112.70	$161.00	—	22% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH REFLEXIVE	$112.70	$161.00	—	22% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH REFLEX TO FT4	$112.70	$161.00	—	22% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE (TSH)	$112.70	$161.00	—	22% above	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC REFLEXIVE TSH	$112.70	$161.00	—	—	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE (TSH)	$112.70	$161.00	—	—	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH(THYROID STIMULATING HORMONE)	$112.70	$161.00	—	—	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH REFLEX TO FT4	$112.70	$161.00	—	—	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH	$112.70	$161.00	—	—	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB	$112.70	$161.00	—	—	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH REFLEXIVE	$112.70	$161.00	—	—	30%
Trichomonas test (NAAT) CPT 87661 HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH CDM	$90.30	$129.00	—	14% below	30%
Trichomonas test (NAAT) CPT 87661 HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB	$98.00	$140.00	—	7% below	30%
Trichomonas test (NAAT) inpatient CPT 87661 HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH CDM	$90.30	$129.00	—	—	30%
Trichomonas test (NAAT) inpatient CPT 87661 HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB	$98.00	$140.00	—	—	30%
Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID CDM	$25.90	$37.00	—	43% below	30%
Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID LAB	$25.90	$37.00	—	43% below	30%
Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID	$25.90	$37.00	—	43% below	30%
Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID	$44.80	$64.00	—	1% below	30%
Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID CDM	$45.50	$65.00	—	1% above	30%
Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID LAB	$45.50	$65.00	—	1% above	30%
Uric acid blood test inpatient CPT 84550 HC ASSAY OF BLOOD/URIC ACID	$44.80	$64.00	—	—	30%
Uric acid blood test inpatient CPT 84550 HC ASSAY OF BLOOD/URIC ACID LAB	$45.50	$65.00	—	—	30%
Uric acid blood test inpatient CPT 84550 HC ASSAY OF BLOOD/URIC ACID CDM	$45.50	$65.00	—	—	30%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM	$16.10	$23.00	—	57% below	30%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB	$16.10	$23.00	—	57% below	30%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB	$82.60	$118.00	—	120% above	30%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM	$82.60	$118.00	—	120% above	30%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB	$82.60	$118.00	—	—	30%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM	$82.60	$118.00	—	—	30%
Urinalysis without microscope exam, automated CPT 81003 HC SPECIFIC GRAVITY URINE	$10.50	$15.00	—	62% below	30%
Urinalysis without microscope exam, automated CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB	$10.50	$15.00	—	62% below	30%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE	$11.20	$16.00	—	60% below	30%
Urinalysis without microscope exam, automated CPT 81003 HC GLUCOSE QUALITATIVE URINE	$11.20	$16.00	—	60% below	30%
Urinalysis without microscope exam, automated CPT 81003 HC KETONE URINE QUALITATIVE	$11.20	$16.00	—	60% below	30%
Urinalysis without microscope exam, automated CPT 81003 HC PROTEIN URINE QUALITATIVE	$11.20	$16.00	—	60% below	30%
Urinalysis without microscope exam, automated CPT 81003 HC PH URINE QUALITATIVE	$23.10	$33.00	—	17% below	30%
Urinalysis without microscope exam, automated CPT 81003 HC PH URINE DIPSTICK AUTO W/O MICROSCOPY LAB	$23.10	$33.00	—	17% below	30%
Urinalysis without microscope exam, automated CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB	$30.10	$43.00	—	8% above	30%
Urinalysis without microscope exam, automated CPT 81003 HC GLUCOSE QUALITATIVE URINE	$30.10	$43.00	—	8% above	30%
Urinalysis without microscope exam, automated CPT 81003 HC SPECIFIC GRAVITY URINE	$30.10	$43.00	—	8% above	30%
Urinalysis without microscope exam, automated CPT 81003 HC PROTEIN URINE QUALITATIVE	$30.10	$43.00	—	8% above	30%
Urinalysis without microscope exam, automated CPT 81003 HC KETONE URINE QUALITATIVE	$33.60	$48.00	—	20% above	30%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE	$54.60	$78.00	—	96% above	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC PH URINE QUALITATIVE	$23.10	$33.00	—	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC PH URINE DIPSTICK AUTO W/O MICROSCOPY LAB	$23.10	$33.00	—	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC GLUCOSE QUALITATIVE URINE	$30.10	$43.00	—	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB	$30.10	$43.00	—	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC SPECIFIC GRAVITY URINE	$30.10	$43.00	—	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC PROTEIN URINE QUALITATIVE	$30.10	$43.00	—	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC KETONE URINE QUALITATIVE	$33.60	$48.00	—	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO W/O SCOPE	$54.60	$78.00	—	—	30%
Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP LAB	$10.50	$15.00	—	49% below	30%
Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM	$12.60	$18.00	—	38% below	30%
Urinalysis without microscope exam, manual CPT 81002 HC SPECIFIC GRAVITY URINE	$12.60	$18.00	—	38% below	30%
Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP LAB	$14.70	$21.00	—	28% below	30%
Urinalysis without microscope exam, manual CPT 81002 HC SPECIFIC GRAVITY URINE	$21.70	$31.00	—	6% above	30%
Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM	$46.20	$66.00	—	127% above	30%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP LAB	$14.70	$21.00	—	—	30%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC SPECIFIC GRAVITY URINE	$21.70	$31.00	—	—	30%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM	$46.20	$66.00	—	—	30%
Urine culture for bacteria, with colony count CPT 87086 HC URINE CULTURE/COLONY COUNT	$72.80	$104.00	—	11% below	30%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB	$72.80	$104.00	—	11% below	30%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB	$182.00	$260.00	—	123% above	30%
Urine culture for bacteria, with colony count CPT 87086 HC URINE CULTURE/COLONY COUNT	$182.00	$260.00	—	123% above	30%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB	$182.00	$260.00	—	—	30%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC URINE CULTURE/COLONY COUNT	$182.00	$260.00	—	—	30%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST	$18.90	$27.00	—	61% below	30%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST	$112.00	$160.00	—	131% above	30%
Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY TEST	$112.00	$160.00	—	—	30%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN-B12	$84.70	$121.00	—	12% below	30%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B-12	$84.70	$121.00	—	12% below	30%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN-B12	$102.20	$146.00	—	6% above	30%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B-12	$102.20	$146.00	—	6% above	30%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN-B12	$102.20	$146.00	—	—	30%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B-12	$102.20	$146.00	—	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED	$164.50	$235.00	—	27% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM	$164.50	$235.00	—	27% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED LAB	$164.50	$235.00	—	27% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM	$257.60	$368.00	—	99% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED LAB	$257.60	$368.00	—	99% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED	$257.60	$368.00	—	99% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM	$257.60	$368.00	—	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED LAB	$257.60	$368.00	—	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED	$257.60	$368.00	—	—	30%
Zinc blood test CPT 84630 HC ZINC	$60.20	$86.00	—	21% below	30%
Zinc blood test CPT 84630 HC ASSAY OF ZINC LAB	$60.20	$86.00	—	21% below	30%
Zinc blood test CPT 84630 HC ASSAY OF ZINC CDM	$60.20	$86.00	—	21% below	30%
Zinc blood test CPT 84630 HC ASSAY OF ZINC LAB	$233.80	$334.00	—	208% above	30%
Zinc blood test CPT 84630 HC ZINC	$233.80	$334.00	—	208% above	30%
Zinc blood test CPT 84630 HC ASSAY OF ZINC CDM	$233.80	$334.00	—	208% above	30%
Zinc blood test inpatient CPT 84630 HC ASSAY OF ZINC LAB	$233.80	$334.00	—	—	30%
Zinc blood test inpatient CPT 84630 HC ZINC	$233.80	$334.00	—	—	30%
Zinc blood test inpatient CPT 84630 HC ASSAY OF ZINC CDM	$233.80	$334.00	—	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE	$39.20	$56.00	—	64% below	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB	$77.00	$110.00	—	29% below	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG (QUANTITATIVE)	$84.70	$121.00	—	22% below	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG PRENATAL RISK	$84.70	$121.00	—	22% below	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG TOTAL QUANTITATIVE	$84.70	$121.00	—	22% below	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM	$84.70	$121.00	—	22% below	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC HCG QUANT	$90.30	$129.00	—	17% below	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG PRENATAL RISK	$153.30	$219.00	—	41% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG (QUANTITATIVE)	$155.40	$222.00	—	43% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM	$155.40	$222.00	—	43% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB	$217.70	$311.00	—	101% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG TOTAL QUANTITATIVE	$238.00	$340.00	—	119% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC HCG QUANT	$251.30	$359.00	—	132% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE	$39.20	$56.00	—	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG PRENATAL RISK	$153.30	$219.00	—	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG (QUANTITATIVE)	$155.40	$222.00	—	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM	$155.40	$222.00	—	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB	$217.70	$311.00	—	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG TOTAL QUANTITATIVE	$238.00	$340.00	—	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC HCG QUANT	$251.30	$359.00	—	—	30%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Washington	Off list
Balloon dilation of the maxillary sinus opening, one side CPT 31295 HC ED SINUS ENDO W/BALLOON DILATION CDM	$12,101.60	$17,288.00	—	155% above	30%
Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 HC ED SINUS ENDO W/BALLOON DILATION CDM	$12,101.60	$17,288.00	—	—	30%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESION STEREO	$1,816.50	$2,595.00	—	18% below	30%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST 1ST LESION STEREO	$1,816.50	$2,595.00	—	—	30%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC ED CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM	$611.10	$873.00	—	8% below	30%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC ED CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM	$611.10	$873.00	—	—	30%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC ED TREAT METATARSAL FRACTURE W/O MANIPULATION CDM	$611.10	$873.00	—	6% above	30%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC ED TREAT METATARSAL FRACTURE W/O MANIPULATION CDM	$611.10	$873.00	—	—	30%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 HC ED CORRECTION OF BUNION CDM	$7,046.90	$10,067.00	—	71% above	30%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 HC ED CORRECTION OF BUNION CDM	$7,046.90	$10,067.00	—	—	30%
Cardiac catheterization with coronary angiogram CPT 93458 HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I	$6,153.70	$8,791.00	—	40% below	30%
Cardiac catheterization with coronary angiogram CPT 93458 HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I	$11,797.80	$16,854.00	—	14% above	30%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I	$11,797.80	$16,854.00	—	—	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$1,298.50	$1,855.00	—	27% above	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$1,682.10	$2,403.00	—	65% above	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$1,682.10	$2,403.00	—	—	30%
Carpal tunnel release, open surgery CPT 64721 HC ED NEUROPLASTY MEDIAN NERVE AT CARP TUNNEL CDM	$4,255.30	$6,079.00	—	47% above	30%
Carpal tunnel release, open surgery inpatient CPT 64721 HC ED NEUROPLASTY MEDIAN NERVE AT CARP TUNNEL CDM	$4,255.30	$6,079.00	—	—	30%
Catheter ablation for atrial fibrillation CPT 93656 HC COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION	$34,365.80	$49,094.00	—	33% above	30%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION	$34,365.80	$49,094.00	—	—	30%
Cervical biopsy CPT 57500 HC ED BIOPSY OF CERVIX CDM	$1,665.30	$2,379.00	—	142% above	30%
Cervical biopsy inpatient CPT 57500 HC ED BIOPSY OF CERVIX CDM	$1,665.30	$2,379.00	—	—	30%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM	$611.10	$873.00	—	2% above	30%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM	$611.10	$873.00	—	—	30%
Colonoscopy, diagnostic CPT 45378 HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM	$1,625.40	$2,322.00	—	1% below	30%
Colonoscopy, diagnostic inpatient CPT 45378 HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM	$1,625.40	$2,322.00	—	—	30%
Coronary stent placement, one artery CPT 92928 HC INSERT COR STENT PERC TRLUML W/ANGIO ONE ART/BRNCH	$17,817.80	$25,454.00	—	16% below	30%
Coronary stent placement, one artery inpatient CPT 92928 HC INSERT COR STENT PERC TRLUML W/ANGIO ONE ART/BRNCH	$17,817.80	$25,454.00	—	—	30%
Cystoscopy with ureteral stent placement CPT 52332 HC CYSTOURETHROSCOPY, W/ INSERTION OF INDWELLING URETERAL STENT	$5,882.80	$8,404.00	—	84% above	30%
Cystoscopy with ureteral stent placement inpatient CPT 52332 HC CYSTOURETHROSCOPY, W/ INSERTION OF INDWELLING URETERAL STENT	$5,882.80	$8,404.00	—	—	30%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOSCOPY	$959.70	$1,371.00	—	7% above	30%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC ED CYSTOURETHROSCOPY CDM	$1,222.90	$1,747.00	—	37% above	30%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC ED CYSTOURETHROSCOPY CDM	$1,222.90	$1,747.00	—	—	30%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HC ED DILATION AND CURETTAGE CDM	$4,831.40	$6,902.00	—	96% above	30%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC ED DILATION AND CURETTAGE CDM	$4,831.40	$6,902.00	—	—	30%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC ED DESTRUCT PREMALG LESION FIRST LESION CDM	$427.70	$611.00	—	135% above	30%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC ED DESTRUCT PREMALG LESION FIRST LESION CDM	$427.70	$611.00	—	—	30%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC ED REMOVE IMPACTED EAR WAX UNI CDM	$230.30	$329.00	—	124% above	30%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC ED REMOVE IMPACTED EAR WAX UNI CDM	$230.30	$329.00	—	—	30%
Earwax removal with instruments, one ear one side CPT 69210 HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM	$256.90	$367.00	—	71% above	30%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM	$256.90	$367.00	—	—	30%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC ED ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX CDM	$422.10	$603.00	—	49% above	30%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC BIOPSY OF UTERUS LINING	$422.10	$603.00	—	49% above	30%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC BIOPSY OF UTERUS LINING	$422.10	$603.00	—	—	30%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC ED ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX CDM	$422.10	$603.00	—	—	30%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG	$1,607.90	$2,297.00	—	25% above	30%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC ED INJ INTERLAMINR CRV-THOR W IMG CDM	$1,607.90	$2,297.00	—	25% above	30%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC ED INJ INTERLAMINR CRV-THOR W IMG CDM	$1,607.90	$2,297.00	—	—	30%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG	$1,607.90	$2,297.00	—	—	30%
Eye injection into the vitreous (intravitreal injection) CPT 67028 HC INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM	$833.00	$1,190.00	—	3% above	30%
Eye injection into the vitreous (intravitreal injection) CPT 67028 HC ED INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM	$833.00	$1,190.00	—	3% above	30%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HC INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM	$833.00	$1,190.00	—	—	30%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HC ED INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM	$833.00	$1,190.00	—	—	30%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV	$1,995.00	$2,850.00	—	at median	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV	$1,995.00	$2,850.00	—	—	30%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC ED SIGMOID DX FLX W WO SPEC COLL CDM	$1,625.40	$2,322.00	—	106% above	30%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC ED SIGMOID DX FLX W WO SPEC COLL CDM	$1,625.40	$2,322.00	—	—	30%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM	$11,358.20	$16,226.00	—	13% above	30%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM	$11,358.20	$16,226.00	—	—	30%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC ED HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS CDM	$1,967.70	$2,811.00	—	62% above	30%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC ED HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS CDM	$1,967.70	$2,811.00	—	—	30%
Hemorrhoidectomy (internal and external), one area CPT 46255 HC ED HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP CDM	$6,209.70	$8,871.00	—	87% above	30%
Hemorrhoidectomy (internal and external), one area CPT 46255 HC REMOVE INT/EXT HEM 1 GROUP	$6,209.70	$8,871.00	—	87% above	30%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HC ED HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP CDM	$6,209.70	$8,871.00	—	—	30%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HC REMOVE INT/EXT HEM 1 GROUP	$6,209.70	$8,871.00	—	—	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$285.60	$408.00	—	13% above	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$285.60	$408.00	—	—	30%
IUD insertion (the device itself billed separately) CPT 58300 HC ED INSERTION INTRAUTERINE DEVICE IUD CDM	$280.00	$400.00	—	3% above	30%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC ED INSERTION INTRAUTERINE DEVICE IUD CDM	$280.00	$400.00	—	—	30%
Incision and drainage of a simple or single skin abscess CPT 10060 HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$693.70	$991.00	—	91% above	30%
Incision and drainage of a simple or single skin abscess CPT 10060 HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM	$693.70	$991.00	—	91% above	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$693.70	$991.00	—	—	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM	$693.70	$991.00	—	—	30%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM	$8,385.30	$11,979.00	—	20% above	30%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM	$8,385.30	$11,979.00	—	—	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC ED INJ TENDON SHEATH/LIGAMENT CDM	$714.00	$1,020.00	—	142% above	30%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC ED INJ TENDON SHEATH/LIGAMENT CDM	$714.00	$1,020.00	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$589.40	$842.00	—	21% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$722.40	$1,032.00	—	48% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM	$722.40	$1,032.00	—	48% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC INJ MAJOR JOINT - SHOULDER/HIP/KNEE	$722.40	$1,032.00	—	48% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$722.40	$1,032.00	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM	$722.40	$1,032.00	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC INJ MAJOR JOINT - SHOULDER/HIP/KNEE	$722.40	$1,032.00	—	—	30%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERT DRUG IMPLANT DEVICE	$259.00	$370.00	—	6% below	30%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC INSERT DRUG IMPLANT DEVICE	$259.00	$370.00	—	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE	$589.40	$842.00	—	29% above	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE	$718.90	$1,027.00	—	57% above	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM	$718.90	$1,027.00	—	57% above	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM	$718.90	$1,027.00	—	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE	$718.90	$1,027.00	—	—	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE	$589.40	$842.00	—	55% above	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM	$714.70	$1,021.00	—	89% above	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE	$714.70	$1,021.00	—	89% above	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM	$714.70	$1,021.00	—	—	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE	$714.70	$1,021.00	—	—	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC REPAIR INTMD WND S/TR/EXT LTE 2.5CM CDM	$702.10	$1,003.00	—	21% above	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM	$702.10	$1,003.00	—	21% above	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC REPAIR INTMD WND S/TR/EXT LTE 2.5CM CDM	$702.10	$1,003.00	—	—	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM	$702.10	$1,003.00	—	—	30%
Left heart catheterization, diagnostic one side CPT 93452 HC LEFT HRT CATH W/VENTRCLGRPHY	$6,090.70	$8,701.00	—	32% below	30%
Left heart catheterization, diagnostic one side CPT 93452 HC LEFT HRT CATH W/VENTRCLGRPHY	$9,333.10	$13,333.00	—	4% above	30%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC LEFT HRT CATH W/VENTRCLGRPHY	$9,333.10	$13,333.00	—	—	30%
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG	$1,655.50	$2,365.00	—	21% above	30%
Lower-back epidural injection, with imaging guidance CPT 62323 HC ED INJ EPI LUMB/SACRAL W IMAGING CDM	$1,655.50	$2,365.00	—	21% above	30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC ED INJ EPI LUMB/SACRAL W IMAGING CDM	$1,655.50	$2,365.00	—	—	30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG	$1,655.50	$2,365.00	—	—	30%
Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	$1,607.90	$2,297.00	—	42% above	30%
Lower-back epidural injection, without imaging guidance CPT 62322 HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM	$1,607.90	$2,297.00	—	42% above	30%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM	$1,607.90	$2,297.00	—	—	30%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	$1,607.90	$2,297.00	—	—	30%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ FORAMEN EPIDURAL L/S	$2,083.90	$2,977.00	—	31% above	30%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ FORAMEN EPIDURAL L/S	$2,083.90	$2,977.00	—	—	30%
Miscarriage treatment with D&C, first trimester CPT 59820 HC ED SPONTANEOUS ABORTION FAC CDM	$4,831.40	$6,902.00	—	8% above	30%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC ED SPONTANEOUS ABORTION FAC CDM	$4,831.40	$6,902.00	—	—	30%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS CDM	$928.90	$1,327.00	—	68% above	30%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM	$1,536.50	$2,195.00	—	178% above	30%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM	$1,536.50	$2,195.00	—	—	30%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS CDM	$928.90	$1,327.00	—	38% above	30%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM	$1,536.50	$2,195.00	—	128% above	30%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM	$1,536.50	$2,195.00	—	—	30%
Nail removal (partial or complete), one nail CPT 11730 HC ED REMOVAL OF NAIL PLATE CDM	$520.10	$743.00	—	82% above	30%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC ED REMOVAL OF NAIL PLATE CDM	$520.10	$743.00	—	—	30%
Occipital nerve block (injection for headaches) CPT 64405 HC ED NERVE BLOCK INJ OCCIPITAL CDM	$1,249.50	$1,785.00	—	102% above	30%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC ED NERVE BLOCK INJ OCCIPITAL CDM	$1,249.50	$1,785.00	—	—	30%
Pacemaker implant (dual chamber) CPT 33208 HC INSERTION PERM AV PACER	$8,015.70	$11,451.00	—	23% below	30%
Pacemaker implant (dual chamber) CPT 33208 HC INSERTION PERM AV PACER	$16,249.80	$23,214.00	—	55% above	30%
Pacemaker implant (dual chamber) CPT 33208 HC PM NEW/REPL PER ART/VENT	$16,249.80	$23,214.00	—	55% above	30%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC PM NEW/REPL PER ART/VENT	$16,249.80	$23,214.00	—	—	30%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC INSERTION PERM AV PACER	$16,249.80	$23,214.00	—	—	30%
Paracentesis with imaging guidance CPT 49083 HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM	$1,120.70	$1,601.00	—	9% below	30%
Paracentesis with imaging guidance CPT 49083 HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM	$2,401.70	$3,431.00	—	96% above	30%
Paracentesis with imaging guidance CPT 49083 HC ED ABD PARACENTESIS W/IMAG GUIDANCE CDM	$2,401.70	$3,431.00	—	96% above	30%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM	$2,401.70	$3,431.00	—	—	30%
Paracentesis with imaging guidance inpatient CPT 49083 HC ED ABD PARACENTESIS W/IMAG GUIDANCE CDM	$2,401.70	$3,431.00	—	—	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC ED REMOVAL OF NAIL BED CDM	$1,124.90	$1,607.00	—	78% above	30%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC ED REMOVAL OF NAIL BED CDM	$1,124.90	$1,607.00	—	—	30%
Prostate biopsy CPT 55700 HC BIOPSY OF PROSTATE	$3,086.30	$4,409.00	—	69% above	30%
Prostate biopsy CPT 55700 HC BIOPSY OF PROSTATE	$3,735.20	$5,336.00	—	104% above	30%
Prostate biopsy inpatient CPT 55700 HC BIOPSY OF PROSTATE	$3,735.20	$5,336.00	—	—	30%
Removal of a foreign object under the skin, simple CPT 10120 HC ED REMOVE FOREIGN BODY SIMPLE CDM	$970.20	$1,386.00	—	89% above	30%
Removal of a foreign object under the skin, simple CPT 10120 HC INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$970.20	$1,386.00	—	89% above	30%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$970.20	$1,386.00	—	—	30%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC ED REMOVE FOREIGN BODY SIMPLE CDM	$970.20	$1,386.00	—	—	30%
Septoplasty to straighten the nasal septum CPT 30520 HC ED REPAIR OF NASAL SEPTUM CDM	$6,736.10	$9,623.00	—	36% above	30%
Septoplasty to straighten the nasal septum inpatient CPT 30520 HC ED REPAIR OF NASAL SEPTUM CDM	$6,736.10	$9,623.00	—	—	30%
Short arm cast (elbow to hand) CPT 29075 HC ED SHORT ARM CAST APPLICATION CDM	$489.30	$699.00	—	32% above	30%
Short arm cast (elbow to hand) inpatient CPT 29075 HC ED SHORT ARM CAST APPLICATION CDM	$489.30	$699.00	—	—	30%
Short arm splint (forearm and hand) CPT 29125 HC ED SHORT ARM SPLINT APPLICATION CDM	$354.20	$506.00	—	47% above	30%
Short arm splint (forearm and hand) inpatient CPT 29125 HC ED SHORT ARM SPLINT APPLICATION CDM	$354.20	$506.00	—	—	30%
Short leg cast (below the knee) CPT 29405 HC ED SHORT LEG CAST APPLICATION CDM	$526.40	$752.00	—	53% above	30%
Short leg cast (below the knee) inpatient CPT 29405 HC ED SHORT LEG CAST APPLICATION CDM	$526.40	$752.00	—	—	30%
Short leg splint (calf to foot) CPT 29515 HC ED SHORT LEG SPLINT APPLICATION CDM	$354.20	$506.00	—	25% above	30%
Short leg splint (calf to foot) inpatient CPT 29515 HC ED SHORT LEG SPLINT APPLICATION CDM	$354.20	$506.00	—	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS	$445.90	$637.00	—	42% above	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM	$445.90	$637.00	—	42% above	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM	$445.90	$637.00	—	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS	$445.90	$637.00	—	—	30%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION	$503.30	$719.00	—	49% above	30%
Skin biopsy, punch, one lesion CPT 11104 HC ED PUNCH BIOPSY SKIN SINGLE LESION CDM	$609.00	$870.00	—	80% above	30%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION	$609.00	$870.00	—	80% above	30%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION	$609.00	$870.00	—	—	30%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC ED PUNCH BIOPSY SKIN SINGLE LESION CDM	$609.00	$870.00	—	—	30%
Skin tag removal, up to 15 tags CPT 11200 HC ED REMOVAL OF SKIN TAGS CDM	$303.80	$434.00	—	48% above	30%
Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15	$303.80	$434.00	—	48% above	30%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC ED REMOVAL OF SKIN TAGS CDM	$303.80	$434.00	—	—	30%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15	$303.80	$434.00	—	—	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$1,061.90	$1,517.00	—	21% above	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$1,288.00	$1,840.00	—	47% above	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM	$1,288.00	$1,840.00	—	47% above	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$1,288.00	$1,840.00	—	—	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM	$1,288.00	$1,840.00	—	—	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC REPAIR SUPERFICIAL WOUND(S) 2.5 TO 7.5 CM	$458.50	$655.00	—	17% above	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC ED REPAIR SUPERFICIAL WND(S) 2.6-7.5CM SLP NK AX EXGEN TRNK E CDM	$458.50	$655.00	—	17% above	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC REPAIR SUPERFICIAL WOUND(S) 2.5 TO 7.5 CM	$458.50	$655.00	—	—	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC ED REPAIR SUPERFICIAL WND(S) 2.6-7.5CM SLP NK AX EXGEN TRNK E CDM	$458.50	$655.00	—	—	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair one side CPT 12011 HC ED REPAIR SUPERFICIAL WOUND(S) LT/2.5 FACE ERS EYLD NSE LPS MUC CDM	$588.00	$840.00	—	59% above	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient one side CPT 12011 HC ED REPAIR SUPERFICIAL WOUND(S) LT/2.5 FACE ERS EYLD NSE LPS MUC CDM	$588.00	$840.00	—	—	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$488.60	$698.00	—	85% above	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$590.80	$844.00	—	124% above	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC ED TANGENTIAL BIOPSY SKIN SINGLE LESION CDM	$590.80	$844.00	—	124% above	30%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC ED TANGENTIAL BIOPSY SKIN SINGLE LESION CDM	$590.80	$844.00	—	—	30%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$590.80	$844.00	—	—	30%
Thoracentesis with imaging guidance CPT 32555 HC PR ED 32555 THORACENTESIS/ASPIR W IMG GD CDM	$190.40	$272.00	—	85% below	30%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$2,221.10	$3,173.00	—	79% above	30%
Thoracentesis with imaging guidance CPT 32555 HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM	$2,221.10	$3,173.00	—	79% above	30%
Thoracentesis with imaging guidance inpatient CPT 32555 HC PR ED 32555 THORACENTESIS/ASPIR W IMG GD CDM	$190.40	$272.00	—	—	30%
Thoracentesis with imaging guidance inpatient CPT 32555 HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM	$2,221.10	$3,173.00	—	—	30%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$2,221.10	$3,173.00	—	—	30%
Trigger point injections, 1 or 2 muscles CPT 20552 HC IR INJ TRIGGER POINT(S)1TO2 MUSC	$589.40	$842.00	—	85% above	30%
Trigger point injections, 1 or 2 muscles CPT 20552 HC IR INJ TRIGGER POINT(S)1TO2 MUSC	$714.00	$1,020.00	—	124% above	30%
Trigger point injections, 1 or 2 muscles CPT 20552 HC ED INJ TRIGGER POINT 1/2 MUSCL CDM	$714.00	$1,020.00	—	124% above	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC IR INJ TRIGGER POINT(S)1TO2 MUSC	$714.00	$1,020.00	—	—	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC ED INJ TRIGGER POINT 1/2 MUSCL CDM	$714.00	$1,020.00	—	—	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMAG	$1,816.50	$2,595.00	—	27% below	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US IMAG	$1,816.50	$2,595.00	—	—	30%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC ED UGI W DILATION ESOPHAGUS BAL CDM	$4,340.70	$6,201.00	—	112% above	30%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC ED UGI W DILATION ESOPHAGUS BAL CDM	$4,340.70	$6,201.00	—	—	30%
Upper endoscopy (EGD) with biopsy CPT 43239 HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM	$2,057.30	$2,939.00	—	12% above	30%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM	$2,057.30	$2,939.00	—	—	30%
Upper endoscopy (EGD), diagnostic CPT 43235 HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM	$1,583.40	$2,262.00	—	55% above	30%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM	$1,583.40	$2,262.00	—	—	30%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCTION BENIGN LESIONS UP TO 14 CDM	$245.00	$350.00	—	11% above	30%
Wart removal, up to 14 warts CPT 17110 HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM	$449.40	$642.00	—	103% above	30%
Wart removal, up to 14 warts inpatient CPT 17110 HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM	$449.40	$642.00	—	—	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC ED DEB SUBQ TISSUE 20 SQ CM OR LESS - DEBRIDE SKIN CDM	$970.20	$1,386.00	—	62% above	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS	$970.20	$1,386.00	—	62% above	30%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS	$970.20	$1,386.00	—	—	30%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC ED DEB SUBQ TISSUE 20 SQ CM OR LESS - DEBRIDE SKIN CDM	$970.20	$1,386.00	—	—	30%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 HC ED TREAT FX RAD EXTRA-ARTICUL CDM	$15,660.40	$22,372.00	—	58% above	30%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 HC ED TREAT FX RAD EXTRA-ARTICUL CDM	$15,660.40	$22,372.00	—	—	30%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Washington	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION EA UNIT CDM	$801.50	$1,145.00	—	13% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION EA UNIT CDM	$968.80	$1,384.00	—	5% above	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION EA UNIT CDM	$968.80	$1,384.00	—	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHALATION TREATMENT DAILY	$487.90	$697.00	—	130% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHALATION TREATMENT DAILY	$487.90	$697.00	—	130% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC ED INHALATION TREATMENT CDM	$487.90	$697.00	—	130% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHALATION TREATMENT DAILY	$487.90	$697.00	—	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC ED INHALATION TREATMENT CDM	$487.90	$697.00	—	—	30%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO IV INFUSION INITIAL HR CDM	$1,078.70	$1,541.00	—	51% above	30%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO IV INFUSION INITIAL HR CDM	$1,135.40	$1,622.00	—	58% above	30%
Chemotherapy IV infusion, first hour CPT 96413 HC TYSABRI INFUSION FIRST HR	$1,135.40	$1,622.00	—	58% above	30%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO IV INFUSION INITIAL HR CDM	$1,135.40	$1,622.00	—	—	30%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC TYSABRI INFUSION FIRST HR	$1,135.40	$1,622.00	—	—	30%
Critical care, first 30 to 74 minutes CPT 99291 HC ED OB FAC CRITICAL CARE FIRST HOUR CDM	$5,294.10	$7,563.00	—	110% above	30%
Critical care, first 30 to 74 minutes CPT 99291 HC ED CRITICAL CARE FIRST HOUR CDM	$5,573.40	$7,962.00	—	121% above	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC ED OB FAC CRITICAL CARE FIRST HOUR CDM	$5,294.10	$7,563.00	—	—	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC ED CRITICAL CARE FIRST HOUR CDM	$5,573.40	$7,962.00	—	—	30%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY	$520.80	$744.00	—	29% below	30%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY	$1,281.70	$1,831.00	—	74% above	30%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY	$1,281.70	$1,831.00	—	—	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ECG 12 LEAD TRACING ONLY	$79.10	$113.00	—	56% below	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ECG 12 LEAD TRACING ONLY	$270.20	$386.00	—	49% above	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC ECG 12 LEAD TRACING ONLY	$270.20	$386.00	—	—	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 1 HOUR	$809.20	$1,156.00	—	4% below	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 1 HOUR	$971.60	$1,388.00	—	16% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 1.5 HOUR	$1,214.50	$1,735.00	—	44% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 1.5 HOUR	$1,456.70	$2,081.00	—	73% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 2 HOUR	$1,619.10	$2,313.00	—	93% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 2 HOUR	$1,942.50	$2,775.00	—	131% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 2.5 HOUR	$2,023.70	$2,891.00	—	141% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 3 HOUR	$2,428.30	$3,469.00	—	189% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 2.5 HOUR	$2,428.30	$3,469.00	—	189% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 3.5 HOUR	$2,832.90	$4,047.00	—	237% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 3 HOUR	$2,914.10	$4,163.00	—	247% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 4 HOUR	$3,237.50	$4,625.00	—	285% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 3.5 HOUR	$3,399.90	$4,857.00	—	304% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 4.5 HOUR	$3,642.80	$5,204.00	—	333% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 4 HOUR	$3,885.70	$5,551.00	—	362% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 5 HOUR	$4,047.40	$5,782.00	—	381% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 4.5 HOUR	$4,370.80	$6,244.00	—	420% above	30%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 5 HOUR	$4,856.60	$6,938.00	—	477% above	30%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY 1 HOUR	$971.60	$1,388.00	—	—	30%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY 1.5 HOUR	$1,456.70	$2,081.00	—	—	30%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY 2 HOUR	$1,942.50	$2,775.00	—	—	30%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY 2.5 HOUR	$2,428.30	$3,469.00	—	—	30%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY 3 HOUR	$2,914.10	$4,163.00	—	—	30%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY 3.5 HOUR	$3,399.90	$4,857.00	—	—	30%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY 4 HOUR	$3,885.70	$5,551.00	—	—	30%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY 4.5 HOUR	$4,370.80	$6,244.00	—	—	30%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY 5 HOUR	$4,856.60	$6,938.00	—	—	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED OB FAC E&M VISIT LEVEL 1 CDM	$224.00	$320.00	—	at median	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED FAC E&M VISIT LEVEL 1 CDM	$235.90	$337.00	—	5% above	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED OB FAC E&M VISIT LEVEL 1 CDM	$224.00	$320.00	—	—	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED FAC E&M VISIT LEVEL 1 CDM	$235.90	$337.00	—	—	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED OB FAC E&M VISIT LEVEL 2 CDM	$429.80	$614.00	—	10% above	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED FAC E&M VISIT LEVEL 2 CDM	$452.20	$646.00	—	16% above	30%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED OB FAC E&M VISIT LEVEL 2 CDM	$429.80	$614.00	—	—	30%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED FAC E&M VISIT LEVEL 2 CDM	$452.20	$646.00	—	—	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED OB FAC E&M VISIT LEVEL 3 CDM	$569.10	$813.00	—	22% below	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED FAC E&M VISIT LEVEL 3 CDM	$599.20	$856.00	—	18% below	30%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED OB FAC E&M VISIT LEVEL 3 CDM	$569.10	$813.00	—	—	30%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED FAC E&M VISIT LEVEL 3 CDM	$599.20	$856.00	—	—	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED OB FAC E&M VISIT LEVEL 4 CDM	$1,024.80	$1,464.00	—	12% below	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED SEXUAL ASSAULT EXAM CDM	$1,078.70	$1,541.00	—	8% below	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED FAC E&M VISIT LEVEL 4 CDM	$1,078.70	$1,541.00	—	8% below	30%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED OB FAC E&M VISIT LEVEL 4 CDM	$1,024.80	$1,464.00	—	—	30%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED FAC E&M VISIT LEVEL 4 CDM	$1,078.70	$1,541.00	—	—	30%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED SEXUAL ASSAULT EXAM CDM	$1,078.70	$1,541.00	—	—	30%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED OB FAC E&M VISIT LEVEL 5 CDM	$2,222.50	$3,175.00	—	13% above	30%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED FAC E&M VISIT LEVEL 5 CDM	$2,339.40	$3,342.00	—	19% above	30%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED OB FAC E&M VISIT LEVEL 5 CDM	$2,222.50	$3,175.00	—	—	30%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED FAC E&M VISIT LEVEL 5 CDM	$2,339.40	$3,342.00	—	—	30%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY	$704.20	$1,006.00	—	21% above	30%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY	$956.90	$1,367.00	—	64% above	30%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY	$956.90	$1,367.00	—	—	30%
Family therapy with the patient, 50 minutes CPT 90847 HC PSYCHOTHERAPY FAMILY W PT 50 MINS CDM	$258.30	$369.00	—	19% above	30%
Family therapy with the patient, 50 minutes CPT 90847 HC FAMILY PSYTX W/PATIENT 60 MIN	$258.30	$369.00	—	19% above	30%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC FAMILY PSYTX W/PATIENT 60 MIN	$258.30	$369.00	—	—	30%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC PSYCHOTHERAPY FAMILY W PT 50 MINS CDM	$258.30	$369.00	—	—	30%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYTX W/O PATIENT 15 MIN	$117.60	$168.00	—	38% below	30%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYTX W/O PATIENT 30 MIN	$186.90	$267.00	—	2% below	30%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYTX W/O PATIENT 45 MIN	$208.60	$298.00	—	10% above	30%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYTX W/O PATIENT 60 MIN	$255.50	$365.00	—	34% above	30%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYTX W/O PATIENT 75 MIN	$320.60	$458.00	—	69% above	30%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYTX W/O PATIENT 90 MIN	$386.40	$552.00	—	103% above	30%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYTX W/O PATIENT 105 MIN	$450.80	$644.00	—	137% above	30%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYTX W/O PATIENT 120 MIN	$520.10	$743.00	—	173% above	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYTX W/O PATIENT 15 MIN	$117.60	$168.00	—	—	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYTX W/O PATIENT 30 MIN	$186.90	$267.00	—	—	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYTX W/O PATIENT 45 MIN	$208.60	$298.00	—	—	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYTX W/O PATIENT 60 MIN	$255.50	$365.00	—	—	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYTX W/O PATIENT 75 MIN	$320.60	$458.00	—	—	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYTX W/O PATIENT 90 MIN	$386.40	$552.00	—	—	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYTX W/O PATIENT 105 MIN	$450.80	$644.00	—	—	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYTX W/O PATIENT 120 MIN	$520.10	$743.00	—	—	30%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY 15 MIN	$58.10	$83.00	—	57% below	30%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY 30 MIN	$116.20	$166.00	—	14% below	30%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY 45 MIN	$173.60	$248.00	—	28% above	30%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY 60 MIN	$258.30	$369.00	—	91% above	30%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY 75 MIN	$287.70	$411.00	—	113% above	30%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY 90 MIN	$387.80	$554.00	—	186% above	30%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY 105 MIN	$444.50	$635.00	—	228% above	30%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY 120 MIN	$520.10	$743.00	—	284% above	30%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY 15 MIN	$58.10	$83.00	—	—	30%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY 30 MIN	$116.20	$166.00	—	—	30%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY 45 MIN	$173.60	$248.00	—	—	30%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY 60 MIN	$258.30	$369.00	—	—	30%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY 75 MIN	$287.70	$411.00	—	—	30%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY 90 MIN	$387.80	$554.00	—	—	30%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY 105 MIN	$444.50	$635.00	—	—	30%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY 120 MIN	$520.10	$743.00	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV HYDRATION INITIAL HR CDM	$175.00	$250.00	—	48% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC ED IV HYDRATION INITIAL HR CDM	$285.60	$408.00	—	15% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV HYDRATION INITIAL HR CDM	$285.60	$408.00	—	15% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC ED IV HYDRATION INITIAL HR CDM	$285.60	$408.00	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV HYDRATION INITIAL HR CDM	$285.60	$408.00	—	—	30%
IV infusion of a medicine, first hour CPT 96365 HC IV INFUSION INITIAL HR CDM	$284.90	$407.00	—	30% below	30%
IV infusion of a medicine, first hour CPT 96365 HC IV INFUSION INITIAL HR CDM	$366.10	$523.00	—	10% below	30%
IV infusion of a medicine, first hour CPT 96365 HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM	$366.10	$523.00	—	10% below	30%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INFUSION INITIAL HR CDM	$366.10	$523.00	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM	$366.10	$523.00	—	—	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJ SQ OR IM CDM	$72.80	$104.00	—	27% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM	$98.70	$141.00	—	1% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJ SQ OR IM CDM	$98.70	$141.00	—	1% below	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM	$98.70	$141.00	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJ SQ OR IM CDM	$98.70	$141.00	—	—	30%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PR 90791 PSYCH DIAG EVAL RHC	$447.30	$639.00	—	86% above	30%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSYCH DIAG EVAL CDM	$514.50	$735.00	—	114% above	30%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PR 90791 PSYCH DIAG EVAL RHC	$447.30	$639.00	—	—	30%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PSYCH DIAG EVAL CDM	$514.50	$735.00	—	—	30%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NERVE CONDUCTION STUDIES 7-8 STUDIES CDM	$940.10	$1,343.00	—	96% above	30%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC NERVE CONDUCTION STUDIES 7-8 STUDIES CDM	$940.10	$1,343.00	—	—	30%
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN	$51.10	$73.00	—	48% below	30%
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN	$102.90	$147.00	—	5% above	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN	$102.90	$147.00	—	—	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM	$91.70	$131.00	—	44% above	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MEDICAL NUTRITION INITIAL ASSMT&IVNTJ BARIATRIC THERAPY INDIV EACH 15MIN	$91.70	$131.00	—	44% above	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM	$110.60	$158.00	—	74% above	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MEDICAL NUTRITION INITIAL ASSMT&IVNTJ BARIATRIC THERAPY INDIV EACH 15MIN	$110.60	$158.00	—	74% above	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC CRISIS TELEH 97802 MEDICAL NUTRITION INDIV INIT THERAPY EA 15 MIN CDM	$110.60	$158.00	—	74% above	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC CRISIS TELEH 97802 MEDICAL NUTRITION INDIV INIT THERAPY EA 15 MIN CDM	$110.60	$158.00	—	—	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM	$110.60	$158.00	—	—	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MEDICAL NUTRITION INITIAL ASSMT&IVNTJ BARIATRIC THERAPY INDIV EACH 15MIN	$110.60	$158.00	—	—	30%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVALUATION LOW COMPLEX	$347.20	$496.00	—	67% above	30%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVALUATION LOW COMPLEX	$347.20	$496.00	—	—	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVALUATION HIGH COMPLEX	$494.90	$707.00	—	83% above	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVALUATION HIGH COMPLEX	$494.90	$707.00	—	—	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVALUATION LOW COMPLEX CDM	$449.40	$642.00	—	108% above	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVALUATION LOW COMPLEX CDM	$449.40	$642.00	—	—	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVALUATION MOD COMPLEX CDM	$471.10	$673.00	—	103% above	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVALUATION MOD COMPLEX CDM	$471.10	$673.00	—	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES	$45.50	$65.00	—	44% below	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES	$77.00	$110.00	—	5% below	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES	$77.00	$110.00	—	—	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN	$49.00	$70.00	—	48% below	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN	$107.10	$153.00	—	14% above	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN	$107.10	$153.00	—	—	30%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC PR 90839 PSYTX FOR CRISIS INITIAL 60 MIN RHC	$366.10	$523.00	—	38% above	30%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MIN CDM	$420.70	$601.00	—	58% above	30%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PR 90839 PSYTX FOR CRISIS INITIAL 60 MIN RHC	$366.10	$523.00	—	—	30%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MIN CDM	$420.70	$601.00	—	—	30%
Psychotherapy session, 30 minutes CPT 90832 HC PR 90832 PSYTX W PT 30 MIN RHC	$112.70	$161.00	—	18% below	30%
Psychotherapy session, 30 minutes CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN CDM	$129.50	$185.00	—	6% below	30%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PR 90832 PSYTX W PT 30 MIN RHC	$112.70	$161.00	—	—	30%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN CDM	$129.50	$185.00	—	—	30%
Psychotherapy session, 45 minutes CPT 90834 HC PR 90834 PSYTX W PT 45 MIN RHC	$168.70	$241.00	—	8% below	30%
Psychotherapy session, 45 minutes CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN CDM	$193.90	$277.00	—	6% above	30%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PR 90834 PSYTX W PT 45 MIN RHC	$168.70	$241.00	—	—	30%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN CDM	$193.90	$277.00	—	—	30%
Psychotherapy session, 60 minutes CPT 90837 HC PR 90837 PSYTX W PT 60 MIN RHC	$224.70	$321.00	—	15% below	30%
Psychotherapy session, 60 minutes CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN CDM	$258.30	$369.00	—	2% below	30%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PR 90837 PSYTX W PT 60 MIN RHC	$224.70	$321.00	—	—	30%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN CDM	$258.30	$369.00	—	—	30%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN	$62.30	$89.00	—	90% above	30%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN	$62.30	$89.00	—	90% above	30%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN	$62.30	$89.00	—	—	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC CRISIS PHONE 99213 LACTATION EDUCATION ESTAB PT VISIT CDM	$344.40	$492.00	—	138% above	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC CRISIS PHONE 99213 LACTATION EDUCATION ESTAB PT VISIT CDM	$344.40	$492.00	—	—	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC CRISIS PHONE 99214 LACTATION EDUCATION ESTAB PT VISIT CDM	$384.30	$549.00	—	110% above	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC CRISIS PHONE 99214 LACTATION EDUCATION ESTAB PT VISIT CDM	$384.30	$549.00	—	—	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC CRISIS PHONE 99212 LACTATION EDUCATION ESTAB PT VISIT CDM	$257.60	$368.00	—	142% above	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC CRISIS PHONE 99212 LACTATION EDUCATION ESTAB PT VISIT CDM	$257.60	$368.00	—	—	30%
Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM	$412.30	$589.00	—	7% above	30%
Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM	$412.30	$589.00	—	—	30%
Speech therapy session, individual CPT 92507 HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL	$200.20	$286.00	—	5% below	30%
Speech therapy session, individual CPT 92507 HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL	$346.50	$495.00	—	64% above	30%
Speech therapy session, individual inpatient CPT 92507 HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL	$346.50	$495.00	—	—	30%
Spirometry (breathing test) CPT 94010 HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$325.50	$465.00	—	59% above	30%
Spirometry (breathing test) CPT 94010 HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$518.00	$740.00	—	153% above	30%
Spirometry (breathing test) CPT 94010 HC BEDSIDE SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ CDM	$518.00	$740.00	—	153% above	30%
Spirometry (breathing test) inpatient CPT 94010 HC BEDSIDE SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ CDM	$518.00	$740.00	—	—	30%
Spirometry (breathing test) inpatient CPT 94010 HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$518.00	$740.00	—	—	30%
Spirometry before and after a bronchodilator CPT 94060 HC SPIROMETRY PRE POST BRONCHODILATOR CDM	$496.30	$709.00	—	27% above	30%
Spirometry before and after a bronchodilator CPT 94060 HC SPIROMETRY PRE POST BRONCHODILATOR CDM	$1,176.70	$1,681.00	—	201% above	30%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC SPIROMETRY PRE POST BRONCHODILATOR CDM	$1,176.70	$1,681.00	—	—	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$53.90	$77.00	—	48% below	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$108.50	$155.00	—	4% above	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$108.50	$155.00	—	—	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC THERAPUTIC PHLEBOTOMY	$236.60	$338.00	—	17% above	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC ED PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE CDM	$379.40	$542.00	—	88% above	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC THERAPUTIC PHLEBOTOMY	$379.40	$542.00	—	88% above	30%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC THERAPUTIC PHLEBOTOMY	$379.40	$542.00	—	—	30%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC ED PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE CDM	$379.40	$542.00	—	—	30%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Washington	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 HC PR RX INFLUENZA INACTIVATED IIV ADJUVANTED IM 0.5 ML	$77.00	$110.00	—	7% below	30%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 HC PR RX INFLUENZA INACTIVATED IIV ADJUVANTED IM 0.5 ML	$77.00	$110.00	—	—	30%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 HC PR RX COVID-19 VACCINE SINGLE DOSE (MODERNA) PF IM 50 MCG/0.5 ML	$204.40	$292.00	—	46% above	30%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 HC PR RX COVID-19 VACCINE SINGLE DOSE (MODERNA) PF IM 50 MCG/0.5 ML	$204.40	$292.00	—	—	30%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 HC PR RX COVID-19 VACCINE SINGLE DOSE (PFIZER) PF TRIS-SUC IM 30 MCG/0.3 ML	$183.40	$262.00	—	8% above	30%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 HC PR RX COVID-19 VACCINE SINGLE DOSE (PFIZER) PF TRIS-SUC IM 30 MCG/0.3 ML	$183.40	$262.00	—	—	30%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VAC LIVE FOR INJ 1350 PFU/0.5ML	$509.97	$728.53	—	174% above	30%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VAC LIVE FOR INJ 1350 PFU/0.5ML	$509.97	$728.53	—	—	30%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC PR RX INFLUENZA TRIVALENT IIV3 SPLIT VIRUS PF IM 0.5 ML	$30.10	$43.00	—	at median	30%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 HC PR RX INFLUENZA TRIVALENT IIV3 SPLIT VIRUS PF IM 0.5 ML	$30.10	$43.00	—	—	30%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS (HPV) 9-VALENT RECOMB VAC SUSP PREF SYR	$753.04	$1,075.77	—	180% above	30%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS (HPV) 9-VALENT RECOMB VAC SUSP PREF SYR	$753.04	$1,075.77	—	—	30%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HC PR RX HEPATITIS A & B VACCINE ADULT IM 1 ML	$59.50	$85.00	—	66% below	30%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HC PR RX HEPATITIS A & B VACCINE ADULT IM 1 ML	$59.50	$85.00	—	—	30%
Hepatitis A vaccine, adult dose CPT 90632 HC PR RX HEPATITIS A VACCINE ADULT IM 1 ML	$35.70	$51.00	—	52% below	30%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML	$133.83	$191.18	—	78% above	30%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HC PR RX HEPATITIS A VACCINE ADULT IM 1 ML	$35.70	$51.00	—	—	30%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML	$133.83	$191.18	—	—	30%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC PR RX HEPB VACCINE ADULT 3 DOSE IM 1 ML	$27.30	$39.00	—	65% below	30%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE (RECOMBINANT) SUSP 20 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML	$619.84	$885.48	—	697% above	30%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HC PR RX HEPB VACCINE ADULT 3 DOSE IM 1 ML	$27.30	$39.00	—	—	30%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE (RECOMBINANT) SUSP 20 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML	$619.84	$885.48	—	—	30%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN	$172.66	$246.65	—	at median	30%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN	$172.66	$246.65	—	—	30%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL (A, C, Y, AND W-135) TETANUS CONJUGATE VACCINE	$211.73	$302.47	—	43% above	30%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL (A, C, Y, AND W-135) TETANUS CONJUGATE VACCINE	$211.73	$302.47	—	—	30%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL VAC B (RECOMB OMV ADJUV) INJ PREFILLED SYRINGE	$1,668.00	$2,382.85	—	375% above	30%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL VAC B (RECOMB OMV ADJUV) INJ PREFILLED SYRINGE	$1,668.00	$2,382.85	—	—	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 HC PR RX PNEUMOCOCCAL CONJ 20 VALENT VACCINE (PCV20) IM 1 EA	$417.90	$597.00	—	12% below	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML	$608.10	$868.71	—	28% above	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 HC PR RX PNEUMOCOCCAL CONJ 20 VALENT VACCINE (PCV20) IM 1 EA	$417.90	$597.00	—	—	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML	$608.10	$868.71	—	—	30%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV PRE-FUSION F A&B VAC RECOMB FOR IM SOLN 120 MCG/0.5ML	$521.74	$745.34	—	13% above	30%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV PRE-FUSION F A&B VAC RECOMB FOR IM SOLN 120 MCG/0.5ML	$521.74	$745.34	—	—	30%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC FOR INJ	$549.74	$785.34	—	10% below	30%
Rabies vaccine, one dose CPT 90675 HC PR RX RABIES VACCINE IM 1 ML	$583.10	$833.00	—	5% below	30%
Rabies vaccine, one dose CPT 90675 RABIES VIRUS VACCINE, HDC FOR INJ SUSP	$1,156.76	$1,652.52	—	89% above	30%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC FOR INJ	$549.74	$785.34	—	—	30%
Rabies vaccine, one dose inpatient CPT 90675 HC PR RX RABIES VACCINE IM 1 ML	$583.10	$833.00	—	—	30%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VIRUS VACCINE, HDC FOR INJ SUSP	$1,156.76	$1,652.52	—	—	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 HC PR RX TD VACCINE PF 7 YRS OR OLDER IM 0.5 ML	$15.40	$22.00	—	72% below	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML	$78.32	$111.88	—	42% above	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 HC PR RX TD VACCINE PF 7 YRS OR OLDER IM 0.5 ML	$15.40	$22.00	—	—	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML	$78.32	$111.88	—	—	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC PR RX TDAP VACCINE 7 YRS OR OLDER IM 0.5 ML	$21.70	$31.00	—	74% below	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML	$446.94	$638.49	—	441% above	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 HC PR RX TDAP VACCINE 7 YRS OR OLDER IM 0.5 ML	$21.70	$31.00	—	—	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML	$446.94	$638.49	—	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN HEPATITIS B VACCINE CDM	$16.10	$23.00	—	64% below	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE CDM	$103.60	$148.00	—	133% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMIN CDM	$103.60	$148.00	—	133% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN INFLUENZA VIRUS VAC CDM	$103.60	$148.00	—	133% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN HEPATITIS B VACCINE CDM	$16.10	$23.00	—	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN INFLUENZA VIRUS VAC CDM	$103.60	$148.00	—	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE CDM	$103.60	$148.00	—	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMIN CDM	$103.60	$148.00	—	—	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMIN EACH ADD CDM	$98.00	$140.00	—	156% above	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADMIN EACH ADD CDM	$98.00	$140.00	—	—	30%

Source file: https://pricetransparency.providence.org/wamt/live/364640211_providence-sacred-hrt-med-center-and-childs-hosp_standardcharges.json