Hospital Cleveland, OH

University Hospitals Ahuja Medical Center

Listed in its price file as “University Hospitals Health System”.

University Hospitals Ahuja Medical Center in Beachwood, OH publishes cash prices for 457 common procedures listed here, from its own machine-readable price file updated Jul 14, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Ohio median for 327 of 448 procedures and below it for 84. By typical cash price it ranks #111 of 137 Ohio hospitals and #24 of 26 hospitals in the Cleveland, OH area, cheapest first. Click a procedure to compare it with other hospitals nearby.

3999 Richmond Road, Beachwood, OH 44122 Collected Sep 23, 2026 Source price file (216) 593-5511

Acute care hospital Emergency department CMS star rating 3 of 5 CCN 360359 · CMS hospital register NPI 1609189604

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN W/O & W/DYE - CT ABDOMEN W WO CONTRAST	$2,049.00	$2,732.00	$165.94–$2,458.80	56% above	25%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN W/O & W/DYE - CT ABDOMEN W WO CONTRAST	$2,049.00	$2,732.00	$600.00–$2,458.80	—	25%
Abdominal X-ray, 2 views CPT 74019 HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW POSTER W DECUBITUS	$489.00	$652.00	$63.96–$586.80	43% above	25%
Abdominal X-ray, 2 views inpatient CPT 74019 HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW POSTER W DECUBITUS	$489.00	$652.00	$236.02–$900.00	—	25%
Ankle X-ray, complete, 3 or more views CPT 73610 HC X-RAY ANKLE COMPLETE MINIMUM 3 VIEWS	$396.75	$529.00	$69.71–$476.10	23% above	25%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC X-RAY ANKLE COMPLETE MINIMUM 3 VIEWS	$396.75	$529.00	$191.50–$900.00	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC UPR/L XTREMITY ART 2 LEVELS - CV US ANKLE BRACHIAL INDICES EXTRM CMP	$885.00	$1,180.00	$125.87–$1,062.00	84% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC UPR/L XTREMITY ART 2 LEVELS - CV US ANKLE BRACHIAL INDICES EXTRM CMP	$885.00	$1,180.00	$427.16–$1,062.00	—	25%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY W/O CONTRAST MATERIAL	$1,473.75	$1,965.00	$98.91–$1,898.00	56% above	25%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREMITY W/O CONTRAST MATERIAL	$1,473.75	$1,965.00	$600.00–$1,768.50	—	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC ESOPHAGRAM - FL ESOPHAGUS BARIUM SWALLOW	$792.75	$1,057.00	$165.94–$951.30	81% above	25%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC ESOPHAGRAM - FL ESOPHAGUS BARIUM SWALLOW	$792.75	$1,057.00	$382.63–$951.30	—	25%
Bone scan, whole body (nuclear medicine) CPT 78306 HC BONE IMAGING, WHOLE BODY - NM BONE WHOLE BODY	$2,499.75	$3,333.00	$378.21–$4,400.00	63% above	25%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC BONE IMAGING, WHOLE BODY - NM BONE WHOLE BODY	$2,499.75	$3,333.00	$900.00–$2,999.70	—	25%
Breast ultrasound, complete, one breast CPT 76641 HC US BREAST UNI REAL TIME WITH IMAGE COMPLETE	$510.00	$680.00	$98.91–$612.00	7% above	25%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST UNI REAL TIME WITH IMAGE COMPLETE	$510.00	$680.00	$246.16–$900.00	—	25%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST UNI REAL TIME WITH IMAGE LIMITED	$478.50	$638.00	$82.33–$574.20	17% above	25%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST UNI REAL TIME WITH IMAGE LIMITED	$478.50	$638.00	$230.96–$900.00	—	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CT ANGIO ABD&PELV W/O&W/DYE - CT ANGIOGRAM ABDOMEN PELVIS W CONTRAST	$2,605.50	$3,474.00	$330.06–$3,126.60	23% above	25%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CT ANGIO ABD&PELV W/O&W/DYE - CT ANGIOGRAM ABDOMEN PELVIS W CONTRAST	$2,605.50	$3,474.00	$600.00–$3,126.60	—	25%
CT angiography (CTA) of the head CPT 70496 HC CT ANGIO,HEAD COMBO - CT HEAD ANGIO W AND WO IV CONTRAST	$2,237.25	$2,983.00	$165.94–$2,684.70	68% above	25%
CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIO,HEAD COMBO - CT HEAD ANGIO W AND WO IV CONTRAST	$2,237.25	$2,983.00	$600.00–$2,684.70	—	25%
CT angiography (CTA) of the neck CPT 70498 HC CT ANGIO,NECK COMBO - CT HEAD NECK ANGIO W AND WO IV CONTRAST	$1,987.50	$2,650.00	$165.94–$2,385.00	52% above	25%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIO,NECK COMBO - CT HEAD NECK ANGIO W AND WO IV CONTRAST	$1,987.50	$2,650.00	$600.00–$2,385.00	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIO, CHEST, COMBO, INCL IMAGE - CT CHEST ANGIO W AND WO IV CONT	$2,150.25	$2,867.00	$165.94–$2,580.30	52% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIO, CHEST, COMBO, INCL IMAGE - CT CHEST ANGIO W AND WO IV CONT	$2,150.25	$2,867.00	$600.00–$2,580.30	—	25%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST	$2,243.25	$2,991.00	$330.06–$2,691.90	40% above	25%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST	$2,243.25	$2,991.00	$900.00–$2,691.90	—	25%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM- AORTIC VALVE	$97.50	$130.00	$28.73–$1,898.00	65% below	25%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC NFL CARDIAC CALCIUM SCORE	$150.00	$200.00	$44.20–$1,898.00	47% below	25%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT HRT W/O DYE W/CA TEST - CT HEART CALCIUM SCORING WO CONTRAST	$2,051.25	$2,735.00	$82.33–$2,461.50	626% above	25%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM- AORTIC VALVE	$97.50	$130.00	$47.06–$900.00	—	25%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC NFL CARDIAC CALCIUM SCORE	$150.00	$200.00	$72.40–$900.00	—	25%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT HRT W/O DYE W/CA TEST - CT HEART CALCIUM SCORING WO CONTRAST	$2,051.25	$2,735.00	$600.00–$2,461.50	—	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD & PELVIS W/O CONTRAST - CT ABDOMEN PELVIS WO CONTRAST	$2,418.75	$3,225.00	$225.74–$2,902.50	54% above	25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD & PELVIS W/O CONTRAST - CT ABDOMEN PELVIS WO CONTRAST	$2,418.75	$3,225.00	$600.00–$2,902.50	—	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABD & PELV W/CONTRAST - CT ABDOMEN PELVIS W CONTRAST	$2,493.75	$3,325.00	$330.06–$2,992.50	28% above	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABD & PELV W/CONTRAST - CT ABDOMEN PELVIS W CONTRAST	$2,493.75	$3,325.00	$600.00–$2,992.50	—	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD & PELV 1/> REGNS - CT ABDOMEN PELVIS W WO CONTRAST	$2,605.50	$3,474.00	$330.06–$3,126.60	12% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABD & PELV 1/> REGNS - CT ABDOMEN PELVIS W WO CONTRAST	$2,605.50	$3,474.00	$600.00–$3,126.60	—	25%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W/DYE - CT ABDOMEN W CONTRAST	$1,962.75	$2,617.00	$165.94–$2,355.30	68% above	25%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W/DYE - CT ABDOMEN W CONTRAST	$1,962.75	$2,617.00	$600.00–$2,355.30	—	25%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN W/O DYE - CT ABDOMEN WO CONTRAST	$1,722.00	$2,296.00	$98.91–$2,066.40	64% above	25%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN W/O DYE - CT ABDOMEN WO CONTRAST	$1,722.00	$2,296.00	$600.00–$2,066.40	—	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS FACIAL BONES WO CONT	$1,303.50	$1,738.00	$98.91–$1,898.00	49% above	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS FACIAL BONES WO CONT	$1,303.50	$1,738.00	$600.00–$1,564.20	—	25%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL - CT HEAD WO CONTRAST	$1,257.00	$1,676.00	$98.91–$1,898.00	50% above	25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL - CT HEAD WO CONTRAST	$1,257.00	$1,676.00	$600.00–$1,508.40	—	25%
CT scan of the head with contrast CPT 70460 HC CT SCAN HEAD CONTRAST - CT HEAD W CONTRAST	$1,496.25	$1,995.00	$165.94–$1,898.00	49% above	25%
CT scan of the head with contrast inpatient CPT 70460 HC CT SCAN HEAD CONTRAST - CT HEAD W CONTRAST	$1,496.25	$1,995.00	$600.00–$1,795.50	—	25%
CT scan of the head without and with contrast CPT 70470 HC CT SCAN HEAD COMBO - CT HEAD W WO CONTRAST	$1,629.00	$2,172.00	$165.94–$1,954.80	41% above	25%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT SCAN HEAD COMBO - CT HEAD W WO CONTRAST	$1,629.00	$2,172.00	$600.00–$1,954.80	—	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT SCAN,LUMBAR SPINE,W/O CONTRAST - CT LUMBAR SPINE WO CONTRAST	$1,734.75	$2,313.00	$98.91–$2,081.70	59% above	25%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT SCAN,LUMBAR SPINE,W/O CONTRAST - CT LUMBAR SPINE WO CONTRAST	$1,734.75	$2,313.00	$600.00–$2,081.70	—	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT SCAN,CERVICAL SPINE,W/O CONTRAST - CT CERVICAL SPINE WO CONTRAST	$1,568.25	$2,091.00	$98.91–$1,898.00	46% above	25%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT SCAN,CERVICAL SPINE,W/O CONTRAST - CT CERVICAL SPINE WO CONTRAST	$1,568.25	$2,091.00	$600.00–$1,881.90	—	25%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT SCAN OF PELVIS CONTRAST - CT PELVIS W CONTRAST	$1,710.75	$2,281.00	$165.94–$2,052.90	40% above	25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT SCAN OF PELVIS CONTRAST - CT PELVIS W CONTRAST	$1,710.75	$2,281.00	$600.00–$2,052.90	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL,BILAT - CAROTID ULTRASOUND NEUROLOGY	$1,306.50	$1,742.00	$225.74–$1,567.80	—	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL,BILAT - CAROTID ULTRASOUND NEUROLOGY	$1,306.50	$1,742.00	$630.60–$1,567.80	—	25%
Chest CT scan without and with contrast CPT 71270 HC CAT SCAN OF CHEST COMBO - CT CHEST W WO CONTRAST	$1,829.25	$2,439.00	$165.94–$2,195.10	24% above	25%
Chest CT scan without and with contrast inpatient CPT 71270 HC CAT SCAN OF CHEST COMBO - CT CHEST W WO CONTRAST	$1,829.25	$2,439.00	$600.00–$2,195.10	—	25%
Chest X-ray, 2 views CPT 71046 HC RADIOLOGIC EXAM CHEST 2 VIEWS	$366.00	$488.00	$57.43–$439.20	34% above	25%
Chest X-ray, 2 views inpatient CPT 71046 HC RADIOLOGIC EXAM CHEST 2 VIEWS	$366.00	$488.00	$176.66–$900.00	—	25%
Chest X-ray, single view CPT 71045 HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW	$292.50	$390.00	$42.69–$351.00	26% above	25%
Chest X-ray, single view inpatient CPT 71045 HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW	$292.50	$390.00	$141.18–$900.00	—	25%
Collarbone (clavicle) X-ray, complete CPT 73000 HC X-RAY CLAVICLE COMPLETE	$364.50	$486.00	$60.70–$437.40	32% above	25%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC X-RAY CLAVICLE COMPLETE	$364.50	$486.00	$175.93–$900.00	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE - US RENAL COMPLETE	$972.75	$1,297.00	$98.91–$1,167.30	37% above	25%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE - US RENAL COMPLETE	$972.75	$1,297.00	$469.51–$1,167.30	—	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DXA BONE DENSITY AXIAL - DEXA BONE DENSITY	$483.00	$644.00	$72.98–$579.60	7% above	25%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DXA BONE DENSITY AXIAL - DEXA BONE DENSITY	$483.00	$644.00	$233.13–$900.00	—	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC DXA BONE DENSITY/PERIPHERAL - DEXA BONE DENSITY EXTREMITY	$417.00	$556.00	$54.97–$500.40	62% above	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC DXA BONE DENSITY/PERIPHERAL - DEXA BONE DENSITY EXTREMITY	$417.00	$556.00	$201.27–$900.00	—	25%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC OB US DETAILED SNGL FETUS - US OB DETAIL FETAL ANAT SING OR 1ST GEST	$915.75	$1,221.00	$161.25–$1,098.90	8% above	25%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC OB US DETAILED SNGL FETUS - US OB DETAIL FETAL ANAT SING OR 1ST GEST	$915.75	$1,221.00	$442.00–$1,098.90	—	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT SCAN,THORAX,W/O CONTRAST - CT CHEST WO CONTRAST	$1,519.50	$2,026.00	$98.91–$1,898.00	62% above	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT SCAN,THORAX,W/O CONTRAST - CT CHEST WO CONTRAST	$1,519.50	$2,026.00	$600.00–$1,823.40	—	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CAT SCAN OF CHEST CONTRAST - DIAGNOSTIC CT THORAX W/CONTRAST	$1,747.50	$2,330.00	$165.94–$2,097.00	53% above	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CAT SCAN OF CHEST CONTRAST - DIAGNOSTIC CT THORAX W/CONTRAST	$1,747.50	$2,330.00	$600.00–$2,097.00	—	25%
Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BI - MAMMO BREAST DIAGNOSTIC BILATERAL	$655.50	$874.00	$129.00–$786.60	—	25%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DX MAMMO INCL CAD BI - MAMMO BREAST DIAGNOSTIC BILATERAL	$655.50	$874.00	$316.39–$900.00	—	25%
Diagnostic mammogram, one breast CPT 77065 HC DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$502.50	$670.00	$115.62–$603.00	41% above	25%
Diagnostic mammogram, one breast inpatient CPT 77065 HC DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$502.50	$670.00	$242.54–$900.00	—	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC VASC DUPLEX LO EXTREM ART BILAT	$1,207.50	$1,610.00	$225.74–$1,449.00	—	25%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC VASC DUPLEX LO EXTREM ART BILAT	$1,207.50	$1,610.00	$582.82–$1,449.00	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUPLEX EXTREM VENOUS,BILAT - CV US DOPPLER VENOUS LEGS BILATERAL	$1,209.00	$1,612.00	$225.74–$1,450.80	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUPLEX EXTREM VENOUS,BILAT - CV US DOPPLER VENOUS LEGS BILATERAL	$1,209.00	$1,612.00	$583.54–$1,450.80	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC TTE W/DOPPLER COMPLETE - TTE COMPLETE	$2,126.25	$2,835.00	$516.95–$2,551.50	26% above	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC TTE W/DOPPLER COMPLETE - TTE COMPLETE	$2,126.25	$2,835.00	$900.00–$2,551.50	—	25%
Elbow X-ray, 2 views CPT 73070 HC X-RAY ELBOW 2 VIEWS	$379.50	$506.00	$52.52–$455.40	42% above	25%
Elbow X-ray, 2 views inpatient CPT 73070 HC X-RAY ELBOW 2 VIEWS	$379.50	$506.00	$183.17–$900.00	—	25%
Elbow X-ray, complete, 3 or more views CPT 73080 HC X-RAY ELBOW COMPLETE MINIMUM 3 VIEWS	$462.00	$616.00	$60.70–$554.40	45% above	25%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC X-RAY ELBOW COMPLETE MINIMUM 3 VIEWS	$462.00	$616.00	$222.99–$900.00	—	25%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,W/O - CT AUDITORY CANALS WO CONT	$1,400.25	$1,867.00	$98.91–$1,898.00	62% above	25%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,W/O - CT AUDITORY CANALS WO CONT	$1,400.25	$1,867.00	$600.00–$1,680.30	—	25%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC X-RAY FACIAL BONES 3+ VW - XR FACIAL BONES 3+ VIEWS	$663.00	$884.00	$86.08–$795.60	71% above	25%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC X-RAY FACIAL BONES 3+ VW - XR FACIAL BONES 3+ VIEWS	$663.00	$884.00	$320.01–$900.00	—	25%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC X-RAY FOREARM 2 VIEWS	$394.50	$526.00	$53.33–$473.40	44% above	25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC X-RAY FOREARM 2 VIEWS	$394.50	$526.00	$190.41–$900.00	—	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER - NM LIVER FUNCTION	$1,494.00	$1,992.00	$378.21–$4,400.00	6% below	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER - NM LIVER FUNCTION	$1,494.00	$1,992.00	$721.10–$1,792.80	—	25%
Hand X-ray, 2 views CPT 73120 HC X-RAY HAND 2 VIEWS	$426.75	$569.00	$58.24–$512.10	60% above	25%
Hand X-ray, 2 views inpatient CPT 73120 HC X-RAY HAND 2 VIEWS	$426.75	$569.00	$205.98–$900.00	—	25%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC X-RAY HEEL - XR CALCANEUS MINIMUM 2 VIEWS	$385.50	$514.00	$51.71–$462.60	40% above	25%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC X-RAY HEEL - XR CALCANEUS MINIMUM 2 VIEWS	$385.50	$514.00	$186.07–$900.00	—	25%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC HOME SLEEP TYPE III	$594.00	$792.00	$175.03–$712.80	15% below	25%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC HOME SLEEP TYPE III	$594.00	$792.00	$286.70–$900.00	—	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND	$6,604.50	$8,806.00	$812.43–$7,925.40	73% above	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND	$6,604.50	$8,806.00	$900.00–$7,925.40	—	25%
Knee X-ray, 3 views CPT 73562 HC X-RAY KNEE 3 VIEWS	$420.75	$561.00	$78.71–$504.90	19% above	25%
Knee X-ray, 3 views inpatient CPT 73562 HC X-RAY KNEE 3 VIEWS	$420.75	$561.00	$203.08–$900.00	—	25%
Knee X-ray, complete, 4 or more views CPT 73564 HC X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS	$508.50	$678.00	$89.34–$610.20	29% above	25%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS	$508.50	$678.00	$245.44–$900.00	—	25%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY W/O CONTRAST MATERIAL	$1,372.50	$1,830.00	$98.91–$1,898.00	45% above	25%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTREMITY W/O CONTRAST MATERIAL	$1,372.50	$1,830.00	$600.00–$1,647.00	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED SPLEEN	$753.00	$1,004.00	$98.91–$903.60	36% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED SPLEEN	$753.00	$1,004.00	$363.45–$903.60	—	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG	$542.25	$723.00	$76.25–$650.70	14% above	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG	$542.25	$723.00	$261.73–$900.00	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT LUNG SCREENING	$187.50	$250.00	$55.25–$1,898.00	34% below	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT LUNG SCREENING	$187.50	$250.00	$90.50–$900.00	—	25%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS	$372.75	$497.00	$59.05–$447.30	35% above	25%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS	$372.75	$497.00	$179.91–$900.00	—	25%
MR angiography (MRA) of the head without contrast CPT 70544 HC MR ANGIO, HEAD - MR HEAD ANGIO WO IV CONTRAST	$1,779.75	$2,373.00	$225.74–$2,326.00	24% above	25%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MR ANGIO, HEAD - MR HEAD ANGIO WO IV CONTRAST	$1,779.75	$2,373.00	$800.00–$2,135.70	—	25%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MR BREAST W WO CONT CAD BI	$303.75	$405.00	$89.51–$2,326.00	—	25%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 HC MR BREAST W WO CONT CAD BI	$303.75	$405.00	$146.61–$900.00	—	25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL	$2,628.75	$3,505.00	$225.74–$3,154.50	54% above	25%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL	$2,628.75	$3,505.00	$800.00–$3,154.50	—	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL	$2,628.75	$3,505.00	$330.06–$3,154.50	11% above	25%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL	$2,628.75	$3,505.00	$800.00–$3,154.50	—	25%
MRI of the abdomen without contrast CPT 74181 HC MRI, ABDOMEN (MRI) - MRI ABDOMEN WO CONTRAST	$2,285.25	$3,047.00	$225.74–$2,742.30	24% above	25%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI, ABDOMEN (MRI) - MRI ABDOMEN WO CONTRAST	$2,285.25	$3,047.00	$800.00–$2,742.30	—	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI, ABDOMEN, COMBO - MRI ABDOMEN RENAL W WO CONTRAST	$2,629.50	$3,506.00	$330.06–$3,155.40	16% above	25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI, ABDOMEN, COMBO - MRI ABDOMEN RENAL W WO CONTRAST	$2,629.50	$3,506.00	$800.00–$3,155.40	—	25%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL	$2,081.25	$2,775.00	$225.74–$2,497.50	31% above	25%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL	$2,081.25	$2,775.00	$800.00–$2,497.50	—	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL	$2,345.25	$3,127.00	$330.06–$2,814.30	7% above	25%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL	$2,345.25	$3,127.00	$800.00–$2,814.30	—	25%
MRI of the lower back, no contrast dye CPT 72148 HC MRI, LUMBAR SPINE - MRI COMPLETE SPINE WO CONTRAST	$2,265.75	$3,021.00	$225.74–$2,718.90	37% above	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI, LUMBAR SPINE - MRI COMPLETE SPINE WO CONTRAST	$2,265.75	$3,021.00	$800.00–$2,718.90	—	25%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI, LUMBAR SPINE COMBO - MRI LUMBAR SPINE W WO CONTRAST	$2,590.50	$3,454.00	$330.06–$3,108.60	11% above	25%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI, LUMBAR SPINE COMBO - MRI LUMBAR SPINE W WO CONTRAST	$2,590.50	$3,454.00	$800.00–$3,108.60	—	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI, DORSAL SPINE - MRI COMPLETE SPINE WO CONTRAST	$2,265.75	$3,021.00	$225.74–$2,718.90	39% above	25%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI, DORSAL SPINE - MRI COMPLETE SPINE WO CONTRAST	$2,265.75	$3,021.00	$800.00–$2,718.90	—	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI, CERV SPINE COMBO - MRI CERVICAL SPINE W WO CONTRAST	$2,590.50	$3,454.00	$330.06–$3,108.60	15% above	25%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI, CERV SPINE COMBO - MRI CERVICAL SPINE W WO CONTRAST	$2,590.50	$3,454.00	$800.00–$3,108.60	—	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI, CERV SPINE - MRI CERVICAL SPINE WO CONTRAST	$2,194.50	$2,926.00	$225.74–$2,633.40	36% above	25%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI, CERV SPINE - MRI CERVICAL SPINE WO CONTRAST	$2,194.50	$2,926.00	$800.00–$2,633.40	—	25%
MRI of the pelvis without and with contrast CPT 72197 HC MRI, PELVIS, COMBO - MRI PELVIS W WO CONTRAST	$2,590.50	$3,454.00	$330.06–$3,108.60	30% above	25%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI, PELVIS, COMBO - MRI PELVIS W WO CONTRAST	$2,590.50	$3,454.00	$800.00–$3,108.60	—	25%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI, PELVIS, W/O CONTRAST - MRI PELVIS WO CONTRAST	$2,221.50	$2,962.00	$225.74–$2,665.80	46% above	25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI, PELVIS, W/O CONTRAST - MRI PELVIS WO CONTRAST	$2,221.50	$2,962.00	$800.00–$2,665.80	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI, JOINT UPPER EXTREM - MR BRACHIAL PLEXUS WO IV CONTRAST	$2,127.00	$2,836.00	$225.74–$2,552.40	47% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI, JOINT UPPER EXTREM - MR BRACHIAL PLEXUS WO IV CONTRAST	$2,127.00	$2,836.00	$800.00–$2,552.40	—	25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC RADEX SPINE CERVICAL 4 OR 5 VIEWS - XR CERVICAL SPINE COMP 4-5 VIEWS	$663.75	$885.00	$98.91–$796.50	47% above	25%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC RADEX SPINE CERVICAL 4 OR 5 VIEWS - XR CERVICAL SPINE COMP 4-5 VIEWS	$663.75	$885.00	$320.37–$900.00	—	25%
Neck soft tissue CT scan with contrast CPT 70491 HC CT NECK TISSUE CONTRAST - CT SOFT TISSUE NECK W CONTRAST	$1,730.25	$2,307.00	$165.94–$2,076.30	48% above	25%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT NECK TISSUE CONTRAST - CT SOFT TISSUE NECK W CONTRAST	$1,730.25	$2,307.00	$600.00–$2,076.30	—	25%
Neck soft tissue CT scan without contrast CPT 70490 HC CT SCAN,SOFT TISSUE NECK,W/O CONTRAST - CT SOFT TISSUE NECK WO CONT	$1,389.75	$1,853.00	$98.91–$1,898.00	51% above	25%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SCAN,SOFT TISSUE NECK,W/O CONTRAST - CT SOFT TISSUE NECK WO CONT	$1,389.75	$1,853.00	$600.00–$1,667.70	—	25%
Neck soft tissue X-ray CPT 70360 HC X-RAY NECK SOFT TISSUE - XR NECK SOFT TISSUE	$350.25	$467.00	$55.78–$420.30	34% above	25%
Neck soft tissue X-ray inpatient CPT 70360 HC X-RAY NECK SOFT TISSUE - XR NECK SOFT TISSUE	$350.25	$467.00	$169.05–$900.00	—	25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC HT MUSCLE IMAGE SPECT MULT - NM HEART PERFUSION SPECT STRESS & REST	$5,417.25	$7,223.00	$881.87–$6,500.70	35% above	25%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC HT MUSCLE IMAGE SPECT MULT - NM HEART PERFUSION SPECT STRESS & REST	$5,417.25	$7,223.00	$900.00–$6,500.70	—	25%
OCT scan of the retina (optical coherence tomography) both sides CPT 92134 HC SCAN CMPTR OPHTH DX IMG, POST SGMT - UNILAT/BILATERAL, W/ INTERPRETATION AND REPORT	$105.00	$140.00	$30.94–$126.00	—	25%
OCT scan of the retina (optical coherence tomography) inpatient both sides CPT 92134 HC SCAN CMPTR OPHTH DX IMG, POST SGMT - UNILAT/BILATERAL, W/ INTERPRETATION AND REPORT	$105.00	$140.00	$50.68–$900.00	—	25%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET IMAGE W/CT SKULL-THIGH - PT/CT BONE SKULL BASE TO MID THIGH	$4,854.75	$6,473.00	$1,352.84–$5,825.70	at median	25%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC PET IMAGE W/CT SKULL-THIGH - PT/CT BONE SKULL BASE TO MID THIGH	$4,854.75	$6,473.00	$900.00–$5,825.70	—	25%
Pelvic CT scan without contrast CPT 72192 HC CT SCAN,PELVIS,W/O CONTRAST - CT PELVIS WO CONTRAST	$1,392.75	$1,857.00	$98.91–$1,898.00	39% above	25%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT SCAN,PELVIS,W/O CONTRAST - CT PELVIS WO CONTRAST	$1,392.75	$1,857.00	$600.00–$1,671.30	—	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC SONO PELVIS LIMITED - US PELVIS LIMITED BLADDER	$567.00	$756.00	$64.80–$680.40	29% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC SONO PELVIS LIMITED - US PELVIS LIMITED BLADDER	$567.00	$756.00	$273.67–$900.00	—	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC ECHO,PELVIC (NONOBSTETRIC) - US PELVIS	$919.50	$1,226.00	$98.91–$1,103.40	80% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC ECHO,PELVIC (NONOBSTETRIC) - US PELVIS	$919.50	$1,226.00	$443.81–$1,103.40	—	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC OB US >/= 14 WKS SNGL FETUS - US OB 14+ WEEKS SINGLE OR FIRST GEST	$867.00	$1,156.00	$98.91–$1,040.40	46% above	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC OB US >/= 14 WKS SNGL FETUS - US OB 14+ WEEKS SINGLE OR FIRST GEST	$867.00	$1,156.00	$418.47–$1,040.40	—	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC OB US < 14 WKS SINGLE FETUS - US OB < 14 WEEKS SINGLE OR FIRST GEST	$801.75	$1,069.00	$98.91–$962.10	46% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC OB US < 14 WKS SINGLE FETUS - US OB < 14 WEEKS SINGLE OR FIRST GEST	$801.75	$1,069.00	$386.98–$962.10	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC OB US LIMITED FETUS(S) - US OB LIMITED 1+ FETUSES	$548.25	$731.00	$98.91–$657.90	15% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC OB US LIMITED FETUS(S) - US OB LIMITED 1+ FETUSES	$548.25	$731.00	$264.62–$900.00	—	25%
Rib X-ray, one side, 2 views one side CPT 71100 HC X-RAY RIBS UNILATERAL 2 VIEWS	$448.50	$598.00	$64.80–$538.20	45% above	25%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC X-RAY RIBS UNILATERAL 2 VIEWS	$448.50	$598.00	$216.48–$900.00	—	25%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS	$471.75	$629.00	$72.98–$566.10	20% above	25%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS	$471.75	$629.00	$227.70–$900.00	—	25%
Screening mammogram, both breasts both sides CPT 77067 HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING BILATERAL	$509.25	$679.00	$117.58–$611.10	—	25%
Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING BILATERAL	$509.25	$679.00	$245.80–$900.00	—	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC X-RAY SHOULDER COMPLETE MINIMUM 2 VIEWS	$461.25	$615.00	$63.96–$553.50	36% above	25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC X-RAY SHOULDER COMPLETE MINIMUM 2 VIEWS	$461.25	$615.00	$222.63–$900.00	—	25%
Sinus X-ray, complete, 3 or more views CPT 70220 HC X-RAY SINUSES 3+ VW - XR PARANASAL SINUSES 3+ VIEWS	$629.25	$839.00	$67.26–$755.10	74% above	25%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC X-RAY SINUSES 3+ VW - XR PARANASAL SINUSES 3+ VIEWS	$629.25	$839.00	$303.72–$900.00	—	25%
Skull X-ray, fewer than 4 views CPT 70250 HC X-RAY SKULL <4 VW - XR SKULL 1-3 VIEWS	$377.25	$503.00	$67.26–$452.70	31% above	25%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC X-RAY SKULL <4 VW - XR SKULL 1-3 VIEWS	$377.25	$503.00	$182.09–$900.00	—	25%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND	$6,070.50	$8,094.00	$812.43–$7,284.60	69% above	25%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND	$6,070.50	$8,094.00	$900.00–$7,284.60	—	25%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG	$2,007.00	$2,676.00	$516.95–$2,408.40	2% below	25%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG	$2,007.00	$2,676.00	$900.00–$2,408.40	—	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC CINE/VID X-RAY THROAT/ESOPH - FL ESOPH BARIUM SWLW W/ VIDEO & SPEECH	$719.25	$959.00	$161.25–$863.10	42% above	25%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC CINE/VID X-RAY THROAT/ESOPH - FL ESOPH BARIUM SWLW W/ VIDEO & SPEECH	$719.25	$959.00	$347.16–$900.00	—	25%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-RAY FEMUR MINIMUM 2 VIEWS	$300.75	$401.00	$66.42–$360.90	11% above	25%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC X-RAY FEMUR MINIMUM 2 VIEWS	$300.75	$401.00	$145.16–$900.00	—	25%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT SCAN,THORACIC SPINE,W/O CONTRAST - CT THORACIC SPINE WO CONTRAST	$1,464.00	$1,952.00	$98.91–$1,898.00	66% above	25%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT SCAN,THORACIC SPINE,W/O CONTRAST - CT THORACIC SPINE WO CONTRAST	$1,464.00	$1,952.00	$600.00–$1,756.80	—	25%
Toe X-ray, 2 or more views CPT 73660 HC X-RAY TOE MINIMUM 2 VIEWS	$375.75	$501.00	$56.59–$450.90	50% above	25%
Toe X-ray, 2 or more views inpatient CPT 73660 HC X-RAY TOE MINIMUM 2 VIEWS	$375.75	$501.00	$181.36–$900.00	—	25%
Transvaginal pelvic ultrasound CPT 76830 HC ECHOGRAPHY,TRANSVAGINAL - US PELVIS TRANSVAGINAL	$877.50	$1,170.00	$98.91–$1,053.00	58% above	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC ECHOGRAPHY,TRANSVAGINAL - US PELVIS TRANSVAGINAL	$877.50	$1,170.00	$423.54–$1,053.00	—	25%
Transvaginal ultrasound during pregnancy CPT 76817 HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL	$765.75	$1,021.00	$98.91–$918.90	53% above	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL	$765.75	$1,021.00	$369.60–$918.90	—	25%
Ultrasound of the abdomen, complete CPT 76700 HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE - US ABDOMEN	$1,119.75	$1,493.00	$98.91–$1,343.70	79% above	25%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE - US ABDOMEN	$1,119.75	$1,493.00	$540.47–$1,343.70	—	25%
Ultrasound of the scrotum and testicles CPT 76870 HC ECHO,SCROTUM & CONTENTS - US SCROTUM	$735.75	$981.00	$98.91–$882.90	38% above	25%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC ECHO,SCROTUM & CONTENTS - US SCROTUM	$735.75	$981.00	$355.12–$900.00	—	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US, HEAD/NECK TISSUES,REAL TIME - US THYROID	$885.75	$1,181.00	$98.91–$1,062.90	56% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US, HEAD/NECK TISSUES,REAL TIME - US THYROID	$885.75	$1,181.00	$427.52–$1,062.90	—	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC X-RAY UPPER GI DELAY W/ KUB - FL UPPER GI WITH KUB	$709.50	$946.00	$165.94–$851.40	20% above	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC X-RAY UPPER GI DELAY W/ KUB - FL UPPER GI WITH KUB	$709.50	$946.00	$342.45–$900.00	—	25%
Upper arm X-ray (humerus), 2 views CPT 73060 HC X-RAY HUMERUS MINIMUM 2 VIEWS	$363.75	$485.00	$59.89–$436.50	29% above	25%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC X-RAY HUMERUS MINIMUM 2 VIEWS	$363.75	$485.00	$175.57–$900.00	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$999.75	$1,333.00	$98.91–$1,199.70	37% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC EXTREMITY STUDY - US LOWER EXTREMITY VEINS RIGHT DIALYSIS	$999.75	$1,333.00	$98.91–$1,199.70	37% above	25%
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	$999.75	$1,333.00	$482.55–$1,199.70	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC EXTREMITY STUDY - US LOWER EXTREMITY VEINS RIGHT DIALYSIS	$999.75	$1,333.00	$482.55–$1,199.70	—	25%
Wrist X-ray, 2 views CPT 73100 HC X-RAY WRIST 2 VIEWS	$355.50	$474.00	$63.96–$426.60	36% above	25%
Wrist X-ray, 2 views inpatient CPT 73100 HC X-RAY WRIST 2 VIEWS	$355.50	$474.00	$171.59–$900.00	—	25%
Wrist X-ray, complete, 3 or more views CPT 73110 HC X-RAY WRIST COMPLETE MINIMUM 3 VIEWS	$461.25	$615.00	$81.16–$553.50	34% above	25%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC X-RAY WRIST COMPLETE MINIMUM 3 VIEWS	$461.25	$615.00	$222.63–$900.00	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC X-RAY HIP UNILATERAL WITH PELVIS 2-3 VIEWS	$436.50	$582.00	$82.33–$523.80	42% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC X-RAY HIP UNILATERAL WITH PELVIS 2-3 VIEWS	$436.50	$582.00	$210.68–$900.00	—	25%
X-ray of the abdomen, 1 view CPT 74018 HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW	$284.25	$379.00	$53.33–$341.10	10% above	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW	$284.25	$379.00	$137.20–$900.00	—	25%
X-ray of the ankle, 2 views CPT 73600 HC X-RAY ANKLE 2 VIEWS	$361.50	$482.00	$60.70–$433.80	37% above	25%
X-ray of the ankle, 2 views inpatient CPT 73600 HC X-RAY ANKLE 2 VIEWS	$361.50	$482.00	$174.48–$900.00	—	25%
X-ray of the finger(s), 2 or more views CPT 73140 HC X-RAY FINGER MINIMIUM 2 VIEWS	$387.00	$516.00	$77.90–$464.40	49% above	25%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC X-RAY FINGER MINIMIUM 2 VIEWS	$387.00	$516.00	$186.79–$900.00	—	25%
X-ray of the foot, 2 views CPT 73620 HC X-RAY FOOT 2 VIEWS	$333.00	$444.00	$52.52–$399.60	42% above	25%
X-ray of the foot, 2 views inpatient CPT 73620 HC X-RAY FOOT 2 VIEWS	$333.00	$444.00	$160.73–$900.00	—	25%
X-ray of the foot, complete, 3 or more views CPT 73630 HC X-RAY FOOT MINIMUM 3 VIEWS	$420.00	$560.00	$64.80–$504.00	37% above	25%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC X-RAY FOOT MINIMUM 3 VIEWS	$420.00	$560.00	$202.72–$900.00	—	25%
X-ray of the hand, 3 or more views CPT 73130 HC X-RAY HAND MINIMUM 3 VIEWS	$431.25	$575.00	$71.33–$517.50	31% above	25%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC X-RAY HAND MINIMUM 3 VIEWS	$431.25	$575.00	$208.15–$900.00	—	25%
X-ray of the knee, 1 or 2 views CPT 73560 HC X-RAY KNEE 1-2 VIEWS	$283.50	$378.00	$64.80–$340.20	2% above	25%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC X-RAY KNEE 1-2 VIEWS	$283.50	$378.00	$136.84–$900.00	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC X-RAY LUMBAR SPINE 2/3 VW - XR LUMBAR SPINE 2-3 VIEWS	$439.50	$586.00	$72.17–$527.40	34% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC X-RAY LUMBAR SPINE 2/3 VW - XR LUMBAR SPINE 2-3 VIEWS	$439.50	$586.00	$212.13–$900.00	—	25%
X-ray of the lower back, 4 or more views CPT 72110 HC X-RAY LUMBAR SPINE 4 VW - XR LUMBAR SPINE COMPLETE 4+ VIEWS	$548.25	$731.00	$97.55–$657.90	16% above	25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC X-RAY LUMBAR SPINE 4 VW - XR LUMBAR SPINE COMPLETE 4+ VIEWS	$548.25	$731.00	$264.62–$900.00	—	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC X-RAY THORACIC SPINE 2 VW - XR THORACIC SPINE 2 VIEWS	$388.50	$518.00	$57.43–$466.20	28% above	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC X-RAY THORACIC SPINE 2 VW - XR THORACIC SPINE 2 VIEWS	$388.50	$518.00	$187.52–$900.00	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 HC X-RAY NASAL BONES - XR NASAL BONES	$367.50	$490.00	$72.98–$441.00	26% above	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC X-RAY NASAL BONES - XR NASAL BONES	$367.50	$490.00	$177.38–$900.00	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC RADEX SPINE CERVICAL 2 OR 3 VIEWS - XR CERVICAL SPINE 1 VIEW	$432.75	$577.00	$71.33–$519.30	28% above	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC RADEX SPINE CERVICAL 2 OR 3 VIEWS - XR CERVICAL SPINE 1 VIEW	$432.75	$577.00	$208.87–$900.00	—	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC X-RAY PELVIS 1/2 VW - XR PELVIS 1-2 VIEWS	$300.00	$400.00	$48.41–$360.00	19% above	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC X-RAY PELVIS 1/2 VW - XR PELVIS 1-2 VIEWS	$300.00	$400.00	$144.80–$900.00	—	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC X-RAY SACRUM/COCCYX 2+ VW - XR SACRUM COCCYX 2+ VIEWS	$297.00	$396.00	$59.89–$356.40	at median	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC X-RAY SACRUM/COCCYX 2+ VW - XR SACRUM COCCYX 2+ VIEWS	$297.00	$396.00	$143.35–$900.00	—	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
ACTH blood test CPT 82024 HC ASSAY OF ACTH - ACTH	$141.75	$189.00	$18.27–$170.10	8% above	25%
ACTH blood test inpatient CPT 82024 HC ASSAY OF ACTH - ACTH	$141.75	$189.00	$68.42–$900.00	—	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT)	$63.75	$85.00	$2.51–$76.50	120% above	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT)	$63.75	$85.00	$30.77–$900.00	—	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC TRANSFERASE ASPARTATE AMINO (AST) (SGOT) - AST (SGOT)	$57.00	$76.00	$2.44–$68.40	126% above	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC TRANSFERASE ASPARTATE AMINO (AST) (SGOT) - AST (SGOT)	$57.00	$76.00	$27.51–$900.00	—	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE	$480.00	$640.00	$21.53–$576.00	124% above	25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE	$480.00	$640.00	$231.68–$900.00	—	25%
Albumin blood test CPT 82040 HC ASSAY OF SERUM ALBUMIN - ALBUMIN	$43.50	$58.00	$2.71–$57.00	97% above	25%
Albumin blood test inpatient CPT 82040 HC ASSAY OF SERUM ALBUMIN - ALBUMIN	$43.50	$58.00	$21.00–$900.00	—	25%
Aldosterone blood test CPT 82088 HC ASSAY OF ALDOSTERONE - ALDOSTERONE	$189.00	$252.00	$22.06–$226.80	35% above	25%
Aldosterone blood test inpatient CPT 82088 HC ASSAY OF ALDOSTERONE - ALDOSTERONE	$189.00	$252.00	$91.22–$900.00	—	25%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE	$51.75	$69.00	$2.45–$62.10	116% above	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE	$51.75	$69.00	$24.98–$900.00	—	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN ASPERGILLUS FUMAGATUS IGE	$27.75	$37.00	$5.22–$57.00	19% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN OAK DUST IGE	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN PENICILLIN G IGE	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN FOOD: PISTACHIO	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN HAZELNUT/FILBERT IGE	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN BRAZIL NUT IGE	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN COCONUT IGE	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN ALMONDS IGE	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN APPLE IGE	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CAT EPITHELLIUM IGE	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN HOUSE DUST: GREER IGE	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN BEEF IGE	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CASHEW IGE	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN INSECT: COCKROACH, GERMAN	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN OCCUPATIONAL: FORMALDEHYDE/FORMALIN	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN SPECIFIC FLOURESC AB	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN OCCUPATIONAL: LATEX	$36.00	$48.00	$5.22–$57.00	54% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CRAB IGE	$39.00	$52.00	$5.22–$57.00	67% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN FOOD: LOBSTER IGE	$39.00	$52.00	$5.22–$57.00	67% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN IMMUNOCAP	$81.00	$108.00	$5.22–$97.20	246% above	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN ASPERGILLUS FUMAGATUS IGE	$27.75	$37.00	$13.39–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN SPECIFIC FLOURESC AB	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN FOOD: PISTACHIO	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN COCONUT IGE	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN HAZELNUT/FILBERT IGE	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN BEEF IGE	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CASHEW IGE	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN HOUSE DUST: GREER IGE	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN INSECT: COCKROACH, GERMAN	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN PENICILLIN G IGE	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN OCCUPATIONAL: LATEX	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CAT EPITHELLIUM IGE	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN OAK DUST IGE	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN APPLE IGE	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN OCCUPATIONAL: FORMALDEHYDE/FORMALIN	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN BRAZIL NUT IGE	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN ALMONDS IGE	$36.00	$48.00	$17.38–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CRAB IGE	$39.00	$52.00	$18.82–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN FOOD: LOBSTER IGE	$39.00	$52.00	$18.82–$900.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN IMMUNOCAP	$81.00	$108.00	$39.10–$900.00	—	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN, SERUM - ALPHA FETOPROTEIN, MATERNAL	$102.75	$137.00	$7.94–$123.30	70% above	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN, SERUM - ALPHA-FETOPROTEIN MARKER	$168.75	$225.00	$7.94–$202.50	178% above	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA-FETOPROTEIN, SERUM - ALPHA FETOPROTEIN, MATERNAL	$102.75	$137.00	$49.59–$900.00	—	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA-FETOPROTEIN, SERUM - ALPHA-FETOPROTEIN MARKER	$168.75	$225.00	$81.45–$900.00	—	25%
Ammonia blood test CPT 82140 HC ASSAY OF AMMONIA - AMMONIA 24 HOUR URINE	$54.75	$73.00	$7.59–$65.70	at median	25%
Ammonia blood test CPT 82140 HC ASSAY OF AMMONIA - AMMONIA	$151.50	$202.00	$7.59–$181.80	177% above	25%
Ammonia blood test inpatient CPT 82140 HC ASSAY OF AMMONIA - AMMONIA 24 HOUR URINE	$54.75	$73.00	$26.43–$900.00	—	25%
Ammonia blood test inpatient CPT 82140 HC ASSAY OF AMMONIA - AMMONIA	$151.50	$202.00	$73.12–$900.00	—	25%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE - AMYLASE,RANDOM	$144.75	$193.00	$3.07–$173.70	193% above	25%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE - AMYLASE, BODY FLUID	$168.00	$224.00	$3.07–$201.60	240% above	25%
Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE - AMYLASE,RANDOM	$144.75	$193.00	$69.87–$900.00	—	25%
Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE - AMYLASE, BODY FLUID	$168.00	$224.00	$81.09–$900.00	—	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - INTERSTITIAL LUNG AUTOANTIBODY PANEL - ARUP - 5 OF 6	$47.25	$63.00	$6.50–$57.00	18% below	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY	$249.75	$333.00	$6.50–$299.70	332% above	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - INTERSTITIAL LUNG AUTOANTIBODY PANEL - ARUP - 5 OF 6	$47.25	$63.00	$22.81–$900.00	—	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY	$249.75	$333.00	$120.55–$900.00	—	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES)	$98.25	$131.00	$5.72–$117.90	78% above	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES)	$98.25	$131.00	$47.42–$900.00	—	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE - PROBRAIN NATRIURETIC PEPTIDE, NT - ARUP	$142.50	$190.00	$16.06–$171.00	5% below	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE - B-TYPE NATRIURETIC PEPTIDE (BNP)	$206.25	$275.00	$16.06–$247.50	38% above	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE - PROBRAIN NATRIURETIC PEPTIDE, NT - ARUP	$142.50	$190.00	$68.78–$900.00	—	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE - B-TYPE NATRIURETIC PEPTIDE (BNP)	$206.25	$275.00	$99.55–$900.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC AEROBIC CULTURE - SYNOVASURE COMP PJI PANEL - CD LABS - 1 OF 4	$126.00	$168.00	$8.62–$151.20	84% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC AEROBIC CULTURE, OTHER SOURCE	$130.50	$174.00	$8.62–$156.60	91% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC AEROBIC CULTURE - SYNOVASURE COMP PJI PANEL - CD LABS - 1 OF 4	$126.00	$168.00	$60.82–$900.00	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC AEROBIC CULTURE, OTHER SOURCE	$130.50	$174.00	$62.99–$900.00	—	25%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL CALCIUM TOTAL - BUNDLED CHARGE	$123.00	$164.00	$3.47–$147.60	87% above	25%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL CALCIUM TOTAL - BUNDLED CHARGE	$123.00	$164.00	$59.37–$900.00	—	25%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL - BILIRUBIN TOTAL	$48.00	$64.00	$1.91–$57.60	100% above	25%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL - BILIRUBIN TOTAL	$48.00	$64.00	$23.17–$900.00	—	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC CELL BLOCK, ANY SOURCE	$295.50	$394.00	$49.30–$354.60	45% above	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC SURG PATH,LEVEL IV - LAB SURG PATH,LEVEL IV	$330.75	$441.00	$49.30–$396.90	63% above	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC CELL BLOCK, ANY SOURCE	$295.50	$394.00	$142.63–$900.00	—	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC SURG PATH,LEVEL IV - LAB SURG PATH,LEVEL IV	$330.75	$441.00	$159.64–$900.00	—	25%
Blood culture for bacteria CPT 87040 HC AEROBIC CULTURE, BLOOD	$150.75	$201.00	$4.88–$180.90	61% above	25%
Blood culture for bacteria inpatient CPT 87040 HC AEROBIC CULTURE, BLOOD	$150.75	$201.00	$72.76–$900.00	—	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC COLLECTION VENOUS BLOOD,VENIPUNCTURE - BUNDLED CHARGE	$22.50	$30.00	$3.39–$57.00	41% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE - DRAW CHARGE	$22.50	$30.00	$3.39–$57.00	41% above	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC COLLECTION VENOUS BLOOD,VENIPUNCTURE - BUNDLED CHARGE	$22.50	$30.00	$10.86–$900.00	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE - DRAW CHARGE	$22.50	$30.00	$10.86–$900.00	—	25%
Blood glucose (sugar) test CPT 82947 HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE RANDOM	$45.00	$60.00	$3.93–$57.00	91% above	25%
Blood glucose (sugar) test CPT 82947 HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GTT FASTING	$45.00	$60.00	$3.93–$57.00	91% above	25%
Blood glucose (sugar) test inpatient CPT 82947 HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GTT FASTING	$45.00	$60.00	$21.72–$900.00	—	25%
Blood glucose (sugar) test inpatient CPT 82947 HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE RANDOM	$45.00	$60.00	$21.72–$900.00	—	25%
Blood lead test CPT 83655 HC ASSAY OF LEAD - LEAD BLOOD	$101.25	$135.00	$7.00–$121.50	108% above	25%
Blood lead test inpatient CPT 83655 HC ASSAY OF LEAD - LEAD BLOOD	$101.25	$135.00	$48.87–$900.00	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE URINE	$138.00	$184.00	$3.55–$165.60	142% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE URINE	$138.00	$184.00	$66.61–$900.00	—	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO - BLOOD TYPE AND SCREEN	$97.50	$130.00	$1.41–$226.57	71% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO - ISHHEMAGGLUTININ TITER IGG (ARUP)	$186.75	$249.00	$1.41–$226.57	227% above	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO - BLOOD TYPE AND SCREEN	$97.50	$130.00	$47.06–$900.00	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO - ISHHEMAGGLUTININ TITER IGG (ARUP)	$186.75	$249.00	$90.14–$900.00	—	25%
Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY UREA NITROGEN, QUAN - BLOOD UREA NITROGEN	$54.00	$72.00	$1.87–$64.80	131% above	25%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC ASSAY UREA NITROGEN, QUAN - BLOOD UREA NITROGEN	$54.00	$72.00	$26.06–$900.00	—	25%
C-peptide blood test CPT 84681 HC ASSAY OF C-PEPTIDE - C-PEPTIDE	$128.25	$171.00	$9.84–$153.90	67% above	25%
C-peptide blood test inpatient CPT 84681 HC ASSAY OF C-PEPTIDE - C-PEPTIDE	$128.25	$171.00	$61.90–$900.00	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN	$97.50	$130.00	$2.45–$117.00	89% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN - SYNOVASURE COMP PJI PANEL - CD LABS - 2 OF 4	$126.00	$168.00	$2.45–$151.20	144% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN	$97.50	$130.00	$47.06–$900.00	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN - SYNOVASURE COMP PJI PANEL - CD LABS - 2 OF 4	$126.00	$168.00	$60.82–$900.00	—	25%
C. difficile toxin gene test (stool PCR) CPT 87493 HC C DIFFICILE AMPLIFIED PROBE	$141.00	$188.00	$20.50–$169.20	6% above	25%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC C DIFFICILE AMPLIFIED PROBE	$141.00	$188.00	$68.06–$900.00	—	25%
CA 19-9 blood test (tumor marker) CPT 86301 HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9 - CANCER ANTIGEN 19-9	$130.50	$174.00	$10.26–$156.60	82% above	25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9 - CANCER ANTIGEN 19-9	$130.50	$174.00	$62.99–$900.00	—	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125 - CA 125	$104.25	$139.00	$10.26–$125.10	11% above	25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125 - CA 125	$104.25	$139.00	$50.32–$900.00	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) one side CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV-2 RT PCR	$141.00	$188.00	$41.55–$169.20	at median	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient one side CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV-2 RT PCR	$141.00	$188.00	$68.06–$900.00	—	25%
Calcium blood test, total CPT 82310 HC ASSAY OF CALCIUM, TOTAL - CALCIUM	$52.50	$70.00	$2.44–$63.00	66% above	25%
Calcium blood test, total inpatient CPT 82310 HC ASSAY OF CALCIUM, TOTAL - CALCIUM	$52.50	$70.00	$25.34–$900.00	—	25%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CARCINOEMBRYONIC ANTIGEN - CEA (CARCINOEMBRYONIC ANTIGEN)	$162.75	$217.00	$8.98–$195.30	91% above	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CARCINOEMBRYONIC ANTIGEN - CEA (CARCINOEMBRYONIC ANTIGEN)	$162.75	$217.00	$78.55–$900.00	—	25%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGG	$98.25	$131.00	$6.09–$117.90	70% above	25%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGM	$99.75	$133.00	$6.09–$119.70	72% above	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGG	$98.25	$131.00	$47.42–$900.00	—	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGM	$99.75	$133.00	$48.15–$900.00	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR	$173.25	$231.00	$16.60–$207.90	85% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR	$173.25	$231.00	$83.62–$900.00	—	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPOPROTEIN METABOLISM PROFILE - MAYO - 1 OF 3	$45.75	$61.00	$6.02–$57.00	14% below	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL - BUNDLED CHARGE	$143.25	$191.00	$6.02–$171.90	168% above	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPOPROTEIN METABOLISM PROFILE - MAYO - 1 OF 3	$45.75	$61.00	$22.08–$900.00	—	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL - BUNDLED CHARGE	$143.25	$191.00	$69.14–$900.00	—	25%
Complete blood count (CBC) with differential CPT 85025 HC COMPLETE CBC & AUTO DIFF WBC - ADDITIONAL CHARGE	$104.25	$139.00	$3.68–$125.10	180% above	25%
Complete blood count (CBC) with differential inpatient CPT 85025 HC COMPLETE CBC & AUTO DIFF WBC - ADDITIONAL CHARGE	$104.25	$139.00	$50.32–$900.00	—	25%
Complete blood count (CBC), no differential CPT 85027 HC COMPLETE CBC - CBC	$90.75	$121.00	$3.06–$108.90	175% above	25%
Complete blood count (CBC), no differential inpatient CPT 85027 HC COMPLETE CBC - CBC	$90.75	$121.00	$43.80–$900.00	—	25%
Comprehensive metabolic panel (blood test) CPT 80053 HC METABOLIC PANEL,COMPREHENSIVE - BUNDLED CHARGE	$198.00	$264.00	$5.00–$237.60	211% above	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC METABOLIC PANEL,COMPREHENSIVE - BUNDLED CHARGE	$198.00	$264.00	$95.57–$900.00	—	25%
Cortisol blood test, total CPT 82533 HC TOTAL CORTISOL - CORTISOL AM	$81.00	$108.00	$7.71–$97.20	12% above	25%
Cortisol blood test, total CPT 82533 HC TOTAL CORTISOL - CORTISOL	$175.50	$234.00	$7.71–$210.60	143% above	25%
Cortisol blood test, total CPT 82533 HC TOTAL CORTISOL - CORTISOL PM	$197.25	$263.00	$7.71–$236.70	174% above	25%
Cortisol blood test, total inpatient CPT 82533 HC TOTAL CORTISOL - CORTISOL AM	$81.00	$108.00	$39.10–$900.00	—	25%
Cortisol blood test, total inpatient CPT 82533 HC TOTAL CORTISOL - CORTISOL	$175.50	$234.00	$84.71–$900.00	—	25%
Cortisol blood test, total inpatient CPT 82533 HC TOTAL CORTISOL - CORTISOL PM	$197.25	$263.00	$95.21–$900.00	—	25%
Creatine kinase (CK) blood test, total CPT 82550 HC ASSAY OF CK (CPK) - CK	$90.00	$120.00	$3.08–$108.00	159% above	25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC ASSAY OF CK (CPK) - CK	$90.00	$120.00	$43.44–$900.00	—	25%
Creatinine blood test CPT 82565 HC PROTEIN MEASUREMENT - CYSTATIN C W/ GFR - ARUP	$44.25	$59.00	$2.42–$57.00	81% above	25%
Creatinine blood test CPT 82565 HC ASSAY OF CREATININE - CREATININE SERUM	$56.25	$75.00	$2.42–$67.50	130% above	25%
Creatinine blood test inpatient CPT 82565 HC PROTEIN MEASUREMENT - CYSTATIN C W/ GFR - ARUP	$44.25	$59.00	$21.36–$900.00	—	25%
Creatinine blood test inpatient CPT 82565 HC ASSAY OF CREATININE - CREATININE SERUM	$56.25	$75.00	$27.15–$900.00	—	25%
Cytomegalovirus (CMV) antibody test CPT 86644 HC CMV ANTIBODY - CMV IGG	$101.25	$135.00	$6.81–$121.50	50% above	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC CMV ANTIBODY - CMV IGG	$101.25	$135.00	$48.87–$900.00	—	25%
D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT - D-DIMER,QUANTITATIVE	$162.00	$216.00	$5.44–$194.40	125% above	25%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT - D-DIMER,QUANTITATIVE	$162.00	$216.00	$78.19–$900.00	—	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE-SULFATE - DHEA-SULFATE	$249.75	$333.00	$10.52–$299.70	151% above	25%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DEHYDROEPIANDROSTERONE-SULFATE - DHEA-SULFATE	$249.75	$333.00	$120.55–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - BENZODIAZEPINE URINE QUAL	$54.00	$72.00	$15.91–$149.13	44% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - ALCOHOL	$54.00	$72.00	$15.91–$149.13	44% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - TRICYCLIC ANTIDEPRESSANTS SCREEN	$54.00	$72.00	$15.91–$149.13	44% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - METHADONE SCREEN, URINE	$54.00	$72.00	$15.91–$149.13	44% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - AMPHETAMINE QUAL URINE	$54.00	$72.00	$15.91–$149.13	44% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - COCAINE URINE QUAL	$54.00	$72.00	$15.91–$149.13	44% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - OPIATE QUALITATIVE URINE	$54.00	$72.00	$15.91–$149.13	44% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - BARBITURATES URINE QUAL	$54.00	$72.00	$15.91–$149.13	44% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - BARBITURATES SCREEN	$54.00	$72.00	$15.91–$149.13	44% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - PHENCYCLIDINE (PCP) SCREEN UR	$54.00	$72.00	$15.91–$149.13	44% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - CANNABINOID SCREEN, URINE	$54.00	$72.00	$15.91–$149.13	44% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - ETHYLGLUCURONIDE SCREEN URINE	$60.75	$81.00	$17.90–$149.13	37% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - FENTANYL SCREEN URINE	$63.00	$84.00	$18.56–$149.13	35% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - BUPRENORPHINE SCREEN URINE - ARUP	$63.00	$84.00	$18.56–$149.13	35% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - TRAMADOL SCREEN URINE	$63.00	$84.00	$18.56–$149.13	35% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - BUPRENORPHINE SCREEN	$120.75	$161.00	$35.58–$149.13	25% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN, SINGLE	$128.25	$171.00	$37.79–$153.90	32% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - MECONIUM SCREEN	$128.25	$171.00	$37.79–$153.90	32% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - LSD SCREEN URINE	$189.00	$252.00	$50.00–$226.80	95% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - KRATOM SCREEN, URINE - ARUP	$207.00	$276.00	$50.00–$248.40	114% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN 10 W/ CONF. MECONIUM	$223.50	$298.00	$50.00–$268.20	131% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRESUMPTIVE	$325.50	$434.00	$50.00–$390.60	236% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN 11 W/ CONF. MECONIUM	$372.75	$497.00	$50.00–$447.30	285% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG PROFILE 9 BLOOD W/ REFLEX TO CONFIRM	$732.00	$976.00	$50.00–$878.40	656% above	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - OPIATE QUALITATIVE URINE	$54.00	$72.00	$26.06–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - TRICYCLIC ANTIDEPRESSANTS SCREEN	$54.00	$72.00	$26.06–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - CANNABINOID SCREEN, URINE	$54.00	$72.00	$26.06–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - COCAINE URINE QUAL	$54.00	$72.00	$26.06–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - PHENCYCLIDINE (PCP) SCREEN UR	$54.00	$72.00	$26.06–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - BARBITURATES SCREEN	$54.00	$72.00	$26.06–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - METHADONE SCREEN, URINE	$54.00	$72.00	$26.06–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - BARBITURATES URINE QUAL	$54.00	$72.00	$26.06–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - AMPHETAMINE QUAL URINE	$54.00	$72.00	$26.06–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - BENZODIAZEPINE URINE QUAL	$54.00	$72.00	$26.06–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - ALCOHOL	$54.00	$72.00	$26.06–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - ETHYLGLUCURONIDE SCREEN URINE	$60.75	$81.00	$29.32–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - FENTANYL SCREEN URINE	$63.00	$84.00	$30.41–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - BUPRENORPHINE SCREEN URINE - ARUP	$63.00	$84.00	$30.41–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - TRAMADOL SCREEN URINE	$63.00	$84.00	$30.41–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - BUPRENORPHINE SCREEN	$120.75	$161.00	$58.28–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN, SINGLE	$128.25	$171.00	$61.90–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - MECONIUM SCREEN	$128.25	$171.00	$61.90–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - LSD SCREEN URINE	$189.00	$252.00	$91.22–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - KRATOM SCREEN, URINE - ARUP	$207.00	$276.00	$99.91–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN 10 W/ CONF. MECONIUM	$223.50	$298.00	$107.88–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRESUMPTIVE	$325.50	$434.00	$157.11–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN 11 W/ CONF. MECONIUM	$372.75	$497.00	$179.91–$900.00	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG PROFILE 9 BLOOD W/ REFLEX TO CONFIRM	$732.00	$976.00	$353.31–$900.00	—	25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL - BUNDLED CHARGE	$120.00	$160.00	$2.14–$144.00	152% above	25%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTE PANEL - BUNDLED CHARGE	$120.00	$160.00	$57.92–$900.00	—	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGM-ARUP	$34.50	$46.00	$6.50–$57.00	47% below	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA ANTIBODY PANEL	$120.75	$161.00	$6.50–$144.90	86% above	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGM-ARUP	$34.50	$46.00	$16.65–$900.00	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA ANTIBODY PANEL	$120.75	$161.00	$58.28–$900.00	—	25%
Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL - ESTRADIOL	$174.00	$232.00	$13.22–$208.80	55% above	25%
Estradiol blood test inpatient CPT 82670 HC ASSAY OF ESTRADIOL - ESTRADIOL	$174.00	$232.00	$83.98–$900.00	—	25%
FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN (FSH) - FSH	$187.50	$250.00	$8.79–$225.00	119% above	25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC GONADOTROPIN (FSH) - FSH	$187.50	$250.00	$90.50–$900.00	—	25%
Fecal calprotectin (stool inflammation test) CPT 83993 HC ASSAY OF CALPROTECTIN - CALPROTECTIN, FECAL	$351.00	$468.00	$9.60–$421.20	135% above	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC ASSAY OF CALPROTECTIN - CALPROTECTIN, FECAL	$351.00	$468.00	$169.42–$900.00	—	25%
Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN - FERRITIN	$156.75	$209.00	$6.44–$188.10	106% above	25%
Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN - THALASSEMIA AND HEMOGLOBINOPATHY EVAL - MAYO - 4 OF 4	$242.25	$323.00	$6.44–$290.70	219% above	25%
Ferritin blood test (iron stores) inpatient CPT 82728 HC ASSAY OF FERRITIN - FERRITIN	$156.75	$209.00	$75.66–$900.00	—	25%
Ferritin blood test (iron stores) inpatient CPT 82728 HC ASSAY OF FERRITIN - THALASSEMIA AND HEMOGLOBINOPATHY EVAL - MAYO - 4 OF 4	$242.25	$323.00	$116.93–$900.00	—	25%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN, ACTIVITY - FIBRINOGEN,QUANTITATIVE	$72.75	$97.00	$7.28–$87.30	62% above	25%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN ACTIVITY TEG	$113.25	$151.00	$7.28–$135.90	152% above	25%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN, ACTIVITY - FIBRINOGEN,QUANTITATIVE	$72.75	$97.00	$35.11–$900.00	—	25%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN ACTIVITY TEG	$113.25	$151.00	$54.66–$900.00	—	25%
Folate (folic acid) blood test CPT 82746 HC BLOOD FOLIC ACID SERUM - FOLATE	$85.50	$114.00	$6.95–$102.60	28% above	25%
Folate (folic acid) blood test inpatient CPT 82746 HC BLOOD FOLIC ACID SERUM - FOLATE	$85.50	$114.00	$41.27–$900.00	—	25%
Free T3 thyroid hormone test CPT 84481 HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE	$62.25	$83.00	$8.01–$74.70	15% below	25%
Free T3 thyroid hormone test inpatient CPT 84481 HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE	$62.25	$83.00	$30.05–$900.00	—	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE - T4 FREE	$45.75	$61.00	$4.27–$57.00	10% above	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC ASSAY OF FREE THYROXINE - T4 FREE	$45.75	$61.00	$22.08–$900.00	—	25%
Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE	$121.50	$162.00	$12.04–$145.80	28% above	25%
Free testosterone test inpatient CPT 84402 HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE	$121.50	$162.00	$58.64–$900.00	—	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC ASSAY OF GGT - POCT GAMMA GLUTAMYL TRANSFERASE (GGT)	$77.25	$103.00	$3.41–$92.70	81% above	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC ASSAY OF GGT - GAMMA GT	$77.25	$103.00	$3.41–$92.70	81% above	25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC ASSAY OF GGT - POCT GAMMA GLUTAMYL TRANSFERASE (GGT)	$77.25	$103.00	$37.29–$900.00	—	25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC ASSAY OF GGT - GAMMA GT	$77.25	$103.00	$37.29–$900.00	—	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE TEST - GTT 2 HOUR	$168.00	$224.00	$2.25–$201.60	377% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE TEST - GTT 2 HOUR	$168.00	$224.00	$81.09–$900.00	—	25%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST (GTT) - GTT 2 HOUR	$194.25	$259.00	$4.63–$233.10	189% above	25%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST (GTT) - BUNDLED CHARGE	$201.75	$269.00	$4.63–$242.10	200% above	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE TEST (GTT) - GTT 2 HOUR	$194.25	$259.00	$93.76–$900.00	—	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE TEST (GTT) - BUNDLED CHARGE	$201.75	$269.00	$97.38–$900.00	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.GONORRHOEAE, DNA, AMP PROB - GC DNA PCR	$168.75	$225.00	$16.60–$202.50	82% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N.GONORRHOEAE, DNA, AMP PROB - GC DNA PCR	$168.75	$225.00	$81.45–$900.00	—	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV RNA, QUANTITATIVE, PCR	$588.00	$784.00	$40.25–$705.60	64% above	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV RNA, QUANTITATIVE, PCR	$588.00	$784.00	$283.81–$900.00	—	25%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2, SINGLE ASSAY - HIV 1 AND 2 SCREEN, DONOR	$75.00	$100.00	$6.49–$90.00	21% above	25%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2, SINGLE ASSAY - HIV CONFIRMATION	$92.25	$123.00	$6.49–$110.70	49% above	25%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2, SINGLE ASSAY - RAPID HIV 1 AND 2 SCREEN	$147.75	$197.00	$6.49–$177.30	139% above	25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV-1/HIV-2, SINGLE ASSAY - HIV 1 AND 2 SCREEN, DONOR	$75.00	$100.00	$36.20–$900.00	—	25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV-1/HIV-2, SINGLE ASSAY - HIV CONFIRMATION	$92.25	$123.00	$44.53–$900.00	—	25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV-1/HIV-2, SINGLE ASSAY - RAPID HIV 1 AND 2 SCREEN	$147.75	$197.00	$71.31–$900.00	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB	$88.50	$118.00	$8.62–$106.20	20% above	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB	$88.50	$118.00	$42.72–$900.00	—	25%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV DNA PROBE, DIRECT	$272.25	$363.00	$16.60–$326.70	130% above	25%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV DNA PROBE, DIRECT	$272.25	$363.00	$131.41–$900.00	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST - POCT GLYCATED HEMOGLOBIN, TOTAL	$101.25	$135.00	$9.00–$121.50	122% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C	$114.75	$153.00	$9.00–$137.70	151% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST - POCT GLYCATED HEMOGLOBIN, TOTAL	$101.25	$135.00	$48.87–$900.00	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C	$114.75	$153.00	$55.39–$900.00	—	25%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN - HEMOGLOBIN	$52.50	$70.00	$2.37–$63.00	224% above	25%
Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN - HEMOGLOBIN	$52.50	$70.00	$25.34–$900.00	—	25%
Hepatitis B core antibody test (total) CPT 86704 HC HEP B CORE AB TEST, TOTAL - HEPATITIS B CORE ANTIBODY, TOTAL	$84.75	$113.00	$5.70–$101.70	57% above	25%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEP B CORE AB TEST, TOTAL - HEPATITIS B CORE ANTIBODY, TOTAL	$84.75	$113.00	$40.91–$900.00	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY	$88.50	$118.00	$5.08–$106.20	84% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY	$88.50	$118.00	$42.72–$900.00	—	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN	$64.50	$86.00	$4.40–$77.40	39% above	25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN	$64.50	$86.00	$31.13–$900.00	—	25%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C AB TEST - HEPATITIS C ANTIBODY	$106.50	$142.00	$6.23–$127.80	66% above	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C AB TEST - HEPATITIS C ANTIBODY	$106.50	$142.00	$51.40–$900.00	—	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HEPATITIS C BDNA	$1,154.25	$1,539.00	$20.26–$1,385.10	500% above	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HEPATITIS C BDNA	$1,154.25	$1,539.00	$557.12–$1,385.10	—	25%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX TEST, TYPE 1 - HSV 1 IGG ANTIBODY	$100.50	$134.00	$6.24–$120.60	70% above	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES SIMPLEX TEST, TYPE 1 - HSV 1 IGG ANTIBODY	$100.50	$134.00	$48.51–$900.00	—	25%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TEST, TYPE 2 - HSV 2 IGG ANTIBODY	$111.00	$148.00	$9.16–$133.20	67% above	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX TEST, TYPE 2 - HSV 2 IGG ANTIBODY	$111.00	$148.00	$53.58–$900.00	—	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN,HIGH SENSITIVITY - HIGH SENSITIVITY CRP	$117.75	$157.00	$6.12–$141.30	74% above	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN,HIGH SENSITIVITY - HIGH SENSITIVITY CRP	$117.75	$157.00	$56.83–$900.00	—	25%
Homocysteine blood test CPT 83090 HC ASSAY OF HOMOCYSTINE - HOMOCYSTEINE	$90.75	$121.00	$17.85–$108.90	13% above	25%
Homocysteine blood test inpatient CPT 83090 HC ASSAY OF HOMOCYSTINE - HOMOCYSTEINE	$90.75	$121.00	$43.80–$900.00	—	25%
Insulin blood test CPT 83525 HC ASSAY OF INSULIN,TOTAL - INSULIN, TOTAL	$103.50	$138.00	$5.41–$124.20	102% above	25%
Insulin blood test inpatient CPT 83525 HC ASSAY OF INSULIN,TOTAL - INSULIN, TOTAL	$103.50	$138.00	$49.96–$900.00	—	25%
Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON - IRON	$64.50	$86.00	$3.06–$77.40	70% above	25%
Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON - IRON, LIVER TISSUE	$428.25	$571.00	$3.06–$513.90	1026% above	25%
Iron blood test (serum iron) inpatient CPT 83540 HC ASSAY OF IRON - IRON	$64.50	$86.00	$31.13–$900.00	—	25%
Iron blood test (serum iron) inpatient CPT 83540 HC ASSAY OF IRON - IRON, LIVER TISSUE	$428.25	$571.00	$206.70–$900.00	—	25%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL	$89.25	$119.00	$4.13–$107.10	129% above	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL	$89.25	$119.00	$43.08–$900.00	—	25%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL - BUNDLED CHARGE	$188.25	$251.00	$4.11–$225.90	158% above	25%
Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL - BUNDLED CHARGE	$188.25	$251.00	$90.86–$900.00	—	25%
LH (luteinizing hormone) test CPT 83002 HC GONADOTROPIN (LH) - LUTEINIZING HORMONE	$129.00	$172.00	$8.76–$154.80	35% above	25%
LH (luteinizing hormone) test inpatient CPT 83002 HC GONADOTROPIN (LH) - LUTEINIZING HORMONE	$129.00	$172.00	$62.26–$900.00	—	25%
Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTIC ACID - LACTATE	$209.25	$279.00	$5.05–$251.10	302% above	25%
Lactate (lactic acid) blood test inpatient CPT 83605 HC ASSAY OF LACTIC ACID - LACTATE	$209.25	$279.00	$101.00–$900.00	—	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE	$61.50	$82.00	$2.86–$73.80	125% above	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE, CSF	$64.50	$86.00	$2.86–$77.40	136% above	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE FL	$65.25	$87.00	$2.86–$78.30	139% above	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE	$61.50	$82.00	$29.68–$900.00	—	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE, CSF	$64.50	$86.00	$31.13–$900.00	—	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE FL	$65.25	$87.00	$31.49–$900.00	—	25%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE - LIPASE	$177.75	$237.00	$3.26–$213.30	205% above	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE - LIPASE	$177.75	$237.00	$85.79–$900.00	—	25%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE	$141.75	$189.00	$2.99–$170.10	127% above	25%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE	$141.75	$189.00	$68.42–$900.00	—	25%
Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY - B. BURGDORFERI ANTIBODIES	$101.25	$135.00	$8.06–$121.50	32% above	25%
Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE ANTIBODY - B. BURGDORFERI ANTIBODIES	$101.25	$135.00	$48.87–$900.00	—	25%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM - MAGNESIUM 24HR URINE	$51.75	$69.00	$2.73–$62.10	54% above	25%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM - MAGNESIUM	$72.75	$97.00	$2.73–$87.30	116% above	25%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM - MAGNESIUM RBC	$72.75	$97.00	$2.73–$87.30	116% above	25%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM - MAGNESIUM URINE	$96.00	$128.00	$2.73–$115.20	185% above	25%
Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM - MAGNESIUM 24HR URINE	$51.75	$69.00	$24.98–$900.00	—	25%
Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM - MAGNESIUM RBC	$72.75	$97.00	$35.11–$900.00	—	25%
Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM - MAGNESIUM	$72.75	$97.00	$35.11–$900.00	—	25%
Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM - MAGNESIUM URINE	$96.00	$128.00	$46.34–$900.00	—	25%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA - RUBEOLA ANTIBODY IGG	$152.25	$203.00	$6.09–$182.70	167% above	25%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA - RUBEOLA ANTIBODY IGM	$171.00	$228.00	$6.09–$205.20	200% above	25%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA - RUBEOLA ANTIBODY IGG	$152.25	$203.00	$73.49–$900.00	—	25%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA - RUBEOLA ANTIBODY IGM	$171.00	$228.00	$82.54–$900.00	—	25%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODIES,SCREEN - MONONUCLEOSIS SCREEN	$62.25	$83.00	$2.45–$74.70	20% above	25%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODY SCREEN - POCT INFECTIOUS MONONUCLEOSIS ANTIBODY	$97.50	$130.00	$2.45–$117.00	87% above	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE ANTIBODIES,SCREEN - MONONUCLEOSIS SCREEN	$62.25	$83.00	$30.05–$900.00	—	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE ANTIBODY SCREEN - POCT INFECTIOUS MONONUCLEOSIS ANTIBODY	$97.50	$130.00	$47.06–$900.00	—	25%
Mumps immunity blood test CPT 86735 HC MUMPS - MUMPS IGM ANTIBODY	$133.50	$178.00	$6.17–$160.20	128% above	25%
Mumps immunity blood test CPT 86735 HC MUMPS - MUMPS IGG ANTIBODY	$148.50	$198.00	$6.17–$178.20	154% above	25%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS - MUMPS IGM ANTIBODY	$133.50	$178.00	$64.44–$900.00	—	25%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS - MUMPS IGG ANTIBODY	$148.50	$198.00	$71.68–$900.00	—	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN - PSA FREE	$128.25	$171.00	$8.70–$153.90	55% above	25%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PROSTATE SPECIFIC ANTIGEN - PSA FREE	$128.25	$171.00	$61.90–$900.00	—	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA	$127.50	$170.00	$8.70–$153.00	61% above	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA	$127.50	$170.00	$61.54–$900.00	—	25%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTOPATH C/V AUTO FLUID REDO - LAB CYTOPAT,CER/VAG,THIN LAYER,INTER	$198.75	$265.00	$26.61–$238.50	98% above	25%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC CYTOPATH C/V AUTO FLUID REDO - LAB CYTOPAT,CER/VAG,THIN LAYER,INTER	$198.75	$265.00	$95.93–$900.00	—	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CYTOPATH C/V THIN LAYER - LAB CYTOPATH CERV/VAG THIN LAYER	$173.25	$231.00	$20.26–$207.90	90% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC CYTOPATH C/V THIN LAYER - LAB CYTOPATH CERV/VAG THIN LAYER	$173.25	$231.00	$83.62–$900.00	—	25%
Parathyroid hormone (PTH) blood test CPT 83970 HC ASSAY OF PARATHORMONE - PTH INTACT	$378.00	$504.00	$19.53–$453.60	168% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 HC ASSAY OF PARATHORMONE - FNAB NEEDLE WASH	$500.25	$667.00	$19.53–$600.30	255% above	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC ASSAY OF PARATHORMONE - PTH INTACT	$378.00	$504.00	$182.45–$900.00	—	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC ASSAY OF PARATHORMONE - FNAB NEEDLE WASH	$500.25	$667.00	$241.45–$900.00	—	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLAS TIME PARTIAL - APTT	$78.00	$104.00	$6.01–$93.60	110% above	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLAS TIME PARTIAL - APTT	$78.00	$104.00	$37.65–$900.00	—	25%
Phosphorus (phosphate) blood test CPT 84100 HC ASSAY OF INORGANIC PHOSPHORUS - PHOSPHORUS	$57.75	$77.00	$2.24–$69.30	62% above	25%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC ASSAY OF INORGANIC PHOSPHORUS - PHOSPHORUS	$57.75	$77.00	$27.87–$900.00	—	25%
Potassium blood test CPT 84132 HC ASSAY OF SERUM POTASSIUM - POTASSIUM	$60.00	$80.00	$2.17–$72.00	157% above	25%
Potassium blood test CPT 84132 HC ASSAY OF STOOL POTASSIUM - POTASSIUM	$101.25	$135.00	$2.17–$121.50	334% above	25%
Potassium blood test inpatient CPT 84132 HC ASSAY OF SERUM POTASSIUM - POTASSIUM	$60.00	$80.00	$28.96–$900.00	—	25%
Potassium blood test inpatient CPT 84132 HC ASSAY OF STOOL POTASSIUM - POTASSIUM	$101.25	$135.00	$48.87–$900.00	—	25%
Progesterone blood test CPT 84144 HC ASSAY OF PROGESTERONE - PROGESTERONE	$99.00	$132.00	$9.06–$118.80	22% above	25%
Progesterone blood test inpatient CPT 84144 HC ASSAY OF PROGESTERONE - PROGESTERONE	$99.00	$132.00	$47.78–$900.00	—	25%
Prolactin blood test CPT 84146 HC ASSAY OF PROLACTIN - PROLACTIN	$162.00	$216.00	$9.17–$194.40	86% above	25%
Prolactin blood test inpatient CPT 84146 HC ASSAY OF PROLACTIN - PROLACTIN	$162.00	$216.00	$78.19–$900.00	—	25%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME - PROTIME-INR	$69.00	$92.00	$4.29–$82.80	187% above	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME - PROTIME-INR	$69.00	$92.00	$33.30–$900.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG TEST PRSMV DIR OPT OBS - TOX SCREEN TRICYCLICS, URINE	$63.75	$85.00	$12.60–$76.50	10% above	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC DRUG TEST PRSMV DIR OPT OBS - TOX SCREEN TRICYCLICS, URINE	$63.75	$85.00	$30.77–$900.00	—	25%
Rapid flu test (influenza antigen) CPT 87804 HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - INFLUENZA A OR B AG	$101.25	$135.00	$16.00–$121.50	54% above	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - INFLUENZA A OR B AG	$101.25	$135.00	$48.87–$900.00	—	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP A ASSAY W/OPTIC - RAPID STREP A SCREEN	$100.50	$134.00	$11.39–$120.60	76% above	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREP A ASSAY W/OPTIC - RAPID STREP A SCREEN	$100.50	$134.00	$48.51–$900.00	—	25%
Renin blood test CPT 84244 HC ASSAY OF RENIN - RENIN DIRECT ASSAY	$147.75	$197.00	$8.21–$177.30	73% above	25%
Renin blood test inpatient CPT 84244 HC ASSAY OF RENIN - RENIN DIRECT ASSAY	$147.75	$197.00	$71.31–$900.00	—	25%
Rh blood typing CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) - BLOOD TYPE AND SCREEN	$69.00	$92.00	$4.17–$82.80	85% above	25%
Rh blood typing CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) - SYNOVASURE COMP PJI PANEL - CD LABS - 3 OF 4	$126.00	$168.00	$4.17–$151.20	238% above	25%
Rh blood typing inpatient CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) - BLOOD TYPE AND SCREEN	$69.00	$92.00	$33.30–$900.00	—	25%
Rh blood typing inpatient CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) - SYNOVASURE COMP PJI PANEL - CD LABS - 3 OF 4	$126.00	$168.00	$60.82–$900.00	—	25%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR, QUANT - INTERSTITIAL LUNG AUTOANTIBODY PANEL - ARUP - 4 OF 6	$47.25	$63.00	$2.68–$57.00	43% above	25%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR	$98.25	$131.00	$2.68–$117.90	196% above	25%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR, QUANT - INTERSTITIAL LUNG AUTOANTIBODY PANEL - ARUP - 4 OF 6	$47.25	$63.00	$22.81–$900.00	—	25%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR	$98.25	$131.00	$47.42–$900.00	—	25%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA - RUBELLA ANTIBODY, IGG	$21.75	$29.00	$6.41–$57.00	55% below	25%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA - RUBELLA ANTIBODY, IGM	$84.00	$112.00	$6.81–$100.80	73% above	25%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA - RUBELLA ANTIBODY, IGG	$21.75	$29.00	$10.50–$900.00	—	25%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA - RUBELLA ANTIBODY, IGM	$84.00	$112.00	$40.54–$900.00	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC RBC SED RATE, AUTO - SEDIMENTATION RATE, AUTOMATED	$75.00	$100.00	$2.05–$90.00	101% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC RBC SED RATE, AUTO - SEDIMENTATION RATE, AUTOMATED	$75.00	$100.00	$36.20–$900.00	—	25%
Sodium blood test CPT 84295 HC ASSAY OF SERUM SODIUM - SODIUM	$57.00	$76.00	$2.28–$68.40	110% above	25%
Sodium blood test inpatient CPT 84295 HC ASSAY OF SERUM SODIUM - SODIUM	$57.00	$76.00	$27.51–$900.00	—	25%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION	$36.00	$48.00	$4.21–$57.00	9% below	25%
Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION	$36.00	$48.00	$17.38–$900.00	—	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - FECAL IMM	$34.50	$46.00	$3.28–$57.00	31% above	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - FECAL IMM	$34.50	$46.00	$16.65–$900.00	—	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLOOD OCCULT,FECAL - OCCULT BLD IMMUNOASSAY	$60.00	$80.00	$12.31–$72.00	12% above	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC BLOOD OCCULT,FECAL - OCCULT BLD IMMUNOASSAY	$60.00	$80.00	$28.96–$900.00	—	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM - FTA ANTIBODIES, IGG AND IGM	$96.75	$129.00	$2.49–$116.10	67% above	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM - T. PALLIDUM CONFIRMATORY	$169.50	$226.00	$2.49–$203.40	193% above	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM - FTA ANTIBODIES, IGG AND IGM	$96.75	$129.00	$46.70–$900.00	—	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM - T. PALLIDUM CONFIRMATORY	$169.50	$226.00	$81.81–$900.00	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP	$52.50	$70.00	$2.02–$63.00	118% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP	$52.50	$70.00	$25.34–$900.00	—	25%
Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE	$193.50	$258.00	$9.64–$232.20	110% above	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE	$193.50	$258.00	$93.40–$900.00	—	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODY - ANTI-MICROSOMAL AB	$85.50	$114.00	$6.88–$102.60	32% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODY - ANTI-LKM AB	$177.00	$236.00	$6.88–$212.40	172% above	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODY - ANTI-MICROSOMAL AB	$85.50	$114.00	$41.27–$900.00	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODY - ANTI-LKM AB	$177.00	$236.00	$85.43–$900.00	—	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY THYROID STIM HORMONE - THYROID STIMULATING HORMONE	$136.50	$182.00	$7.95–$163.80	82% above	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC ASSAY THYROID STIM HORMONE - THYROID STIMULATING HORMONE	$136.50	$182.00	$65.88–$900.00	—	25%
Total IgE blood test CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE	$148.50	$198.00	$7.79–$178.20	131% above	25%
Total IgE blood test inpatient CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE	$148.50	$198.00	$71.68–$900.00	—	25%
Total cholesterol blood test CPT 82465 HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL	$63.75	$85.00	$2.06–$76.50	74% above	25%
Total cholesterol blood test inpatient CPT 82465 HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL	$63.75	$85.00	$30.77–$900.00	—	25%
Total thyroxine (T4) blood test CPT 84436 HC ASSAY OF TOTAL THYROXINE - T4 (THYROID HORMONE)	$99.75	$133.00	$3.25–$119.70	146% above	25%
Total thyroxine (T4) blood test inpatient CPT 84436 HC ASSAY OF TOTAL THYROXINE - T4 (THYROID HORMONE)	$99.75	$133.00	$48.15–$900.00	—	25%
Total triiodothyronine (T3) blood test CPT 84480 HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)	$52.50	$70.00	$6.71–$63.00	13% below	25%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)	$52.50	$70.00	$25.34–$900.00	—	25%
Transferrin blood test CPT 84466 HC ASSAY OF TRANSFERRIN - TRANSFERRIN	$136.50	$182.00	$5.74–$163.80	88% above	25%
Transferrin blood test inpatient CPT 84466 HC ASSAY OF TRANSFERRIN - TRANSFERRIN	$136.50	$182.00	$65.88–$900.00	—	25%
Trichomonas test (NAAT) CPT 87661 HC TRICHOMONAS VAGIN, AMP PROBE - TRICHOMONAS VAGINALIS DNA PROBE	$129.00	$172.00	$19.15–$154.80	49% above	25%
Trichomonas test (NAAT) inpatient CPT 87661 HC TRICHOMONAS VAGIN, AMP PROBE - TRICHOMONAS VAGINALIS DNA PROBE	$129.00	$172.00	$62.26–$900.00	—	25%
Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES - TRIGLYCERIDES	$78.75	$105.00	$2.72–$94.50	115% above	25%
Triglycerides blood test inpatient CPT 84478 HC ASSAY OF TRIGLYCERIDES - TRIGLYCERIDES	$78.75	$105.00	$38.01–$900.00	—	25%
Troponin test, quantitative CPT 84484 HC ASSAY OF TROPONIN, QUANT - TROPONIN T	$180.00	$240.00	$4.66–$216.00	114% above	25%
Troponin test, quantitative inpatient CPT 84484 HC ASSAY OF TROPONIN, QUANT - TROPONIN T	$180.00	$240.00	$86.88–$900.00	—	25%
Uric acid blood test CPT 84550 HC ASSAY OF URIC ACID, BLOOD - URIC ACID	$58.50	$78.00	$2.14–$70.20	66% above	25%
Uric acid blood test inpatient CPT 84550 HC ASSAY OF URIC ACID, BLOOD - URIC ACID	$58.50	$78.00	$28.24–$900.00	—	25%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS, AUTO, W/SCOPE - BUNDLED CHARGE	$123.00	$164.00	$3.17–$147.60	356% above	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS, AUTO, W/SCOPE - BUNDLED CHARGE	$123.00	$164.00	$59.37–$900.00	—	25%
Urinalysis with microscope exam, manual CPT 81000 HC URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY	$100.50	$134.00	$4.02–$120.60	452% above	25%
Urinalysis with microscope exam, manual inpatient CPT 81000 HC URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY	$100.50	$134.00	$48.51–$900.00	—	25%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY	$62.25	$83.00	$1.06–$74.70	159% above	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY	$62.25	$83.00	$30.05–$900.00	—	25%
Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS NONAUTO W/O SCOPE	$34.50	$46.00	$2.77–$57.00	109% above	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINALYSIS NONAUTO W/O SCOPE	$34.50	$46.00	$16.65–$900.00	—	25%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE, URINE	$126.00	$168.00	$8.07–$151.20	121% above	25%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE, URINE	$126.00	$168.00	$60.82–$900.00	—	25%
Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN 24HR URINE	$85.50	$114.00	$3.39–$102.60	68% above	25%
Urine microalbumin (albumin) test inpatient CPT 82043 HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN 24HR URINE	$85.50	$114.00	$41.27–$900.00	—	25%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST - PREGNANCY URINE	$69.75	$93.00	$8.21–$83.70	43% above	25%
Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY TEST - PREGNANCY URINE	$69.75	$93.00	$33.67–$900.00	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B-12 - VITAMIN B12	$111.00	$148.00	$7.13–$133.20	50% above	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B-12 - VITAMIN B12	$111.00	$148.00	$53.58–$900.00	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS - 25-HYDROXYVITAMIN D:24,25-DIHYDROXYVITAMIN D RAIO - MAYO - 1 OF 2	$174.75	$233.00	$14.00–$209.70	90% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VITAMIN D 25	$265.50	$354.00	$14.00–$318.60	189% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS - 25-HYDROXYVITAMIN D:24,25-DIHYDROXYVITAMIN D RAIO - MAYO - 1 OF 2	$174.75	$233.00	$84.35–$900.00	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VITAMIN D 25	$265.50	$354.00	$128.15–$900.00	—	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC ASSAY, DIHYDROXY VITAMIN D - VITAMIN D 1,25	$193.50	$258.00	$20.01–$232.20	26% above	25%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC ASSAY, DIHYDROXY VITAMIN D - VITAMIN D 1,25	$193.50	$258.00	$93.40–$900.00	—	25%
Zinc blood test CPT 84630 HC ASSAY OF ZINC - ZINC	$90.00	$120.00	$5.39–$108.00	75% above	25%
Zinc blood test inpatient CPT 84630 HC ASSAY OF ZINC - ZINC	$90.00	$120.00	$43.44–$900.00	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD	$75.75	$101.00	$7.12–$90.90	12% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC CHORIONIC GONADOTROPIN, QUANT - BETA-HCG CSF - MAYO	$88.50	$118.00	$7.12–$106.20	31% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD	$75.75	$101.00	$36.56–$900.00	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC CHORIONIC GONADOTROPIN, QUANT - BETA-HCG CSF - MAYO	$88.50	$118.00	$42.72–$900.00	—	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Botox injections for chronic migraine CPT 64615 HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$512.25	$683.00	$150.94–$2,758.00	9% below	25%
Botox injections for chronic migraine inpatient CPT 64615 HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$512.25	$683.00	$247.25–$900.00	—	25%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE	$4,984.50	$6,646.00	$1,468.77–$5,981.40	24% above	25%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE	$4,984.50	$6,646.00	$900.00–$5,981.40	—	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC CLOSED RX DIST FIBULA FX	$358.50	$478.00	$105.64–$2,758.00	5% below	25%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC CLOSED RX DIST FIBULA FX	$358.50	$478.00	$173.04–$900.00	—	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC CLSD TX METATARSAL FRACTURE W/O MANIPULATION	$363.75	$485.00	$107.19–$2,758.00	at median	25%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC CLSD TX METATARSAL FRACTURE W/O MANIPULATION	$363.75	$485.00	$175.57–$900.00	—	25%
Cardiac catheterization with coronary angiogram one side CPT 93458 HC CATH CATH PLACE/CORON ANGIO, IMG SUPER/INTERP,W LEFT HEART VENTRICULOGRAPHY	$16,669.50	$22,226.00	$3,067.12–$20,003.40	39% above	25%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 HC CATH CATH PLACE/CORON ANGIO, IMG SUPER/INTERP,W LEFT HEART VENTRICULOGRAPHY	$16,669.50	$22,226.00	$900.00–$20,003.40	—	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC EP CARDIOVERSION, ELECTIVE;EXTERN	$2,109.00	$2,812.00	$621.45–$2,758.00	2% above	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION, ELECTIVE;EXTERN	$2,109.00	$2,812.00	$621.45–$17,103.00	2% above	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTRIC EXT - TEE COMPLETE W/ CARDIOVERSION	$2,301.75	$3,069.00	$625.30–$2,762.10	12% above	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION, ELECTIVE;EXTERN	$2,109.00	$2,812.00	$900.00–$2,530.80	—	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC EP CARDIOVERSION, ELECTIVE;EXTERN	$2,109.00	$2,812.00	$900.00–$2,530.80	—	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTRIC EXT - TEE COMPLETE W/ CARDIOVERSION	$2,301.75	$3,069.00	$900.00–$2,762.10	—	25%
Catheter ablation for atrial fibrillation CPT 93656 HC EP EPHYS EVL TRNSPTL TX ATRIAL FIB ISOLAT PULM VEIN	$29,199.75	$38,933.00	$8,604.19–$44,511.17	12% below	25%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC EP EPHYS EVL TRNSPTL TX ATRIAL FIB ISOLAT PULM VEIN	$29,199.75	$38,933.00	$900.00–$35,039.70	—	25%
Cervical biopsy CPT 57500 HC BIOPSY CERVIX, 1 OR MORE, OR EXCISION OF LESION	$1,827.75	$2,437.00	$538.58–$2,758.00	at median	25%
Cervical biopsy inpatient CPT 57500 HC BIOPSY CERVIX, 1 OR MORE, OR EXCISION OF LESION	$1,827.75	$2,437.00	$882.19–$2,193.30	—	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC NEWBORN CIRCUMCISION	$1,549.50	$2,066.00	$456.59–$8,271.00	18% below	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC NEWBORN CIRCUMCISION	$1,549.50	$2,066.00	$747.89–$1,859.40	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC CLOSED RX DIST RAD/ULNA FX	$409.50	$546.00	$120.67–$2,758.00	2% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC CLOSED RX DIST RAD/ULNA FX	$409.50	$546.00	$197.65–$900.00	—	25%
Colonoscopy with endoscopic ultrasound CPT 45391 HC COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX - ENDO US (LOWER)	$3,201.00	$4,268.00	$943.23–$3,963.00	2% above	25%
Colonoscopy with endoscopic ultrasound inpatient CPT 45391 HC COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX - ENDO US (LOWER)	$3,201.00	$4,268.00	$900.00–$3,841.20	—	25%
Colonoscopy with polyp removal CPT 45385 HC COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ - COLONOSCOPY	$2,472.75	$3,297.00	$728.64–$3,963.00	30% below	25%
Colonoscopy with polyp removal inpatient CPT 45385 HC COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ - COLONOSCOPY	$2,472.75	$3,297.00	$900.00–$2,967.30	—	25%
Colonoscopy with tissue sample CPT 45380 HC COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE - COLONOSCOPY	$2,538.00	$3,384.00	$747.86–$3,963.00	28% below	25%
Colonoscopy with tissue sample inpatient CPT 45380 HC COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE - COLONOSCOPY	$2,538.00	$3,384.00	$900.00–$3,045.60	—	25%
Colonoscopy, diagnostic CPT 45378 HC COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD - COLONOSCOPY	$2,602.50	$3,470.00	$766.87–$3,963.00	7% below	25%
Colonoscopy, diagnostic inpatient CPT 45378 HC COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD - COLONOSCOPY	$2,602.50	$3,470.00	$900.00–$3,123.00	—	25%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP BX	$3,876.00	$5,168.00	$1,142.13–$8,271.00	at median	25%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HC COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP BX	$3,876.00	$5,168.00	$900.00–$4,651.20	—	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG	$1,140.75	$1,521.00	$288.30–$2,758.00	25% above	25%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG	$1,140.75	$1,521.00	$550.60–$1,368.90	—	25%
Coronary stent placement, one artery CPT 92928 HC CATH PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH	$12,034.50	$16,046.00	$3,546.17–$19,659.05	7% below	25%
Coronary stent placement, one artery inpatient CPT 92928 HC CATH PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH	$12,034.50	$16,046.00	$900.00–$14,441.40	—	25%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOURETHROSCOPY	$2,580.00	$3,440.00	$659.70–$3,096.00	29% above	25%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC CYSTOURETHROSCOPY	$2,580.00	$3,440.00	$900.00–$3,096.00	—	25%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HC DILATION/CURETTAGE, DIAGNOSTIC	$2,361.75	$3,149.00	$695.93–$8,271.00	67% below	25%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC DILATION/CURETTAGE, DIAGNOSTIC	$2,361.75	$3,149.00	$900.00–$2,834.10	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DESTRUC BENIGN/PREMAL,FIRST LESION	$199.50	$266.00	$58.79–$2,758.00	1% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DESTRUC BENIGN/PREMAL,FIRST LESION	$199.50	$266.00	$96.29–$900.00	—	25%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 HC CREATE EARDRUM OPENING,LOCAL ANESTH	$2,048.25	$2,731.00	$510.25–$2,758.00	78% above	25%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 HC CREATE EARDRUM OPENING,LOCAL ANESTH	$2,048.25	$2,731.00	$900.00–$2,457.90	—	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$216.75	$289.00	$55.81–$2,758.00	40% above	25%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$216.75	$289.00	$104.62–$900.00	—	25%
Earwax removal with instruments, one ear one side CPT 69210 HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	$170.25	$227.00	$50.17–$2,758.00	10% above	25%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	$170.25	$227.00	$82.17–$900.00	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC BIOPSY OF UTERUS LINING	$1,692.75	$2,257.00	$191.27–$2,758.00	341% above	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC BIOPSY OF UTERUS LINING	$1,692.75	$2,257.00	$817.03–$2,031.30	—	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN	$2,233.50	$2,978.00	$658.14–$2,758.00	at median	25%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN	$2,233.50	$2,978.00	$900.00–$2,680.20	—	25%
Eye injection into the vitreous (intravitreal injection) CPT 67028 HC INJECT INTRAVITREAL PHARMCOLOGIC	$387.00	$516.00	$114.04–$2,758.00	2% below	25%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HC INJECT INTRAVITREAL PHARMCOLOGIC	$387.00	$516.00	$186.79–$900.00	—	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,LUMBAR/SAC, 1ST LEVEL	$1,512.75	$2,017.00	$445.76–$3,340.00	31% below	25%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,LUMBAR/SAC, 1ST LEVEL	$1,512.75	$2,017.00	$730.15–$1,815.30	—	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD - ENDOSCOPY SIGMOID	$1,763.25	$2,351.00	$519.57–$2,758.00	31% below	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD - ENDOSCOPY SIGMOID	$1,763.25	$2,351.00	$851.06–$2,115.90	—	25%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS	$1,314.00	$1,752.00	$387.19–$2,758.00	31% below	25%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS	$1,314.00	$1,752.00	$634.22–$1,576.80	—	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATH/INJECT HYSTEROSALPINGOGRAM	$521.25	$695.00	$153.60–$2,623.00	37% above	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC CATH/INJECT HYSTEROSALPINGOGRAM	$521.25	$695.00	$251.59–$900.00	—	25%
Hysteroscopy with endometrial ablation CPT 58563 HC HYSTEROSCOPY,W/ENDOMETRIAL ABLATION	$5,865.75	$7,821.00	$1,728.44–$9,707.00	55% below	25%
Hysteroscopy with endometrial ablation inpatient CPT 58563 HC HYSTEROSCOPY,W/ENDOMETRIAL ABLATION	$5,865.75	$7,821.00	$900.00–$7,038.90	—	25%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HC HYSTEROSCOPY,W/ENDO BX	$5,110.50	$6,814.00	$1,505.89–$8,271.00	46% below	25%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HC HYSTEROSCOPY,W/ENDO BX	$5,110.50	$6,814.00	$900.00–$6,132.60	—	25%
IUD insertion (the device itself billed separately) CPT 58300 HC INSERT INTRAUTERINE DEVICE	$723.75	$965.00	$99.56–$2,758.00	23% above	25%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC INSERT INTRAUTERINE DEVICE	$723.75	$965.00	$349.33–$900.00	—	25%
Incision and drainage of a simple or single skin abscess CPT 10060 HC DRAIN SKIN ABSCESS SIMPLE	$561.75	$749.00	$165.53–$2,758.00	46% above	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC DRAIN SKIN ABSCESS SIMPLE	$561.75	$749.00	$271.14–$900.00	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJECT TENDON SHEATH/LIGAMENT	$255.00	$340.00	$75.14–$2,758.00	25% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJECT TENDON SHEATH/LIGAMENT	$255.00	$340.00	$123.08–$900.00	—	25%
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	$696.00	$928.00	$205.09–$2,758.00	at median	25%
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	$696.00	$928.00	$335.94–$900.00	—	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERT NON-BIODEGRADABLE DRUG DELIVERY IMPLANT	$1,418.25	$1,891.00	$125.87–$2,758.00	225% above	25%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC INSERT NON-BIODEGRADABLE DRUG DELIVERY IMPLANT	$1,418.25	$1,891.00	$684.54–$1,701.90	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	$609.00	$812.00	$179.45–$2,758.00	2% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	$609.00	$812.00	$293.94–$900.00	—	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	$493.50	$658.00	$145.42–$2,758.00	at median	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	$493.50	$658.00	$238.20–$900.00	—	25%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 HC DISCISSION,2ND CATARACT,LASER	$1,499.25	$1,999.00	$441.78–$3,710.00	6% above	25%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 HC DISCISSION,2ND CATARACT,LASER	$1,499.25	$1,999.00	$723.64–$1,799.10	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM	$396.00	$528.00	$116.69–$2,758.00	29% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM	$396.00	$528.00	$191.14–$900.00	—	25%
Left heart catheterization, diagnostic one side CPT 93452 HC CATH LEFT HEART CATH INJECT VETRICULOGRAPHY, IMAGE SUPERVISE/INTERP	$12,170.25	$16,227.00	$3,067.12–$17,739.00	30% above	25%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC CATH LEFT HEART CATH INJECT VETRICULOGRAPHY, IMAGE SUPERVISE/INTERP	$12,170.25	$16,227.00	$900.00–$14,604.30	—	25%
Lower-back epidural injection, with imaging guidance CPT 62323 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	$1,943.25	$2,591.00	$572.61–$2,758.00	2% below	25%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	$1,943.25	$2,591.00	$900.00–$2,331.90	—	25%
Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	$1,623.75	$2,165.00	$478.47–$2,758.00	1% below	25%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	$1,623.75	$2,165.00	$783.73–$1,948.50	—	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL	$1,668.00	$2,224.00	$491.50–$2,758.00	19% below	25%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL	$1,668.00	$2,224.00	$805.09–$2,001.60	—	25%
Miscarriage treatment with D&C, first trimester CPT 59820 HC TREATMENT OF SPONTANEOUS ABORTION, 1ST TRIMESTER	$7,085.25	$9,447.00	$2,087.79–$8,502.30	at median	25%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC TREATMENT OF SPONTANEOUS ABORTION, 1ST TRIMESTER	$7,085.25	$9,447.00	$900.00–$8,502.30	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXCISON SKIN BENIG 0.5 CM/< TRUNK,ARM,LEG	$2,040.00	$2,720.00	$601.12–$2,758.00	49% above	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXCISON SKIN BENIG 0.5 CM/< TRUNK,ARM,LEG	$2,040.00	$2,720.00	$900.00–$2,448.00	—	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXC SKIN BENIG <0.5 CM FACE,FACIAL	$1,447.50	$1,930.00	$426.53–$3,710.00	5% above	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC EXC SKIN BENIG <0.5 CM FACE,FACIAL	$1,447.50	$1,930.00	$698.66–$1,737.00	—	25%
Nail removal (partial or complete), one nail CPT 11730 HC REMOVAL OF NAIL PLATE	$318.75	$425.00	$93.93–$2,758.00	at median	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC REMOVAL OF NAIL PLATE	$318.75	$425.00	$153.85–$900.00	—	25%
Occipital nerve block (injection for headaches) CPT 64405 HC INJECT NERV BLCK,GREAT OCCIPTL	$1,218.00	$1,624.00	$290.40–$2,758.00	29% above	25%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC INJECT NERV BLCK,GREAT OCCIPTL	$1,218.00	$1,624.00	$587.89–$1,461.60	—	25%
Pacemaker implant (dual chamber) CPT 33208 HC EP INSER HART PACER XVENOUS ATR/VENTR	$11,024.25	$14,699.00	$3,248.48–$24,700.00	27% below	25%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC EP INSER HART PACER XVENOUS ATR/VENTR	$11,024.25	$14,699.00	$900.00–$13,229.10	—	25%
Paracentesis with imaging guidance CPT 49083 HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE	$1,527.75	$2,037.00	$450.18–$3,963.00	12% below	25%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE	$1,527.75	$2,037.00	$737.39–$1,833.30	—	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC REMOVAL OF NAIL BED	$1,716.75	$2,289.00	$384.59–$2,758.00	120% above	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC REMOVAL OF NAIL BED	$1,716.75	$2,289.00	$828.62–$2,060.10	—	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTRUCTION LUMBAR/SACRUM SINGLE LEVEL	$2,325.75	$3,101.00	$685.32–$8,271.00	29% below	25%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DESTRUCTION LUMBAR/SACRUM SINGLE LEVEL	$2,325.75	$3,101.00	$900.00–$2,790.90	—	25%
Removal of a breast lump, open surgery CPT 19120 HC EXCISE BREAST CYST	$3,704.25	$4,939.00	$1,091.52–$8,271.00	17% below	25%
Removal of a breast lump, open surgery inpatient CPT 19120 HC EXCISE BREAST CYST	$3,704.25	$4,939.00	$900.00–$4,445.10	—	25%
Removal of a foreign object under the skin, simple CPT 10120 HC REMOVE FOREIGN BODY SIMPLE URG CARE	$676.50	$902.00	$199.34–$2,758.00	1% above	25%
Removal of a foreign object under the skin, simple CPT 10120 HC REMOVE FOREIGN BODY SIMPLE	$676.50	$902.00	$199.34–$2,758.00	1% above	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC REMOVE FOREIGN BODY SIMPLE	$676.50	$902.00	$326.52–$900.00	—	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC REMOVE FOREIGN BODY SIMPLE URG CARE	$676.50	$902.00	$326.52–$900.00	—	25%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 HC COLON CA SCRN NOT HI RSK IND	$2,602.50	$3,470.00	$766.87–$3,710.00	at median	25%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 HC COLON CA SCRN NOT HI RSK IND	$2,602.50	$3,470.00	$900.00–$3,123.00	—	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HC COLORECTAL SCRN; HI RISK IND	$2,602.50	$3,470.00	$766.87–$3,710.00	at median	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 HC COLORECTAL SCRN; HI RISK IND	$2,602.50	$3,470.00	$900.00–$3,123.00	—	25%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 HC LITHOTRIPSY XTRCORP SHOCK WAVE	$9,827.25	$13,103.00	$2,895.76–$13,901.00	3% below	25%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 HC LITHOTRIPSY XTRCORP SHOCK WAVE	$9,827.25	$13,103.00	$900.00–$11,792.70	—	25%
Short arm cast (elbow to hand) CPT 29075 HC APPLY FOREARM CAST	$303.00	$404.00	$89.28–$2,758.00	1% above	25%
Short arm cast (elbow to hand) inpatient CPT 29075 HC APPLY FOREARM CAST	$303.00	$404.00	$146.25–$900.00	—	25%
Short arm splint (forearm and hand) CPT 29125 HC APPLY FOREARM SPLINT,STATIC - URGENT CARE	$307.50	$410.00	$90.61–$2,758.00	6% above	25%
Short arm splint (forearm and hand) CPT 29125 HC APPLY FOREARM SPLINT,STATIC	$307.50	$410.00	$90.61–$2,758.00	6% above	25%
Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLY FOREARM SPLINT,STATIC	$307.50	$410.00	$148.42–$900.00	—	25%
Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLY FOREARM SPLINT,STATIC - URGENT CARE	$307.50	$410.00	$148.42–$900.00	—	25%
Short leg cast (below the knee) CPT 29405 HC APPLY SHORT LEG CAST	$265.50	$354.00	$78.23–$2,758.00	33% below	25%
Short leg cast (below the knee) inpatient CPT 29405 HC APPLY SHORT LEG CAST	$265.50	$354.00	$128.15–$900.00	—	25%
Short leg splint (calf to foot) CPT 29515 HC APPLY LOWER LEG SPLINT	$471.75	$629.00	$139.01–$2,758.00	55% above	25%
Short leg splint (calf to foot) inpatient CPT 29515 HC APPLY LOWER LEG SPLINT	$471.75	$629.00	$227.70–$900.00	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC RESUPERF WND BODY <2.5CM	$330.00	$440.00	$97.24–$2,758.00	at median	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC RESUPERF WND BODY <2.5CM	$330.00	$440.00	$159.28–$900.00	—	25%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BX SKIN SINGLE LESION	$311.25	$415.00	$91.72–$2,758.00	31% below	25%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BX SKIN SINGLE LESION	$311.25	$415.00	$150.23–$900.00	—	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC EXC SKIN MALIG >.5 CM TRUNK,ARM,LEG	$1,407.75	$1,877.00	$414.82–$3,340.00	3% above	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC EXC SKIN MALIG >.5 CM TRUNK,ARM,LEG	$1,407.75	$1,877.00	$679.47–$1,689.30	—	25%
Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL OF SKIN TAGS, UP TO 15	$292.50	$390.00	$86.19–$2,758.00	at median	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC REMOVAL OF SKIN TAGS, UP TO 15	$292.50	$390.00	$141.18–$900.00	—	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC	$1,088.25	$1,451.00	$320.67–$2,758.00	at median	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC	$1,088.25	$1,451.00	$525.26–$1,305.90	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC RESUP NPTERF WND BODY 2.6-7.5 CM	$352.50	$470.00	$103.87–$2,758.00	at median	25%
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 RESUP NPTERF WND BODY 2.6-7.5 CM	$352.50	$470.00	$170.14–$900.00	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC RESUPERF WND FACE <2.5 CM	$317.25	$423.00	$93.48–$2,758.00	at median	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC RESUPERF WND FACE <2.5 CM	$317.25	$423.00	$153.13–$900.00	—	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$300.00	$400.00	$88.40–$2,758.00	1% below	25%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$300.00	$400.00	$144.80–$900.00	—	25%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$1,687.50	$2,250.00	$497.25–$2,758.00	6% below	25%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$1,687.50	$2,250.00	$814.50–$2,025.00	—	25%
Tonsil and adenoid removal, age 12 or older CPT 42821 HC REMOVE TONSILS/ADENOIDS,12+ Y/O	$3,600.75	$4,801.00	$1,061.02–$8,271.00	30% below	25%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 HC REMOVE TONSILS/ADENOIDS,12+ Y/O	$3,600.75	$4,801.00	$900.00–$4,320.90	—	25%
Trigger finger release surgery CPT 26055 HC INCISE FINGER TENDON SHEATH	$2,124.75	$2,833.00	$626.09–$3,963.00	35% below	25%
Trigger finger release surgery inpatient CPT 26055 HC INCISE FINGER TENDON SHEATH	$2,124.75	$2,833.00	$900.00–$2,549.70	—	25%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJECT TRIGGER POINT, 1 OR 2	$1,078.50	$1,438.00	$290.40–$2,758.00	54% above	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJECT TRIGGER POINT, 1 OR 2	$1,078.50	$1,438.00	$520.56–$1,294.20	—	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE	$4,049.25	$5,399.00	$1,193.18–$4,859.10	21% above	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE	$4,049.25	$5,399.00	$900.00–$4,859.10	—	25%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM - EGD	$2,597.25	$3,463.00	$765.32–$3,963.00	27% below	25%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM - EGD	$2,597.25	$3,463.00	$900.00–$3,116.70	—	25%
Upper endoscopy (EGD) with biopsy CPT 43239 HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE - EGD	$2,464.50	$3,286.00	$726.21–$3,963.00	12% below	25%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE - EGD	$2,464.50	$3,286.00	$900.00–$2,957.40	—	25%
Upper endoscopy (EGD) with injection into the lining CPT 43236 HC ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION - EGD	$2,262.00	$3,016.00	$666.54–$3,963.00	19% below	25%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 HC ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION - EGD	$2,262.00	$3,016.00	$900.00–$2,714.40	—	25%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 HC EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH - EGD	$2,597.25	$3,463.00	$765.32–$3,963.00	23% below	25%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 HC EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH - EGD	$2,597.25	$3,463.00	$900.00–$3,116.70	—	25%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 HC EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS - EGD	$2,765.25	$3,687.00	$814.83–$3,963.00	1% below	25%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 HC EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS - EGD	$2,765.25	$3,687.00	$900.00–$3,318.30	—	25%
Upper endoscopy (EGD), diagnostic CPT 43235 HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$2,514.75	$3,353.00	$741.01–$3,963.00	3% below	25%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$2,514.75	$3,353.00	$900.00–$3,017.70	—	25%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 HC EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST - ENDO US (UPPER)	$4,379.25	$5,839.00	$1,290.42–$10,338.37	4% below	25%
Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 HC EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST - ENDO US (UPPER)	$4,379.25	$5,839.00	$900.00–$5,255.10	—	25%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 HC CYSTO W/URETEROSCOPY W/LITHOTRIPSY	$11,789.25	$15,719.00	$2,693.60–$14,147.10	at median	25%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 HC CYSTO W/URETEROSCOPY W/LITHOTRIPSY	$11,789.25	$15,719.00	$900.00–$14,147.10	—	25%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 HC VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS	$2,361.00	$3,148.00	$695.71–$8,271.00	—	25%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 HC VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS	$2,361.00	$3,148.00	$900.00–$2,833.20	—	25%
Vein ablation, radiofrequency, first vein CPT 36475 HC ENDOVENOUS RF, 1ST VEIN	$6,527.25	$8,703.00	$1,923.36–$9,707.00	at median	25%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC ENDOVENOUS RF, 1ST VEIN	$6,527.25	$8,703.00	$900.00–$7,832.70	—	25%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCTION BENIGN LESIONS UP TO 14	$268.50	$358.00	$79.12–$2,758.00	14% below	25%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCTION BENIGN LESIONS UP TO 14	$268.50	$358.00	$129.60–$900.00	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM	$1,148.25	$1,531.00	$338.35–$2,758.00	47% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM	$1,148.25	$1,531.00	$554.22–$1,377.90	—	25%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 HC OPEN RX DISTAL RADIUS FX, EXTRA-ARTICULAR	$8,370.75	$11,161.00	$2,466.58–$13,901.00	55% below	25%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 HC OPEN RX DISTAL RADIUS FX, EXTRA-ARTICULAR	$8,370.75	$11,161.00	$900.00–$10,044.90	—	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION SERVICE	$1,166.25	$1,555.00	$343.66–$2,758.00	5% above	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION SERVICE	$1,166.25	$1,555.00	$562.91–$1,399.50	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$198.75	$265.00	$58.57–$372.90	12% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 HC RT EZPAP TREATMENT	$198.75	$265.00	$58.57–$372.90	12% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 HC RT INHALATION TREATMENT	$198.75	$265.00	$58.57–$372.90	12% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$198.75	$265.00	$95.93–$900.00	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient one side CPT 94640 HC RT INHALATION TREATMENT	$198.75	$265.00	$95.93–$900.00	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient one side CPT 94640 HC RT EZPAP TREATMENT	$198.75	$265.00	$95.93–$900.00	—	25%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMOTHER, IV INFUSION, 1 HR	$857.25	$1,143.00	$252.60–$1,028.70	12% above	25%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMOTHER, IV INFUSION, 1 HR	$857.25	$1,143.00	$413.77–$1,028.70	—	25%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 HC EYE EXAM, NEW PATIENT, COMPREHENSIVE	$186.00	$248.00	$54.81–$226.72	28% below	25%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 HC EYE EXAM, NEW PATIENT, COMPREHENSIVE	$186.00	$248.00	$89.78–$900.00	—	25%
Comprehensive eye exam, returning patient CPT 92014 HC EYE EXAM, EST PATIENT, COMPREHENSIVE	$214.50	$286.00	$63.21–$257.40	7% below	25%
Comprehensive eye exam, returning patient inpatient CPT 92014 HC EYE EXAM, EST PATIENT, COMPREHENSIVE	$214.50	$286.00	$103.53–$900.00	—	25%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC COMPREHENSIVE HEARING TEST	$190.50	$254.00	$56.13–$228.60	29% below	25%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC COMPREHENSIVE HEARING TEST	$190.50	$254.00	$91.95–$900.00	—	25%
Critical care, first 30 to 74 minutes CPT 99291 HC CRITICAL CARE, E/M 30-74 MINUTES	$2,937.75	$3,917.00	$781.49–$6,035.00	at median	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC CRITICAL CARE, E/M 30-74 MINUTES	$2,937.75	$3,917.00	$900.00–$3,525.30	—	25%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG,W/AWAKE & DROWSY RECORD - EEG AWAKE OR DROWSY PORTABLE	$1,099.50	$1,466.00	$204.28–$1,319.40	15% above	25%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG,W/AWAKE & DROWSY RECORD - EEG AWAKE OR DROWSY PORTABLE	$1,099.50	$1,466.00	$530.69–$1,319.40	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ELECTROCARDIOGRAM, TRACING - ECG 12-LEAD	$292.50	$390.00	$55.81–$351.00	58% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC ELECTROCARDIOGRAM, TRACING - ECG 12-LEAD	$292.50	$390.00	$141.18–$900.00	—	25%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY	$1,353.00	$1,804.00	$398.68–$1,623.60	at median	25%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY	$1,353.00	$1,804.00	$653.05–$1,623.60	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB	$312.00	$416.00	$79.78–$718.00	at median	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB	$312.00	$416.00	$150.59–$900.00	—	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY	$510.00	$680.00	$145.26–$848.00	at median	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY	$510.00	$680.00	$246.16–$900.00	—	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY	$850.50	$1,134.00	$250.61–$2,232.00	1% above	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY	$850.50	$1,134.00	$410.51–$1,020.60	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY	$1,334.25	$1,779.00	$393.16–$2,392.00	at median	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY	$1,334.25	$1,779.00	$644.00–$1,601.10	—	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC TRAUMA ACTIVATION EVALUATION W/O NOTICE	$1,518.75	$2,025.00	$447.53–$4,160.00	12% below	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC	$2,097.00	$2,796.00	$563.42–$4,160.00	21% above	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC TRAUMA PARTIAL ACTIVATION W/O NOTICE	$3,569.25	$4,759.00	$563.42–$4,283.10	106% above	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC TRAUMA FULL ACTIVATION W/O NOTICE	$4,134.00	$5,512.00	$563.42–$4,960.80	139% above	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC TRAUMA ACTIVATION EVALUATION W/O NOTICE	$1,518.75	$2,025.00	$733.05–$1,822.50	—	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC	$2,097.00	$2,796.00	$900.00–$2,516.40	—	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC TRAUMA PARTIAL ACTIVATION W/O NOTICE	$3,569.25	$4,759.00	$900.00–$4,283.10	—	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC TRAUMA FULL ACTIVATION W/O NOTICE	$4,134.00	$5,512.00	$900.00–$4,960.80	—	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIAC STRESS TST,TRACING ONLY	$1,012.50	$1,350.00	$204.28–$1,215.00	13% above	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CARDIAC STRESS TST,TRACING ONLY	$1,012.50	$1,350.00	$488.70–$1,215.00	—	25%
Eye exam, returning patient, intermediate CPT 92012 HC EYE EXAM, EST PATIENT,INTERMED	$161.25	$215.00	$47.52–$226.72	47% below	25%
Eye exam, returning patient, intermediate inpatient CPT 92012 HC EYE EXAM, EST PATIENT,INTERMED	$161.25	$215.00	$77.83–$900.00	—	25%
Family therapy with the patient, 50 minutes CPT 90847 HC FAMILY PSYCHOTHERAPY W PHYS	$297.00	$396.00	$87.52–$356.40	at median	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC FAMILY PSYCHOTHERAPY W PHYS	$297.00	$396.00	$143.35–$900.00	—	25%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYCHOTHERAPY,NO PT	$309.75	$413.00	$91.27–$371.70	at median	25%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYCHOTHERAPY,NO PT	$309.75	$413.00	$149.51–$900.00	—	25%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY INTENSIVE OUTPATIENT PSYCHIATRIC VIRTUAL	$69.75	$93.00	$20.55–$173.00	60% below	25%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY INTENSIVE OUTPATIENT CHEMICAL DEPENDENCY	$69.75	$93.00	$20.55–$224.00	60% below	25%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY INTENSIVE OUTPATIENT PSYCHIATRIC	$241.50	$322.00	$71.16–$289.80	39% above	25%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY INTENSIVE OUTPATIENT PSYCHIATRIC OFFICE	$271.50	$362.00	$80.00–$325.80	57% above	25%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY INTENSIVE OUTPATIENT PSYCHIATRIC VIRTUAL	$69.75	$93.00	$33.67–$900.00	—	25%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY INTENSIVE OUTPATIENT CHEMICAL DEPENDENCY	$69.75	$93.00	$33.67–$900.00	—	25%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY INTENSIVE OUTPATIENT PSYCHIATRIC	$241.50	$322.00	$116.56–$900.00	—	25%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY INTENSIVE OUTPATIENT PSYCHIATRIC OFFICE	$271.50	$362.00	$131.04–$900.00	—	25%
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 HC XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I	$558.75	$745.00	$65.54–$670.50	at median	25%
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient CPT 93224 HC XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I	$558.75	$745.00	$269.69–$900.00	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INFUSION, HYDRATION, 31-60 MIN	$722.25	$963.00	$201.23–$866.70	73% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV INFUSION, HYDRATION, 31-60 MIN	$722.25	$963.00	$348.61–$900.00	—	25%
IV infusion of a medicine, first hour CPT 96365 HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR	$722.25	$963.00	$201.23–$866.70	67% above	25%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR	$722.25	$963.00	$348.61–$900.00	—	25%
IV push of a medicine, first drug CPT 96374 HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG	$609.75	$813.00	$179.67–$731.70	150% above	25%
IV push of a medicine, first drug inpatient CPT 96374 HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG	$609.75	$813.00	$294.31–$900.00	—	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT	$174.00	$232.00	$51.27–$208.80	23% above	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT	$174.00	$232.00	$83.98–$900.00	—	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSYCHIATRIC DIAGNOSTIC EVALUATION VIRTUAL	$509.25	$679.00	$150.06–$611.10	63% above	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSYCHIATRIC DIAGNOSTIC EVALUATION	$509.25	$679.00	$150.06–$611.10	63% above	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PSYCHIATRIC DIAGNOSTIC EVALUATION VIRTUAL	$509.25	$679.00	$245.80–$900.00	—	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PSYCHIATRIC DIAGNOSTIC EVALUATION	$509.25	$679.00	$245.80–$900.00	—	25%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NERVE CONDUCTION STUDY, 7-8 NERVES	$2,176.50	$2,902.00	$353.04–$2,611.80	58% above	25%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC NERVE CONDUCTION STUDY, 7-8 NERVES	$2,176.50	$2,902.00	$900.00–$2,611.80	—	25%
Neuromuscular re-education, 15 minutes CPT 97112 HC PT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN	$138.75	$185.00	$31.37–$166.50	29% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 HC OT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN	$138.75	$185.00	$31.37–$166.50	29% above	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC OT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN	$138.75	$185.00	$66.97–$900.00	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC PT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN	$138.75	$185.00	$66.97–$900.00	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MED NUTR THER, 1ST, INDIV, EA 15 MIN	$65.25	$87.00	$19.23–$78.30	at median	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MED NUTR THER, 1ST, INDIV, EA 15 MIN	$65.25	$87.00	$31.49–$900.00	—	25%
Occupational therapy evaluation, low complexity CPT 97165 HC OT OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS	$297.00	$396.00	$87.52–$356.40	14% above	25%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS	$297.00	$396.00	$143.35–$900.00	—	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS	$297.00	$396.00	$87.52–$356.40	1% below	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS	$297.00	$396.00	$143.35–$900.00	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS	$264.00	$352.00	$77.79–$316.80	1% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS	$264.00	$352.00	$127.42–$900.00	—	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS	$264.00	$352.00	$77.79–$316.80	5% below	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS	$264.00	$352.00	$127.42–$900.00	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC AT MANUAL THER TECH,1+REGIONS,EA 15 MIN	$138.75	$185.00	$26.59–$166.50	29% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC PT MANUAL THER TECH,1+REGIONS,EA 15 MIN	$138.75	$185.00	$26.59–$166.50	29% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC OT MANUAL THER TECH,1+REGIONS,EA 15 MIN	$138.75	$185.00	$26.59–$166.50	29% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC SLP MANUAL THER TECH,1+REGIONS,EA 15 MIN	$138.75	$185.00	$26.59–$166.50	29% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC SLP MANUAL THER TECH,1+REGIONS,EA 15 MIN	$138.75	$185.00	$66.97–$900.00	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC AT MANUAL THER TECH,1+REGIONS,EA 15 MIN	$138.75	$185.00	$66.97–$900.00	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC PT MANUAL THER TECH,1+REGIONS,EA 15 MIN	$138.75	$185.00	$66.97–$900.00	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC OT MANUAL THER TECH,1+REGIONS,EA 15 MIN	$138.75	$185.00	$66.97–$900.00	—	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PT THERAPEUTIC EXERCISES	$143.25	$191.00	$27.87–$171.90	24% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT THERAPEUTIC EXERCISES	$143.25	$191.00	$27.87–$171.90	24% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC AT THERAPEUTIC EXERCISES	$143.25	$191.00	$27.87–$171.90	24% above	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC OT THERAPEUTIC EXERCISES	$143.25	$191.00	$69.14–$900.00	—	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC PT THERAPEUTIC EXERCISES	$143.25	$191.00	$69.14–$900.00	—	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC AT THERAPEUTIC EXERCISES	$143.25	$191.00	$69.14–$900.00	—	25%
Preventive checkup, new patient aged 18–39 CPT 99385 HC PREVENTIVE VISIT,NEW,18-39	$167.25	$223.00	$32.00–$231.94	40% above	25%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC PREVENTIVE VISIT,NEW,18-39	$167.25	$223.00	$80.73–$900.00	—	25%
Preventive checkup, new patient aged 40–64 CPT 99386 HC PREVENTIVE VISIT,NEW,40-64	$167.25	$223.00	$32.00–$268.84	13% above	25%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC PREVENTIVE VISIT,NEW,40-64	$167.25	$223.00	$80.73–$900.00	—	25%
Preventive checkup, new patient aged 65 or older CPT 99387 HC PREVENTIVE VISIT,NEW,65 AND OVER	$167.25	$223.00	$32.00–$291.19	6% above	25%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC PREVENTIVE VISIT,NEW,65 AND OVER	$167.25	$223.00	$80.73–$900.00	—	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC PREVENTIVE VISIT,EST,18-39	$167.25	$223.00	$32.00–$209.59	33% above	25%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC PREVENTIVE VISIT,EST,18-39	$167.25	$223.00	$80.73–$900.00	—	25%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC PREVENTIVE VISIT,EST,40-64	$167.25	$223.00	$32.00–$222.50	25% above	25%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC PREVENTIVE VISIT,EST,40-64	$167.25	$223.00	$80.73–$900.00	—	25%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC PREVENTIVE VISIT,EST,65 AND OVER	$167.25	$223.00	$32.00–$239.49	24% above	25%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC PREVENTIVE VISIT,EST,65 AND OVER	$167.25	$223.00	$80.73–$900.00	—	25%
Psychiatric evaluation with medical services CPT 90792 HC PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	$394.50	$526.00	$116.25–$473.40	11% above	25%
Psychiatric evaluation with medical services inpatient CPT 90792 HC PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	$394.50	$526.00	$190.41–$900.00	—	25%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HC PSYCH TESTING EVAL INITIAL 60 MINS OFFICE	$316.50	$422.00	$93.26–$379.80	25% below	25%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HC PSYCH TESTING EVAL INITIAL 60 MINS VIRTUAL	$316.50	$422.00	$93.26–$379.80	25% below	25%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 HC PSYCH TESTING EVAL INITIAL 60 MINS OFFICE	$316.50	$422.00	$152.76–$900.00	—	25%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 HC PSYCH TESTING EVAL INITIAL 60 MINS VIRTUAL	$316.50	$422.00	$152.76–$900.00	—	25%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC PSYCHOTHERAPY CRISIS INITIAL 60 MINS	$567.00	$756.00	$167.08–$680.40	81% above	25%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PSYCHOTHERAPY CRISIS INITIAL 60 MINS	$567.00	$756.00	$273.67–$900.00	—	25%
Psychotherapy session, 30 minutes CPT 90832 HC PSYCHOTHERAPY W/PATIENT 30 MINUTES VIRTUAL	$193.50	$258.00	$57.02–$302.26	5% above	25%
Psychotherapy session, 30 minutes CPT 90832 HC PSYCHOTHERAPY W/PATIENT 30 MINUTES	$193.50	$258.00	$57.02–$302.26	5% above	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCHOTHERAPY W/PATIENT 30 MINUTES VIRTUAL	$193.50	$258.00	$93.40–$900.00	—	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCHOTHERAPY W/PATIENT 30 MINUTES	$193.50	$258.00	$93.40–$900.00	—	25%
Psychotherapy session, 45 minutes CPT 90834 HC PSYCHOTHERAPY W/PATIENT 45 MINUTES	$267.00	$356.00	$78.68–$320.40	at median	25%
Psychotherapy session, 45 minutes CPT 90834 HC PSYCHOTHERAPY W/PATIENT 45 MINUTES VIRTUAL	$267.00	$356.00	$78.68–$320.40	at median	25%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCHOTHERAPY W/PATIENT 45 MINUTES	$267.00	$356.00	$128.87–$900.00	—	25%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCHOTHERAPY W/PATIENT 45 MINUTES VIRTUAL	$267.00	$356.00	$128.87–$900.00	—	25%
Psychotherapy session, 60 minutes CPT 90837 HC PSYCHOTHERAPY W/PATIENT 60 MINUTES	$328.50	$438.00	$96.80–$394.20	5% above	25%
Psychotherapy session, 60 minutes CPT 90837 HC PSYCHOTHERAPY W/PATIENT 60 MINUTES VIRTUAL	$328.50	$438.00	$96.80–$394.20	5% above	25%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYCHOTHERAPY W/PATIENT 60 MINUTES	$328.50	$438.00	$158.56–$900.00	—	25%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYCHOTHERAPY W/PATIENT 60 MINUTES VIRTUAL	$328.50	$438.00	$158.56–$900.00	—	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES	$120.75	$161.00	$35.45–$144.90	176% above	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES	$120.75	$161.00	$58.28–$900.00	—	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OFFICE OUTPATIENT VISIT NEW LEVEL 5	$168.75	$225.00	$32.00–$332.02	at median	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OFFICE OUTPATIENT VISIT EST LEVEL 5	$168.75	$225.00	$32.00–$332.02	at median	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OFFICE OUTPATIENT VISIT NEW LEVEL 5	$168.75	$225.00	$81.45–$900.00	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OFFICE OUTPATIENT VISIT EST LEVEL 5	$168.75	$225.00	$81.45–$900.00	—	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OFFICE OUTPATIENT VISIT EST LEVEL 3	$126.00	$168.00	$32.00–$163.75	9% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OFFICE OUTPATIENT VISIT NEW LEVEL 3	$126.00	$168.00	$32.00–$163.75	9% above	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OFFICE OUTPATIENT VISIT EST LEVEL 3	$126.00	$168.00	$60.82–$900.00	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OFFICE OUTPATIENT VISIT NEW LEVEL 3	$126.00	$168.00	$60.82–$900.00	—	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OFFICE OUTPATIENT VISIT NEW LEVEL 4	$147.75	$197.00	$32.00–$233.70	8% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OFFICE OUTPATIENT VISIT EST LEVEL 4	$147.75	$197.00	$32.00–$233.70	8% above	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OFFICE OUTPATIENT VISIT EST LEVEL 4	$147.75	$197.00	$71.31–$900.00	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OFFICE OUTPATIENT VISIT NEW LEVEL 4	$147.75	$197.00	$71.31–$900.00	—	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OFFICE OUTPATIENT VISIT NEW LEVEL 2	$114.00	$152.00	$32.00–$136.80	17% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OFFICE OUTPATIENT VISIT EST LEVEL 2	$114.00	$152.00	$32.00–$136.80	17% above	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OFFICE OUTPATIENT VISIT NEW LEVEL 2	$114.00	$152.00	$55.02–$900.00	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OFFICE OUTPATIENT VISIT EST LEVEL 2	$114.00	$152.00	$55.02–$900.00	—	25%
Speech and language evaluation CPT 92523 HC SLP EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION	$387.00	$516.00	$114.04–$464.40	17% above	25%
Speech and language evaluation inpatient CPT 92523 HC SLP EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION	$387.00	$516.00	$186.79–$900.00	—	25%
Speech therapy session, individual CPT 92507 HC SLP SPEECH/HEARING THERAPY, INDIVIDUAL	$332.25	$443.00	$73.34–$398.70	52% above	25%
Speech therapy session, individual inpatient CPT 92507 HC SLP SPEECH/HEARING THERAPY, INDIVIDUAL	$332.25	$443.00	$160.37–$900.00	—	25%
Spirometry (breathing test) CPT 94010 HC BREATHING CAPACITY TEST - SPIROMETRY WITHOUT BRONCHODILATOR	$478.50	$638.00	$141.00–$574.20	54% above	25%
Spirometry (breathing test) inpatient CPT 94010 HC BREATHING CAPACITY TEST - SPIROMETRY WITHOUT BRONCHODILATOR	$478.50	$638.00	$230.96–$900.00	—	25%
Spirometry before and after a bronchodilator CPT 94060 HC EVAL OF BRONCHOSPASM - SPIROMETRY WITH BRONCHODILATOR	$672.00	$896.00	$198.02–$806.40	17% above	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC EVAL OF BRONCHOSPASM - SPIROMETRY WITH BRONCHODILATOR	$672.00	$896.00	$324.35–$900.00	—	25%
TMS (transcranial magnetic stimulation), first session with mapping CPT 90867 HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING	$354.00	$472.00	$104.31–$424.80	21% below	25%
TMS (transcranial magnetic stimulation), first session with mapping inpatient CPT 90867 HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING	$354.00	$472.00	$170.86–$900.00	—	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC OT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$156.75	$209.00	$33.33–$188.10	32% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC PT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$156.75	$209.00	$33.33–$188.10	32% above	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC PT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$156.75	$209.00	$75.66–$900.00	—	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC OT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$156.75	$209.00	$75.66–$900.00	—	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY	$308.25	$411.00	$90.83–$369.90	30% above	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY	$308.25	$411.00	$148.78–$900.00	—	25%
Visual field test, extended both sides CPT 92083 HC VISUAL FIELD EXAM,EXTENDED, UNILAT/BILATERAL, W/ INTERPRETATION AND REPORT	$162.75	$217.00	$47.96–$226.57	—	25%
Visual field test, extended inpatient both sides CPT 92083 HC VISUAL FIELD EXAM,EXTENDED, UNILAT/BILATERAL, W/ INTERPRETATION AND REPORT	$162.75	$217.00	$78.55–$900.00	—	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE	$50.25	$67.00	$14.81–$230.18	33% below	25%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE	$50.25	$67.00	$24.25–$900.00	—	25%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 HC SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$368.25	$491.00	$108.51–$445.67	78% above	25%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 HC SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$368.25	$491.00	$177.74–$900.00	—	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 HC SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$331.50	$442.00	$97.68–$429.79	at median	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 HC SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$331.50	$442.00	$160.00–$900.00	—	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 HC VAR VACCINE LIVE FOR SUBCUTANEOUS USE	$75.00	$100.00	$22.10–$90.00	79% below	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [113088]	$642.96	$857.28	$189.46–$771.55	78% above	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 HC VAR VACCINE LIVE FOR SUBCUTANEOUS USE	$75.00	$100.00	$36.20–$900.00	—	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [113088]	$642.96	$857.28	$310.34–$900.00	—	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 HC DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE	$129.00	$172.00	$38.01–$154.80	at median	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 HC DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE	$129.00	$172.00	$62.26–$900.00	—	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 HC DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM	$60.00	$80.00	$17.68–$72.00	9% below	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 HC DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM	$60.00	$80.00	$28.96–$900.00	—	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HC DTAP-HEPB-IPV VACCINE INTRAMUSCULAR	$25.50	$34.00	$7.51–$30.60	87% below	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]	$233.91	$311.87	$68.92–$280.68	23% above	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HC DTAP-HEPB-IPV VACCINE INTRAMUSCULAR	$25.50	$34.00	$12.31–$900.00	—	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]	$233.91	$311.87	$112.90–$900.00	—	25%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 HC DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE	$25.50	$34.00	$7.51–$30.60	84% below	25%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 HC DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE	$25.50	$34.00	$12.31–$900.00	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$45.75	$61.00	$13.48–$61.62	at median	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 HC IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$45.75	$61.00	$22.08–$900.00	—	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HC 9VHPV VACC 2/3 DOSE SCHED IM USE	$519.00	$692.00	$152.93–$622.80	at median	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [127764]	$1,044.16	$1,392.21	$307.68–$1,252.99	101% above	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HC 9VHPV VACC 2/3 DOSE SCHED IM USE	$519.00	$692.00	$250.50–$900.00	—	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [127764]	$1,044.16	$1,392.21	$503.98–$1,252.99	—	25%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HC HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM	$327.75	$437.00	$96.58–$393.30	7% above	25%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [166255]	$354.74	$472.98	$104.53–$425.68	16% above	25%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HC HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM	$327.75	$437.00	$158.19–$900.00	—	25%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [166255]	$354.74	$472.98	$171.22–$900.00	—	25%
Hepatitis A vaccine, adult dose CPT 90632 HC HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE	$234.75	$313.00	$69.17–$281.70	21% above	25%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [180221]	$241.96	$322.61	$71.30–$290.35	25% above	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HC HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE	$234.75	$313.00	$113.31–$900.00	—	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [180221]	$241.96	$322.61	$116.78–$900.00	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM INJECTION (WRAPPED) [430127]	$99.21	$132.28	$29.23–$119.05	11% above	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE [91033]	$100.79	$134.38	$29.70–$120.94	12% above	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HC HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE	$135.00	$180.00	$39.78–$162.00	51% above	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM INJECTION (WRAPPED) [430127]	$99.21	$132.28	$47.89–$900.00	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE [91033]	$100.79	$134.38	$48.65–$900.00	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HC HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE	$135.00	$180.00	$65.16–$900.00	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE	$161.25	$215.00	$47.52–$194.01	3% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [180156]	$162.07	$216.09	$47.76–$194.48	4% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SUSP [180187]	$162.07	$216.09	$47.76–$194.48	4% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HC HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE	$161.25	$215.00	$77.83–$900.00	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SUSP [180187]	$162.07	$216.09	$78.22–$900.00	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [180156]	$162.07	$216.09	$78.22–$900.00	—	25%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HC HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE	$118.50	$158.00	$34.92–$489.51	47% below	25%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HC HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE	$118.50	$158.00	$57.20–$900.00	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HC HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM	$48.00	$64.00	$14.14–$87.31	21% below	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [27325]	$70.27	$93.69	$20.71–$87.31	16% above	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 5 MCG/0.5 ML INTRAMUSCULAR SUSP [180905]	$75.39	$100.52	$22.21–$90.47	24% above	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HC HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM	$48.00	$64.00	$23.17–$900.00	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [27325]	$70.27	$93.69	$33.92–$900.00	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 5 MCG/0.5 ML INTRAMUSCULAR SUSP [180905]	$75.39	$100.52	$36.39–$900.00	—	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HAEMOPH B POLYSAC CONJ-MENING (PF) 7.5 MCG/0.5 ML INTRAMUSCULAR SOLN [126228]	$99.92	$133.22	$29.44–$119.90	42% above	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HC HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE	$111.00	$148.00	$32.71–$133.20	58% above	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HAEMOPH B POLYSAC CONJ-MENING (PF) 7.5 MCG/0.5 ML INTRAMUSCULAR SOLN [126228]	$99.92	$133.22	$48.23–$900.00	—	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HC HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE	$111.00	$148.00	$53.58–$900.00	—	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HC HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE	$26.25	$35.00	$7.74–$31.50	14% below	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [11931]	$40.79	$54.38	$12.02–$48.94	34% above	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HC HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE	$26.25	$35.00	$12.67–$900.00	—	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [11931]	$40.79	$54.38	$19.69–$900.00	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM	$67.50	$90.00	$19.89–$230.18	43% below	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 HC IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM	$67.50	$90.00	$32.58–$900.00	—	25%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 JAPANESE ENCEPHALITIS VACCINE (PF) 6 MCG/0.5 ML INTRAMUSCULAR SYRINGE [99449]	$2,069.33	$2,759.10	$609.76–$2,483.19	50% above	25%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule inpatient CPT 90738 JAPANESE ENCEPHALITIS VACCINE (PF) 6 MCG/0.5 ML INTRAMUSCULAR SYRINGE [99449]	$2,069.33	$2,759.10	$900.00–$2,483.19	—	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 HC MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ	$103.50	$138.00	$30.50–$124.20	50% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT [168883]	$311.03	$414.70	$91.65–$373.23	49% above	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 HC MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ	$103.50	$138.00	$49.96–$900.00	—	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT [168883]	$311.03	$414.70	$150.12–$900.00	—	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 HC MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ	$511.50	$682.00	$150.72–$613.80	at median	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MEASLES,MUMPS,RUBEL,VARICEL LIV(PF)10E3-4.3-3-3.99TCID50/0.5 ML SUBCUT [162637]	$957.30	$1,276.39	$282.08–$1,148.75	87% above	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 HC MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ	$511.50	$682.00	$246.88–$900.00	—	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MEASLES,MUMPS,RUBEL,VARICEL LIV(PF)10E3-4.3-3-3.99TCID50/0.5 ML SUBCUT [162637]	$957.30	$1,276.39	$462.05–$1,148.75	—	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 HC MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE	$259.50	$346.00	$76.47–$311.40	18% below	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOC VAC A,C,Y,W-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS) [181766]	$389.28	$519.03	$114.71–$467.13	23% above	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOC VAC A,C,Y,W-135 DIP (PF) 4 MCG/0.5 ML INTRAMUSCULAR SOLUTION [40540]	$450.39	$600.51	$132.71–$540.46	42% above	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 HC MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE	$259.50	$346.00	$125.25–$900.00	—	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOC VAC A,C,Y,W-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS) [181766]	$389.28	$519.03	$187.89–$900.00	—	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOC VAC A,C,Y,W-135 DIP (PF) 4 MCG/0.5 ML INTRAMUSCULAR SOLUTION [40540]	$450.39	$600.51	$217.38–$900.00	—	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 HC MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM	$378.75	$505.00	$111.61–$454.50	32% below	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE [127348]	$569.67	$759.56	$167.86–$683.60	3% above	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 HC MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM	$378.75	$505.00	$182.81–$900.00	—	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE [127348]	$569.67	$759.56	$274.96–$900.00	—	25%
Meningococcal B vaccine (Trumenba) CPT 90621 HC MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM	$747.00	$996.00	$220.12–$896.40	90% above	25%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 HC MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM	$747.00	$996.00	$360.55–$900.00	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 HC PCV13 VACCINE FOR INTRAMUSCULAR USE	$262.50	$350.00	$77.35–$711.25	41% below	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [103895]	$793.01	$1,057.34	$233.67–$951.61	78% above	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 HC PCV13 VACCINE FOR INTRAMUSCULAR USE	$262.50	$350.00	$126.70–$900.00	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [103895]	$793.01	$1,057.34	$382.76–$951.61	—	25%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 HC PCV15 VACCINE FOR INTRAMUSCULAR USE	$239.25	$319.00	$70.50–$719.96	at median	25%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 HC PCV15 VACCINE FOR INTRAMUSCULAR USE	$239.25	$319.00	$115.48–$900.00	—	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 HC PREVNAR 2 - PNEUMOCOCCAL 20 VALENT VACCINE	$913.50	$1,218.00	$269.18–$1,096.20	38% above	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 HC PREVNAR 2 - PNEUMOCOCCAL 20 VALENT VACCINE	$913.50	$1,218.00	$440.92–$1,096.20	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE	$77.25	$103.00	$22.76–$367.98	72% below	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION (WRAPPED) [430124]	$401.34	$535.11	$118.26–$481.60	46% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HC PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE	$77.25	$103.00	$37.29–$900.00	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION (WRAPPED) [430124]	$401.34	$535.11	$193.71–$900.00	—	25%
Polio vaccine, inactivated (IPV) CPT 90713 HC POLIOVIRUS VACCINE INACTIVATED SUBQ/IM	$27.00	$36.00	$7.96–$32.40	56% below	25%
Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [108127]	$1,529.59	$2,039.45	$450.72–$1,835.51	2387% above	25%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 HC POLIOVIRUS VACCINE INACTIVATED SUBQ/IM	$27.00	$36.00	$13.03–$900.00	—	25%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [108127]	$1,529.59	$2,039.45	$738.28–$1,835.51	—	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 HC RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$907.50	$1,210.00	$267.41–$1,089.00	26% above	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 HC RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$907.50	$1,210.00	$438.02–$1,089.00	—	25%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 HC RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE	$998.25	$1,331.00	$294.15–$1,197.90	182% above	25%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 HC RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE	$998.25	$1,331.00	$481.82–$1,197.90	—	25%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]	$1,415.34	$1,887.11	$315.22–$1,698.40	48% above	25%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]	$1,514.28	$2,019.04	$315.22–$1,817.14	59% above	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]	$1,415.34	$1,887.11	$683.13–$1,698.40	—	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]	$1,514.28	$2,019.04	$730.89–$1,817.14	—	25%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTAVIRUS VACCINE,LIVE, 89-12 STRAIN G1P(8) 10EXP6 CCID50/ML ORAL SUSP [91822]	$372.30	$496.40	$109.70–$446.76	42% above	25%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 HC RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE	$504.00	$672.00	$148.51–$604.80	93% above	25%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 ROTAVIRUS VACCINE,LIVE, 89-12 STRAIN G1P(8) 10EXP6 CCID50/ML ORAL SUSP [91822]	$372.30	$496.40	$179.70–$900.00	—	25%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 HC RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE	$504.00	$672.00	$243.26–$900.00	—	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION [122171]	$291.89	$389.18	$86.01–$350.26	123% above	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 HC RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE	$344.25	$459.00	$101.44–$413.10	163% above	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION [122171]	$291.89	$389.18	$140.88–$900.00	—	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 HC RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE	$344.25	$459.00	$166.16–$900.00	—	25%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HC HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX	$556.50	$742.00	$163.98–$667.80	10% above	25%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT [150819]	$650.11	$866.81	$191.57–$780.13	29% above	25%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HC HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX	$556.50	$742.00	$268.60–$900.00	—	25%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT [150819]	$650.11	$866.81	$313.79–$900.00	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS-TD 2 LF UNIT-2 LF UNIT/0.5 ML IM SUSPENSION [37504]	$81.47	$108.62	$24.01–$100.24	9% below	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 HC TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE	$123.00	$164.00	$36.24–$147.60	37% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 -2 LF UNIT/0.5 ML IM (WRAPPED) [430123]	$145.19	$193.58	$42.78–$174.22	62% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS-TD 2 LF UNIT-2 LF UNIT/0.5 ML IM SUSPENSION [37504]	$81.47	$108.62	$39.32–$900.00	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 HC TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE	$123.00	$164.00	$59.37–$900.00	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 -2 LF UNIT/0.5 ML IM (WRAPPED) [430123]	$145.19	$193.58	$70.08–$900.00	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH,PERTUSSIS(ACEL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5ML IM SYRINGE [41293]	$131.22	$174.95	$38.66–$157.46	19% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH,PERTUSSIS(ACELL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML IM SUSP [179537]	$131.22	$174.95	$38.66–$157.46	19% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC TDAP VACCINE 7 YRS/> IM	$140.25	$187.00	$41.33–$168.30	27% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTH,PERTUSSIS(ACEL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5ML IM SYRINGE [41293]	$131.22	$174.95	$63.33–$900.00	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTH,PERTUSSIS(ACELL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML IM SUSP [179537]	$131.22	$174.95	$63.33–$900.00	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 HC TDAP VACCINE 7 YRS/> IM	$140.25	$187.00	$67.69–$900.00	—	25%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 HC TYPHOID VACCINE, IM	$333.00	$444.00	$98.12–$399.60	16% above	25%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 HC TYPHOID VACCINE, IM	$333.00	$444.00	$160.73–$900.00	—	25%
Typhoid vaccine, oral capsules (Vivotif) CPT 90690 TYPHOID VACCINE,LIVE,ATTENUATED 2 BILLION UNIT CAPSULE,DELAYED RELEASE [29268]	$365.66	$487.54	$107.75–$438.79	637% above	25%
Typhoid vaccine, oral capsules (Vivotif) inpatient CPT 90690 TYPHOID VACCINE,LIVE,ATTENUATED 2 BILLION UNIT CAPSULE,DELAYED RELEASE [29268]	$365.66	$487.54	$176.49–$900.00	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID	$33.75	$45.00	$9.95–$122.61	12% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID	$33.75	$45.00	$16.29–$900.00	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZ,ADMIN,EACH ADDL	$33.75	$45.00	$9.95–$40.50	3% below	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZ,ADMIN,EACH ADDL	$33.75	$45.00	$16.29–$900.00	—	25%
Yellow fever vaccine, live CPT 90717 YELLOW FEVER VACCINE LIVE(PF) 10 EXP4.74 UNIT/0.5 ML SUBCUTANEOUS SUSP [8822]	$632.19	$842.91	$186.28–$758.62	50% above	25%
Yellow fever vaccine, live CPT 90717 HC YELLOW FEVER IMMUNIZATN,LIVE,SUB-Q	$714.00	$952.00	$210.39–$856.80	70% above	25%
Yellow fever vaccine, live inpatient CPT 90717 YELLOW FEVER VACCINE LIVE(PF) 10 EXP4.74 UNIT/0.5 ML SUBCUTANEOUS SUSP [8822]	$632.19	$842.91	$305.13–$900.00	—	25%
Yellow fever vaccine, live inpatient CPT 90717 HC YELLOW FEVER IMMUNIZATN,LIVE,SUB-Q	$714.00	$952.00	$344.62–$900.00	—	25%

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/7890/264827222-1609189604_university-hospitals-health-system_standardcharges.csv