Hospital Fresno, CA

Community Behavioral Health Center

Listed in its price file as “Fresno Community Hospital and Medical Center”.

Community Behavioral Health Center in Fresno, CA publishes cash prices for 375 common procedures listed here, from its own machine-readable price file updated Jun 18, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the California median for 255 of 370 procedures and below it for 106. Click a procedure to compare it with other hospitals nearby.

7171 N. Cedar Ave., Fresno, CA 93720 Collected Sep 24, 2026 Source price file (559) 459-6000

Acute care hospital Emergency department CMS star rating 1 of 5 CCN 050060 · CMS hospital register NPI 1104906569

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Abdominal CT scan without and with contrast CPT 74170 CT-ABDOMEN W/WO CONTRAST	$3,499.20	$4,374.00	$161.28–$4,811.40	23% above	20%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT-ABDOMEN W/WO CONTRAST	$3,499.20	$4,374.00	$1,115.37–$4,811.40	—	20%
Abdominal X-ray, 2 views CPT 74019 XRAY EXAM ABDOMEN 2 VIEWS	$692.80	$866.00	$30.10–$952.60	61% above	20%
Abdominal X-ray, 2 views inpatient CPT 74019 XRAY EXAM ABDOMEN 2 VIEWS	$692.80	$866.00	$220.83–$952.60	—	20%
Ankle X-ray, complete, 3 or more views CPT 73610 XRAY-ANKLE 3+ VIEW	$624.00	$780.00	$25.14–$858.00	16% above	20%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 XRAY-ANKLE 3+ VIEW	$624.00	$780.00	$198.90–$858.00	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ANKLE BRACHIAL INDICES (ABI)	$821.60	$1,027.00	$52.10–$1,129.70	47% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 NON INV PHYSIOLOGIC STUDY-UNILAT	$821.60	$1,027.00	$52.10–$1,129.70	47% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ANKLE BRACHIAL INDICES (ABI)	$821.60	$1,027.00	$261.89–$1,129.70	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 NON INV PHYSIOLOGIC STUDY-UNILAT	$821.60	$1,027.00	$261.89–$1,129.70	—	20%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT-ELBOW W/O CONTRAST	$3,198.40	$3,998.00	$96.13–$4,397.80	41% above	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT-ELBOW W/O CONTRAST	$3,198.40	$3,998.00	$1,019.49–$4,397.80	—	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XRAY XM ESOPHAGUS SINGLE CONTRAST	$1,085.60	$1,357.00	$38.09–$1,492.70	81% above	20%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XRAY XM ESOPHAGUS SINGLE CONTRAST	$1,085.60	$1,357.00	$346.04–$1,492.70	—	20%
Bone scan, whole body (nuclear medicine) CPT 78306 NM-BONE IMAGING WHOLE BODY	$3,568.80	$4,461.00	$141.03–$4,907.10	68% above	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM-BONE IMAGING WHOLE BODY	$3,568.80	$4,461.00	$1,137.56–$4,907.10	—	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST UNILATERAL COMPLETE	$728.00	$910.00	$96.13–$1,001.00	1% above	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST UNILATERAL COMPLETE	$728.00	$910.00	$232.05–$1,001.00	—	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST UNILAT LTD	$604.80	$756.00	$78.46–$831.60	12% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 POC US BREAST UNILAT LTD	$604.80	$756.00	$78.46–$831.60	12% above	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST UNILAT LTD	$604.80	$756.00	$192.78–$831.60	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 POC US BREAST UNILAT LTD	$604.80	$756.00	$192.78–$831.60	—	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABDOMEN AND PELVIS W/WO	$6,279.20	$7,849.00	$320.79–$8,633.90	16% above	20%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABDOMEN AND PELVIS W/WO	$6,279.20	$7,849.00	$2,001.50–$8,633.90	—	20%
CT angiography (CTA) of the head CPT 70496 CTA HEAD WITH CONTRAST	$3,840.00	$4,800.00	$161.28–$5,280.00	24% above	20%
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD WITH CONTRAST	$3,840.00	$4,800.00	$1,224.00–$5,280.00	—	20%
CT angiography (CTA) of the neck CPT 70498 CTA NECK WITH CONTRAST	$3,760.00	$4,700.00	$161.28–$5,170.00	27% above	20%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK WITH CONTRAST	$3,760.00	$4,700.00	$1,198.50–$5,170.00	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA-CHEST W/ CONTRAST	$4,000.00	$5,000.00	$161.28–$5,500.00	18% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA-CHEST W/ CONTRAST	$4,000.00	$5,000.00	$1,275.00–$5,500.00	—	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA CORONARY ART W/O CALCIUM	$3,948.80	$4,936.00	$312.13–$5,429.60	46% above	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA CORONARY ART W/O CALCIUM	$3,948.80	$4,936.00	$1,258.68–$5,429.60	—	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT-CARDIAC CALCIUM SCORING W	$672.80	$841.00	$80.02–$925.10	63% above	20%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT-CARDIAC CALCIUM SCORING W	$672.80	$841.00	$214.46–$925.10	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST	$4,040.80	$5,051.00	$603.56–$760.03	33% above	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CONTRAST	$4,040.80	$5,051.00	$1,288.01–$5,556.10	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN & PELVIS W/CONTRAST	$5,760.00	$7,200.00	$281.80–$7,920.00	40% above	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN & PELVIS W/CONTRAST	$5,760.00	$7,200.00	$1,836.00–$7,920.00	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD & PELVIS 1+ SECTION/REGNS	$6,503.20	$8,129.00	$319.24–$8,941.90	45% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD & PELVIS 1+ SECTION/REGNS	$6,503.20	$8,129.00	$2,072.90–$8,941.90	—	20%
CT scan of the abdomen with contrast CPT 74160 CT-ABDOMEN COMPLETE W CON	$4,666.40	$5,833.00	$161.28–$6,416.30	85% above	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT-ABDOMEN COMPLETE W CON	$4,666.40	$5,833.00	$1,487.42–$6,416.30	—	20%
CT scan of the abdomen without contrast CPT 74150 CT-ABDOMEN WO CONTRAST	$2,547.20	$3,184.00	$96.13–$3,502.40	33% above	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT-ABDOMEN WO CONTRAST	$2,547.20	$3,184.00	$811.92–$3,502.40	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT-SINUS W/O CONTRAST	$2,800.00	$3,500.00	$96.13–$3,850.00	28% above	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT-SINUS W/O CONTRAST	$2,800.00	$3,500.00	$892.50–$3,850.00	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT-HEAD COMPLETE W/O CONTRAS	$2,320.00	$2,900.00	$96.13–$3,190.00	1% above	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT-HEAD COMPLETE W/O CONTRAS	$2,320.00	$2,900.00	$739.50–$3,190.00	—	20%
CT scan of the head with contrast CPT 70460 CT-HEAD W/CONTRAST	$2,400.00	$3,000.00	$142.83–$3,300.00	11% below	20%
CT scan of the head with contrast inpatient CPT 70460 CT-HEAD W/CONTRAST	$2,400.00	$3,000.00	$765.00–$3,300.00	—	20%
CT scan of the head without and with contrast CPT 70470 CT-HEAD W & WO CONT	$3,866.40	$4,833.00	$161.28–$5,316.30	27% above	20%
CT scan of the head without and with contrast inpatient CPT 70470 CT-HEAD W & WO CONT	$3,866.40	$4,833.00	$1,232.42–$5,316.30	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT-L-SPINE W/O CONTRAST	$3,000.00	$3,750.00	$96.13–$4,125.00	5% above	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT-L-SPINE W/O CONTRAST	$3,000.00	$3,750.00	$956.25–$4,125.00	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT-C-SPINE W/O CONTRAST	$3,360.00	$4,200.00	$96.13–$4,620.00	15% above	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT-C-SPINE W/O CONTRAST	$3,360.00	$4,200.00	$1,071.00–$4,620.00	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT-PELVIS W/CONTRAST	$4,155.20	$5,194.00	$161.28–$5,713.40	63% above	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT-PELVIS W/CONTRAST	$4,155.20	$5,194.00	$1,324.47–$5,713.40	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 CAROTID ULTRASOUND BILAT	$2,048.00	$2,560.00	$156.64–$2,816.00	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US-BILAT CAROTID DUPLEX	$2,048.00	$2,560.00	$156.64–$2,816.00	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US-BILAT CAROTID DUPLEX	$2,048.00	$2,560.00	$652.80–$2,816.00	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 CAROTID ULTRASOUND BILAT	$2,048.00	$2,560.00	$652.80–$2,816.00	—	20%
Chest CT scan without and with contrast CPT 71270 CT-CHEST DX W/WO CONTRAST	$4,157.60	$5,197.00	$161.28–$5,716.70	34% above	20%
Chest CT scan without and with contrast inpatient CPT 71270 CT-CHEST DX W/WO CONTRAST	$4,157.60	$5,197.00	$1,325.24–$5,716.70	—	20%
Chest X-ray, 2 views CPT 71046 XRAY EXAM CHEST 2 VIEWS	$477.60	$597.00	$27.48–$656.70	17% above	20%
Chest X-ray, 2 views inpatient CPT 71046 XRAY EXAM CHEST 2 VIEWS	$477.60	$597.00	$152.24–$656.70	—	20%
Chest X-ray, single view CPT 71045 XRAY EXAM CHEST 1 VIEW	$352.00	$440.00	$17.67–$484.00	3% below	20%
Chest X-ray, single view inpatient CPT 71045 XRAY EXAM CHEST 1 VIEW	$352.00	$440.00	$112.20–$484.00	—	20%
Collarbone (clavicle) X-ray, complete CPT 73000 XRAY-CLAVICLE	$644.00	$805.00	$20.78–$885.50	33% above	20%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 XRAY-CLAVICLE	$644.00	$805.00	$205.28–$885.50	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US-RETROPERITONEAL COMPLETE	$1,042.40	$1,303.00	$80.72–$1,433.30	22% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 POC US RETROPERITONEAL COMPLETE	$1,042.40	$1,303.00	$80.72–$1,433.30	22% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 POC US RETROPERITONEAL COMPLETE	$1,042.40	$1,303.00	$332.27–$1,433.30	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US-RETROPERITONEAL COMPLETE	$1,042.40	$1,303.00	$332.27–$1,433.30	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 XRAY-DEXA SCAN/AXIAL SKELETO	$481.60	$602.00	$34.27–$662.20	4% below	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 XRAY-DEXA SCAN/AXIAL SKELETO	$481.60	$602.00	$153.51–$662.20	—	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA SCAN/APPENDICULAR SKEL.	$454.40	$568.00	$25.10–$624.80	64% above	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA SCAN/APPENDICULAR SKEL.	$454.40	$568.00	$144.84–$624.80	—	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US-PREGNANCY COMPLETE SNGL/1	$1,205.60	$1,507.00	$164.15–$1,657.70	34% above	20%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US-PREGNANCY COMPLETE SNGL/1	$1,205.60	$1,507.00	$384.29–$1,657.70	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT-CHEST DX WO CONTRAST	$2,458.40	$3,073.00	$96.13–$3,380.30	22% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT-HIGH RES CHEST DX WO CONTRAST	$2,458.40	$3,073.00	$96.13–$3,380.30	22% above	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT-HIGH RES CHEST DX WO CONTRAST	$2,458.40	$3,073.00	$783.62–$3,380.30	—	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT-CHEST DX WO CONTRAST	$2,458.40	$3,073.00	$783.62–$3,380.30	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT-CHEST DX W CONTRAST	$3,600.00	$4,500.00	$160.94–$4,950.00	24% above	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT-CHEST DX W CONTRAST	$3,600.00	$4,500.00	$1,147.50–$4,950.00	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI	$695.20	$869.00	$148.03–$955.90	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI	$695.20	$869.00	$221.60–$955.90	—	20%
Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI	$503.20	$629.00	$435.66–$548.60	34% above	20%
Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI	$503.20	$629.00	$160.40–$691.90	—	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US-LOWER EXTREM DUPLEX BILAT	$2,234.40	$2,793.00	$96.87–$3,072.30	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US-LOWER EXTREM DUPLEX BILAT	$2,234.40	$2,793.00	$712.22–$3,072.30	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US-VENOUS EXT BILAT COMP	$2,299.20	$2,874.00	$168.24–$3,161.40	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US-VENOUS EXT BILAT COMP	$2,299.20	$2,874.00	$732.87–$3,161.40	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER, COMPLETE	$2,120.00	$2,650.00	$239.76–$2,915.00	21% below	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 PEDIATRIC TTE W/DOPPLER COMPLETE	$2,240.00	$2,800.00	$239.76–$3,080.00	17% below	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W/DOPPLER, COMPLETE	$2,120.00	$2,650.00	$675.75–$2,915.00	—	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 PEDIATRIC TTE W/DOPPLER COMPLETE	$2,240.00	$2,800.00	$714.00–$3,080.00	—	20%
Elbow X-ray, 2 views CPT 73070 XRAY-ELBOW TWO VIEWS	$478.40	$598.00	$20.78–$657.80	21% above	20%
Elbow X-ray, 2 views inpatient CPT 73070 XRAY-ELBOW TWO VIEWS	$478.40	$598.00	$152.49–$657.80	—	20%
Elbow X-ray, complete, 3 or more views CPT 73080 XRAY-ELBOW 3+ VIEWS	$624.00	$780.00	$25.98–$858.00	30% above	20%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 XRAY-ELBOW 3+ VIEWS	$624.00	$780.00	$198.90–$858.00	—	20%
Eye socket (orbit) CT scan without contrast CPT 70480 CT-ORBIT-SELLA-P FOSSA WO C	$3,468.80	$4,336.00	$96.13–$4,769.60	52% above	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT-ORBIT-SELLA-P FOSSA WO C	$3,468.80	$4,336.00	$1,105.68–$4,769.60	—	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 XRAY-FACIAL BNS MORE THAN 3V	$728.00	$910.00	$37.28–$1,001.00	47% above	20%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XRAY-FACIAL BNS MORE THAN 3V	$728.00	$910.00	$232.05–$1,001.00	—	20%
Forearm X-ray (radius and ulna), 2 views CPT 73090 XRAY-FOREARM 2 VIEWS	$486.40	$608.00	$20.78–$668.80	22% above	20%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 XRAY-FOREARM 2 VIEWS	$486.40	$608.00	$155.04–$668.80	—	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM-HEPATOBILIARY WO PHARM INT	$2,352.80	$2,941.00	$291.01–$3,235.10	28% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM-HEPATOBILIARY WO PHARM INT	$2,352.80	$2,941.00	$749.96–$3,235.10	—	20%
Hand X-ray, 2 views CPT 73120 XRAY-HAND 2 VIEWS	$396.80	$496.00	$17.30–$545.60	3% below	20%
Hand X-ray, 2 views inpatient CPT 73120 XRAY-HAND 2 VIEWS	$396.80	$496.00	$126.48–$545.60	—	20%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 XRAY-CALCANEUS HEEL 2+ VIEWS	$458.40	$573.00	$19.02–$630.30	31% above	20%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 XRAY-CALCANEUS HEEL 2+ VIEWS	$458.40	$573.00	$146.12–$630.30	—	20%
Knee X-ray, 3 views CPT 73562 XRAY-KNEE 3 VIEWS	$564.80	$706.00	$23.38–$776.60	23% above	20%
Knee X-ray, 3 views inpatient CPT 73562 XRAY-KNEE 3 VIEWS	$564.80	$706.00	$180.03–$776.60	—	20%
Knee X-ray, complete, 4 or more views CPT 73564 XRAY-KNEE 4+ VIEWS	$522.40	$653.00	$27.70–$718.30	11% below	20%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 XRAY-KNEE 4+ VIEWS	$522.40	$653.00	$166.52–$718.30	—	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT-LOWER EXTREMITY WO CON	$3,192.00	$3,990.00	$96.13–$4,389.00	50% above	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT-ANKLE W/O CONTRAST	$3,192.00	$3,990.00	$96.13–$4,389.00	50% above	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT-ANKLE W/O CONTRAST	$3,192.00	$3,990.00	$1,017.45–$4,389.00	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT-LOWER EXTREMITY WO CON	$3,192.00	$3,990.00	$1,017.45–$4,389.00	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 POC US ABDOMEN LTD	$992.00	$1,240.00	$60.74–$1,364.00	20% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US-ABDOMEN LTD	$992.00	$1,240.00	$60.74–$1,364.00	20% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 POC US SOFT TISSUE ABDOMINAL WALL	$992.00	$1,240.00	$60.74–$1,364.00	20% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US-ABDOMEN LTD	$992.00	$1,240.00	$316.20–$1,364.00	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 POC US SOFT TISSUE ABDOMINAL WALL	$992.00	$1,240.00	$316.20–$1,364.00	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 POC US ABDOMEN LTD	$992.00	$1,240.00	$316.20–$1,364.00	—	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 POC US LMTD NON-VASC EXTRTY W IMG	$909.60	$1,137.00	$26.25–$1,250.70	81% above	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LMTD NON-VASC EXTRTY W IMG	$909.60	$1,137.00	$26.25–$1,250.70	81% above	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LMTD NON-VASC EXTRTY W IMG	$909.60	$1,137.00	$289.94–$1,250.70	—	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 POC US LMTD NON-VASC EXTRTY W IMG	$909.60	$1,137.00	$289.94–$1,250.70	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAZ LUNG CANCER SCR WITHOUT CONTRAST	$433.60	$542.00	$96.13–$596.20	31% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAZ LUNG CANCER SCR WITHOUT CONTRAST	$433.60	$542.00	$138.21–$596.20	—	20%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 XRAY-TIBIA FIBULA 2 VIEWS	$423.20	$529.00	$20.78–$581.90	2% below	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 XRAY-TIBIA FIBULA 2 VIEWS	$423.20	$529.00	$134.90–$581.90	—	20%
MR angiography (MRA) of the head without contrast CPT 70544 MRA-HEAD-W/O CONTRAST	$3,598.40	$4,498.00	$210.94–$4,947.80	23% above	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA-HEAD-W/O CONTRAST	$3,598.40	$4,498.00	$1,146.99–$4,947.80	—	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI-TOES W/O CONTRAST	$4,500.00	$5,625.00	$196.92–$6,187.50	39% above	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI-TOES W/O CONTRAST	$4,500.00	$5,625.00	$1,345.00–$6,187.50	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI-TOES W&W/O CONTRAST	$6,650.40	$8,313.00	$320.79–$9,144.30	42% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI-TOES W&W/O CONTRAST	$6,650.40	$8,313.00	$1,345.00–$9,144.30	—	20%
MRI of the abdomen without contrast CPT 74181 MRI-MRCP W/O CONTRAST	$3,978.40	$4,973.00	$190.96–$5,470.30	44% above	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI-MRCP W/O CONTRAST	$3,978.40	$4,973.00	$1,268.12–$5,470.30	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI-ABDMEN W & W/O CONTRAST	$5,413.60	$6,767.00	$320.79–$7,443.70	24% above	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI-ABDMEN W & W/O CONTRAST	$5,413.60	$6,767.00	$1,345.00–$7,443.70	—	20%
MRI of the brain, no contrast dye CPT 70551 MRI-BRAIN W/O CONTRAST	$4,064.00	$5,080.00	$190.16–$5,588.00	38% above	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI-BRAIN W/O CONTRAST	$4,064.00	$5,080.00	$1,295.40–$5,588.00	—	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI-BRAIN W/&W/O CONTRAST	$6,640.00	$8,300.00	$311.06–$9,130.00	51% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI-BRAIN W/&W/O CONTRAST	$6,640.00	$8,300.00	$1,345.00–$9,130.00	—	20%
MRI of the lower back, no contrast dye CPT 72148 MRI-L-SPINE W/O CONTRAST	$3,944.80	$4,931.00	$186.00–$5,424.10	27% above	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI-L-SPINE W/O CONTRAST	$3,944.80	$4,931.00	$1,257.41–$5,424.10	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI-L-SPINE W/&W/O CONTRAST	$6,685.60	$8,357.00	$312.29–$9,192.70	47% above	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI-L-SPINE W/&W/O CONTRAST	$6,685.60	$8,357.00	$1,345.00–$9,192.70	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI-T-SPINE W/O CONTRAST	$4,182.40	$5,228.00	$185.35–$5,750.80	38% above	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI-T-SPINE W/O CONTRAST	$4,182.40	$5,228.00	$1,333.14–$5,750.80	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI-C-SPINE W/&W/O CONTRAST	$7,256.80	$9,071.00	$313.24–$9,978.10	64% above	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI-C-SPINE W/&W/O CONTRAST	$7,256.80	$9,071.00	$1,345.00–$9,978.10	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI-C-SPINE W/O CONTRAST	$4,432.80	$5,541.00	$185.65–$6,095.10	45% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI-C-SPINE W/O CONTRAST	$4,432.80	$5,541.00	$1,345.00–$6,095.10	—	20%
MRI of the pelvis without and with contrast CPT 72197 MRI-PELVIS W/ & W/O CONTRAST	$7,278.40	$9,098.00	$320.79–$10,007.80	71% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI-PELVIS W/ & W/O CONTRAST	$7,278.40	$9,098.00	$1,345.00–$10,007.80	—	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI-PELVIS W/O CONTRAST	$4,929.60	$6,162.00	$219.39–$6,778.20	91% above	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI-SI JOINTS W/O CONTRAST	$4,929.60	$6,162.00	$219.39–$6,778.20	91% above	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI-SI JOINTS W/O CONTRAST	$4,929.60	$6,162.00	$1,345.00–$6,778.20	—	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI-PELVIS W/O CONTRAST	$4,929.60	$6,162.00	$1,345.00–$6,778.20	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI U EXTR ANY JOINT WO CNTRST	$4,378.40	$5,473.00	$197.26–$6,020.30	64% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI U EXTR ANY JOINT WO CNTRST	$4,378.40	$5,473.00	$1,345.00–$6,020.30	—	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XRAY-SPINE CERVICAL MIN 4/5V	$955.20	$1,194.00	$40.00–$1,313.40	56% above	20%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XRAY-SPINE CERVICAL MIN 4/5V	$955.20	$1,194.00	$304.47–$1,313.40	—	20%
Neck soft tissue CT scan with contrast CPT 70491 CT-NECK W/CONTRAST	$3,147.20	$3,934.00	$161.28–$4,327.40	22% above	20%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT-NECK W/CONTRAST	$3,147.20	$3,934.00	$1,003.17–$4,327.40	—	20%
Neck soft tissue CT scan without contrast CPT 70490 CT-NECK W/O CONTRAST	$2,777.60	$3,472.00	$96.13–$3,819.20	36% above	20%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT-NECK W/O CONTRAST	$2,777.60	$3,472.00	$885.36–$3,819.20	—	20%
Neck soft tissue X-ray CPT 70360 XRAY-NECK SOFT TISSUE	$490.40	$613.00	$17.30–$674.30	53% above	20%
Neck soft tissue X-ray inpatient CPT 70360 XRAY-NECK SOFT TISSUE	$490.40	$613.00	$156.32–$674.30	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM-THALL VIABL STUDY SPECT M	$6,092.80	$7,616.00	$348.12–$8,377.60	51% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM-CARDIAC SPECT STRESS/REST	$6,092.80	$7,616.00	$348.12–$8,377.60	51% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM-CARDIAC SPECT STRESS/REST	$6,092.80	$7,616.00	$1,942.08–$8,377.60	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM-THALL VIABL STUDY SPECT M	$6,092.80	$7,616.00	$1,942.08–$8,377.60	—	20%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET CT TUMOR SKULL/MID TH	$8,000.00	$10,000.00	$1,314.83–$11,000.00	11% above	20%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET CT TUMOR SKULL/MID TH	$8,000.00	$10,000.00	$2,550.00–$11,000.00	—	20%
Pelvic CT scan without contrast CPT 72192 CT-PELVIS W/O CONTRAST	$3,365.60	$4,207.00	$96.13–$4,627.70	72% above	20%
Pelvic CT scan without contrast inpatient CPT 72192 CT-PELVIS W/O CONTRAST	$3,365.60	$4,207.00	$1,072.79–$4,627.70	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 POC US PELVIS LTD OR F/U (NON OB	$644.00	$805.00	$42.17–$885.50	14% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 POC US SOFT TISSUE US PELVIC WALL	$644.00	$805.00	$42.17–$885.50	14% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US-PELVIS LTD OR F/U (NON OB	$644.00	$805.00	$42.17–$885.50	14% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 POC US PELVIS LTD OR F/U (NON OB	$644.00	$805.00	$205.28–$885.50	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 POC US SOFT TISSUE US PELVIC WALL	$644.00	$805.00	$205.28–$885.50	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US-PELVIS LTD OR F/U (NON OB	$644.00	$805.00	$205.28–$885.50	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US-PELVIS COMPLETE/NON-OB	$1,202.40	$1,503.00	$67.65–$1,653.30	28% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US-PELVIS COMPLETE/NON-OB	$1,202.40	$1,503.00	$383.27–$1,653.30	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US-PREGNANCY 14-17 WEEKS	$1,116.00	$1,395.00	$96.13–$1,534.50	24% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US-PREGNANCY 14-17 WEEKS	$1,116.00	$1,395.00	$355.73–$1,534.50	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US-PREG 1ST TRIMESTER COMPLE	$1,060.00	$1,325.00	$96.13–$1,457.50	29% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US-PREG 1ST TRIMESTER COMPLE	$1,060.00	$1,325.00	$337.88–$1,457.50	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US-PREG LTD SZ/POS/FETL LOC	$701.60	$877.00	$76.53–$964.70	16% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 POC US PREG LTD SZ/POS/FETL LOC	$701.60	$877.00	$76.53–$964.70	16% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US-OB LTD STUDY	$701.60	$877.00	$76.53–$964.70	16% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US-OB LTD STUDY	$701.60	$877.00	$223.64–$964.70	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US-PREG LTD SZ/POS/FETL LOC	$701.60	$877.00	$223.64–$964.70	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 POC US PREG LTD SZ/POS/FETL LOC	$701.60	$877.00	$223.64–$964.70	—	20%
Rib X-ray, one side, 2 views one side CPT 71100 XRAY-RIBS UNILAT 2 VIEWS	$629.60	$787.00	$27.16–$865.70	36% above	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XRAY-RIBS UNILAT 2 VIEWS	$629.60	$787.00	$200.69–$865.70	—	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XRAY-RIBS UNILAT W/PA CHEST	$616.80	$771.00	$32.32–$848.10	at median	20%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XRAY-RIBS UNILAT W/PA CHEST	$616.80	$771.00	$196.61–$848.10	—	20%
Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD	$460.00	$575.00	$119.45–$632.50	—	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO BI INCL CAD	$460.00	$575.00	$146.63–$632.50	—	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 XRAY-SHOULDER 2+ VIEWS	$673.60	$842.00	$25.86–$926.20	20% above	20%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XRAY-SHOULDER 2+ VIEWS	$673.60	$842.00	$214.71–$926.20	—	20%
Sinus X-ray, complete, 3 or more views CPT 70220 XRAY-SINUSES COMPLETE MIN 3V	$501.60	$627.00	$33.35–$689.70	10% above	20%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XRAY-SINUSES COMPLETE MIN 3V	$501.60	$627.00	$159.89–$689.70	—	20%
Skull X-ray, fewer than 4 views CPT 70250 XRAY-SKULL LTD <4V	$566.40	$708.00	$25.98–$778.80	34% above	20%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XRAY-SKULL LTD <4V	$566.40	$708.00	$180.54–$778.80	—	20%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 STRESS TTE COMPLETE	$3,178.40	$3,973.00	$247.29–$4,370.30	at median	20%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 STRESS TTE COMPLETE	$3,178.40	$3,973.00	$1,013.12–$4,370.30	—	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XRAY XM SWALLOW VIDEO CONTRAST STUDY	$889.60	$1,112.00	$51.91–$1,223.20	34% above	20%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XRAY XM SWALLOW VIDEO CONTRAST STUDY	$889.60	$1,112.00	$283.56–$1,223.20	—	20%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 XRAY FEMUR 2+ VIEWS	$368.80	$461.00	$29.15–$507.10	5% below	20%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 XRAY FEMUR 2+ VIEWS	$368.80	$461.00	$117.56–$507.10	—	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT-T-SPINE W/O CONTRAST	$3,342.40	$4,178.00	$96.13–$4,595.80	19% above	20%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT-T-SPINE W/O CONTRAST	$3,342.40	$4,178.00	$1,065.39–$4,595.80	—	20%
Toe X-ray, 2 or more views CPT 73660 XRAY-TOES MIN 2 VIEWS	$446.40	$558.00	$15.59–$613.80	35% above	20%
Toe X-ray, 2 or more views inpatient CPT 73660 XRAY-TOES MIN 2 VIEWS	$446.40	$558.00	$142.29–$613.80	—	20%
Transvaginal pelvic ultrasound CPT 76830 POC US TRANSVAGINAL NON OB	$931.20	$1,164.00	$67.65–$1,280.40	30% above	20%
Transvaginal pelvic ultrasound CPT 76830 US-TRANSVAGINAL ULTRASOUND	$931.20	$1,164.00	$67.65–$1,280.40	30% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 POC US TRANSVAGINAL NON OB	$931.20	$1,164.00	$296.82–$1,280.40	—	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 US-TRANSVAGINAL ULTRASOUND	$931.20	$1,164.00	$296.82–$1,280.40	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 US-TRANSVAGINAL PREGNANCY	$1,032.00	$1,290.00	$87.23–$1,419.00	52% above	20%
Transvaginal ultrasound during pregnancy CPT 76817 POC US TRANSVAGINAL PREGNANCY	$1,032.00	$1,290.00	$87.23–$1,419.00	52% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 POC US TRANSVAGINAL PREGNANCY	$1,032.00	$1,290.00	$328.95–$1,419.00	—	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US-TRANSVAGINAL PREGNANCY	$1,032.00	$1,290.00	$328.95–$1,419.00	—	20%
Ultrasound of the abdomen, complete CPT 76700 US-ABDOMEN COMPLETE	$1,377.60	$1,722.00	$83.20–$1,894.20	22% above	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 US-ABDOMEN COMPLETE	$1,377.60	$1,722.00	$439.11–$1,894.20	—	20%
Ultrasound of the scrotum and testicles CPT 76870 US-SCROTUM/TESTICLE	$1,132.80	$1,416.00	$59.78–$1,557.60	27% above	20%
Ultrasound of the scrotum and testicles CPT 76870 POC US SCROTUM/TESTICLE	$1,132.80	$1,416.00	$59.78–$1,557.60	27% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US-SCROTUM/TESTICLE	$1,132.80	$1,416.00	$361.08–$1,557.60	—	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 POC US SCROTUM/TESTICLE	$1,132.80	$1,416.00	$361.08–$1,557.60	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US-THYROID/SOFT TISS-HEAD&NE	$997.60	$1,247.00	$59.74–$1,371.70	19% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 POC US THYROID/SOFT TISSUS-HEAD&NE	$997.60	$1,247.00	$59.74–$1,371.70	19% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US-THYROID/SOFT TISS-HEAD&NE	$997.60	$1,247.00	$317.99–$1,371.70	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 POC US THYROID/SOFT TISSUS-HEAD&NE	$997.60	$1,247.00	$317.99–$1,371.70	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XRAY XM UGI TRC SINGLE CONTRAST STUDY	$1,013.60	$1,267.00	$102.03–$1,393.70	65% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XRAY XM UGI TRC SINGLE CONTRAST STUDY	$1,013.60	$1,267.00	$323.09–$1,393.70	—	20%
Upper arm X-ray (humerus), 2 views CPT 73060 XRAY-HUMERUS 2 VIEWS	$609.60	$762.00	$20.78–$838.20	43% above	20%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 XRAY-HUMERUS 2 VIEWS	$609.60	$762.00	$194.31–$838.20	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 POC US VENOUS EXT UNILAT COMP	$1,341.60	$1,677.00	$84.56–$1,844.70	50% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US-VENOUS EXT UNILAT COMP	$1,341.60	$1,677.00	$84.56–$1,844.70	50% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US-VENOUS EXT UNILAT COMP	$1,341.60	$1,677.00	$427.64–$1,844.70	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 POC US VENOUS EXT UNILAT COMP	$1,341.60	$1,677.00	$427.64–$1,844.70	—	20%
Wrist X-ray, 2 views CPT 73100 XRAY-WRIST 2 VIEWS	$516.00	$645.00	$17.30–$709.50	33% above	20%
Wrist X-ray, 2 views inpatient CPT 73100 XRAY-WRIST 2 VIEWS	$516.00	$645.00	$164.48–$709.50	—	20%
Wrist X-ray, complete, 3 or more views CPT 73110 XRAY-WRIST 3+ VIEWS	$620.80	$776.00	$25.14–$853.60	23% above	20%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 XRAY-WRIST 3+ VIEWS	$620.80	$776.00	$197.88–$853.60	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XRAY HIP UNILAT 2/3 VWS W/PELVIS IF DONE	$374.40	$468.00	$37.28–$514.80	11% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XRAY HIP UNILAT 2/3 VWS W/PELVIS IF DONE	$374.40	$468.00	$119.34–$514.80	—	20%
X-ray of the abdomen, 1 view CPT 74018 XRAY EXAM ABDOMEN 1 VIEW	$412.80	$516.00	$24.63–$567.60	37% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 XRAY EXAM ABDOMEN 1 VIEW	$412.80	$516.00	$131.58–$567.60	—	20%
X-ray of the ankle, 2 views CPT 73600 XRAY-ANKLE 2 VIEWS	$562.40	$703.00	$19.02–$773.30	43% above	20%
X-ray of the ankle, 2 views inpatient CPT 73600 XRAY-ANKLE 2 VIEWS	$562.40	$703.00	$179.27–$773.30	—	20%
X-ray of the finger(s), 2 or more views CPT 73140 XRAY-FINGERS MIN 2 VIEWS	$412.80	$516.00	$15.59–$567.60	10% above	20%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 XRAY-FINGERS MIN 2 VIEWS	$412.80	$516.00	$131.58–$567.60	—	20%
X-ray of the foot, 2 views CPT 73620 XRAY-FOOT 2 VIEWS	$541.60	$677.00	$17.30–$744.70	34% above	20%
X-ray of the foot, 2 views inpatient CPT 73620 XRAY-FOOT 2 VIEWS	$541.60	$677.00	$172.64–$744.70	—	20%
X-ray of the foot, complete, 3 or more views CPT 73630 XRAY-FOOT 3+ VIEWS	$640.00	$800.00	$24.22–$880.00	24% above	20%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XRAY-FOOT 3+ VIEWS	$640.00	$800.00	$204.00–$880.00	—	20%
X-ray of the hand, 3 or more views CPT 73130 XRAY-HAND 3+ VIEWS	$530.40	$663.00	$25.14–$729.30	4% above	20%
X-ray of the hand, 3 or more views inpatient CPT 73130 XRAY-HAND 3+ VIEWS	$530.40	$663.00	$169.07–$729.30	—	20%
X-ray of the knee, 1 or 2 views CPT 73560 XRAY-KNEE 2 VIEWS	$416.00	$520.00	$19.02–$572.00	9% above	20%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XRAY-KNEE 2 VIEWS	$416.00	$520.00	$132.60–$572.00	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XRAY-SPINE LUMBAR 2/3 VIEWS	$569.60	$712.00	$30.29–$783.20	15% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XRAY-SPINE LUMBAR 2/3 VIEWS	$569.60	$712.00	$181.56–$783.20	—	20%
X-ray of the lower back, 4 or more views CPT 72110 XRAY-SPINE LUMBAR MIN 4 VIEW	$873.60	$1,092.00	$43.85–$1,201.20	29% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XRAY-SPINE LUMBAR MIN 4 VIEW	$873.60	$1,092.00	$278.46–$1,201.20	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XRAY-THORACIC 2V	$588.80	$736.00	$28.04–$809.60	27% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XRAY-THORACIC 2V	$588.80	$736.00	$187.68–$809.60	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 XRAY-NASAL BONES	$672.00	$840.00	$24.79–$924.00	48% above	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XRAY-NASAL BONES	$672.00	$840.00	$214.20–$924.00	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XRAY-SPINE CERV <=3 VIEWS	$642.40	$803.00	$25.98–$883.30	41% above	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XRAY-SPINE CERV <=3 VIEWS	$642.40	$803.00	$204.77–$883.30	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 XRAY-PELVIS 1/2 VIEWS	$544.80	$681.00	$21.62–$749.10	38% above	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XRAY-PELVIS 1/2 VIEWS	$544.80	$681.00	$173.66–$749.10	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XRAY-SACRUM AND COCCYX	$666.40	$833.00	$25.02–$916.30	38% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XRAY-SACRUM AND COCCYX	$666.40	$833.00	$212.42–$916.30	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs California	Off list
ACTH blood test CPT 82024 ACTH;Q	$19.20	$24.00	$6.00–$196.23	72% below	20%
ACTH blood test inpatient CPT 82024 ACTH;Q	$19.20	$24.00	$6.12–$26.40	—	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT (ALT)	$56.70	$70.87	$4.58–$77.96	31% above	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT (ALT)	$56.70	$70.87	$18.07–$77.96	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT (AST)	$52.40	$65.49	$4.41–$72.04	16% above	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT (AST)	$52.40	$65.49	$16.70–$72.04	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS ACUTE PNL	$290.73	$363.41	$34.86–$399.75	7% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS ACUTE PNL	$384.70	$480.87	$122.62–$528.96	—	20%
Albumin blood test CPT 82040 ALBUMIN SERUM	$58.97	$73.71	$4.02–$81.08	136% above	20%
Albumin blood test inpatient CPT 82040 ALBUMIN SERUM	$72.51	$90.63	$23.11–$99.69	—	20%
Aldosterone blood test CPT 82088 ALDOSTERONE, SERUM;Q	$20.68	$25.85	$6.46–$207.06	48% below	20%
Aldosterone blood test CPT 82088 ALDOSTERONE24HRURINE;Q	$45.22	$56.52	$14.13–$207.06	13% above	20%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE, SERUM;Q	$20.68	$25.85	$6.59–$28.44	—	20%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE24HRURINE;Q	$45.22	$56.52	$14.41–$62.17	—	20%
Alkaline phosphatase (ALP) blood test CPT 84075 ALP BONE SPECIFIC;Q	$25.70	$32.12	$4.13–$35.33	30% below	20%
Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE	$28.80	$36.00	$4.13–$39.60	22% below	20%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALP BONE SPECIFIC;Q	$25.70	$32.12	$8.19–$35.33	—	20%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE	$35.20	$44.00	$11.22–$48.40	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN, INDIVIDUAL;Q	$13.15	$16.43	$4.11–$18.07	58% above	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN, INDIVIDUAL;Q	$13.15	$16.43	$4.19–$18.07	—	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP	$119.79	$149.73	$15.09–$164.70	27% above	20%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP	$163.20	$204.00	$52.02–$224.40	—	20%
Ammonia blood test CPT 82140 AMMONIA	$177.34	$221.67	$12.95–$243.84	2% below	20%
Ammonia blood test inpatient CPT 82140 AMMONIA	$228.00	$285.00	$72.68–$313.50	—	20%
Amylase blood test CPT 82150 AMYLASE,PANC.FLUID;REDPATH	$15.17	$18.96	$4.74–$32.93	77% below	20%
Amylase blood test CPT 82150 AMYLASE SERUM	$123.64	$154.55	$5.73–$170.01	86% above	20%
Amylase blood test CPT 82150 AMYLASE RANDOM URINE	$166.52	$208.15	$5.73–$228.97	150% above	20%
Amylase blood test CPT 82150 AMYLASE BODY FLUID	$166.52	$208.15	$5.73–$228.97	150% above	20%
Amylase blood test inpatient CPT 82150 AMYLASE,PANC.FLUID;REDPATH	$15.17	$18.96	$4.83–$20.86	—	20%
Amylase blood test inpatient CPT 82150 AMYLASE RANDOM URINE	$166.52	$208.15	$53.08–$228.97	—	20%
Amylase blood test inpatient CPT 82150 AMYLASE BODY FLUID	$166.52	$208.15	$53.08–$228.97	—	20%
Amylase blood test inpatient CPT 82150 AMYLASE SERUM	$166.52	$208.15	$53.08–$228.97	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEP;Q	$32.64	$40.80	$7.10–$44.88	37% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEP;Q	$32.64	$40.80	$10.40–$44.88	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB;Q	$13.60	$17.00	$4.25–$35.44	74% below	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR AB;Q	$13.60	$17.00	$4.34–$18.70	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT PROBNP;Q	$101.92	$127.39	$30.15–$140.13	51% below	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BTYPE NATRIURETIC PEPTIDE BNP	$230.68	$288.34	$30.15–$317.17	10% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT PROBNP;Q	$101.92	$127.39	$32.48–$140.13	—	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BTYPE NATRIURETIC PEPTIDE BNP	$302.40	$378.00	$96.39–$415.80	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 LEGIONELLA CULTURE;Q	$20.50	$25.62	$6.41–$28.18	85% below	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 H PYLORI CULTURE;ARUP	$32.27	$40.33	$7.51–$44.36	76% below	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 SKIN WOUND CULTURE	$138.03	$172.53	$7.51–$189.78	4% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 STERILE FLD CULT (AER & ANA)	$138.03	$172.53	$7.51–$189.78	4% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 EAR CULTURE	$138.03	$172.53	$7.51–$189.78	4% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 EYE CULTURE	$138.03	$172.53	$7.51–$189.78	4% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 GENITAL CULTURE (AER&ANA)	$188.46	$235.57	$7.51–$259.13	42% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 RESP CULTURE (AER & ANA)	$188.46	$235.57	$7.51–$259.13	42% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 WOUND CULTURE (AER & ANA)	$188.46	$235.57	$7.51–$259.13	42% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 LEGIONELLA CULTURE;Q	$20.50	$25.62	$6.53–$28.18	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 H PYLORI CULTURE;ARUP	$32.27	$40.33	$10.28–$44.36	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 GENITAL CULTURE (AER&ANA)	$188.46	$235.57	$60.07–$259.13	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 RESP CULTURE (AER & ANA)	$188.46	$235.57	$60.07–$259.13	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 STERILE FLD CULT (AER & ANA)	$188.46	$235.57	$60.07–$259.13	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 WOUND CULTURE (AER & ANA)	$188.46	$235.57	$60.07–$259.13	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 EAR CULTURE	$188.46	$235.57	$60.07–$259.13	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 EYE CULTURE	$188.46	$235.57	$60.07–$259.13	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 SKIN WOUND CULTURE	$188.46	$235.57	$60.07–$259.13	—	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$146.40	$183.00	$7.27–$201.30	24% below	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$146.40	$183.00	$46.67–$201.30	—	20%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$87.27	$109.08	$20.28–$25.49	93% above	20%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL	$87.27	$109.08	$27.82–$119.99	—	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV SURGICAL PATHOLOGY;UCLA	$156.88	$196.10	$40.99–$270.44	21% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV SURGICAL PATH	$160.00	$200.00	$40.99–$270.44	23% above	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV SURGICAL PATHOLOGY;UCLA	$156.88	$196.10	$50.01–$215.71	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV SURGICAL PATH	$160.00	$200.00	$51.00–$220.00	—	20%
Blood culture for bacteria CPT 87040 BLOOD CULTURE	$176.00	$220.00	$8.98–$242.00	35% below	20%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE	$176.00	$220.00	$56.10–$242.00	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE ROUTINE	$46.40	$58.00	$6.21–$63.80	132% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 DRAWING FEE	$46.40	$58.00	$6.21–$63.80	132% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 DRAWING FEE OP	$46.40	$58.00	$6.21–$63.80	132% above	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 DRAWING FEE OP	$46.40	$58.00	$14.79–$63.80	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 DRAWING FEE	$46.40	$58.00	$14.79–$63.80	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE ROUTINE	$46.40	$58.00	$14.79–$63.80	—	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE SERUM RANDOM	$58.80	$73.50	$3.30–$80.85	57% above	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE 1 HR PP	$58.80	$73.50	$3.30–$80.85	57% above	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE 2 HR PP	$58.80	$73.50	$3.30–$80.85	57% above	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE 2 HR PP	$81.42	$101.77	$25.95–$111.95	—	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE 1 HR PP	$81.42	$101.77	$25.95–$111.95	—	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE SERUM RANDOM	$81.42	$101.77	$25.95–$111.95	—	20%
Blood lead test CPT 83655 LEAD WHOLE BLOOD;Q	$14.40	$18.00	$4.50–$61.47	20% above	20%
Blood lead test CPT 83655 HEAVY METAL LEAD;Q	$17.62	$22.02	$5.51–$61.47	47% above	20%
Blood lead test inpatient CPT 83655 LEAD WHOLE BLOOD;Q	$14.40	$18.00	$4.59–$19.80	—	20%
Blood lead test inpatient CPT 83655 HEAVY METAL LEAD;Q	$17.62	$22.02	$5.62–$24.22	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY TEST SERUM	$104.71	$130.88	$6.46–$143.97	40% below	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY TEST, POINT OF CARE	$104.71	$130.88	$6.46–$143.97	40% below	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY TEST SERUM	$179.10	$223.87	$57.09–$246.26	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY TEST, POINT OF CARE	$179.10	$223.87	$57.09–$246.26	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO	$173.60	$217.00	$2.38–$292.25	65% above	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO	$173.60	$217.00	$55.34–$238.70	—	20%
Blood urea nitrogen (BUN) test CPT 84520 UREA, CAPD	$21.72	$27.14	$3.15–$29.85	41% below	20%
Blood urea nitrogen (BUN) test CPT 84520 BUN SERUM OR PLASMA	$21.72	$27.14	$3.15–$29.85	41% below	20%
Blood urea nitrogen (BUN) test CPT 84520 UREA DIALYSATE	$21.72	$27.14	$3.15–$29.85	41% below	20%
Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA DIALYSATE	$30.40	$38.00	$9.69–$41.80	—	20%
Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA, CAPD	$30.40	$38.00	$9.69–$41.80	—	20%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN SERUM OR PLASMA	$30.40	$38.00	$9.69–$41.80	—	20%
C-peptide blood test CPT 84681 C-PEPTIDE;Q	$24.00	$30.00	$7.50–$93.13	62% below	20%
C-peptide blood test inpatient CPT 84681 C-PEPTIDE;Q	$24.00	$30.00	$7.65–$33.00	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP INFLAMMATION	$44.75	$55.93	$4.60–$61.52	35% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP INFLAMMATION	$72.00	$90.00	$22.95–$99.00	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFFICILE PCR	$272.00	$340.00	$28.64–$374.00	78% above	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFFICILE PCR	$272.00	$340.00	$86.70–$374.00	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 TUMOR ANTIGEN	$70.40	$88.00	$18.50–$96.80	25% above	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 TUMOR ANTIGEN	$120.00	$150.00	$38.25–$165.00	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA125 TUMOR ANTIGEN	$44.68	$55.85	$13.96–$61.44	68% below	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA125 TUMOR ANTIGEN	$80.80	$101.00	$25.76–$111.10	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID 19;VCH	$92.00	$115.00	$28.75–$126.50	at median	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID 19;VCH	$92.00	$115.00	$29.33–$126.50	—	20%
Calcium blood test, total CPT 82310 CALCIUM SERUM OR PLASMA	$37.31	$46.63	$4.10–$51.29	40% below	20%
Calcium blood test, total CPT 82310 CALCIUM RANDOM URINE	$38.40	$48.00	$4.10–$52.80	38% below	20%
Calcium blood test, total CPT 82310 CALCIUM BODY FLUID	$38.40	$48.00	$4.10–$52.80	38% below	20%
Calcium blood test, total inpatient CPT 82310 CALCIUM BODY FLUID	$51.20	$64.00	$16.32–$70.40	—	20%
Calcium blood test, total inpatient CPT 82310 CALCIUM RANDOM URINE	$51.20	$64.00	$16.32–$70.40	—	20%
Calcium blood test, total inpatient CPT 82310 CALCIUM SERUM OR PLASMA	$51.29	$64.11	$16.35–$70.52	—	20%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA, PANC. FLUID; REDPATH	$20.00	$25.00	$6.25–$55.62	81% below	20%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA	$175.43	$219.28	$16.85–$241.21	65% above	20%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA, PANC. FLUID; REDPATH	$20.00	$25.00	$6.38–$27.50	—	20%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA	$239.12	$298.90	$76.22–$328.79	—	20%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA-ZOSTER AB;Q	$10.60	$13.25	$3.31–$37.78	72% below	20%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB, IGG	$31.20	$39.00	$9.75–$42.90	18% below	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA-ZOSTER AB;Q	$10.60	$13.25	$3.38–$14.58	—	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB, IGG	$37.92	$47.39	$12.08–$52.13	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACH AMPLIFIED DN	$124.80	$156.00	$25.59–$171.60	129% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACH AMPLIFIED DN	$84.22	$105.27	$26.84–$115.80	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$114.43	$143.03	$11.54–$157.33	at median	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$151.20	$189.00	$48.20–$207.90	—	20%
Complete blood count (CBC) with differential CPT 85025 CBC W/AUTOMATED DIFF	$124.00	$155.00	$6.75–$170.50	12% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/AUTOMATED DIFF	$124.00	$155.00	$39.53–$170.50	—	20%
Complete blood count (CBC), no differential CPT 85027 HEMOGRAM W/PLT CT	$92.00	$115.00	$5.71–$126.50	6% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM W/PLT CT	$92.00	$115.00	$29.33–$126.50	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$164.80	$206.00	$9.19–$226.60	35% below	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$164.80	$206.00	$52.53–$226.60	—	20%
Cortisol blood test, total CPT 82533 CORTISOL SERUM OR PLASMA	$132.72	$165.90	$14.49–$182.49	34% above	20%
Cortisol blood test, total inpatient CPT 82533 CORTISOL SERUM OR PLASMA	$132.72	$165.90	$42.30–$182.49	—	20%
Creatine kinase (CK) blood test, total CPT 82550 CPK	$122.40	$153.00	$5.79–$168.30	40% above	20%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK	$122.40	$153.00	$39.02–$168.30	—	20%
Creatinine blood test CPT 82565 CREATININE SERUM OR PLASMA	$69.69	$87.11	$4.31–$95.82	46% above	20%
Creatinine blood test inpatient CPT 82565 CREATININE SERUM OR PLASMA	$69.69	$87.11	$22.21–$95.82	—	20%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV AB, IGG;Q	$15.53	$19.41	$4.85–$73.12	50% below	20%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV IGG ABS;Q	$15.53	$19.41	$4.85–$73.12	50% below	20%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV SCREEN	$73.60	$92.00	$12.38–$101.20	135% above	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV IGG ABS;Q	$15.53	$19.41	$4.95–$21.35	—	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV AB, IGG;Q	$15.53	$19.41	$4.95–$21.35	—	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV SCREEN	$73.60	$92.00	$23.46–$101.20	—	20%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER, QUANTITATIVE	$105.28	$131.60	$9.05–$144.76	27% below	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER, QUANTITATIVE	$121.60	$152.00	$38.76–$167.20	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE;Q	$13.76	$17.20	$4.30–$112.97	86% below	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE;Q	$13.76	$17.20	$4.39–$18.92	—	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ETHYL ALCOHOL URINE;Q	$34.62	$43.27	$10.82–$288.14	52% below	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TOX MONITORING 8 SCREEN, URINE;Q	$72.60	$90.74	$22.69–$288.14	2% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG MONITORING, PNL 1, WITH CONF. URINE;Q	$94.20	$117.74	$29.44–$288.14	32% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TOXICOLOGY MONITORING 9 SCREEN, URINE ;Q	$96.15	$120.18	$30.05–$288.14	35% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG PNL UMBILICAL CORD;ARUP	$97.60	$122.00	$30.50–$288.14	37% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN-SERUM;Q	$112.00	$140.00	$35.00–$288.14	57% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 UR DRUGS OF ABUSE SCREEN	$220.32	$275.40	$43.50–$302.94	208% above	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ETHYL ALCOHOL URINE;Q	$34.62	$43.27	$11.03–$47.60	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TOX MONITORING 8 SCREEN, URINE;Q	$72.60	$90.74	$23.14–$99.81	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG MONITORING, PNL 1, WITH CONF. URINE;Q	$94.20	$117.74	$30.02–$129.51	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TOXICOLOGY MONITORING 9 SCREEN, URINE ;Q	$96.15	$120.18	$30.65–$132.20	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG PNL UMBILICAL CORD;ARUP	$97.60	$122.00	$31.11–$134.20	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN-SERUM;Q	$112.00	$140.00	$35.70–$154.00	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 UR DRUGS OF ABUSE SCREEN	$408.00	$510.00	$130.05–$561.00	—	20%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL	$191.23	$239.03	$6.23–$262.93	119% above	20%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL	$191.23	$239.03	$60.95–$262.93	—	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN BARR VCA VCA,I;Q	$23.80	$29.74	$7.44–$88.57	13% below	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN BARR VCA VCA,I;Q	$23.80	$29.74	$7.58–$32.71	—	20%
Estradiol blood test CPT 82670 ESTRADIOL; TOTAL	$84.80	$106.00	$24.71–$141.98	8% below	20%
Estradiol blood test inpatient CPT 82670 ESTRADIOL; TOTAL	$102.40	$128.00	$32.64–$140.80	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH;Q	$13.60	$17.00	$4.25–$94.40	87% below	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH PEDS;Q	$28.63	$35.78	$8.95–$94.40	72% below	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH;Q	$13.60	$17.00	$4.34–$18.70	—	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH PEDS;Q	$28.63	$35.78	$9.12–$39.36	—	20%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL;Q	$106.76	$133.45	$17.45–$146.80	47% above	20%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN FECAL;Q	$106.76	$133.45	$34.03–$146.80	—	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN;Q	$9.80	$12.25	$3.06–$69.21	91% below	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$158.87	$198.58	$12.07–$218.44	48% above	20%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN;Q	$9.80	$12.25	$3.12–$13.48	—	20%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$193.15	$241.43	$61.56–$265.57	—	20%
Fibrinogen blood test CPT 85384 FIBRINOGEN	$173.16	$216.45	$7.63–$238.10	20% above	20%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN	$173.16	$216.45	$55.19–$238.10	—	20%
Folate (folic acid) blood test CPT 82746 FOLATE (FOLIC ACID, SERUM)	$142.96	$178.69	$13.07–$196.56	31% above	20%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE (FOLIC ACID, SERUM)	$161.37	$201.71	$51.44–$221.88	—	20%
Free T3 thyroid hormone test CPT 84481 T3, FREE;Q	$15.20	$19.00	$4.75–$49.68	85% below	20%
Free T3 thyroid hormone test CPT 84481 T3, FREE	$76.80	$96.00	$11.93–$105.60	25% below	20%
Free T3 thyroid hormone test inpatient CPT 84481 T3, FREE;Q	$15.20	$19.00	$4.85–$20.90	—	20%
Free T3 thyroid hormone test inpatient CPT 84481 T3, FREE	$92.80	$116.00	$29.58–$127.60	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE FTI;Q	$22.32	$27.90	$6.98–$45.81	67% below	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4	$98.56	$123.20	$7.91–$135.52	45% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE FTI;Q	$22.32	$27.90	$7.11–$30.69	—	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4	$165.63	$207.03	$52.79–$227.73	—	20%
Free testosterone test CPT 84402 TESTOSTERONE FREE;Q	$23.80	$29.75	$7.44–$129.41	20% below	20%
Free testosterone test CPT 84402 TESTOSTERONE, FREE MALE;Q	$44.00	$55.00	$13.75–$129.41	48% above	20%
Free testosterone test CPT 84402 TESTOSTERONE,FREE-FEMALE OR CHILD;ARUP	$44.61	$55.76	$13.94–$129.41	50% above	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE;Q	$23.80	$29.75	$7.59–$32.73	—	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE MALE;Q	$44.00	$55.00	$14.03–$60.50	—	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE,FREE-FEMALE OR CHILD;ARUP	$44.61	$55.76	$14.22–$61.34	—	20%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GAMMA GT	$43.54	$54.42	$6.40–$59.86	2% below	20%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GAMMA GT	$65.01	$81.26	$20.72–$89.39	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 DIABETIC SCREEN GEST	$16.00	$20.00	$4.19–$24.10	68% below	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 1 HR PG	$16.00	$20.00	$4.19–$24.10	68% below	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 2 HR PG	$16.00	$20.00	$4.19–$24.10	68% below	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 DIABETIC SCREEN GEST	$16.00	$20.00	$5.10–$22.00	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 2 HR PG	$16.00	$20.00	$5.10–$22.00	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 1 HR PG	$16.00	$20.00	$5.10–$22.00	—	20%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST 2 HR	$88.46	$110.57	$11.27–$121.63	36% below	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST 2 HR	$120.80	$151.00	$38.51–$166.10	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC (N GONORRHOR) AMPLIFED DNA	$84.22	$105.27	$25.36–$115.80	28% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC (N GONORRHOR) AMPLIFED DNA	$84.22	$105.27	$26.84–$115.80	—	20%
H. pylori antibody blood test CPT 86677 H.PYLORI AB, IGG	$100.96	$126.19	$12.95–$138.81	11% below	20%
H. pylori antibody blood test inpatient CPT 86677 H.PYLORI AB, IGG	$132.89	$166.11	$42.36–$182.72	—	20%
H. pylori stool antigen test CPT 87338 H. PYLORI STOOL ANTIGEN	$128.00	$160.00	$12.79–$176.00	52% above	20%
H. pylori stool antigen test inpatient CPT 87338 H. PYLORI STOOL ANTIGEN	$128.00	$160.00	$40.80–$176.00	—	20%
HIV viral load test (HIV-1 RNA, quantitative) one side CPT 87536 HIV-1 RNA QNT RT PCR;Q	$56.00	$70.00	$17.50–$249.48	49% below	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient one side CPT 87536 HIV-1 RNA QNT RT PCR;Q	$56.00	$70.00	$17.85–$77.00	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV AG AB SINGLE RESULT	$130.40	$163.00	$20.26–$179.30	49% above	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV AG AB SINGLE RESULT	$130.40	$163.00	$41.57–$179.30	—	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 INFECTIOUS AGENT HPV HIGH RISK	$84.22	$105.27	$26.32–$115.80	38% below	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 INFECTIOUS AGENT HPV HIGH RISK	$84.22	$105.27	$26.84–$115.80	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 CARDIO IQ HA1C;Q	$12.80	$16.00	$4.00–$28.46	80% below	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCATED HEMOGLOBIN A1C	$100.15	$125.18	$8.54–$137.70	53% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 CARDIO IQ HA1C;Q	$12.80	$16.00	$4.08–$17.60	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCATED HEMOGLOBIN A1C	$139.52	$174.39	$44.47–$191.83	—	20%
Hemoglobin blood test CPT 85018 HEMOGLOBIN;Q	$3.20	$3.99	$1.00–$6.93	92% below	20%
Hemoglobin blood test CPT 85018 HEMOCUE/HEMOGLOBIN	$34.19	$42.73	$2.07–$47.00	15% below	20%
Hemoglobin blood test CPT 85018 HEMOGLOBIN	$56.87	$71.08	$2.07–$78.19	41% above	20%
Hemoglobin blood test CPT 85018 HEMOGLOBIN-NOVA	$56.87	$71.08	$2.07–$78.19	41% above	20%
Hemoglobin blood test CPT 85018 POC HEMOGLOBIN	$56.87	$71.08	$2.07–$78.19	41% above	20%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN;Q	$3.20	$3.99	$1.02–$4.39	—	20%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN-NOVA	$56.87	$71.08	$18.13–$78.19	—	20%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN	$56.87	$71.08	$18.13–$78.19	—	20%
Hemoglobin blood test inpatient CPT 85018 HEMOCUE/HEMOGLOBIN	$56.87	$71.08	$18.13–$78.19	—	20%
Hemoglobin blood test inpatient CPT 85018 POC HEMOGLOBIN	$56.87	$71.08	$18.13–$78.19	—	20%
Hepatitis B core antibody test (total) CPT 86704 HEP B CORE TOT AB	$48.04	$60.04	$10.71–$66.04	27% above	20%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEP B CORE TOT AB	$65.60	$82.00	$20.91–$90.20	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SFC AB	$83.60	$104.49	$9.51–$114.94	96% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SFC AB	$83.60	$104.49	$26.64–$114.94	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SFC AG	$112.80	$141.00	$9.12–$155.10	57% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SFC AG	$112.80	$141.00	$35.96–$155.10	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB	$117.98	$147.47	$12.57–$162.22	100% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB	$117.98	$147.47	$37.60–$162.22	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C QUANT (PCR);Q	$78.40	$98.00	$24.50–$125.59	11% below	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C QUANT (PCR);Q	$78.40	$98.00	$24.99–$107.80	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV IGG I&II;Q	$15.18	$18.97	$4.74–$38.67	22% below	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV IGG I&II;Q	$15.18	$18.97	$4.84–$20.87	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IGG TYPE-SPEC AB;Q	$18.54	$23.17	$5.79–$56.74	23% below	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IGG TYPE-SPEC AB;Q	$18.54	$23.17	$5.91–$25.49	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 CARDIO IQ HSCRP;Q	$28.96	$36.20	$9.05–$39.82	57% below	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP ULTRASENSITIVE	$99.78	$124.72	$11.06–$137.19	47% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CARDIO IQ HSCRP;Q	$28.96	$36.20	$9.23–$39.82	—	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP ULTRASENSITIVE	$153.82	$192.27	$49.03–$211.50	—	20%
Homocysteine blood test CPT 83090 HOMOCYSTEINE;Q	$20.80	$26.00	$6.50–$49.45	71% below	20%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE;Q	$20.80	$26.00	$6.63–$28.60	—	20%
Insulin blood test CPT 83525 INSULIN;Q	$14.40	$18.00	$4.50–$58.07	68% below	20%
Insulin blood test inpatient CPT 83525 INSULIN;Q	$14.40	$18.00	$4.59–$19.80	—	20%
Iron blood test (serum iron) CPT 83540 IRON	$67.20	$84.00	$5.72–$92.40	15% above	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$67.20	$84.00	$21.42–$92.40	—	20%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$157.25	$196.56	$35.08–$44.11	11% above	20%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$220.80	$276.00	$70.38–$303.60	—	20%
LH (luteinizing hormone) test CPT 83002 LH;Q	$13.60	$17.00	$4.25–$94.09	87% below	20%
LH (luteinizing hormone) test CPT 83002 LH PEDS;Q	$16.40	$20.50	$5.13–$94.09	85% below	20%
LH (luteinizing hormone) test inpatient CPT 83002 LH;Q	$13.60	$17.00	$4.34–$18.70	—	20%
LH (luteinizing hormone) test inpatient CPT 83002 LH PEDS;Q	$16.40	$20.50	$5.23–$22.55	—	20%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID	$110.40	$138.00	$9.41–$151.80	22% below	20%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID	$176.00	$220.00	$56.10–$242.00	—	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH;Q	$6.40	$8.00	$2.00–$30.71	81% below	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH	$62.68	$78.35	$5.37–$86.19	86% above	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH, BODY FLUID	$85.00	$106.25	$5.37–$116.88	152% above	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH;Q	$6.40	$8.00	$2.04–$8.80	—	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH	$92.80	$116.00	$29.58–$127.60	—	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH, BODY FLUID	$125.85	$157.31	$40.11–$173.04	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$76.52	$95.64	$6.08–$105.20	31% below	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$140.00	$175.00	$44.63–$192.50	—	20%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$144.00	$180.00	$33.01–$41.50	5% below	20%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$163.20	$204.00	$52.02–$224.40	—	20%
Lyme disease antibody test CPT 86618 LYMEDISEASE;Q	$18.47	$23.08	$5.77–$49.93	20% below	20%
Lyme disease antibody test CPT 86618 LYME CSF, IGG, EIA;Q	$22.84	$28.55	$7.14–$49.93	2% below	20%
Lyme disease antibody test CPT 86618 LYME CSF, IGM, EIA;Q	$22.85	$28.56	$7.14–$49.93	1% below	20%
Lyme disease antibody test inpatient CPT 86618 LYMEDISEASE;Q	$18.47	$23.08	$5.89–$25.39	—	20%
Lyme disease antibody test inpatient CPT 86618 LYME CSF, IGG, EIA;Q	$22.84	$28.55	$7.28–$31.41	—	20%
Lyme disease antibody test inpatient CPT 86618 LYME CSF, IGM, EIA;Q	$22.85	$28.56	$7.28–$31.42	—	20%
Magnesium blood test CPT 83735 MAGNESIUM SERUM	$122.40	$153.00	$5.96–$168.30	54% above	20%
Magnesium blood test CPT 83735 MAGNESIUM URINE 24 HOUR	$127.73	$159.66	$5.96–$175.63	61% above	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM SERUM	$140.00	$175.00	$44.63–$192.50	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM URINE 24 HOUR	$146.10	$182.62	$46.57–$200.88	—	20%
Measles (rubeola) antibody test CPT 86765 RUBEIOLA IGM	$19.76	$24.70	$6.18–$37.78	41% below	20%
Measles (rubeola) antibody test CPT 86765 MEASLES AB, IGG	$29.71	$37.13	$9.28–$40.84	11% below	20%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEIOLA IGM	$19.76	$24.70	$6.30–$27.17	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES AB, IGG	$29.71	$37.13	$9.47–$40.84	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SCREEN	$80.80	$101.00	$4.49–$111.10	23% below	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SCREEN	$97.60	$122.00	$31.11–$134.20	—	20%
Mumps immunity blood test CPT 86735 MUMPS IGM; ARUP	$15.94	$19.92	$4.98–$38.27	18% below	20%
Mumps immunity blood test CPT 86735 MUMPS IGM AB;Q	$18.64	$23.29	$5.82–$38.27	4% below	20%
Mumps immunity blood test CPT 86735 MUMPS AB, IGG	$45.60	$57.00	$11.59–$62.70	135% above	20%
Mumps immunity blood test inpatient CPT 86735 MUMPS IGM; ARUP	$15.94	$19.92	$5.08–$21.91	—	20%
Mumps immunity blood test inpatient CPT 86735 MUMPS IGM AB;Q	$18.64	$23.29	$5.94–$25.62	—	20%
Mumps immunity blood test inpatient CPT 86735 MUMPS AB, IGG	$45.60	$57.00	$14.54–$62.70	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA PROSTATE SPECIFIC AG FREE;Q	$11.20	$14.00	$3.50–$53.94	80% below	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA PROSTATE SPECIFIC AG FREE;Q	$11.20	$14.00	$3.57–$15.40	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA PROSTATE SPECIFIC AG TOTAL;Q	$17.60	$22.00	$5.50–$53.94	70% below	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA PROSTATE SPECIFIC ANTIGEN	$143.62	$179.52	$16.35–$197.47	145% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA PROSTATE SPECIFIC AG TOTAL;Q	$17.60	$22.00	$5.61–$24.20	—	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA PROSTATE SPECIFIC ANTIGEN	$143.62	$179.52	$45.78–$197.47	—	20%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATHOLOGY	$63.87	$79.83	$19.96–$87.81	22% below	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTOPATHOLOGY	$63.87	$79.83	$20.36–$87.81	—	20%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH/THIN PREP-GYN;SP	$48.63	$60.78	$15.20–$102.92	47% below	20%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATH/THIN PREP-GYN;SP	$48.63	$60.78	$15.50–$66.86	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 ASSAY PARATHORMONE/PTH INTACT	$126.07	$157.58	$34.84–$209.71	14% above	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 ASSAY PARATHORMONE/PTH INTACT	$184.00	$230.00	$58.65–$253.00	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN	$92.13	$115.16	$5.34–$126.68	38% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLASTIN	$128.00	$160.00	$40.80–$176.00	—	20%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS SERUM OR PLASMA	$64.00	$80.00	$4.21–$88.00	15% below	20%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS SERUM OR PLASMA	$64.00	$80.00	$20.40–$88.00	—	20%
Potassium blood test CPT 84132 POTASSIUM SERUM OR PLASMA	$77.23	$96.53	$3.44–$106.18	5% above	20%
Potassium blood test inpatient CPT 84132 POTASSIUM SERUM OR PLASMA	$77.23	$96.53	$24.62–$106.18	—	20%
Progesterone blood test CPT 84144 PROGESTERONE	$64.00	$80.00	$18.30–$106.01	25% below	20%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$77.60	$97.00	$24.74–$106.70	—	20%
Prolactin blood test CPT 84146 PROLACTIN;Q	$12.00	$15.00	$3.75–$98.44	89% below	20%
Prolactin blood test CPT 84146 PROLACTIN	$157.27	$196.58	$17.11–$216.24	47% above	20%
Prolactin blood test inpatient CPT 84146 PROLACTIN;Q	$12.00	$15.00	$3.83–$16.50	—	20%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$157.27	$196.58	$50.13–$216.24	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$72.00	$90.00	$3.49–$99.00	9% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$92.00	$115.00	$29.33–$126.50	—	20%
Renin blood test CPT 84244 PLASMA RENIN ACTIVITY;Q	$22.40	$28.00	$7.00–$111.75	10% below	20%
Renin blood test inpatient CPT 84244 PLASMA RENIN ACTIVITY;Q	$22.40	$28.00	$7.14–$30.80	—	20%
Rh blood typing CPT 86901 RH (D)	$96.00	$120.00	$2.46–$132.00	35% above	20%
Rh blood typing inpatient CPT 86901 RH (D)	$96.00	$120.00	$30.60–$132.00	—	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATIOD FACTOR QUANT;Q	$13.20	$16.50	$4.13–$18.15	at median	20%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATIOD FACTOR QUANT;Q	$13.20	$16.50	$4.21–$18.15	—	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG;Q	$11.20	$14.00	$3.50–$42.21	80% below	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA	$38.59	$48.23	$12.06–$53.05	31% below	20%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGG;Q	$11.20	$14.00	$3.57–$15.40	—	20%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA	$58.40	$73.00	$18.62–$80.30	—	20%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS COMPLETE	$225.60	$282.00	$11.08–$310.20	62% above	20%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANALYSIS COMPLETE	$225.60	$282.00	$71.91–$310.20	—	20%
Sodium blood test CPT 84295 SODIUM SERUM OR PLASMA	$64.36	$80.44	$3.51–$88.48	2% below	20%
Sodium blood test inpatient CPT 84295 SODIUM SERUM OR PLASMA	$64.36	$80.44	$20.51–$88.48	—	20%
Stool ova and parasites exam CPT 87177 OVA AND PARASITE EXAM;Q	$12.00	$15.00	$3.75–$45.20	43% below	20%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITE EXAM;Q	$12.00	$15.00	$3.83–$16.50	—	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECES	$22.09	$27.61	$2.92–$30.37	43% below	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD FECES	$34.40	$43.00	$10.97–$47.30	—	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD IMMUNO	$39.20	$48.99	$12.25–$80.82	at median	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD	$52.00	$65.00	$14.14–$80.82	33% above	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD	$52.00	$65.00	$16.58–$71.50	—	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD IMMUNO	$52.00	$65.00	$16.58–$71.50	—	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM ABS;Q	$17.40	$21.75	$5.44–$38.81	23% below	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 AB TREPONEMA PALLIDUM	$37.94	$47.42	$11.40–$52.16	68% above	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM ABS;Q	$17.40	$21.75	$5.55–$23.93	—	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 AB TREPONEMA PALLIDUM	$54.46	$68.07	$17.36–$74.88	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR REFLEX TO TP-PA;Q	$10.48	$13.10	$3.18–$21.71	50% below	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, CSF;Q	$20.53	$25.66	$3.18–$28.23	2% below	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR REFLEX TO TP-PA;Q	$10.48	$13.10	$3.34–$14.41	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL, CSF;Q	$20.53	$25.66	$6.54–$28.23	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, FREE FEM/PED;Q	$15.20	$19.00	$4.75–$131.15	69% below	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL FEM/PED;Q	$16.00	$20.00	$5.00–$131.15	68% below	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOT;Q	$16.00	$20.00	$5.00–$131.15	68% below	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE FREE	$204.80	$256.00	$22.80–$281.60	315% above	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, FREE FEM/PED;Q	$15.20	$19.00	$4.85–$20.90	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL FEM/PED;Q	$16.00	$20.00	$5.10–$22.00	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOT;Q	$16.00	$20.00	$5.10–$22.00	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE FREE	$204.80	$256.00	$65.28–$281.60	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AUTO ABS;Q	$15.75	$19.68	$4.92–$42.66	31% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE ABS;Q	$15.99	$19.98	$5.00–$42.66	30% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER-KIDNEY MICROSOME;Q	$22.28	$27.85	$6.96–$42.66	3% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL AB EACH;Q	$108.36	$135.45	$12.93–$149.00	374% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AUTO ABS;Q	$15.75	$19.68	$5.02–$21.65	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE ABS;Q	$15.99	$19.98	$5.09–$21.98	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER-KIDNEY MICROSOME;Q	$22.28	$27.85	$7.10–$30.64	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL AB EACH;Q	$108.36	$135.45	$34.54–$149.00	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH NAPS;NB	$22.60	$28.25	$7.06–$49.27	79% below	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$147.00	$183.75	$14.76–$202.13	35% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH NAPS;NB	$22.60	$28.25	$7.20–$31.08	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$191.74	$239.67	$61.12–$263.64	—	20%
Total IgE blood test CPT 82785 IGE, SERUM;Q	$15.20	$19.00	$4.75–$83.69	76% below	20%
Total IgE blood test inpatient CPT 82785 IGE, SERUM;Q	$15.20	$19.00	$4.85–$20.90	—	20%
Total cholesterol blood test CPT 82465 CHOLESTEROL	$70.65	$88.31	$3.87–$97.14	60% above	20%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL	$94.20	$117.75	$30.03–$129.53	—	20%
Total thyroxine (T4) blood test CPT 84436 T4, TOTAL;Q	$14.40	$18.00	$4.50–$20.14	63% below	20%
Total thyroxine (T4) blood test CPT 84436 THYROXIN TOTAL (T4)	$135.20	$168.99	$5.18–$185.89	245% above	20%
Total thyroxine (T4) blood test inpatient CPT 84436 T4, TOTAL;Q	$14.40	$18.00	$4.59–$19.80	—	20%
Total thyroxine (T4) blood test inpatient CPT 84436 THYROXIN TOTAL (T4)	$161.31	$201.63	$51.42–$221.79	—	20%
Total triiodothyronine (T3) blood test CPT 84480 T3, TOTAL;Q	$14.40	$18.00	$4.50–$41.57	82% below	20%
Total triiodothyronine (T3) blood test CPT 84480 T3, TOTAL	$70.40	$88.00	$12.59–$96.80	10% below	20%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3, TOTAL;Q	$14.40	$18.00	$4.59–$19.80	—	20%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3, TOTAL	$70.40	$88.00	$22.44–$96.80	—	20%
Transferrin blood test CPT 84466 TRANSFERRIN	$95.20	$119.00	$11.01–$130.90	52% above	20%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$117.60	$147.00	$37.49–$161.70	—	20%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS AMPLIFIED DNA PROBE	$115.20	$144.00	$30.54–$172.83	16% above	20%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS AMPLIFIED DNA PROBE	$139.20	$174.00	$44.37–$191.40	—	20%
Triglycerides blood test CPT 84478 CARDIO IQ TRIGLYCERIDES;Q	$6.36	$7.94	$1.99–$29.23	85% below	20%
Triglycerides blood test CPT 84478 TRIGLYCERIDE	$109.03	$136.28	$5.02–$149.91	164% above	20%
Triglycerides blood test inpatient CPT 84478 CARDIO IQ TRIGLYCERIDES;Q	$6.36	$7.94	$2.02–$8.73	—	20%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDE	$109.03	$136.28	$34.75–$149.91	—	20%
Troponin test, quantitative CPT 84484 TROPONIN CHARGE	$182.40	$228.00	$8.47–$250.80	1% above	20%
Troponin test, quantitative inpatient CPT 84484 TROPONIN CHARGE	$182.40	$228.00	$58.14–$250.80	—	20%
Uric acid blood test CPT 84550 URIC ACID SERUM	$61.60	$77.00	$4.01–$84.70	6% below	20%
Uric acid blood test inpatient CPT 84550 URIC ACID SERUM	$61.60	$77.00	$19.64–$84.70	—	20%
Urinalysis with microscope exam, automated CPT 81001 AUTOM URINE DIP W MICRO	$84.00	$105.00	$2.77–$115.50	1% above	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 AUTOM URINE DIP W MICRO	$84.00	$105.00	$26.78–$115.50	—	20%
Urinalysis without microscope exam, automated CPT 81003 URINE SPECIFIC GRAVITY	$71.52	$89.39	$1.96–$98.33	28% above	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS POC	$71.52	$89.39	$1.96–$98.33	28% above	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS POC	$71.52	$89.39	$22.79–$98.33	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE SPECIFIC GRAVITY	$71.52	$89.39	$22.79–$98.33	—	20%
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN URINE 24 HOUR	$65.60	$82.00	$5.08–$90.20	84% above	20%
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN URINE 24 HOUR	$78.84	$98.55	$25.13–$108.41	—	20%
Urine pregnancy test, read by color change CPT 81025 URINE	$66.40	$83.00	$2.80–$91.30	24% below	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREG TEST	$126.13	$157.66	$2.80–$173.43	43% above	20%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE	$66.40	$83.00	$21.17–$91.30	—	20%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREG TEST	$126.13	$157.66	$40.20–$173.43	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 (CYANOCOBALAMIN)	$138.40	$173.00	$13.33–$190.30	49% above	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 (CYANOCOBALAMIN)	$138.40	$173.00	$44.12–$190.30	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 QUESTASSURED 25 HYDROXYVITAMIN D;Q	$20.80	$26.00	$6.50–$150.42	68% below	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D	$105.24	$131.54	$20.72–$150.42	61% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 QUESTASSURED 25 HYDROXYVITAMIN D;Q	$20.80	$26.00	$6.63–$28.60	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D	$152.00	$190.00	$48.45–$209.00	—	20%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D, 1, 25 DIHY;Q	$24.00	$30.00	$7.50–$164.52	65% below	20%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D, 1, 25 DIHY;Q	$24.00	$30.00	$7.65–$33.00	—	20%
Zinc blood test CPT 84630 ZINC SERUM;Q	$17.60	$22.00	$5.50–$57.86	26% above	20%
Zinc blood test inpatient CPT 84630 ZINC SERUM;Q	$17.60	$22.00	$5.61–$24.20	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG MALIGNANT	$21.08	$26.35	$6.59–$44.15	88% below	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG QUANTITATIVE	$113.14	$141.42	$13.24–$155.56	37% below	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG MALIGNANT	$21.08	$26.35	$6.72–$28.99	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG QUANTITATIVE	$250.40	$313.00	$79.82–$344.30	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Botox injections for chronic migraine CPT 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$888.00	$1,110.00	$103.87–$3,989.00	1% above	20%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$888.00	$1,110.00	$283.05–$1,221.00	—	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Cyberknife	$4,240.00	$5,300.00	$632.17–$70,603.00	2% below	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 RADP BX BRST 1ST LESION STRTCTC	$4,240.00	$5,300.00	$632.17–$70,603.00	2% below	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Prostate Seed Implant	$4,240.00	$5,300.00	$632.17–$70,603.00	2% below	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 RADP BX BRST 1ST LESION STRTCTC	$4,240.00	$5,300.00	$1,351.50–$52,580.00	—	20%
Cardiac catheterization with coronary angiogram CPT 93458 L HRT ARTERY/VENTRICLE ANGIO	$17,061.75	$21,327.18	$950.01–$23,459.90	32% above	20%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 L HRT ARTERY/VENTRICLE ANGIO	$17,061.75	$21,327.18	$5,438.43–$23,459.90	—	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Prostate Seed Implant	$2,880.00	$3,600.00	$122.46–$70,603.00	54% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION	$2,880.00	$3,600.00	$122.46–$70,603.00	54% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cyberknife	$2,880.00	$3,600.00	$122.46–$70,603.00	54% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION EXTERNAL	$2,880.00	$3,600.00	$122.46–$3,960.00	54% above	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION EXTERNAL	$2,880.00	$3,600.00	$918.00–$3,960.00	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION	$2,880.00	$3,600.00	$918.00–$3,960.00	—	20%
Carpal tunnel release, open surgery CPT 64721 NEUROPLASTY/TRANSPOS MEDIAN NRV CARPAL TUNNEL	$5,789.60	$7,237.00	$316.83–$8,490.00	60% above	20%
Carpal tunnel release, open surgery inpatient CPT 64721 NEUROPLASTY/TRANSPOS MEDIAN NRV CARPAL TUNNEL	$5,789.60	$7,237.00	$1,845.44–$7,960.70	—	20%
Catheter ablation for atrial fibrillation CPT 93656 COMPRE EP EVAL ABLTJ ATR FIB	$64,272.00	$80,340.00	$3,814.20–$4,795.31	92% above	20%
Catheter ablation for atrial fibrillation inpatient CPT 93656 COMPRE EP EVAL ABLTJ ATR FIB	$64,272.00	$80,340.00	$18,194.00–$88,374.00	—	20%
Cervical biopsy CPT 57500 BX SING/MULTI LESION CERVIX	$1,581.60	$1,977.00	$143.89–$3,989.00	1% below	20%
Cervical biopsy inpatient CPT 57500 BX SING/MULTI LESION CERVIX	$1,581.60	$1,977.00	$504.14–$2,174.70	—	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONL BLOCK	$7,868.00	$9,835.00	$319.12–$5,624.00	628% above	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/REGIONL BLOCK	$7,868.00	$9,835.00	$2,507.93–$10,818.50	—	20%
Coronary stent placement, one artery CPT 92928 STENT PLACEMENT INCL ANGIOPLASTY	$17,855.20	$22,319.00	$483.05–$25,612.00	19% above	20%
Coronary stent placement, one artery inpatient CPT 92928 STENT PLACEMENT INCL ANGIOPLASTY	$17,855.20	$22,319.00	$5,691.35–$24,550.90	—	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 D&C DIAG OR THERAP NOT OB	$6,149.60	$7,687.00	$272.38–$8,490.00	45% above	20%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 D&C DIAG OR THERAP NOT OB	$6,149.60	$7,687.00	$1,960.19–$8,455.70	—	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$229.90	$287.37	$15.69–$1,297.00	30% above	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI	$229.90	$287.37	$73.28–$316.11	—	20%
Earwax removal with instruments, one ear CPT 69210 EAR CERUMEN REMOVAL W INST UNI	$163.20	$204.00	$43.20–$3,989.00	7% below	20%
Earwax removal with instruments, one ear inpatient CPT 69210 EAR CERUMEN REMOVAL W INST UNI	$163.20	$204.00	$52.02–$224.40	—	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Prostate Seed Implant	$606.40	$758.00	$93.00–$70,603.00	11% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BX, WO CERVICAL DILATION	$606.40	$758.00	$93.00–$3,989.00	11% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Cyberknife	$606.40	$758.00	$93.00–$70,603.00	11% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BX, WO CERVICAL DILATION	$606.40	$758.00	$193.29–$833.80	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 RADP INJ INTERLAMINAR CRV/THRC	$2,447.20	$3,059.00	$223.38–$70,603.00	25% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Prostate Seed Implant	$2,447.20	$3,059.00	$223.38–$70,603.00	25% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Cyberknife	$2,447.20	$3,059.00	$223.38–$70,603.00	25% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 RADP INJ INTERLAMINAR CRV/THRC	$2,447.20	$3,059.00	$780.05–$52,580.00	—	20%
Eye injection into the vitreous (intravitreal injection) CPT 67028 INTRAVITREAL INJECTION OF DRUGS	$913.60	$1,142.00	$285.50–$4,053.00	1% above	20%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 INTRAVITREAL INJECTION OF DRUGS	$913.60	$1,142.00	$291.21–$1,256.20	—	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Cyberknife	$1,210.40	$1,513.00	$185.45–$70,603.00	87% above	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Prostate Seed Implant	$1,210.40	$1,513.00	$185.45–$70,603.00	87% above	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 RADP-CATH HYSTEROSALPINGOGRM	$1,210.40	$1,513.00	$185.45–$70,603.00	87% above	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 RADP-CATH HYSTEROSALPINGOGRM	$1,210.40	$1,513.00	$385.82–$52,580.00	—	20%
IUD insertion (the device itself billed separately) CPT 58300 MW I.U.D. INSERTION	$4,120.80	$5,151.00	$99.93–$5,666.10	601% above	20%
IUD insertion (the device itself billed separately) inpatient CPT 58300 MW I.U.D. INSERTION	$4,120.80	$5,151.00	$1,313.51–$5,666.10	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 RADP - I&D ABSCESS SIMPLE	$970.40	$1,213.00	$42.44–$70,603.00	107% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSC, SMPL OR SGL	$970.40	$1,213.00	$42.44–$5,447.00	107% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 Cyberknife	$970.40	$1,213.00	$42.44–$70,603.00	107% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 Prostate Seed Implant	$970.40	$1,213.00	$42.44–$70,603.00	107% above	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSC, SMPL OR SGL	$970.40	$1,213.00	$309.32–$1,334.30	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 RADP - I&D ABSCESS SIMPLE	$970.40	$1,213.00	$309.32–$52,580.00	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION(S)SINGLE TENDON/LIG	$741.51	$926.88	$52.58–$4,053.00	12% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION(S)SINGLE TENDON/LIG	$741.51	$926.88	$236.35–$1,019.57	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 RADP-ARTHROCENTESES/MAJ JT A	$996.00	$1,245.00	$58.61–$70,603.00	5% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Cyberknife	$996.00	$1,245.00	$58.61–$70,603.00	5% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Prostate Seed Implant	$996.00	$1,245.00	$58.61–$70,603.00	5% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 RADP-DRAIN/INJ MAJ JT W/O US	$996.00	$1,245.00	$58.61–$70,603.00	5% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ MAJ JNT/BURSA WO US	$996.00	$1,245.00	$58.61–$3,989.00	5% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ MAJ JNT/BURSA WO US	$996.00	$1,245.00	$317.48–$1,369.50	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 RADP-ARTHROCENTESES/MAJ JT A	$996.00	$1,245.00	$317.48–$52,580.00	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 RADP-DRAIN/INJ MAJ JT W/O US	$996.00	$1,245.00	$317.48–$52,580.00	—	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 FAM PLAN INSERT IMPL CONTR CAPSULE	$320.00	$400.00	$100.00–$3,989.00	13% above	20%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 FAM PLAN INSERT IMPL CONTR CAPSULE	$320.00	$400.00	$102.00–$440.00	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Prostate Seed Implant	$869.60	$1,087.00	$50.14–$70,603.00	43% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Cyberknife	$869.60	$1,087.00	$50.14–$70,603.00	43% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ INTERM JNT/BURSA WO US	$869.60	$1,087.00	$50.14–$3,989.00	43% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 RADP DRAIN/INJ INTERM J W/O US	$869.60	$1,087.00	$50.14–$70,603.00	43% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 RADP DRAIN/INJ INTERM J W/O US	$869.60	$1,087.00	$277.19–$52,580.00	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ INTERM JNT/BURSA WO US	$869.60	$1,087.00	$277.19–$1,195.70	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ SM JNT/BURSA W/O US	$799.20	$999.00	$48.23–$3,989.00	10% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Cyberknife	$799.20	$999.00	$48.23–$70,603.00	10% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Prostate Seed Implant	$799.20	$999.00	$48.23–$70,603.00	10% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 RADP DRAIN/INJ SMALL JT W/O US	$799.20	$999.00	$48.23–$70,603.00	10% above	20%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 RADP PERQ SACRAL AUGMT UNILAT INJ (SACROPLASTY)	$799.20	$999.00	$48.23–$70,603.00	10% above	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ SM JNT/BURSA W/O US	$799.20	$999.00	$254.75–$1,098.90	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 RADP DRAIN/INJ SMALL JT W/O US	$799.20	$999.00	$254.75–$52,580.00	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 RADP PERQ SACRAL AUGMT UNILAT INJ (SACROPLASTY)	$799.20	$999.00	$254.75–$52,580.00	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 SUTURE TO 2.5 CM INTERMED	$784.00	$980.00	$84.51–$5,447.00	10% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 SUTURE TO 2.5 CM INTERMED	$784.00	$980.00	$249.90–$1,078.00	—	20%
Left heart catheterization, diagnostic one side CPT 93452 LEFT HRT CATH W/VENTRCLGRPHY	$10,196.00	$12,745.00	$762.86–$16,757.00	3% above	20%
Left heart catheterization, diagnostic inpatient one side CPT 93452 LEFT HRT CATH W/VENTRCLGRPHY	$10,196.00	$12,745.00	$3,249.98–$23,144.00	—	20%
Lower-back epidural injection, with imaging guidance CPT 62323 Prostate Seed Implant	$1,360.00	$1,700.00	$220.03–$70,603.00	39% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 Cyberknife	$1,360.00	$1,700.00	$220.03–$70,603.00	39% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 RADP INJ INTERLAMINAR LMBR/SAC	$1,360.00	$1,700.00	$220.03–$70,603.00	39% below	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 RADP INJ INTERLAMINAR LMBR/SAC	$1,360.00	$1,700.00	$433.50–$52,580.00	—	20%
Lower-back epidural injection, without imaging guidance CPT 62322 Prostate Seed Implant	$1,792.80	$2,241.00	$138.50–$70,603.00	9% above	20%
Lower-back epidural injection, without imaging guidance CPT 62322 Cyberknife	$1,792.80	$2,241.00	$138.50–$70,603.00	9% above	20%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC	$1,792.80	$2,241.00	$138.50–$70,603.00	9% above	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC	$1,792.80	$2,241.00	$571.46–$52,580.00	—	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ TRNSFRML EPI LUMB/SACRAL, SINGLE LEVEL	$3,522.40	$4,403.00	$143.34–$8,490.00	82% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Cyberknife	$3,522.40	$4,403.00	$143.34–$70,603.00	82% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Prostate Seed Implant	$3,522.40	$4,403.00	$143.34–$70,603.00	82% above	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ TRNSFRML EPI LUMB/SACRAL, SINGLE LEVEL	$3,522.40	$4,403.00	$1,122.77–$23,144.00	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BEN LES T/A/L <=0.5CM	$4,485.60	$5,607.00	$119.85–$6,167.70	238% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BEN LES T/A/L <=0.5CM	$4,485.60	$5,607.00	$1,429.79–$6,167.70	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5CM/<	$2,000.00	$2,500.00	$134.46–$5,447.00	35% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC FACE-MM B9+MARG 0.5CM/<	$2,000.00	$2,500.00	$637.50–$2,750.00	—	20%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SIMPLE SINGLE	$393.60	$492.00	$107.09–$3,989.00	19% below	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SIMPLE SINGLE	$393.60	$492.00	$125.46–$541.20	—	20%
Occipital nerve block (injection for headaches) CPT 64405 INJ ANESTH/STEROID, GREATER OCCIPITAL NERVE	$799.20	$999.00	$62.92–$3,989.00	9% below	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJ ANESTH/STEROID, GREATER OCCIPITAL NERVE	$799.20	$999.00	$254.75–$1,098.90	—	20%
Pacemaker implant (dual chamber) CPT 33208 PM STYTEM IMPLANT DDD (R)	$21,005.60	$26,257.00	$744.60–$28,882.70	29% above	20%
Pacemaker implant (dual chamber) inpatient CPT 33208 PM STYTEM IMPLANT DDD (R)	$21,005.60	$26,257.00	$6,695.54–$28,882.70	—	20%
Paracentesis with imaging guidance CPT 49083 Prostate Seed Implant	$1,783.20	$2,229.00	$89.85–$70,603.00	3% below	20%
Paracentesis with imaging guidance CPT 49083 RADP-ABD PARACENTESIS W/IMAGING	$1,783.20	$2,229.00	$89.85–$5,447.00	3% below	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$1,783.20	$2,229.00	$89.85–$70,603.00	3% below	20%
Paracentesis with imaging guidance CPT 49083 Cyberknife	$1,783.20	$2,229.00	$89.85–$70,603.00	3% below	20%
Paracentesis with imaging guidance inpatient CPT 49083 RADP-ABD PARACENTESIS W/IMAGING	$1,783.20	$2,229.00	$568.40–$52,580.00	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING	$1,783.20	$2,229.00	$568.40–$52,580.00	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL & MATRIX PERM	$1,360.00	$1,700.00	$84.51–$4,053.00	5% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL & MATRIX PERM	$1,360.00	$1,700.00	$433.50–$1,870.00	—	20%
Prostate biopsy CPT 55700 Prostate Seed Implant	$4,006.40	$5,008.00	$87.49–$70,603.00	at median	20%
Prostate biopsy CPT 55700 RADP-PERC NEEDLE BX PROSTATE	$4,006.40	$5,008.00	$87.49–$70,603.00	at median	20%
Prostate biopsy CPT 55700 Cyberknife	$4,006.40	$5,008.00	$87.49–$70,603.00	at median	20%
Prostate biopsy inpatient CPT 55700 RADP-PERC NEEDLE BX PROSTATE	$4,006.40	$5,008.00	$1,277.04–$23,144.00	—	20%
Removal of a foreign object under the skin, simple CPT 10120 INC & REM FB, SQ, SMPL	$1,688.80	$2,111.00	$140.63–$3,989.00	74% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INC & REM FB, SQ, SMPL	$1,688.80	$2,111.00	$538.31–$2,322.10	—	20%
Short arm cast (elbow to hand) CPT 29075 APPLY SHORT ARM CAST	$854.49	$1,068.11	$82.65–$2,708.00	71% above	20%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLY SHORT ARM CAST	$854.49	$1,068.11	$272.37–$1,174.92	—	20%
Short arm splint (forearm and hand) CPT 29125 APPLY SHORT ARM SPLINT FOREARM TO HAND, STATIC	$481.60	$602.00	$52.87–$2,708.00	19% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY SHORT ARM SPLINT FOREARM TO HAND, STATIC	$481.60	$602.00	$153.51–$662.20	—	20%
Short leg cast (below the knee) CPT 29405 APPLY SH LEG CAST	$737.60	$922.00	$85.26–$2,708.00	48% above	20%
Short leg cast (below the knee) inpatient CPT 29405 APPLY SH LEG CAST	$737.60	$922.00	$235.11–$1,014.20	—	20%
Short leg splint (calf to foot) CPT 29515 APPLY SHORT LEG SPLINT	$531.20	$664.00	$65.90–$2,708.00	8% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 APPLY SHORT LEG SPLINT	$531.20	$664.00	$169.32–$730.40	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Prostate Seed Implant	$754.40	$943.00	$86.58–$70,603.00	37% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Cyberknife	$754.40	$943.00	$86.58–$70,603.00	37% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SUT SMPL S/N/A/G/TR/EXT <=2.5CM	$754.40	$943.00	$86.58–$5,447.00	37% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SUT SMPL S/N/A/G/TR/EXT <=2.5CM	$754.40	$943.00	$240.47–$1,037.30	—	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$784.00	$980.00	$118.03–$4,696.21	8% above	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION	$784.00	$980.00	$249.90–$1,078.00	—	20%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS	$936.00	$1,170.00	$84.77–$3,989.00	137% above	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS	$936.00	$1,170.00	$298.35–$1,287.00	—	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE, LUMBAR DIAGNOSTIC	$1,360.00	$1,700.00	$121.83–$70,603.00	3% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Prostate Seed Implant	$1,360.00	$1,700.00	$121.83–$70,603.00	3% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Cyberknife	$1,360.00	$1,700.00	$121.83–$70,603.00	3% above	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE, LUMBAR DIAGNOSTIC	$1,360.00	$1,700.00	$433.50–$23,144.00	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SUT SMPL S/N/A/G/TR/EXT 2.6-7.5CM	$824.00	$1,030.00	$74.46–$2,708.00	10% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SUT SMPL S/N/A/G/TR/EXT 2.6-7.5CM	$824.00	$1,030.00	$262.65–$1,133.00	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SUT SMPL F/E/E/N/L/MM <= 2.5CM	$784.00	$980.00	$103.33–$2,708.00	19% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SUT SMPL F/E/E/N/L/MM <= 2.5CM	$784.00	$980.00	$249.90–$1,078.00	—	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LESION	$552.00	$690.00	$95.41–$4,696.21	at median	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LESION	$552.00	$690.00	$175.95–$759.00	—	20%
Thoracentesis with imaging guidance CPT 32555 Cyberknife	$2,088.80	$2,611.00	$92.33–$70,603.00	3% above	20%
Thoracentesis with imaging guidance CPT 32555 RADP-US GUIDED THORACENTESIS	$2,088.80	$2,611.00	$92.33–$4,053.00	3% above	20%
Thoracentesis with imaging guidance CPT 32555 THORACEN,NDL/CATH,ASPIR W/IMAG	$2,088.80	$2,611.00	$92.33–$70,603.00	3% above	20%
Thoracentesis with imaging guidance CPT 32555 Prostate Seed Implant	$2,088.80	$2,611.00	$92.33–$70,603.00	3% above	20%
Thoracentesis with imaging guidance CPT 32555 RADP-THORACENTESIS/ASP PLEURA W/IMAGING	$2,088.80	$2,611.00	$92.33–$70,603.00	3% above	20%
Thoracentesis with imaging guidance inpatient CPT 32555 RADP-US GUIDED THORACENTESIS	$2,088.80	$2,611.00	$665.81–$52,580.00	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACEN,NDL/CATH,ASPIR W/IMAG	$2,088.80	$2,611.00	$665.81–$52,580.00	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 RADP-THORACENTESIS/ASP PLEURA W/IMAGING	$2,088.80	$2,611.00	$665.81–$23,144.00	—	20%
Trigger finger release surgery CPT 26055 INCISION FINGER TENDON SHEATH	$4,819.20	$6,024.00	$210.72–$8,490.00	57% above	20%
Trigger finger release surgery inpatient CPT 26055 INCISION FINGER TENDON SHEATH	$4,819.20	$6,024.00	$1,536.12–$6,626.40	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Cyberknife	$924.00	$1,155.00	$52.49–$70,603.00	48% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 TRIG PT INJ 1/2 MUSCLES	$924.00	$1,155.00	$52.49–$70,603.00	48% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 Prostate Seed Implant	$924.00	$1,155.00	$52.49–$70,603.00	48% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 TRIG PT INJ 1/2 MUSCLES	$924.00	$1,155.00	$294.53–$1,270.50	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 RADP BX BRST 1ST LESION US IMAG	$4,032.80	$5,041.00	$613.92–$70,603.00	25% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Cyberknife	$4,032.80	$5,041.00	$613.92–$70,603.00	25% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Prostate Seed Implant	$4,032.80	$5,041.00	$613.92–$70,603.00	25% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 RADP BX BRST 1ST LESION US IMAG	$4,032.80	$5,041.00	$1,285.46–$52,580.00	—	20%
Vein ablation, radiofrequency, first vein CPT 36475 RADP SCLEROTHERAPY RF ABLATION 1ST VEIN	$11,596.80	$14,496.00	$1,989.03–$70,603.00	64% above	20%
Vein ablation, radiofrequency, first vein CPT 36475 Prostate Seed Implant	$11,596.80	$14,496.00	$1,989.03–$70,603.00	64% above	20%
Vein ablation, radiofrequency, first vein CPT 36475 Cyberknife	$11,596.80	$14,496.00	$1,989.03–$70,603.00	64% above	20%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 RADP SCLEROTHERAPY RF ABLATION 1ST VEIN	$11,596.80	$14,496.00	$3,696.48–$52,580.00	—	20%
Wart removal, up to 14 warts CPT 17110 DESTR BENIGN LESIONS/UP TO 14	$393.60	$492.00	$106.86–$3,989.00	10% above	20%
Wart removal, up to 14 warts inpatient CPT 17110 DESTR BENIGN LESIONS/UP TO 14	$393.60	$492.00	$125.46–$541.20	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE, SKIN TO SQ TISSUE FIRST 20 SQ CM	$1,040.00	$1,300.00	$119.98–$70,603.00	53% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Prostate Seed Implant	$1,040.00	$1,300.00	$119.98–$70,603.00	53% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Cyberknife	$1,040.00	$1,300.00	$119.98–$70,603.00	53% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE, SKIN TO SQ TISSUE FIRST 20 SQ CM	$1,040.00	$1,300.00	$331.50–$1,430.00	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Blood transfusion (giving blood or blood components) CPT 36430 LEVEL 1: UP TO 1 HOUR -TRANSF	$1,202.40	$1,503.00	$375.75–$4,053.00	38% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 LEVEL 2: 1.5-3 HOURS- TRANSF	$1,782.40	$2,228.00	$405.66–$4,053.00	104% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 LEVEL 2: 1.5-3 HOURS - TRANSF	$1,782.40	$2,228.00	$405.66–$4,053.00	104% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 LEVEL 3: 3.5-5 HOURS-TRANSF	$2,769.60	$3,462.00	$405.66–$4,053.00	217% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 LEVEL 3: 3-5.5 HOURS - TRANSF	$2,769.60	$3,462.00	$405.66–$4,053.00	217% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 LEVEL 4: 5.5-7.0 HOURS-TRANSF	$3,380.80	$4,226.00	$405.66–$4,648.60	287% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 LEVEL 4: 5.5-7.0 HOURS TRANSF	$3,380.80	$4,226.00	$405.66–$4,648.60	287% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 LEVEL 5: 7.5 + HOURS-TRANSFU	$3,991.20	$4,989.00	$405.66–$5,487.90	357% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 LEVEL 5: 7.5+ HOURS- TRANSF	$3,991.20	$4,989.00	$405.66–$5,487.90	357% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 LEVEL 1: UP TO 1 HOUR -TRANSF	$1,202.40	$1,503.00	$383.27–$1,653.30	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 LEVEL 2: 1.5-3 HOURS- TRANSF	$1,782.40	$2,228.00	$568.14–$2,450.80	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 LEVEL 2: 1.5-3 HOURS - TRANSF	$1,782.40	$2,228.00	$568.14–$2,450.80	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 LEVEL 3: 3.5-5 HOURS-TRANSF	$2,769.60	$3,462.00	$882.81–$3,808.20	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 LEVEL 3: 3-5.5 HOURS - TRANSF	$2,769.60	$3,462.00	$882.81–$3,808.20	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 LEVEL 4: 5.5-7.0 HOURS TRANSF	$3,380.80	$4,226.00	$1,077.63–$4,648.60	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 LEVEL 4: 5.5-7.0 HOURS-TRANSF	$3,380.80	$4,226.00	$1,077.63–$4,648.60	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 LEVEL 5: 7.5+ HOURS- TRANSF	$3,991.20	$4,989.00	$1,144.00–$5,487.90	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 LEVEL 5: 7.5 + HOURS-TRANSFU	$3,991.20	$4,989.00	$1,144.00–$5,487.90	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HHN/MDI/EZPAP	$540.80	$676.00	$11.70–$743.60	67% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HHN WITH ANTIBIOTIC	$540.80	$676.00	$11.70–$743.60	67% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM INDUCTION	$540.80	$676.00	$11.70–$743.60	67% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HHN, MDI OR EZPAP SUBSEQ	$540.80	$676.00	$11.70–$743.60	67% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HHN/MDI/EZPAP	$540.80	$676.00	$172.38–$743.60	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM INDUCTION	$540.80	$676.00	$172.38–$743.60	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HHN, MDI OR EZPAP SUBSEQ	$540.80	$676.00	$172.38–$743.60	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HHN WITH ANTIBIOTIC	$540.80	$676.00	$172.38–$743.60	—	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEM ADMN,IV INFUS UP TO 1 HR	$1,198.40	$1,498.00	$28.59–$1,647.80	37% above	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEM ADMN,IV INFUS TO 1 HR INIT	$1,198.40	$1,498.00	$28.59–$1,647.80	37% above	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEM ADMN,IV INFUS TO 1 HR INIT	$1,198.40	$1,498.00	$381.99–$1,647.80	—	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEM ADMN,IV INFUS UP TO 1 HR	$1,198.40	$1,498.00	$381.99–$1,647.80	—	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL #6	$7,392.00	$9,240.00	$432.00–$10,164.00	60% above	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL #6	$7,392.00	$9,240.00	$2,356.20–$10,164.00	—	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG, AWAKE & DROWSY	$1,221.60	$1,527.00	$75.58–$1,679.70	19% above	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG, AWAKE & DROWSY	$1,221.60	$1,527.00	$389.39–$1,679.70	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 12 LEAD ECG (TRACING)	$306.40	$383.00	$7.43–$421.30	9% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 12 LEAD ECG (TRACING)	$306.40	$383.00	$97.67–$421.30	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED- MODIFIED TRMT RM #1	$684.00	$855.00	$15.18–$3,772.00	63% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED- MODIFIED TRMT RM #1	$684.00	$855.00	$218.03–$940.50	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED- BRIEF TRMT RM #2	$1,280.00	$1,600.00	$24.38–$4,022.00	47% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED- BRIEF TRMT RM #2	$1,280.00	$1,600.00	$408.00–$1,760.00	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED- LIMITED TRMT RM #3	$2,184.00	$2,730.00	$44.60–$4,098.00	43% above	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED- LIMITED TRMT RM #3	$2,184.00	$2,730.00	$696.15–$3,003.00	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED-INTERMEDIATE #4	$3,360.00	$4,200.00	$68.35–$4,620.00	24% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED-INTERMEDIATE #4	$3,360.00	$4,200.00	$1,071.00–$4,620.00	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED-EXTENDED #5	$5,050.40	$6,313.00	$108.08–$6,944.30	43% above	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED-EXTENDED #5	$5,050.40	$6,313.00	$1,609.82–$6,944.30	—	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 MED NUC STRESS TEST	$1,347.20	$1,684.00	$52.50–$1,852.40	at median	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 NUC TREAD STRESS TEST	$1,347.20	$1,684.00	$52.50–$1,852.40	at median	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 TREADMILL STRESS TEST	$1,347.20	$1,684.00	$52.50–$1,852.40	at median	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TREADMILL STRESS TEST	$1,347.20	$1,684.00	$429.42–$1,852.40	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 MED NUC STRESS TEST	$1,347.20	$1,684.00	$429.42–$1,852.40	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 NUC TREAD STRESS TEST	$1,347.20	$1,684.00	$429.42–$1,852.40	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION UP TO 1 HR	$524.00	$655.00	$51.30–$955.00	6% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION 31 MIN TO 1 HR INIT	$524.00	$655.00	$51.30–$955.00	6% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION 31 MIN TO 1 HR INIT	$524.00	$655.00	$167.03–$720.50	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION UP TO 1 HR	$524.00	$655.00	$167.03–$720.50	—	20%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION THER 1ST HR	$580.00	$725.00	$62.60–$955.00	1% below	20%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION THER 1ST HOUR	$580.00	$725.00	$62.60–$955.00	1% below	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION THER 1ST HOUR	$580.00	$725.00	$184.88–$797.50	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION THER 1ST HR	$580.00	$725.00	$184.88–$797.50	—	20%
IV push of a medicine, first drug CPT 96374 INFUSION OF DIAG MED	$398.40	$498.00	$49.82–$955.00	13% above	20%
IV push of a medicine, first drug CPT 96374 THERA/PROPH/DX IV PUSH INITIAL	$398.40	$498.00	$49.82–$955.00	13% above	20%
IV push of a medicine, first drug CPT 96374 THERA PROPH INTRA PUSH	$398.40	$498.00	$49.82–$955.00	13% above	20%
IV push of a medicine, first drug inpatient CPT 96374 THERA/PROPH/DX IV PUSH INITIAL	$398.40	$498.00	$126.99–$547.80	—	20%
IV push of a medicine, first drug inpatient CPT 96374 INFUSION OF DIAG MED	$398.40	$498.00	$126.99–$547.80	—	20%
IV push of a medicine, first drug inpatient CPT 96374 THERA PROPH INTRA PUSH	$398.40	$498.00	$126.99–$547.80	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM	$198.40	$248.00	$18.75–$955.00	11% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM ANTIBIOTIC	$198.40	$248.00	$18.75–$272.80	11% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ, SC/IM	$198.40	$248.00	$18.75–$2,708.00	11% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 RADP-IM THERAPY SEDATION MD	$198.40	$248.00	$18.75–$955.00	11% above	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM ANTIBIOTIC	$198.40	$248.00	$63.24–$272.80	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM	$198.40	$248.00	$63.24–$272.80	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 RADP-IM THERAPY SEDATION MD	$198.40	$248.00	$63.24–$272.80	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ, SC/IM	$198.40	$248.00	$63.24–$272.80	—	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAGNOSTIC EVALUATION	$429.60	$537.00	$134.25–$590.70	2% above	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAGNOSTIC EVALUATION	$429.60	$537.00	$136.94–$590.70	—	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE CONDUCTION STUDIES; 7-8 ST	$926.40	$1,158.00	$160.95–$1,273.80	at median	20%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NERVE CONDUCTION STUDIES; 7-8 ST	$926.40	$1,158.00	$295.29–$1,273.80	—	20%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROM RE-ED/BAL/CRD L2 EA15	$163.20	$204.00	$12.22–$419.00	28% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROM RE-ED/BAL/CRD EA 15	$163.20	$204.00	$12.22–$419.00	28% above	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROM RE-ED/BAL/CRD EA 15	$163.20	$204.00	$52.02–$224.40	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROM RE-ED/BAL/CRD L2 EA15	$163.20	$204.00	$52.02–$224.40	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INIT ASSESS/INTERV EA 15 MIN TELEHEALTH	$76.80	$96.00	$24.00–$105.60	23% below	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INIT ASSESS/INTERV EA 15 MIN	$152.80	$191.00	$33.81–$210.10	53% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INIT ASSESS/INTERV EA 15 MIN TELEHEALTH	$76.80	$96.00	$24.48–$105.60	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INIT ASSESS/INTERV EA 15 MIN	$152.80	$191.00	$48.71–$210.10	—	20%
Occupational therapy evaluation, low complexity CPT 97165 OT EVALUATION - LOW COMPLEXITY	$315.20	$394.00	$95.34–$433.40	21% above	20%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVALUATION - LOW COMPLEXITY	$315.20	$394.00	$100.47–$433.40	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVALUATION - HIGH COMPLEXITY	$388.80	$486.00	$92.71–$534.60	8% below	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVALUATION - HIGH COMPLEXITY	$388.80	$486.00	$123.93–$534.60	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVALUATION - LOW COMPLEXITY	$315.20	$394.00	$92.71–$433.40	33% above	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVALUATION - LOW COMPLEXITY	$315.20	$394.00	$100.47–$433.40	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVALUATION - MODERATE COMPLEXITY	$354.40	$443.00	$92.71–$487.30	1% below	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVALUATION - MODERATE COMPLEXITY	$354.40	$443.00	$112.97–$487.30	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MAN THER/TRX/MFR/MOB EA 15	$163.20	$204.00	$22.21–$419.00	36% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MAN THER/TRX/MFR/MOB EA 15	$163.20	$204.00	$52.02–$224.40	—	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THRX-STRGT,ENDR,ROM,FLX EA15	$157.60	$197.00	$6.37–$419.00	22% above	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THRX-STRGT,ENDR,ROM,FLX EA15	$157.60	$197.00	$50.24–$216.70	—	20%
Psychotherapy session, 30 minutes CPT 90832 PSYTX PT&/FAMILY 30 MINUTES	$390.40	$488.00	$67.83–$536.80	23% above	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX PT&/FAMILY 30 MINUTES	$390.40	$488.00	$124.44–$536.80	—	20%
Psychotherapy session, 45 minutes CPT 90834 PSYTX PT&/FAMILY 45 MINUTES	$287.20	$359.00	$89.64–$394.90	10% below	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX PT&/FAMILY 45 MINUTES	$287.20	$359.00	$91.55–$394.90	—	20%
Psychotherapy session, 60 minutes CPT 90837 PSYTX PT&/FAMILY 60 MINS	$367.20	$459.00	$51.00–$504.90	at median	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX PT&/FAMILY 60 MINS	$367.20	$459.00	$117.05–$504.90	—	20%
Speech and language evaluation CPT 92523 SLP LANG/ARTIC EVALUATION A	$598.40	$748.00	$107.68–$822.80	31% above	20%
Speech and language evaluation CPT 92523 SLP LANG/ARTIC EVALUATION F	$604.00	$755.00	$107.68–$830.50	32% above	20%
Speech and language evaluation CPT 92523 SLP LANG/ARTIC EVALUATION E	$604.00	$755.00	$107.68–$830.50	32% above	20%
Speech and language evaluation CPT 92523 SLP LANG/ARTIC EVALUATION C	$604.00	$755.00	$107.68–$830.50	32% above	20%
Speech and language evaluation CPT 92523 SLP LANG/ARTIC EVALUATION D	$604.00	$755.00	$107.68–$830.50	32% above	20%
Speech and language evaluation CPT 92523 SLP LANG/ARTIC EVALUATION B	$604.80	$756.00	$107.68–$831.60	32% above	20%
Speech and language evaluation inpatient CPT 92523 SLP LANG/ARTIC EVALUATION A	$598.40	$748.00	$190.74–$822.80	—	20%
Speech and language evaluation inpatient CPT 92523 SLP LANG/ARTIC EVALUATION D	$604.00	$755.00	$192.53–$830.50	—	20%
Speech and language evaluation inpatient CPT 92523 SLP LANG/ARTIC EVALUATION C	$604.00	$755.00	$192.53–$830.50	—	20%
Speech and language evaluation inpatient CPT 92523 SLP LANG/ARTIC EVALUATION E	$604.00	$755.00	$192.53–$830.50	—	20%
Speech and language evaluation inpatient CPT 92523 SLP LANG/ARTIC EVALUATION F	$604.00	$755.00	$192.53–$830.50	—	20%
Speech and language evaluation inpatient CPT 92523 SLP LANG/ARTIC EVALUATION B	$604.80	$756.00	$192.78–$831.60	—	20%
Speech therapy session, individual CPT 92507 SLP TREAT B	$367.20	$459.00	$56.41–$590.00	32% above	20%
Speech therapy session, individual CPT 92507 SLP TREAT D	$367.20	$459.00	$56.41–$590.00	32% above	20%
Speech therapy session, individual CPT 92507 SLP TREAT C	$367.20	$459.00	$56.41–$590.00	32% above	20%
Speech therapy session, individual CPT 92507 SLP TREAT A	$367.20	$459.00	$56.41–$590.00	32% above	20%
Speech therapy session, individual inpatient CPT 92507 SLP TREAT A	$367.20	$459.00	$117.05–$504.90	—	20%
Speech therapy session, individual inpatient CPT 92507 SLP TREAT C	$367.20	$459.00	$117.05–$504.90	—	20%
Speech therapy session, individual inpatient CPT 92507 SLP TREAT B	$367.20	$459.00	$117.05–$504.90	—	20%
Speech therapy session, individual inpatient CPT 92507 SLP TREAT D	$367.20	$459.00	$117.05–$504.90	—	20%
Spirometry (breathing test) CPT 94010 SPIROMETRY - NORC	$505.60	$632.00	$25.01–$695.20	43% above	20%
Spirometry (breathing test) CPT 94010 SIMPLE SPIRO (SPIROMETRY)	$505.60	$632.00	$25.01–$695.20	43% above	20%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY - NORC	$505.60	$632.00	$161.16–$695.20	—	20%
Spirometry (breathing test) inpatient CPT 94010 SIMPLE SPIRO (SPIROMETRY)	$505.60	$632.00	$161.16–$695.20	—	20%
Spirometry before and after a bronchodilator CPT 94060 PRE&POST SPIRO (BRONCHSPASM PRE&POST BD)	$1,028.80	$1,286.00	$45.03–$1,414.60	29% above	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 PRE&POST SPIRO (BRONCHSPASM PRE&POST BD)	$1,028.80	$1,286.00	$327.93–$1,414.60	—	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 DYNAMC FUNC OT ACT L2 EA15	$163.20	$204.00	$11.14–$419.00	19% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 DYNAMIC/FUNC OT ACT EA 15	$163.20	$204.00	$11.14–$419.00	19% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 DYNAMIC/FUNC PT ACT EA 15	$163.20	$204.00	$11.14–$419.00	19% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 DYNAMC FUNC PT ACT L2 EA15	$163.20	$204.00	$11.14–$419.00	19% above	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 DYNAMIC/FUNC OT ACT EA 15	$163.20	$204.00	$52.02–$224.40	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 DYNAMC FUNC PT ACT L2 EA15	$163.20	$204.00	$52.02–$224.40	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 DYNAMIC/FUNC PT ACT EA 15	$163.20	$204.00	$52.02–$224.40	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 DYNAMC FUNC OT ACT L2 EA15	$163.20	$204.00	$52.02–$224.40	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC	$327.20	$409.00	$16.40–$3,630.00	1% above	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC	$327.20	$409.00	$104.30–$449.90	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs California	Off list
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DPAT-IPV (KINRIX) 0.5ML SDPF 4-6YR	$287.19	$358.98	$63.67–$394.88	73% above	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DPAT-IPV (KINRIX) 0.5ML SDPF 4-6YR	$287.19	$358.98	$91.54–$394.88	—	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP VACC 0.5ML(INFANRIX)<7Y	$137.78	$172.22	$31.52–$189.44	93% above	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH,PERTUS(ACEL),TET PED(PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SYRINGE	$160.66	$200.82	$31.52–$220.90	125% above	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP (DAPTACEL) 0.5ML VL <7Y	$172.09	$215.11	$31.52–$236.62	141% above	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP VACC 0.5ML(INFANRIX)<7Y	$137.78	$172.22	$43.92–$189.44	—	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPH,PERTUS(ACEL),TET PED(PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SYRINGE	$160.66	$200.82	$51.21–$220.90	—	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP (DAPTACEL) 0.5ML VL <7Y	$172.09	$215.11	$54.85–$236.62	—	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HEP B VACC/DPAT/IP .5ML SYR<	$434.24	$542.80	$98.68–$597.08	164% above	20%
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	$539.62	$674.52	$98.68–$741.97	228% above	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HEP B VACC/DPAT/IP .5ML SYR<	$434.24	$542.80	$138.41–$597.08	—	20%
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	$539.62	$674.52	$172.00–$741.97	—	20%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-HIB-IP VACC IM 0.5ML VIAL	$529.39	$661.73	$111.06–$727.90	154% above	20%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-POLIO-HIB CONJ-TET(PF) 15 LF-48MCG-5 LF-62 DU-10MCG/ 0.5ML IM KIT	$663.35	$829.18	$111.06–$912.10	218% above	20%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP-HIB-IP VACC IM 0.5ML VIAL	$529.39	$661.73	$168.74–$727.90	—	20%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP-POLIO-HIB CONJ-TET(PF) 15 LF-48MCG-5 LF-62 DU-10MCG/ 0.5ML IM KIT	$663.35	$829.18	$211.44–$912.10	—	20%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 FLU VACCINE IIV3 PF (FLUZONE TRIVALENT) 0.5 ML IM SYRINGE	$418.64	$523.29	$45.07–$575.62	353% above	20%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 FLU VACCINE IIV3 PF (FLUZONE TRIVALENT) 0.5 ML IM SYRINGE	$418.64	$523.29	$133.44–$575.62	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE	$118.29	$147.86	$20.90–$162.65	188% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE IIV3 PF (FLUARIX TRIVALENT) 0.5 ML IM	$118.29	$147.86	$20.90–$162.65	188% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE IIV3 PF (FLUZONE TRIVALENT) 0.5 ML IM SYRINGE	$123.60	$154.50	$20.90–$169.95	201% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE	$118.29	$147.86	$37.70–$162.65	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE IIV3 PF (FLUARIX TRIVALENT) 0.5 ML IM	$118.29	$147.86	$37.70–$162.65	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE IIV3 PF (FLUZONE TRIVALENT) 0.5 ML IM SYRINGE	$123.60	$154.50	$39.40–$169.95	—	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT PF (GARDASIL 9) 0.5 ML SYRINGE IM	$667.66	$834.57	$208.64–$918.03	25% above	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE	$1,644.93	$2,056.16	$291.25–$2,261.78	207% above	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV 9-VALENT PF (GARDASIL 9) 0.5 ML SYRINGE IM	$667.66	$834.57	$212.82–$918.03	—	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE	$1,644.93	$2,056.16	$524.32–$2,261.78	—	20%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEP B RECOMB/HEP A VIR VACC 1M	$586.00	$732.50	$129.16–$805.75	173% above	20%
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	$710.30	$887.87	$129.16–$976.66	230% above	20%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEP B RECOMB/HEP A VIR VACC 1M	$586.00	$732.50	$186.79–$805.75	—	20%
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	$710.30	$887.87	$226.41–$976.66	—	20%
Hepatitis A vaccine, adult dose CPT 90632 HEP A VACC PF (HAVRIX) 1440 UNITS/ML 1ML SYRINGE IM	$204.68	$255.84	$63.96–$281.42	47% above	20%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEP A VACC PF (HAVRIX) 1440 UNITS/ML 1ML SYRINGE IM	$204.68	$255.84	$65.24–$281.42	—	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEP A VACC (VAQTA)25U/0.5ML-	$190.68	$238.35	$41.45–$262.19	158% above	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEP A PED VACC 720U/0.5ML-2D	$191.99	$239.98	$41.45–$263.98	160% above	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEP A VACC (VAQTA)25U/0.5ML-	$190.68	$238.35	$60.78–$262.19	—	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEP A PED VACC 720U/0.5ML-2D	$191.99	$239.98	$61.19–$263.98	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VACC ADULT 10MCG/.5ML	$140.64	$175.79	$43.95–$193.37	28% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VACC ADULT PF (ENGERIX-B) 20MCG/ML 1ML SDV 3 DOSE IM	$337.92	$422.40	$67.63–$464.64	207% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VACC ADULT 20MCG/1ML S	$367.91	$459.88	$67.63–$505.87	234% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SUSP	$396.95	$496.18	$67.63–$545.80	260% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE	$396.95	$496.18	$67.63–$545.80	260% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VACC ADULT 10MCG/.5ML	$140.64	$175.79	$44.83–$193.37	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VACC ADULT 20MCG/1ML S	$337.92	$422.40	$107.71–$464.64	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VACC ADULT PF (ENGERIX-B) 20MCG/ML 1ML SDV 3 DOSE IM	$337.92	$422.40	$107.71–$464.64	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE	$396.95	$496.18	$126.53–$545.80	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SUSP	$396.95	$496.18	$126.53–$545.80	—	20%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEP B VACC ADJUV (HEPLISAV-B) IM 0.5 ML SYRINGE	$759.04	$948.80	$159.80–$1,043.68	197% above	20%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEP B VACC PF ADJUVANT (HEPLISAV-B) 20 MCG/0.5 ML IM SYRINGE	$838.73	$1,048.41	$159.80–$1,153.25	229% above	20%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEP B VACC ADJUV (HEPLISAV-B) IM 0.5 ML SYRINGE	$759.04	$948.80	$241.94–$1,043.68	—	20%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEP B VACC PF ADJUVANT (HEPLISAV-B) 20 MCG/0.5 ML IM SYRINGE	$838.73	$1,048.41	$267.34–$1,153.25	—	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B VACCINE 0.5ML-PED/ADOL	$78.76	$98.45	$24.61–$108.30	37% above	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B VACC PED 10MCG/0.5ML S	$136.88	$171.10	$29.88–$188.21	137% above	20%
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	$164.08	$205.10	$29.88–$225.61	184% above	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VIRUS VACCINE RECMB(PF) 5 MCG/0.5 ML INTRAMUSCULAR SYRINGE	$164.08	$205.10	$29.88–$225.61	184% above	20%
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	$166.96	$208.70	$29.88–$229.57	189% above	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B VACCINE 0.5ML-PED/ADOL	$78.76	$98.45	$25.10–$108.30	—	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B VACC PED 10MCG/0.5ML S	$136.88	$171.10	$43.63–$188.21	—	20%
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	$164.08	$205.10	$52.30–$225.61	—	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VIRUS VACCINE RECMB(PF) 5 MCG/0.5 ML INTRAMUSCULAR SYRINGE	$164.08	$205.10	$52.30–$225.61	—	20%
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	$166.96	$208.70	$53.22–$229.57	—	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HAEMOPH B VACC (PRP-OMP) 0.5	$154.71	$193.38	$33.42–$212.72	128% above	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HAEMOPH B VACC (PRP-OMP) 0.5	$154.71	$193.38	$49.31–$212.72	—	20%
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	$82.88	$103.59	$14.29–$113.95	123% above	20%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPH INFLU B VAC PRP-T 1D	$100.26	$125.32	$14.29–$137.85	170% above	20%
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	$82.88	$103.59	$26.42–$113.95	—	20%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPH INFLU B VAC PRP-T 1D	$100.26	$125.32	$31.96–$137.85	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 M.M.R. VACCINE 1 DOSE	$419.62	$524.52	$94.70–$576.97	227% above	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT	$532.53	$665.66	$94.70–$732.23	315% above	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 M.M.R. VACCINE 1 DOSE	$419.62	$524.52	$133.75–$576.97	—	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT	$532.53	$665.66	$169.74–$732.23	—	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 M-M-R-V VACC (PROQUAD) 0.5ML SDV	$1,186.57	$1,483.21	$271.61–$1,631.53	154% above	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MEASLE/MUMP/RUB/VARI VACC .5	$1,186.57	$1,483.21	$271.61–$1,631.53	154% above	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 M-M-R-V VACC (PROQUAD) 0.5ML SDV	$1,186.57	$1,483.21	$378.22–$1,631.53	—	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MEASLE/MUMP/RUB/VARI VACC .5	$1,186.57	$1,483.21	$378.22–$1,631.53	—	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGCCAL VACC ACWYCRM IM USE	$697.56	$871.94	$152.46–$959.13	167% above	20%
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)	$888.97	$1,111.21	$152.46–$1,222.33	240% above	20%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGCCAL VACC ACWYCRM IM USE	$697.56	$871.94	$222.34–$959.13	—	20%
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)	$888.97	$1,111.21	$283.36–$1,222.33	—	20%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENINGOCOCCAL CONJ VACC ACWY TET PF (MENQUADFI) 10 MCG/0.5ML SDV IM	$942.92	$1,178.64	$170.69–$1,296.50	253% above	20%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION	$970.84	$1,213.55	$170.69–$1,334.91	264% above	20%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENINGOCOCCAL CONJ VACC ACWY TET PF (MENQUADFI) 10 MCG/0.5ML SDV IM	$942.92	$1,178.64	$300.55–$1,296.50	—	20%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION	$970.84	$1,213.55	$309.46–$1,334.91	—	20%
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	$1,242.39	$1,552.98	$227.46–$1,708.28	285% above	20%
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	$1,242.39	$1,552.98	$396.01–$1,708.28	—	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNCCAL VACC 13VAL 0.5ML SYRINGE	$61.55	$76.93	$19.23–$554.68	80% below	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL 13-VAL (PREVNAR 13) VACCINE 0.5 ML SYRINGE	$1,255.28	$1,569.09	$232.19–$1,726.00	302% above	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNCCAL VACC 13VAL 0.5ML SYRINGE	$61.55	$76.93	$19.62–$84.62	—	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL 13-VAL (PREVNAR 13) VACCINE 0.5 ML SYRINGE	$1,255.28	$1,569.09	$400.12–$1,726.00	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL CONJ PF (PREVNAR 20) 0.5ML SYRINGE IM -10	$1,423.89	$1,779.86	$281.61–$1,957.85	184% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL CONJ PF (PREVNAR 20) 0.5ML SYRINGE IM -02	$1,513.65	$1,892.06	$281.61–$2,081.27	201% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$1,527.81	$1,909.76	$281.61–$2,100.74	204% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL CONJ PF (PREVNAR 20) 0.5ML SYRINGE IM -10	$1,423.89	$1,779.86	$453.86–$1,957.85	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL CONJ PF (PREVNAR 20) 0.5ML SYRINGE IM -02	$1,513.65	$1,892.06	$482.48–$2,081.27	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$1,527.81	$1,909.76	$486.99–$2,100.74	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNCCAL VACC 23VAL 0.5ML VL =	$573.04	$716.30	$118.38–$787.93	254% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23 VAL VACCINE INJ	$667.66	$834.57	$118.38–$918.03	313% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE	$667.66	$834.57	$118.38–$918.03	313% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL PSV (PNEUMOVAX-23) 0.5ML SYRINGE SQ OR IM 2Y UP	$1,548.57	$1,935.71	$118.38–$2,129.28	858% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNCCAL VACC 23VAL 0.5ML VL =	$573.04	$716.30	$182.66–$787.93	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE	$667.66	$834.57	$212.82–$918.03	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23 VAL VACCINE INJ	$667.66	$834.57	$212.82–$918.03	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL PSV (PNEUMOVAX-23) 0.5ML SYRINGE SQ OR IM 2Y UP	$1,548.57	$1,935.71	$493.61–$2,129.28	—	20%
Polio vaccine, inactivated (IPV) CPT 90713 POLIOMYELITIS VACC KILLED 0.5ML INJ	$195.55	$244.43	$46.35–$268.87	116% above	20%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOMYELITIS VACC KILLED 0.5ML INJ	$195.55	$244.43	$62.33–$268.87	—	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE	$2,666.80	$3,333.50	$645.88–$3,666.85	175% above	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE	$2,666.80	$3,333.50	$850.04–$3,666.85	—	20%
Rabies vaccine, one dose CPT 90675 RABIES VAC (IMOVAX)2.5U/1ML V	$903.67	$1,129.58	$282.40–$1,242.54	28% above	20%
Rabies vaccine, one dose CPT 90675 RABIES VACC (RABAVERT)2.5U K	$1,789.60	$2,237.00	$283.70–$2,460.70	153% above	20%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP	$2,158.77	$2,698.46	$283.70–$2,968.31	206% above	20%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VAC (IMOVAX)2.5U/1ML V	$903.67	$1,129.58	$288.04–$1,242.54	—	20%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACC (RABAVERT)2.5U K	$1,789.60	$2,237.00	$570.44–$2,460.70	—	20%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP	$2,158.77	$2,698.46	$688.11–$2,968.31	—	20%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTAVIRUS VAC LIVE PENT 2ML	$469.19	$586.48	$119.45–$645.13	159% above	20%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 ROTAVIRUS VAC LIVE PENT 2ML	$469.19	$586.48	$149.55–$645.13	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS/DIPTHERIA TOXOIDS ADSOR	$152.68	$190.85	$34.80–$209.94	89% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPTHERIA-DECAVAC	$193.06	$241.32	$34.80–$265.45	140% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE	$229.32	$286.64	$34.80–$315.30	185% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS/DIPTHERIA TOXOIDS ADSOR	$152.68	$190.85	$48.67–$209.94	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPTHERIA-DECAVAC	$193.06	$241.32	$61.54–$265.45	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE	$229.32	$286.64	$73.09–$315.30	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACC 0.5ML (ADACEL) >7Y	$254.21	$317.76	$42.77–$349.54	119% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP (BOOSTRIX) IM 0.5ML VIAL 7 YRS & OLDER - 11	$264.80	$330.99	$42.77–$364.09	128% above	20%
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	$264.80	$330.99	$42.77–$364.09	128% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP (BOOSTRIX) IM 0.5ML SYRINGE 7 YRS & OLDER - 52	$264.80	$330.99	$42.77–$364.09	128% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACC 0.5ML (ADACEL) >7Y	$254.21	$317.76	$81.03–$349.54	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP (BOOSTRIX) IM 0.5ML SYRINGE 7 YRS & OLDER - 52	$264.80	$330.99	$84.40–$364.09	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP (BOOSTRIX) IM 0.5ML VIAL 7 YRS & OLDER - 11	$264.80	$330.99	$84.40–$364.09	—	20%
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	$264.80	$330.99	$84.40–$364.09	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN 1 VACCINE	$89.60	$112.00	$4.46–$158.15	14% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN 1 VACCINE	$89.60	$112.00	$28.56–$123.20	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE ADMIN-EA ADDL VACCINE	$42.40	$53.00	$13.25–$58.30	45% below	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 VACCINE ADMIN-EA ADDL VACCINE	$42.40	$53.00	$13.52–$58.30	—	20%

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/8231/941156276-1104906569_fresno-community-hospital-and-medical-center_standardcharges.csv