Hospital Cleveland, OH

Metrohealth System

Metrohealth System in Cleveland, OH publishes cash prices for 471 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Ohio median for 435 of 461 procedures and above it for 26. By typical cash price it ranks #5 of 139 Ohio hospitals and #1 of 26 hospitals in the Cleveland, OH area, cheapest first. Select a procedure to compare it with other hospitals nearby.

2500 Metrohealth Drive, Cleveland, OH 44109 Collected Sep 22, 2026 Source price file Check a bill from this hospital (216) 778-7089

Acute care hospital Nonprofit hospital Emergency department CMS star rating 3 of 5 CCN 360059 · CMS hospital register NPI 1700828852

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

Metrohealth System is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

State law

This state limits hospital bills for lower-income patients

Ohio's Hospital Care Assurance Program (HCAP): Ohio residents who are not on Medicaid and whose income is at or below 100% of the federal poverty level get basic, medically necessary hospital services free at hospitals in the program; physician bills are not included. Ask the hospital's billing office for an HCAP application. Other states' laws.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Abdominal CT scan without and with contrast CPT 74170 Hc Ct Adbomen W/O&W/Contrast	$811.30	$2,318.00	—	39% below	65%
Abdominal CT scan without and with contrast inpatient CPT 74170 Hc Ct Adbomen W/O&W/Contrast	$811.30	$2,318.00	—	—	65%
Abdominal X-ray, 2 views CPT 74019 Hc Hc Xray Abdomen 2 View	$150.50	$430.00	—	56% below	65%
Abdominal X-ray, 2 views inpatient CPT 74019 Hc Hc Xray Abdomen 2 View	$150.50	$430.00	—	—	65%
Ankle X-ray, complete, 3 or more views one side CPT 73610 Hc Xray Ankle 3 Views Rt	$158.55	$453.00	—	50% below	65%
Ankle X-ray, complete, 3 or more views one side CPT 73610 Hc Xray Ankle 3 Views Lt	$158.55	$453.00	—	50% below	65%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Hc Xray Ankle 3 Views Rt	$158.55	$453.00	—	—	65%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Hc Xray Ankle 3 Views Lt	$158.55	$453.00	—	—	65%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Hc Abi Limited Bilateral Study	$549.68	$1,570.50	—	—	65%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 Hc Abi Limited Bilateral Study	$549.68	$1,570.50	—	—	65%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Hc Ct Up Extrem Wo/Contrast	$459.90	$1,314.00	—	51% below	65%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Hc Ct Up Extrem Wo/Contrast	$459.90	$1,314.00	—	51% below	65%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Hc Ct Up Extrem Wo/Contrast	$459.90	$1,314.00	—	—	65%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Hc Ct Up Extrem Wo/Contrast	$459.90	$1,314.00	—	—	65%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Hc Xray Esophagus, Single Contrast	$294.00	$840.00	—	34% below	65%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Hc Xray Esophagus, Single Contrast	$294.00	$840.00	—	—	65%
Bone scan, whole body (nuclear medicine) CPT 78306 Hc Nm Bone/Joint Whole Body	$904.05	$2,583.00	—	41% below	65%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Hc Nm Bone/Joint Whole Body	$904.05	$2,583.00	—	—	65%
Breast ultrasound, complete, one breast both sides CPT 76641 Hc Mg Abus Bilat	$186.55	$533.00	—	—	65%
Breast ultrasound, complete, one breast one side CPT 76641 Hc Mg Abus Lt	$186.55	$533.00	—	61% below	65%
Breast ultrasound, complete, one breast one side CPT 76641 Hc Mg Abus Rt	$186.55	$533.00	—	61% below	65%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 Hc Mg Abus Bilat	$186.55	$533.00	—	—	65%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 Hc Mg Abus Lt	$186.55	$533.00	—	—	65%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 Hc Mg Abus Rt	$186.55	$533.00	—	—	65%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 Hc Us Breast /Axilla Bilat	$209.65	$599.00	—	—	65%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Hc Us Breast /Axilla Left	$209.65	$599.00	—	49% below	65%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Hc Us Breast /Axilla Left	$209.65	$599.00	—	49% below	65%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Hc Us Breast/Axilla Right	$209.65	$599.00	—	49% below	65%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Hc Us Breast/Axilla Right	$209.65	$599.00	—	49% below	65%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 Hc Us Breast /Axilla Bilat	$209.65	$599.00	—	—	65%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Hc Us Breast /Axilla Left	$209.65	$599.00	—	—	65%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Hc Us Breast/Axilla Right	$209.65	$599.00	—	—	65%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Hc Us Breast /Axilla Left	$209.65	$599.00	—	—	65%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Hc Us Breast/Axilla Right	$209.65	$599.00	—	—	65%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 Hc Ct Angio Abd&Pelv W/O&W/Contr	$1,622.60	$4,636.00	—	24% below	65%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 Hc Ct Angio Abd&Pelv W/O&W/Contr	$1,622.60	$4,636.00	—	—	65%
CT angiography (CTA) of the head CPT 70496 Hc Ct Angio Head Wo&W/Contr	$922.25	$2,635.00	—	31% below	65%
CT angiography (CTA) of the head inpatient CPT 70496 Hc Ct Angio Head Wo&W/Contr	$922.25	$2,635.00	—	—	65%
CT angiography (CTA) of the neck CPT 70498 Hc Ct Angio Neck Wo&W/Contr	$934.50	$2,670.00	—	28% below	65%
CT angiography (CTA) of the neck inpatient CPT 70498 Hc Ct Angio Neck Wo&W/Contr	$934.50	$2,670.00	—	—	65%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Hc Ct Chest Angiography Chest Wo&W/Contr	$876.05	$2,503.00	—	38% below	65%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Hc Ct Chest Angiography Chest Wo&W/Contr	$876.05	$2,503.00	—	—	65%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Hc Ct Angio Hrt W/3D Image	$2,299.15	$6,569.00	—	44% above	65%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 Hc Ct Angio Hrt W/3D Image	$2,299.15	$6,569.00	—	—	65%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 Hc Ct Hrt W/O Dye W/Ca Test	$435.40	$1,244.00	—	55% above	65%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 Hc Ct Hrt W/O Dye W/Ca Test	$435.40	$1,244.00	—	—	65%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Hc Ct Abdomen/Pelvis W/O	$1,050.00	$3,000.00	—	34% below	65%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Hc Ct Abdomen/Pelvis W/O	$1,050.00	$3,000.00	—	—	65%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 Hc Ct Abdomen/Pelvis W/	$1,160.25	$3,315.00	—	42% below	65%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Hc Ct Abdomen/Pelvis W/	$1,160.25	$3,315.00	—	—	65%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Hc Ct Abdomen/Pelvis W/+W/O	$1,258.60	$3,596.00	—	46% below	65%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Hc Ct Abdomen/Pelvis W/+W/O	$1,258.60	$3,596.00	—	—	65%
CT scan of the abdomen with contrast CPT 74160 Hc Ct Adbomen W/Contrast	$691.25	$1,975.00	—	41% below	65%
CT scan of the abdomen with contrast inpatient CPT 74160 Hc Ct Adbomen W/Contrast	$691.25	$1,975.00	—	—	65%
CT scan of the abdomen without contrast CPT 74150 Hc Ct Abdomen W/O Contrast	$462.35	$1,321.00	—	56% below	65%
CT scan of the abdomen without contrast inpatient CPT 74150 Hc Ct Abdomen W/O Contrast	$462.35	$1,321.00	—	—	65%
CT scan of the face and sinuses, no contrast dye CPT 70486 Hc Ct Maxillofacial Wo/Contrast	$484.75	$1,385.00	—	45% below	65%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Hc Ct Maxillofacial Wo/Contrast	$484.75	$1,385.00	—	—	65%
CT scan of the head or brain, no contrast dye CPT 70450 Hc Ct Head Wo/Contrast	$535.50	$1,530.00	—	36% below	65%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 Hc Ct Head Wo/Contrast	$535.50	$1,530.00	—	—	65%
CT scan of the head with contrast CPT 70460 Hc Ct Head W/Contrast	$561.75	$1,605.00	—	44% below	65%
CT scan of the head with contrast inpatient CPT 70460 Hc Ct Head W/Contrast	$561.75	$1,605.00	—	—	65%
CT scan of the head without and with contrast CPT 70470 Hc Ct Head W&Wo/Contrast	$726.25	$2,075.00	—	39% below	65%
CT scan of the head without and with contrast inpatient CPT 70470 Hc Ct Head W&Wo/Contrast	$726.25	$2,075.00	—	—	65%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Hc Ct Lumbar Spine Wo/Contrast	$631.40	$1,804.00	—	43% below	65%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 Hc Ct Lumbar Spine Wo/Contrast	$631.40	$1,804.00	—	—	65%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Hc Ct Cervical Spine Wo/Contrast	$617.75	$1,765.00	—	42% below	65%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 Hc Ct Cervical Spine Wo/Contrast	$617.75	$1,765.00	—	—	65%
CT scan of the pelvis, with contrast dye CPT 72193 Hc Ct Pelvis W/Contrast	$635.95	$1,817.00	—	48% below	65%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 Hc Ct Pelvis W/Contrast	$635.95	$1,817.00	—	—	65%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Hc Extracranial Bilat Study	$857.50	$2,450.00	—	—	65%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Hc Extracranial Bilat Study	$857.50	$2,450.00	—	—	65%
Chest CT scan without and with contrast CPT 71270 Hc Ct Chest W/O&W/Contr	$786.10	$2,246.00	—	48% below	65%
Chest CT scan without and with contrast inpatient CPT 71270 Hc Ct Chest W/O&W/Contr	$786.10	$2,246.00	—	—	65%
Chest X-ray, 2 views CPT 71046 Hc Xray Chest 2 Views	$121.80	$348.00	—	54% below	65%
Chest X-ray, 2 views inpatient CPT 71046 Hc Xray Chest 2 Views	$121.80	$348.00	—	—	65%
Chest X-ray, single view CPT 71045 Hc Hc Xray Chest Single View	$121.80	$348.00	—	46% below	65%
Chest X-ray, single view inpatient CPT 71045 Hc Hc Xray Chest Single View	$121.80	$348.00	—	—	65%
Collarbone (clavicle) X-ray, complete one side CPT 73000 Hc Xray Clavicle Complete Lt	$126.70	$362.00	—	53% below	65%
Collarbone (clavicle) X-ray, complete one side CPT 73000 Hc Xray Clavicle Complete Rt	$126.70	$362.00	—	53% below	65%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Hc Xray Clavicle Complete Rt	$126.70	$362.00	—	—	65%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Hc Xray Clavicle Complete Lt	$126.70	$362.00	—	—	65%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Hc Us Retroperitoneal	$359.45	$1,027.00	—	49% below	65%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Hc Pocus Retroperitoneal Us, Complete	$359.45	$1,027.00	—	49% below	65%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Hc Us Retroperitoneal	$359.45	$1,027.00	—	—	65%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Hc Pocus Retroperitoneal Us, Complete	$359.45	$1,027.00	—	—	65%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Hc Bone Dens Study Axial 1(+) Sites	$195.65	$559.00	—	57% below	65%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Hc Bone Dens Study Axial 1(+) Sites	$195.65	$559.00	—	—	65%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Hc Bone Dens Stdy Appendicular 1(+)_Sites	$119.35	$341.00	—	54% below	65%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 Hc Bone Dens Stdy Appendicular 1(+)_Sites	$119.35	$341.00	—	—	65%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Hc Us Preg>1St Tri,Detail1St Gest	$432.60	$1,236.00	—	49% below	65%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 Hc Us Preg>1St Tri,Detail1St Gest	$432.60	$1,236.00	—	—	65%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Hc Ct Chest W/O Contr	$647.50	$1,850.00	—	31% below	65%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Hc Ct Chest W/O Contr	$647.50	$1,850.00	—	—	65%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Hc Ct Chest W/Contr	$710.15	$2,029.00	—	41% below	65%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Hc Ct Chest W/Contr	$710.15	$2,029.00	—	—	65%
Diagnostic mammogram, both breasts both sides CPT 77066 Hc Hc Mg Digital Mammo Diagnos Bilat	$216.30	$618.00	—	—	65%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Hc Hc Mg Digital Mammo Diagnos Bilat	$216.30	$618.00	—	—	65%
Diagnostic mammogram, one breast one side CPT 77065 Hc Hc Mg Digital Mammo Diagn Unilat	$172.20	$492.00	—	52% below	65%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Hc Hc Mg Digital Mammo Diagn Unilat	$172.20	$492.00	—	—	65%
Duplex ultrasound of the leg arteries, both legs CPT 93925 Hc Lower Extremity Study; Complete	$612.85	$1,751.00	—	32% below	65%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 Hc Lower Extremity Study; Complete	$612.85	$1,751.00	—	—	65%
Duplex ultrasound of the leg veins, both legs CPT 93970 Hc Extremity Study; Complete	$770.70	$2,202.00	—	14% below	65%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Hc Extremity Study; Complete	$770.70	$2,202.00	—	—	65%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Hc Echo 2D M-Mode,Dop,Colr Flow	$1,260.00	$3,600.00	—	25% below	65%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Hc Tte W/Doppler Complete	$1,260.00	$3,600.00	—	25% below	65%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Hc Tte W/Doppler Complete	$1,260.00	$3,600.00	—	—	65%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Hc Echo 2D M-Mode,Dop,Colr Flow	$1,260.00	$3,600.00	—	—	65%
Elbow X-ray, 2 views one side CPT 73070 Hc Xray Elbow 2 View	$151.90	$434.00	—	42% below	65%
Elbow X-ray, 2 views one side CPT 73070 Hc Xray Elbow 2 View	$151.90	$434.00	—	42% below	65%
Elbow X-ray, 2 views inpatient one side CPT 73070 Hc Xray Elbow 2 View	$151.90	$434.00	—	—	65%
Elbow X-ray, 2 views inpatient one side CPT 73070 Hc Xray Elbow 2 View	$151.90	$434.00	—	—	65%
Elbow X-ray, complete, 3 or more views one side CPT 73080 Hc Xray Elbow 3 Views Rt	$159.95	$457.00	—	49% below	65%
Elbow X-ray, complete, 3 or more views one side CPT 73080 Hc Xray Elbow 3 Views Lt	$159.95	$457.00	—	49% below	65%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Hc Xray Elbow 3 Views Rt	$159.95	$457.00	—	—	65%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Hc Xray Elbow 3 Views Lt	$159.95	$457.00	—	—	65%
Eye socket (orbit) CT scan without contrast CPT 70480 Hc Ct Orbit/Sella/Ear Wo/Contrast	$541.80	$1,548.00	—	37% below	65%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Hc Ct Orbit/Sella/Ear Wo/Contrast	$541.80	$1,548.00	—	—	65%
Facial bones X-ray, complete, 3 or more views CPT 70150 Hc Xray Facial Bones 3+ Views	$224.35	$641.00	—	41% below	65%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 Hc Xray Facial Bones 3+ Views	$224.35	$641.00	—	—	65%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Hc Xray Forearm 2 Views Lt	$135.10	$386.00	—	50% below	65%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Hc Xray Forearm 2 Views Rt	$135.10	$386.00	—	50% below	65%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Hc Xray Forearm 2 Views Lt	$135.10	$386.00	—	—	65%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Hc Xray Forearm 2 Views Rt	$135.10	$386.00	—	—	65%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hc Hepatobiliary System Imaging	$609.70	$1,742.00	—	62% below	65%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hc Hepatobiliary System Imaging	$609.70	$1,742.00	—	—	65%
Hand X-ray, 2 views one side CPT 73120 Hc Xray Hand 2 Views Lt	$160.65	$459.00	—	40% below	65%
Hand X-ray, 2 views one side CPT 73120 Hc Xray Hand 2 Views Rt	$160.65	$459.00	—	40% below	65%
Hand X-ray, 2 views inpatient one side CPT 73120 Hc Xray Hand 2 Views Rt	$160.65	$459.00	—	—	65%
Hand X-ray, 2 views inpatient one side CPT 73120 Hc Xray Hand 2 Views Lt	$160.65	$459.00	—	—	65%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Hc Xray Heel 2 Views Lt	$120.40	$344.00	—	56% below	65%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Hc Xray Heel 2 Views Rt	$120.40	$344.00	—	56% below	65%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Hc Xray Heel 2 Views Rt	$120.40	$344.00	—	—	65%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Hc Xray Heel 2 Views Lt	$120.40	$344.00	—	—	65%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Hc Sleep Study Unattended	$719.80	$2,056.58	—	3% above	65%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Hc Sleep Study Unattended	$719.80	$2,056.58	—	—	65%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Hc Polysom 6/>Yrs Cpap 4/> Parm	$3,083.56	$8,810.17	—	25% below	65%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Hc Polysom 6/>Yrs Cpap 4/> Parm	$3,083.56	$8,810.17	—	—	65%
Knee X-ray, 3 views one side CPT 73562 Hc Xray Knee 3 Views Rt	$155.75	$445.00	—	56% below	65%
Knee X-ray, 3 views one side CPT 73562 Hc Xray Knee 3 Views Lt	$155.75	$445.00	—	56% below	65%
Knee X-ray, 3 views inpatient one side CPT 73562 Hc Xray Knee 3 Views Lt	$155.75	$445.00	—	—	65%
Knee X-ray, 3 views inpatient one side CPT 73562 Hc Xray Knee 3 Views Rt	$155.75	$445.00	—	—	65%
Knee X-ray, complete, 4 or more views one side CPT 73564 Hc Xray Knee 4 Or More Views	$180.25	$515.00	—	54% below	65%
Knee X-ray, complete, 4 or more views one side CPT 73564 Hc Xray Knee 4 Or More Views	$180.25	$515.00	—	54% below	65%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Hc Xray Knee 4 Or More Views	$180.25	$515.00	—	—	65%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Hc Xray Knee 4 Or More Views	$180.25	$515.00	—	—	65%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Hc Ct Lower Extrm Wo/Cntrst	$572.95	$1,637.00	—	39% below	65%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Hc Ct Lower Extrm Wo/Cntrst	$572.95	$1,637.00	—	39% below	65%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Hc Ct Lower Extrm Wo/Cntrst	$572.95	$1,637.00	—	—	65%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Hc Ct Lower Extrm Wo/Cntrst	$572.95	$1,637.00	—	—	65%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Hc Us Abdominal Limited	$305.55	$873.00	—	45% below	65%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Hc Us Abdominal Limited Study (Single Organ, Quad, Or Follow Up)	$305.55	$873.00	—	45% below	65%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Hc Us Abdominal Limited Study (Single Organ, Quad, Or Follow Up)	$305.55	$873.00	—	—	65%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Hc Us Abdominal Limited	$305.55	$873.00	—	—	65%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Us Xtr Non-Vasc Lmtd	$164.50	$470.00	—	66% below	65%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Hc Us Extremity, Non-Vascular, Limited	$164.50	$470.00	—	66% below	65%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Hc Us Xtr Non-Vasc Lmtd Rt	$164.50	$470.00	—	66% below	65%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Hc Us Xtr Non-Vasc Lmtd Lt	$164.50	$470.00	—	66% below	65%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 Hc Us Extremity, Non-Vascular, Limited	$164.50	$470.00	—	—	65%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 Us Xtr Non-Vasc Lmtd	$164.50	$470.00	—	—	65%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Hc Us Xtr Non-Vasc Lmtd Lt	$164.50	$470.00	—	—	65%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Hc Us Xtr Non-Vasc Lmtd Rt	$164.50	$470.00	—	—	65%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Hc Ct Chest Low Dose Lung Cancer Screening	$264.60	$756.00	—	10% below	65%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Hc Ct Chest Low Dose Lung Cancer Screening	$264.60	$756.00	—	—	65%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Hc Xray Tibia & Fibuala 2 Views Lt	$143.15	$409.00	—	48% below	65%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Hc Xray Tibia & Fibuala 2 Views Rt	$143.15	$409.00	—	48% below	65%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Hc Xray Tibia & Fibuala 2 Views Lt	$143.15	$409.00	—	—	65%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Hc Xray Tibia & Fibuala 2 Views Rt	$143.15	$409.00	—	—	65%
MR angiography (MRA) of the head without contrast CPT 70544 Hc Mr Angiography Head W/O Contr	$1,021.30	$2,918.00	—	30% below	65%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 Hc Mr Angiography Head W/O Contr	$1,021.30	$2,918.00	—	—	65%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 Mri Breast Without&With Contrast W/Cad Bilateral	$1,176.70	$3,362.00	—	—	65%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 Mri Breast Without&With Contrast W/Cad Bilateral	$1,176.70	$3,362.00	—	—	65%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Hc Mri Lower Extr Joint W/O Cntrst	$1,021.30	$2,918.00	—	42% below	65%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Hc Mri Lower Extr Joint W/O Cntrst	$1,021.30	$2,918.00	—	42% below	65%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Hc Mri Lower Extr Joint W/O Cntrst	$1,021.30	$2,918.00	—	—	65%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Hc Mri Lower Extr Joint W/O Cntrst	$1,021.30	$2,918.00	—	—	65%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Hc Mri Lower Extr Joint W/O & W/Contrast	$2,013.20	$5,752.00	—	16% below	65%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Hc Mri Lower Extr Joint W/O & W/Contrast	$2,013.20	$5,752.00	—	16% below	65%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Hc Mri Lower Extr Joint W/O & W/Contrast	$2,013.20	$5,752.00	—	—	65%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Hc Mri Lower Extr Joint W/O & W/Contrast	$2,013.20	$5,752.00	—	—	65%
MRI of the abdomen without contrast CPT 74181 Hc Mri Abdomen Wo/Contrast	$1,021.30	$2,918.00	—	45% below	65%
MRI of the abdomen without contrast inpatient CPT 74181 Hc Mri Abdomen Wo/Contrast	$1,021.30	$2,918.00	—	—	65%
MRI of the abdomen, without and then with contrast dye CPT 74183 Hc Mri Abdomen Wo&W/Contrast	$1,567.65	$4,479.00	—	32% below	65%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Hc Mri Abdomen Wo&W/Contrast	$1,567.65	$4,479.00	—	—	65%
MRI of the brain, no contrast dye CPT 70551 Hc Mri Brain W/O Contr	$1,021.30	$2,918.00	—	37% below	65%
MRI of the brain, no contrast dye inpatient CPT 70551 Hc Mri Brain W/O Contr	$1,021.30	$2,918.00	—	—	65%
MRI of the brain, with and without contrast dye CPT 70553 Hc Mri Brain W/O&W/Contr	$1,750.00	$5,000.00	—	20% below	65%
MRI of the brain, with and without contrast dye inpatient CPT 70553 Hc Mri Brain W/O&W/Contr	$1,750.00	$5,000.00	—	—	65%
MRI of the lower back, no contrast dye CPT 72148 Hc Mri Lumbar Spine Wo/Contrast	$1,021.30	$2,918.00	—	39% below	65%
MRI of the lower back, no contrast dye inpatient CPT 72148 Hc Mri Lumbar Spine Wo/Contrast	$1,021.30	$2,918.00	—	—	65%
MRI of the lower back, without and then with contrast dye CPT 72158 Hc Mri Lumbar Spine Wo&W/Contrast	$1,430.10	$4,086.00	—	39% below	65%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 Hc Mri Lumbar Spine Wo&W/Contrast	$1,430.10	$4,086.00	—	—	65%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Hc Mri Thoracic Spine Wo/Contrast	$1,021.30	$2,918.00	—	39% below	65%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 Hc Mri Thoracic Spine Wo/Contrast	$1,021.30	$2,918.00	—	—	65%
MRI of the neck (cervical spine) without and with contrast CPT 72156 Hc Mri Cervicl Spine W&Wo/Contrst	$1,537.55	$4,393.00	—	32% below	65%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 Hc Mri Cervicl Spine W&Wo/Contrst	$1,537.55	$4,393.00	—	—	65%
MRI of the neck (cervical spine), no contrast dye CPT 72141 Hc Mri Cervical Spine Wo/Contrast	$1,021.30	$2,918.00	—	38% below	65%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 Hc Mri Cervical Spine Wo/Contrast	$1,021.30	$2,918.00	—	—	65%
MRI of the pelvis without and with contrast CPT 72197 Hc Mri Pelvis Wo&W/Contrast	$1,524.60	$4,356.00	—	22% below	65%
MRI of the pelvis without and with contrast inpatient CPT 72197 Hc Mri Pelvis Wo&W/Contrast	$1,524.60	$4,356.00	—	—	65%
MRI of the pelvis, no contrast dye CPT 72195 Hc Mri Pelvis Wo/Contrast	$1,021.30	$2,918.00	—	33% below	65%
MRI of the pelvis, no contrast dye inpatient CPT 72195 Hc Mri Pelvis Wo/Contrast	$1,021.30	$2,918.00	—	—	65%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Hc Mri Up Extr Joint Wo/Contr	$1,021.30	$2,918.00	—	32% below	65%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Hc Mri Up Extr Joint Wo/Contr	$1,021.30	$2,918.00	—	32% below	65%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Hc Mri Up Extr Joint Wo/Contr	$1,021.30	$2,918.00	—	—	65%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Hc Mri Up Extr Joint Wo/Contr	$1,021.30	$2,918.00	—	—	65%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Hc Xray Spine Cervical 4+ Views	$208.60	$596.00	—	54% below	65%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 Hc Xray Spine Cervical 4+ Views	$208.60	$596.00	—	—	65%
Neck soft tissue CT scan with contrast CPT 70491 Hc Ct Neck W/Contrast	$658.70	$1,882.00	—	44% below	65%
Neck soft tissue CT scan with contrast inpatient CPT 70491 Hc Ct Neck W/Contrast	$658.70	$1,882.00	—	—	65%
Neck soft tissue CT scan without contrast CPT 70490 Hc Ct Neck Wo/Contrast	$487.20	$1,392.00	—	47% below	65%
Neck soft tissue CT scan without contrast inpatient CPT 70490 Hc Ct Neck Wo/Contrast	$487.20	$1,392.00	—	—	65%
Neck soft tissue X-ray CPT 70360 Xr Neck Soft Tissue Ap & Lat	$120.40	$344.00	—	54% below	65%
Neck soft tissue X-ray inpatient CPT 70360 Xr Neck Soft Tissue Ap & Lat	$120.40	$344.00	—	—	65%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Hc Ht Muscle Image Spect Mult	$2,431.45	$6,947.00	—	39% below	65%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Hc Ht Muscle Image Spect Mult	$2,431.45	$6,947.00	—	—	65%
OCT scan of the retina (optical coherence tomography) CPT 92134 Hc Cptr Ophth Dx Img Post Segmt	$142.28	$406.50	—	81% above	65%
OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 Hc Cptr Ophth Dx Img Post Segmt	$142.28	$406.50	—	—	65%
Pelvic CT scan without contrast CPT 72192 Hc Ct Pelvis Wo/Contrast	$481.60	$1,376.00	—	52% below	65%
Pelvic CT scan without contrast inpatient CPT 72192 Hc Ct Pelvis Wo/Contrast	$481.60	$1,376.00	—	—	65%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Hc Pocus Pelvic (Non-Obsteteric) Real Time With Us Guidance & Img Doc, Limited Or Follow Up	$204.75	$585.00	—	53% below	65%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Hc Us Pelvic Gyn	$204.75	$585.00	—	53% below	65%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us Fdc Gyn Limited	$204.75	$585.00	—	53% below	65%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Hc Us Pelvic, Limited	$204.75	$585.00	—	53% below	65%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Hc Us Pelvic, Limited	$204.75	$585.00	—	—	65%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Hc Pocus Pelvic (Non-Obsteteric) Real Time With Us Guidance & Img Doc, Limited Or Follow Up	$204.75	$585.00	—	—	65%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Hc Us Pelvic Gyn	$204.75	$585.00	—	—	65%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Us Fdc Gyn Limited	$204.75	$585.00	—	—	65%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Hc Us Pelvic Complete	$285.25	$815.00	—	43% below	65%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Hc Gyn Ultrasound	$285.25	$815.00	—	43% below	65%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us Fdc Gyn Complete	$285.25	$815.00	—	43% below	65%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Us Fdc Gyn Complete	$285.25	$815.00	—	—	65%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Hc Gyn Ultrasound	$285.25	$815.00	—	—	65%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Hc Us Pelvic Complete	$285.25	$815.00	—	—	65%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Us Gravid Uterus Comprehensive	$282.10	$806.00	—	53% below	65%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Us Gravid Uterus Comprehensive	$282.10	$806.00	—	—	65%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Hc U/S Preg-1St Tri, 1St Gestatn	$302.40	$864.00	—	45% below	65%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Hc Us Preg 1St Tri, 1St Gestation	$302.40	$864.00	—	45% below	65%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Us Fdc Ob First Trimester	$302.40	$864.00	—	45% below	65%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Hc Us Preg 1St Tri, 1St Gestation	$302.40	$864.00	—	—	65%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Hc U/S Preg-1St Tri, 1St Gestatn	$302.40	$864.00	—	—	65%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Us Fdc Ob First Trimester	$302.40	$864.00	—	—	65%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Fdc >15 Week Limited	$244.65	$699.00	—	49% below	65%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Preg Uterus Ltd-Emerg Dept	$244.65	$699.00	—	49% below	65%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Us Preg Uterus Ltd-Emerg Dept	$244.65	$699.00	—	—	65%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Us Fdc >15 Week Limited	$244.65	$699.00	—	—	65%
Rib X-ray, one side, 2 views one side CPT 71100 Hc Xray Ribs Unilat 2 Views	$156.80	$448.00	—	48% below	65%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Hc Xray Ribs Unilat 2 Views	$156.80	$448.00	—	—	65%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Hc Xray Ribs&Chest Unilat 3 Views-Rt	$149.10	$426.00	—	61% below	65%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Hc Xray Ribs&Chest Unilat 3 Views-Lt	$149.10	$426.00	—	61% below	65%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Hc Xray Ribs&Chest Unilat 3 Views-Lt	$149.10	$426.00	—	—	65%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Hc Xray Ribs&Chest Unilat 3 Views-Rt	$149.10	$426.00	—	—	65%
Screening mammogram, both breasts both sides CPT 77067 Hc Mg Digital Mammo Screen Bilat	$183.05	$523.00	—	—	65%
Screening mammogram, both breasts inpatient both sides CPT 77067 Hc Mg Digital Mammo Screen Bilat	$183.05	$523.00	—	—	65%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Hc Xray Shoulder 2 Views	$153.30	$438.00	—	55% below	65%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Hc Xray Shoulder 2 Views	$153.30	$438.00	—	55% below	65%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Hc Xray Shoulder 2 Views	$153.30	$438.00	—	—	65%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Hc Xray Shoulder 2 Views	$153.30	$438.00	—	—	65%
Sinus X-ray, complete, 3 or more views CPT 70220 Hc Xray Sinuses	$167.65	$479.00	—	54% below	65%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Hc Xray Sinuses	$167.65	$479.00	—	—	65%
Skull X-ray, fewer than 4 views CPT 70250 Hc Xray Skull < 4 Views	$152.95	$437.00	—	47% below	65%
Skull X-ray, fewer than 4 views inpatient CPT 70250 Hc Xray Skull < 4 Views	$152.95	$437.00	—	—	65%
Sleep study in a lab (polysomnography) CPT 95810 Hc Polysom 6/> Yrs 4/> Param	$2,772.81	$7,922.31	—	23% below	65%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Hc Polysom 6/> Yrs 4/> Param	$2,772.81	$7,922.31	—	—	65%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Hc Echo 2D Stress W/Report	$1,090.95	$3,117.00	—	47% below	65%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Hc Echo 2D Stress W/Report	$1,090.95	$3,117.00	—	—	65%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Hc Xray Swallowing Function Eval	$323.75	$925.00	—	36% below	65%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Hc Xray Swallowing Function Eval	$323.75	$925.00	—	—	65%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Hc Xr Rt Femur Min 2 Views	$145.25	$415.00	—	46% below	65%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Hc Xr Lt Femur Min 2 Views	$145.25	$415.00	—	46% below	65%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Hc Xr Lt Femur Min 2 Views	$145.25	$415.00	—	—	65%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Hc Xr Rt Femur Min 2 Views	$145.25	$415.00	—	—	65%
Thoracic spine (mid back) CT scan without contrast CPT 72128 Hc Ct Thoracic Spine Wo/Contrast	$535.85	$1,531.00	—	41% below	65%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 Hc Ct Thoracic Spine Wo/Contrast	$535.85	$1,531.00	—	—	65%
Toe X-ray, 2 or more views one side CPT 73660 Hc Xray Toes 2 Views Rt	$121.80	$348.00	—	51% below	65%
Toe X-ray, 2 or more views one side CPT 73660 Hc Xray Toes 2 Views Lt	$121.80	$348.00	—	51% below	65%
Toe X-ray, 2 or more views inpatient one side CPT 73660 Hc Xray Toes 2 Views Rt	$121.80	$348.00	—	—	65%
Toe X-ray, 2 or more views inpatient one side CPT 73660 Hc Xray Toes 2 Views Lt	$121.80	$348.00	—	—	65%
Transvaginal pelvic ultrasound CPT 76830 Us Transvaginal	$273.70	$782.00	—	51% below	65%
Transvaginal pelvic ultrasound CPT 76830 Us Fdc Gyn Transvaginal	$273.70	$782.00	—	51% below	65%
Transvaginal pelvic ultrasound inpatient CPT 76830 Us Transvaginal	$273.70	$782.00	—	—	65%
Transvaginal pelvic ultrasound inpatient CPT 76830 Us Fdc Gyn Transvaginal	$273.70	$782.00	—	—	65%
Transvaginal ultrasound during pregnancy CPT 76817 Us Fdc Ob Transvaginal	$339.85	$971.00	—	32% below	65%
Transvaginal ultrasound during pregnancy CPT 76817 Fetal Us - Transvaginal	$339.85	$971.00	—	32% below	65%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 Us Fdc Ob Transvaginal	$339.85	$971.00	—	—	65%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 Fetal Us - Transvaginal	$339.85	$971.00	—	—	65%
Ultrasound of the abdomen, complete CPT 76700 Hc Us Abdomen Complete	$480.20	$1,372.00	—	23% below	65%
Ultrasound of the abdomen, complete inpatient CPT 76700 Hc Us Abdomen Complete	$480.20	$1,372.00	—	—	65%
Ultrasound of the scrotum and testicles CPT 76870 Hc Echo Exam Of Scrotum	$279.30	$798.00	—	48% below	65%
Ultrasound of the scrotum and testicles CPT 76870 Echo Exam Of Scrotum	$279.30	$798.00	—	48% below	65%
Ultrasound of the scrotum and testicles inpatient CPT 76870 Hc Echo Exam Of Scrotum	$279.30	$798.00	—	—	65%
Ultrasound of the scrotum and testicles inpatient CPT 76870 Echo Exam Of Scrotum	$279.30	$798.00	—	—	65%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Hc Us Thyroid/Parathyroid/Parotid	$351.40	$1,004.00	—	39% below	65%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Hc Us Soft Tissue Head & Neck	$351.40	$1,004.00	—	39% below	65%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Hc Us Soft Tissue Head & Neck	$351.40	$1,004.00	—	—	65%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Hc Us Thyroid/Parathyroid/Parotid	$351.40	$1,004.00	—	—	65%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Hc Xray Upper Gi Tract, Single Contrast	$344.05	$983.00	—	42% below	65%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Hc Xray Upper Gi Tract, Single Contrast	$344.05	$983.00	—	—	65%
Upper arm X-ray (humerus), 2 views one side CPT 73060 Hc Xray Humerus 2 Views Rt	$133.70	$382.00	—	51% below	65%
Upper arm X-ray (humerus), 2 views one side CPT 73060 Hc Xray Humerus 2 Views Lt	$133.70	$382.00	—	51% below	65%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Hc Xray Humerus 2 Views Lt	$133.70	$382.00	—	—	65%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Hc Xray Humerus 2 Views Rt	$133.70	$382.00	—	—	65%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Hc Extremity Study; Limited	$534.45	$1,527.00	—	27% below	65%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Hc Duplex Scan Veins, Unilateral	$228.20	$652.00	—	69% below	65%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Hc Duplex Extremity Scan Right	$534.45	$1,527.00	—	27% below	65%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Hc Duplex Extremity Scan Left	$534.45	$1,527.00	—	27% below	65%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Hc Extremity Study; Limited	$534.45	$1,527.00	—	—	65%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Hc Duplex Scan Veins, Unilateral	$228.20	$652.00	—	—	65%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Hc Duplex Extremity Scan Left	$534.45	$1,527.00	—	—	65%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Hc Duplex Extremity Scan Right	$534.45	$1,527.00	—	—	65%
Wrist X-ray, 2 views one side CPT 73100 Hc Xray Wrist 2 Views Lt	$131.60	$376.00	—	50% below	65%
Wrist X-ray, 2 views one side CPT 73100 Hc Xray Wrist 2 Views Rt	$131.60	$376.00	—	50% below	65%
Wrist X-ray, 2 views inpatient one side CPT 73100 Hc Xray Wrist 2 Views Lt	$131.60	$376.00	—	—	65%
Wrist X-ray, 2 views inpatient one side CPT 73100 Hc Xray Wrist 2 Views Rt	$131.60	$376.00	—	—	65%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Hc Xray Wrist 3 Views Lt	$157.15	$449.00	—	53% below	65%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Hc Xray Wrist 3 Views Rt	$157.15	$449.00	—	53% below	65%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Hc Xray Wrist 3 Views Lt	$157.15	$449.00	—	—	65%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Hc Xray Wrist 3 Views Rt	$157.15	$449.00	—	—	65%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 Hc Xr Peds Ap And Frog W/ Pelvis	$152.25	$435.00	—	51% below	65%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hc Xr Lt Hip W/ Pelvis 2-3 Views	$152.25	$435.00	—	51% below	65%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hc Xr Rt Hip W/ Pelvis 2-3 Views	$152.25	$435.00	—	51% below	65%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 Hc Xr Peds Ap And Frog W/ Pelvis	$152.25	$435.00	—	—	65%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Hc Xr Rt Hip W/ Pelvis 2-3 Views	$152.25	$435.00	—	—	65%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Hc Xr Lt Hip W/ Pelvis 2-3 Views	$152.25	$435.00	—	—	65%
X-ray of the abdomen, 1 view CPT 74018 Hc Hc Xray Abdomen 1 View	$110.60	$316.00	—	57% below	65%
X-ray of the abdomen, 1 view inpatient CPT 74018 Hc Hc Xray Abdomen 1 View	$110.60	$316.00	—	—	65%
X-ray of the ankle, 2 views one side CPT 73600 Hc Xray Ankle 2 Views Lt	$164.85	$471.00	—	34% below	65%
X-ray of the ankle, 2 views one side CPT 73600 Hc Xray Ankle 2 Views Rt	$164.85	$471.00	—	34% below	65%
X-ray of the ankle, 2 views inpatient one side CPT 73600 Hc Xray Ankle 2 Views Lt	$164.85	$471.00	—	—	65%
X-ray of the ankle, 2 views inpatient one side CPT 73600 Hc Xray Ankle 2 Views Rt	$164.85	$471.00	—	—	65%
X-ray of the finger(s), 2 or more views one side CPT 73140 Hc Xray Fingers 2 Views Lt	$119.70	$342.00	—	54% below	65%
X-ray of the finger(s), 2 or more views one side CPT 73140 Hc Xray Fingers 2 Views Rt	$119.70	$342.00	—	54% below	65%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Hc Xray Fingers 2 Views Rt	$119.70	$342.00	—	—	65%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Hc Xray Fingers 2 Views Lt	$119.70	$342.00	—	—	65%
X-ray of the foot, 2 views one side CPT 73620 Hc Xray Foot 2 Views	$149.45	$427.00	—	36% below	65%
X-ray of the foot, 2 views one side CPT 73620 Hc Xray Foot 2 Views	$149.45	$427.00	—	36% below	65%
X-ray of the foot, 2 views inpatient one side CPT 73620 Hc Xray Foot 2 Views	$149.45	$427.00	—	—	65%
X-ray of the foot, 2 views inpatient one side CPT 73620 Hc Xray Foot 2 Views	$149.45	$427.00	—	—	65%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Hc Xray Foot 3 Views Lt	$162.40	$464.00	—	47% below	65%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Hc Xray Foot 3 Views Rt	$162.40	$464.00	—	47% below	65%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Hc Xray Foot 3 Views Lt	$162.40	$464.00	—	—	65%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Hc Xray Foot 3 Views Rt	$162.40	$464.00	—	—	65%
X-ray of the hand, 3 or more views one side CPT 73130 Hc Xray Hand 3 Views Lt	$160.30	$458.00	—	51% below	65%
X-ray of the hand, 3 or more views one side CPT 73130 Hc Xray Hand 3 Views Rt	$160.30	$458.00	—	51% below	65%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 Hc Xray Hand 3 Views Rt	$160.30	$458.00	—	—	65%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 Hc Xray Hand 3 Views Lt	$160.30	$458.00	—	—	65%
X-ray of the knee, 1 or 2 views one side CPT 73560 Hc Xray Knee 1 Or 2 Views	$134.75	$385.00	—	51% below	65%
X-ray of the knee, 1 or 2 views one side CPT 73560 Hc Xray Knee 1 Or 2 Views	$134.75	$385.00	—	51% below	65%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Hc Xray Knee 1 Or 2 Views	$134.75	$385.00	—	—	65%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Hc Xray Knee 1 Or 2 Views	$134.75	$385.00	—	—	65%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Hc Xray Spine Lumbosacr 2 Or 3 Vw	$150.50	$430.00	—	53% below	65%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Hc Xray Spine Lumbosacr 2 Or 3 Vw	$150.50	$430.00	—	—	65%
X-ray of the lower back, 4 or more views CPT 72110 Hc Xray Spine Lumbosacr 4+ Views	$224.00	$640.00	—	52% below	65%
X-ray of the lower back, 4 or more views inpatient CPT 72110 Hc Xray Spine Lumbosacr 4+ Views	$224.00	$640.00	—	—	65%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Hc Xray Spine Thoracic 2 View	$149.10	$426.00	—	51% below	65%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Hc Xray Spine Thoracic 2 View	$149.10	$426.00	—	—	65%
X-ray of the nasal bones, 3 or more views CPT 70160 Hc Xray Nasal Bones	$132.30	$378.00	—	55% below	65%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Hc Xray Nasal Bones	$132.30	$378.00	—	—	65%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Hc Xray Spine Cervical 2 Or 3 Vws	$161.00	$460.00	—	52% below	65%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Hc Xray Spine Cervical 2 Or 3 Vws	$161.00	$460.00	—	—	65%
X-ray of the pelvis, 1 or 2 views CPT 72170 Hc Xray Pelvis 1 Or 2 Views	$152.25	$435.00	—	39% below	65%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Hc Xray Pelvis 1 Or 2 Views	$152.25	$435.00	—	—	65%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Hc Xray Sacrum & Coccyx	$147.00	$420.00	—	51% below	65%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Hc Xray Sacrum & Coccyx	$147.00	$420.00	—	—	65%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
ACTH blood test CPT 82024 Hc Acth Test	$89.95	$257.00	—	32% below	65%
ACTH blood test inpatient CPT 82024 Hc Acth Test	$89.95	$257.00	—	—	65%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Hc Act	$16.80	$48.00	—	40% below	65%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Hc Alt	$17.85	$51.00	—	36% below	65%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Hc Act	$16.80	$48.00	—	—	65%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Hc Alt	$17.85	$51.00	—	—	65%
AST (aspartate aminotransferase) enzyme test CPT 84450 Hc Ast	$13.65	$39.00	—	46% below	65%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Hc Ast	$13.65	$39.00	—	—	65%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hc Acute Hepatitis Panel	$107.45	$307.00	—	51% below	65%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hc Acute Hepatitis Panel	$107.45	$307.00	—	—	65%
Albumin blood test CPT 82040 Hc Albumin Blood	$11.55	$33.00	—	48% below	65%
Albumin blood test CPT 82040 Hc Albumin Serum	$14.70	$42.00	—	33% below	65%
Albumin blood test inpatient CPT 82040 Hc Albumin Blood	$11.55	$33.00	—	—	65%
Albumin blood test inpatient CPT 82040 Hc Albumin Serum	$14.70	$42.00	—	—	65%
Aldosterone blood test CPT 82088 Hc Aldosterone	$61.60	$176.00	—	56% below	65%
Aldosterone blood test CPT 82088 Hc Aldosterone Serum	$94.15	$269.00	—	33% below	65%
Aldosterone blood test inpatient CPT 82088 Hc Aldosterone	$61.60	$176.00	—	—	65%
Aldosterone blood test inpatient CPT 82088 Hc Aldosterone Serum	$94.15	$269.00	—	—	65%
Alkaline phosphatase (ALP) blood test CPT 84075 Hc Alkaline Phosphatase	$13.30	$38.00	—	45% below	65%
Alkaline phosphatase (ALP) blood test CPT 84075 Hc Phosphatase Alkaline	$17.15	$49.00	—	29% below	65%
Alkaline phosphatase (ALP) blood test CPT 84075 Hc Alk Phos Bone Specific	$34.30	$98.00	—	43% above	65%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Hc Alkaline Phosphatase	$13.30	$38.00	—	—	65%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Hc Phosphatase Alkaline	$17.15	$49.00	—	—	65%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Hc Alk Phos Bone Specific	$34.30	$98.00	—	—	65%
Allergy blood test, specific IgE, per allergen CPT 86003 Hc Rast, Latex	$21.00	$60.00	—	10% below	65%
Allergy blood test, specific IgE, per allergen CPT 86003 Hc Rast Allergen Each	$21.00	$60.00	—	10% below	65%
Allergy blood test, specific IgE, per allergen CPT 86003 Hc Rast Single Allergen	$21.00	$60.00	—	10% below	65%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hc Rast, Latex	$21.00	$60.00	—	—	65%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hc Rast Single Allergen	$21.00	$60.00	—	—	65%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hc Rast Allergen Each	$21.00	$60.00	—	—	65%
Alpha-fetoprotein (AFP) blood test CPT 82105 Hc Alpha-Fetoprotein	$53.20	$152.00	—	12% below	65%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Hc Alpha-Fetoprotein	$53.20	$152.00	—	—	65%
Ammonia blood test CPT 82140 Hc Ammonia Assay	$44.10	$126.00	—	19% below	65%
Ammonia blood test inpatient CPT 82140 Hc Ammonia Assay	$44.10	$126.00	—	—	65%
Amylase blood test CPT 82150 Hc Amylase Blood Or Urine	$26.95	$77.00	—	44% below	65%
Amylase blood test CPT 82150 Hc Amylase-Body Fluid	$26.95	$77.00	—	44% below	65%
Amylase blood test inpatient CPT 82150 Hc Amylase-Body Fluid	$26.95	$77.00	—	—	65%
Amylase blood test inpatient CPT 82150 Hc Amylase Blood Or Urine	$26.95	$77.00	—	—	65%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Hc Cyclic Citrullinated Peptide	$33.95	$97.00	—	41% below	65%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Hc Cyclic Citrullinated Peptide	$33.95	$97.00	—	—	65%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Rheum Hep2 Ifa Reflex	$38.15	$109.00	—	31% below	65%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Hc Antinuclear Antibdy-Ana Screen	$38.15	$109.00	—	31% below	65%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Hc Antinuclear Ab - Ana Screen	$38.15	$109.00	—	31% below	65%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Hc Antinuclear Antibdy-Ana Screen	$38.15	$109.00	—	—	65%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Hc Antinuclear Ab - Ana Screen	$38.15	$109.00	—	—	65%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Rheum Hep2 Ifa Reflex	$38.15	$109.00	—	—	65%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Hc B Type Natriuretic Peptide	$99.40	$284.00	—	33% below	65%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Hc B Type Natriuretic Peptide	$99.40	$284.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Sterility Cult	$26.60	$76.00	—	60% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Legionella Culture	$26.60	$76.00	—	60% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Acanthamoeba Culture	$26.60	$76.00	—	60% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Sinus Culture	$40.95	$117.00	—	38% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Hardware Cult	$40.95	$117.00	—	38% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Cath Tip Cult	$40.95	$117.00	—	38% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Ear Culture	$40.95	$117.00	—	38% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Culture Body Fluid	$40.95	$117.00	—	38% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Eye Culture	$40.95	$117.00	—	38% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Culture Sputum	$40.95	$117.00	—	38% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Culture Respiratory	$40.95	$117.00	—	38% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Culture Throat/Nose General	$40.95	$117.00	—	38% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Culture Misc Pyogen	$40.95	$117.00	—	38% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Culture Tissue Pyogens	$40.95	$117.00	—	38% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Culture Csf	$40.95	$117.00	—	38% below	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Legionella Culture	$26.60	$76.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Sterility Cult	$26.60	$76.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Acanthamoeba Culture	$26.60	$76.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Sinus Culture	$40.95	$117.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Culture Csf	$40.95	$117.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Culture Body Fluid	$40.95	$117.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Culture Sputum	$40.95	$117.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Culture Respiratory	$40.95	$117.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Culture Misc Pyogen	$40.95	$117.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Culture Tissue Pyogens	$40.95	$117.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Cath Tip Cult	$40.95	$117.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Hardware Cult	$40.95	$117.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Eye Culture	$40.95	$117.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Ear Culture	$40.95	$117.00	—	—	65%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Culture Throat/Nose General	$40.95	$117.00	—	—	65%
Basic metabolic panel (blood test) CPT 80048 Hc Basic Metabolic Panel	$44.80	$128.00	—	32% below	65%
Basic metabolic panel (blood test) inpatient CPT 80048 Hc Basic Metabolic Panel	$44.80	$128.00	—	—	65%
Bilirubin blood test, total CPT 82247 Hc Bilirubin, Total	$13.30	$38.00	—	45% below	65%
Bilirubin blood test, total CPT 82247 Hc Bilirubin Total	$14.00	$40.00	—	42% below	65%
Bilirubin blood test, total CPT 82247 Hc Bilirubin Neonatal Total	$14.00	$40.00	—	42% below	65%
Bilirubin blood test, total inpatient CPT 82247 Hc Bilirubin, Total	$13.30	$38.00	—	—	65%
Bilirubin blood test, total inpatient CPT 82247 Hc Bilirubin Neonatal Total	$14.00	$40.00	—	—	65%
Bilirubin blood test, total inpatient CPT 82247 Hc Bilirubin Total	$14.00	$40.00	—	—	65%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Hc Surgical Path Level Iv	$119.35	$341.00	—	41% below	65%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Hc Surgical Path Level Iv	$119.35	$341.00	—	—	65%
Blood culture for bacteria CPT 87040 Hc Culture Blood	$63.35	$181.00	—	32% below	65%
Blood culture for bacteria inpatient CPT 87040 Hc Culture Blood	$63.35	$181.00	—	—	65%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture, By Non-Physician	$3.85	$11.00	—	76% below	65%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Hc Routine Venipuncture	$11.20	$32.00	—	30% below	65%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Res Venipuncture	$11.20	$32.00	—	30% below	65%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture, By Non-Physician	$3.85	$11.00	—	—	65%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Res Venipuncture	$11.20	$32.00	—	—	65%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Hc Routine Venipuncture	$11.20	$32.00	—	—	65%
Blood glucose (sugar) test CPT 82947 Hc Glucose Quant	$17.15	$49.00	—	27% below	65%
Blood glucose (sugar) test CPT 82947 Hc Glucose Whole Blood	$17.15	$49.00	—	27% below	65%
Blood glucose (sugar) test inpatient CPT 82947 Hc Glucose Whole Blood	$17.15	$49.00	—	—	65%
Blood glucose (sugar) test inpatient CPT 82947 Hc Glucose Quant	$17.15	$49.00	—	—	65%
Blood lead test CPT 83655 Hc Poct Lead Level	$24.50	$70.00	—	50% below	65%
Blood lead test CPT 83655 Hc Lead Level	$28.35	$81.00	—	42% below	65%
Blood lead test inpatient CPT 83655 Hc Poct Lead Level	$24.50	$70.00	—	—	65%
Blood lead test inpatient CPT 83655 Hc Lead Level	$28.35	$81.00	—	—	65%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Hc Blood Typing-Abo	$30.45	$87.00	—	49% below	65%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Hc Blood Typing-Abo	$30.45	$87.00	—	—	65%
Blood urea nitrogen (BUN) test CPT 84520 Hc Bun Urea Nitrogen Quant	$13.65	$39.00	—	42% below	65%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Hc Bun Urea Nitrogen Quant	$13.65	$39.00	—	—	65%
C-peptide blood test CPT 84681 Hc C-Peptide	$47.95	$137.00	—	39% below	65%
C-peptide blood test inpatient CPT 84681 Hc C-Peptide	$47.95	$137.00	—	—	65%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Hc C-Reactive Protein	$33.60	$96.00	—	33% below	65%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 Hc C-Reactive Protein	$33.60	$96.00	—	—	65%
C. difficile toxin gene test (stool PCR) CPT 87493 Hc C. Difficle Dna	$99.40	$284.00	—	24% below	65%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Hc C. Difficle Dna	$99.40	$284.00	—	—	65%
CA 19-9 blood test (tumor marker) CPT 86301 Hc Ca19-9	$55.65	$159.00	—	24% below	65%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Hc Ca19-9	$55.65	$159.00	—	—	65%
CA-125 blood test (ovarian cancer marker) CPT 86304 Hc Ca125	$58.45	$167.00	—	38% below	65%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Hc Ca125	$58.45	$167.00	—	—	65%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Hc Poct Covid-19	$46.55	$133.00	—	67% below	65%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Hc Coronavirus (Covid-19)	$50.40	$144.00	—	64% below	65%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Hc Poct Covid-19	$46.55	$133.00	—	—	65%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Hc Coronavirus (Covid-19)	$50.40	$144.00	—	—	65%
Calcium blood test, total CPT 82310 Hc Calcium Urine	$12.60	$36.00	—	60% below	65%
Calcium blood test, total CPT 82310 Hc Calcium Blood	$12.60	$36.00	—	60% below	65%
Calcium blood test, total inpatient CPT 82310 Hc Calcium Urine	$12.60	$36.00	—	—	65%
Calcium blood test, total inpatient CPT 82310 Hc Calcium Blood	$12.60	$36.00	—	—	65%
Carcinoembryonic antigen (CEA) test CPT 82378 Hc Cea, Fluid	$52.50	$150.00	—	40% below	65%
Carcinoembryonic antigen (CEA) test CPT 82378 Hc Carcinoembryonic Antigen-Cea	$64.40	$184.00	—	26% below	65%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Hc Cea, Fluid	$52.50	$150.00	—	—	65%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Hc Carcinoembryonic Antigen-Cea	$64.40	$184.00	—	—	65%
Chickenpox (varicella) immunity blood test CPT 86787 Hc Varicella Zoster Igg Ab, Csf	$29.75	$85.00	—	49% below	65%
Chickenpox (varicella) immunity blood test CPT 86787 Hc Varicella Zoster Igm	$31.15	$89.00	—	46% below	65%
Chickenpox (varicella) immunity blood test CPT 86787 Hc Varicella Zoster Antibody Igg	$39.55	$113.00	—	32% below	65%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Hc Varicella Zoster Igg Ab, Csf	$29.75	$85.00	—	—	65%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Hc Varicella Zoster Igm	$31.15	$89.00	—	—	65%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Hc Varicella Zoster Antibody Igg	$39.55	$113.00	—	—	65%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Hc Chlamydia Amp Probe	$85.75	$245.00	—	7% below	65%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Hc Chlamydia Amp Probe	$85.75	$245.00	—	—	65%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Hc Full Lipid Panel	$47.60	$136.00	—	10% below	65%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Hc Lipid Panel	$47.60	$136.00	—	10% below	65%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Hc Lipid Panel	$47.60	$136.00	—	—	65%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Hc Full Lipid Panel	$47.60	$136.00	—	—	65%
Complete blood count (CBC) with differential CPT 85025 Hc Cbc, Auto&Diff	$29.75	$85.00	—	18% below	65%
Complete blood count (CBC) with differential CPT 85025 Hc Automated Hemogram	$29.75	$85.00	—	18% below	65%
Complete blood count (CBC) with differential CPT 85025 Hc Blood Cnt Comp,Auto And Diff	$29.75	$85.00	—	18% below	65%
Complete blood count (CBC) with differential inpatient CPT 85025 Hc Automated Hemogram	$29.75	$85.00	—	—	65%
Complete blood count (CBC) with differential inpatient CPT 85025 Hc Cbc, Auto&Diff	$29.75	$85.00	—	—	65%
Complete blood count (CBC) with differential inpatient CPT 85025 Hc Blood Cnt Comp,Auto And Diff	$29.75	$85.00	—	—	65%
Complete blood count (CBC), no differential CPT 85027 Hc Cell Count-Blood Complete	$25.20	$72.00	—	26% below	65%
Complete blood count (CBC), no differential inpatient CPT 85027 Hc Cell Count-Blood Complete	$25.20	$72.00	—	—	65%
Cortisol blood test, total CPT 82533 Hc Cortisol Pm	$59.50	$170.00	—	18% below	65%
Cortisol blood test, total CPT 82533 Hc Cortisol Blood Total	$59.50	$170.00	—	18% below	65%
Cortisol blood test, total CPT 82533 Hc Cortisol Am	$59.50	$170.00	—	18% below	65%
Cortisol blood test, total inpatient CPT 82533 Hc Cortisol Pm	$59.50	$170.00	—	—	65%
Cortisol blood test, total inpatient CPT 82533 Hc Cortisol Am	$59.50	$170.00	—	—	65%
Cortisol blood test, total inpatient CPT 82533 Hc Cortisol Blood Total	$59.50	$170.00	—	—	65%
Creatine kinase (CK) blood test, total CPT 82550 Hc Creatine Kinase Total-Cpk	$19.25	$55.00	—	46% below	65%
Creatine kinase (CK) blood test, total CPT 82550 Hc Creatine Kinase	$19.25	$55.00	—	46% below	65%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Hc Creatine Kinase Total-Cpk	$19.25	$55.00	—	—	65%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Hc Creatine Kinase	$19.25	$55.00	—	—	65%
Creatinine blood test CPT 82565 Hc Creatinine Blood	$15.05	$43.00	—	39% below	65%
Creatinine blood test inpatient CPT 82565 Hc Creatinine Blood	$15.05	$43.00	—	—	65%
Cytomegalovirus (CMV) antibody test CPT 86644 Hc Cytomegalovirus Antibody Igg	$64.05	$183.00	—	7% below	65%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Hc Cytomegalovirus Antibody Igg	$64.05	$183.00	—	—	65%
DHEA sulfate (DHEA-S) blood test CPT 82627 Hc Dhea-S	$71.05	$203.00	—	29% below	65%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Hc Dhea-S	$71.05	$203.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Drug Screen Presumptive Class	$68.25	$195.00	—	29% below	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Drug Screen, One Result Class	$68.25	$195.00	—	29% below	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Oral Fluid Toxicology Screen	$106.40	$304.00	—	11% above	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Ob Toxicology Screen	$139.30	$398.00	—	46% above	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Oxycodone Urine	$139.30	$398.00	—	46% above	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Toxicology Screen	$139.30	$398.00	—	46% above	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Buprenorphine Screen	$139.30	$398.00	—	46% above	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Pain Management Panel	$139.30	$398.00	—	46% above	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Hydrocodone Screen	$139.30	$398.00	—	46% above	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Fentanyl Urine	$139.30	$398.00	—	46% above	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Cotinine Urine	$139.30	$398.00	—	46% above	65%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Tox Screen W/Confirmation	$139.30	$398.00	—	46% above	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Drug Screen Presumptive Class	$68.25	$195.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Drug Screen, One Result Class	$68.25	$195.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Oral Fluid Toxicology Screen	$106.40	$304.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Pain Management Panel	$139.30	$398.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Buprenorphine Screen	$139.30	$398.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Fentanyl Urine	$139.30	$398.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Cotinine Urine	$139.30	$398.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Toxicology Screen	$139.30	$398.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Tox Screen W/Confirmation	$139.30	$398.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Hydrocodone Screen	$139.30	$398.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Ob Toxicology Screen	$139.30	$398.00	—	—	65%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Oxycodone Urine	$139.30	$398.00	—	—	65%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Blood Gas Lytes	$26.95	$77.00	—	44% below	65%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Hc Blood Gas Lytes	$26.95	$77.00	—	44% below	65%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Hc Electrolytes Whole Blood	$26.95	$77.00	—	44% below	65%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Hc Electrolyte Panel, Serum	$26.95	$77.00	—	44% below	65%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Hc Electrolytes Whole Blood	$26.95	$77.00	—	—	65%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Hc Blood Gas Lytes	$26.95	$77.00	—	—	65%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Hc Electrolyte Panel, Serum	$26.95	$77.00	—	—	65%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Blood Gas Lytes	$26.95	$77.00	—	—	65%
Epstein-Barr virus (EBV) antibody test CPT 86665 Hc Epstein-Barr Virus Ab Vca Igg	$54.95	$157.00	—	15% below	65%
Epstein-Barr virus (EBV) antibody test CPT 86665 Hc Epstein Barr Virus-Vca Igm	$54.95	$157.00	—	15% below	65%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Hc Epstein Barr Virus-Vca Igm	$54.95	$157.00	—	—	65%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Hc Epstein-Barr Virus Ab Vca Igg	$54.95	$157.00	—	—	65%
Estradiol blood test CPT 82670 Hc Estradiol Blood	$57.40	$164.00	—	49% below	65%
Estradiol blood test inpatient CPT 82670 Hc Estradiol Blood	$57.40	$164.00	—	—	65%
FSH (follicle-stimulating hormone) test CPT 83001 Hc Follicle Stimulating Hormone	$63.35	$181.00	—	26% below	65%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Hc Follicle Stimulating Hormone	$63.35	$181.00	—	—	65%
Fecal calprotectin (stool inflammation test) CPT 83993 Hc Calprotectin,Fecal	$101.50	$290.00	—	32% below	65%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Hc Calprotectin,Fecal	$101.50	$290.00	—	—	65%
Ferritin blood test (iron stores) CPT 82728 Hc Ferritin	$47.95	$137.00	—	37% below	65%
Ferritin blood test (iron stores) inpatient CPT 82728 Hc Ferritin	$47.95	$137.00	—	—	65%
Fibrinogen blood test CPT 85384 Hc Fibrinogen	$27.65	$79.00	—	39% below	65%
Fibrinogen blood test inpatient CPT 85384 Hc Fibrinogen	$27.65	$79.00	—	—	65%
Folate (folic acid) blood test CPT 82746 Hc Folic Acid	$47.95	$137.00	—	29% below	65%
Folate (folic acid) blood test inpatient CPT 82746 Hc Folic Acid	$47.95	$137.00	—	—	65%
Free T3 thyroid hormone test CPT 84481 Hc Free T3(Triiodothyronine)	$63.70	$182.00	—	16% below	65%
Free T3 thyroid hormone test CPT 84481 Hc T3	$123.90	$354.00	—	63% above	65%
Free T3 thyroid hormone test inpatient CPT 84481 Hc Free T3(Triiodothyronine)	$63.70	$182.00	—	—	65%
Free T3 thyroid hormone test inpatient CPT 84481 Hc T3	$123.90	$354.00	—	—	65%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Hc T4-Free By Direct Dialysis	$14.35	$41.00	—	66% below	65%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Hc T4 Thyroxine Free	$37.45	$107.00	—	12% below	65%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Hc T4-Free By Direct Dialysis	$14.35	$41.00	—	—	65%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Hc T4 Thyroxine Free	$37.45	$107.00	—	—	65%
Free testosterone test CPT 84402 Hc Free Testosterone 3523	$38.50	$110.00	—	60% below	65%
Free testosterone test CPT 84402 Hc Free Testosterone	$50.05	$143.00	—	49% below	65%
Free testosterone test inpatient CPT 84402 Hc Free Testosterone 3523	$38.50	$110.00	—	—	65%
Free testosterone test inpatient CPT 84402 Hc Free Testosterone	$50.05	$143.00	—	—	65%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Hc Glutamyltransferase Gamma Ggt	$24.50	$70.00	—	42% below	65%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Hc Ggt	$24.50	$70.00	—	42% below	65%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Hc Glutamyltransferase Gamma Ggt	$24.50	$70.00	—	—	65%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Hc Ggt	$24.50	$70.00	—	—	65%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Hc Glucose Post-Glucose Dose	$24.85	$71.00	—	35% below	65%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Hc Glucose 2 Hr Post Prandial	$24.85	$71.00	—	35% below	65%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Hc Glucose 2 Hr Post Prandial	$24.85	$71.00	—	—	65%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Hc Glucose Post-Glucose Dose	$24.85	$71.00	—	—	65%
Glucose tolerance test, 3 samples CPT 82951 Hc Glucose Tol Initial 3 Specimen	$49.00	$140.00	—	27% below	65%
Glucose tolerance test, 3 samples inpatient CPT 82951 Hc Glucose Tol Initial 3 Specimen	$49.00	$140.00	—	—	65%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Hc Gc Amp Probe	$79.45	$227.00	—	15% below	65%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Hc Gc Amp Probe	$79.45	$227.00	—	—	65%
H. pylori antibody blood test CPT 86677 Hc Helicobacter Pylori	$23.10	$66.00	—	69% below	65%
H. pylori antibody blood test CPT 86677 Hc Helicobacter Pylori Igg Ab	$35.70	$102.00	—	53% below	65%
H. pylori antibody blood test inpatient CPT 86677 Hc Helicobacter Pylori	$23.10	$66.00	—	—	65%
H. pylori antibody blood test inpatient CPT 86677 Hc Helicobacter Pylori Igg Ab	$35.70	$102.00	—	—	65%
H. pylori stool antigen test CPT 87338 Hc H.Pylori Antigen, Stool	$22.75	$65.00	—	67% below	65%
H. pylori stool antigen test CPT 87338 H. Pylori Antigen, Stool	$29.40	$84.00	—	58% below	65%
H. pylori stool antigen test inpatient CPT 87338 Hc H.Pylori Antigen, Stool	$22.75	$65.00	—	—	65%
H. pylori stool antigen test inpatient CPT 87338 H. Pylori Antigen, Stool	$29.40	$84.00	—	—	65%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hc Hiv-1 Rna Quant Pcr	$211.05	$603.00	—	41% below	65%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Hc Hiv-1 Rna Quant Pcr	$211.05	$603.00	—	—	65%
HIV-1 and HIV-2 antibody test CPT 86703 Poct Oral Hiv	$28.70	$82.00	—	54% below	65%
HIV-1 and HIV-2 antibody test CPT 86703 Hc Hiv 1/2 Antibody	$77.70	$222.00	—	26% above	65%
HIV-1 and HIV-2 antibody test CPT 86703 Hc Hiv - 1/2 Antibody, Rapid	$77.70	$222.00	—	26% above	65%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Poct Oral Hiv	$28.70	$82.00	—	—	65%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Hc Hiv 1/2 Antibody	$77.70	$222.00	—	—	65%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Hc Hiv - 1/2 Antibody, Rapid	$77.70	$222.00	—	—	65%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hc Hiv 1/Hiv 2 Combo Ag/Ab	$73.85	$211.00	—	at median	65%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Hc Hiv 1/Hiv 2 Combo Ag/Ab	$73.85	$211.00	—	—	65%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Hc Hpv Probe	$105.00	$300.00	—	12% below	65%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Hc Hpv Probe	$105.00	$300.00	—	—	65%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hc Poct Hemoglobin A1C	$31.50	$90.00	—	31% below	65%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hc Hemoglobin Glycated	$31.50	$90.00	—	31% below	65%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hc Hemoglobin Glycated	$31.50	$90.00	—	—	65%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hc Poct Hemoglobin A1C	$31.50	$90.00	—	—	65%
Hemoglobin blood test CPT 85018 Hc Hemoglobin Blood	$11.20	$32.00	—	31% below	65%
Hemoglobin blood test CPT 85018 Hc Hemoglobin	$11.20	$32.00	—	31% below	65%
Hemoglobin blood test inpatient CPT 85018 Hc Hemoglobin Blood	$11.20	$32.00	—	—	65%
Hemoglobin blood test inpatient CPT 85018 Hc Hemoglobin	$11.20	$32.00	—	—	65%
Hepatitis B core antibody test (total) CPT 86704 Hc Hepatitis B Core Ab Total	$31.15	$89.00	—	42% below	65%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hc Hepatitis B Core Ab Total	$31.15	$89.00	—	—	65%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hc Hepatitis B Surface Antibody	$40.95	$117.00	—	15% below	65%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hc Hepatitis B Surface Antibody	$40.95	$117.00	—	—	65%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hc Hepatitis B Surface Antigen	$42.00	$120.00	—	11% below	65%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hc Hepatitis B Surface Antigen	$42.00	$120.00	—	—	65%
Hepatitis C antibody blood test (screening) CPT 86803 Hc Hepatitis C Antibody	$50.75	$145.00	—	21% below	65%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hc Hepatitis C Antibody	$50.75	$145.00	—	—	65%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hc Hepatitis C Rna Quant Pcr	$185.15	$529.00	—	4% below	65%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hc Hepatitis C Rna Quant Pcr	$185.15	$529.00	—	—	65%
Herpes blood test, HSV-1 antibody CPT 86695 Hc Herpes Simplex Type 1 Test	$24.85	$71.00	—	58% below	65%
Herpes blood test, HSV-1 antibody CPT 86695 Hc Herpes Simplex Type 1	$31.50	$90.00	—	47% below	65%
Herpes blood test, HSV-1 antibody CPT 86695 Hc Herpes Simplex Virus 1 Igg	$35.35	$101.00	—	40% below	65%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Hc Herpes Simplex Type 1 Test	$24.85	$71.00	—	—	65%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Hc Herpes Simplex Type 1	$31.50	$90.00	—	—	65%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Hc Herpes Simplex Virus 1 Igg	$35.35	$101.00	—	—	65%
Herpes blood test, HSV-2 antibody CPT 86696 Hc Herpes Simplex Type 2	$40.60	$116.00	—	39% below	65%
Herpes blood test, HSV-2 antibody CPT 86696 Hc Herpes Simplex Virus 2 Igg	$40.60	$116.00	—	39% below	65%
Herpes blood test, HSV-2 antibody CPT 86696 Hc Herpes Simplex Type 2 Test	$40.60	$116.00	—	39% below	65%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Hc Herpes Simplex Type 2	$40.60	$116.00	—	—	65%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Hc Herpes Simplex Type 2 Test	$40.60	$116.00	—	—	65%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Hc Herpes Simplex Virus 2 Igg	$40.60	$116.00	—	—	65%
High-sensitivity CRP (hs-CRP) test CPT 86141 Hc Crp, Ultra Sensitive	$47.25	$135.00	—	30% below	65%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 Hc Crp, Ultra Sensitive	$47.25	$135.00	—	—	65%
Homocysteine blood test CPT 83090 Hc Nbs-Homocystinuria Quant	$41.30	$118.00	—	49% below	65%
Homocysteine blood test CPT 83090 Hc Homocysteine, Serum	$56.70	$162.00	—	30% below	65%
Homocysteine blood test inpatient CPT 83090 Hc Nbs-Homocystinuria Quant	$41.30	$118.00	—	—	65%
Homocysteine blood test inpatient CPT 83090 Hc Homocysteine, Serum	$56.70	$162.00	—	—	65%
Insulin blood test CPT 83525 Hc Insulin	$29.75	$85.00	—	42% below	65%
Insulin blood test inpatient CPT 83525 Hc Insulin	$29.75	$85.00	—	—	65%
Iron blood test (serum iron) CPT 83540 Hc Iron	$22.40	$64.00	—	41% below	65%
Iron blood test (serum iron) CPT 83540 Hc Iron Quant-Tissue	$74.90	$214.00	—	97% above	65%
Iron blood test (serum iron) inpatient CPT 83540 Hc Iron	$22.40	$64.00	—	—	65%
Iron blood test (serum iron) inpatient CPT 83540 Hc Iron Quant-Tissue	$74.90	$214.00	—	—	65%
LH (luteinizing hormone) test CPT 83002 Hc Luteinizing Hormone	$60.55	$173.00	—	37% below	65%
LH (luteinizing hormone) test inpatient CPT 83002 Hc Luteinizing Hormone	$60.55	$173.00	—	—	65%
Lactate (lactic acid) blood test CPT 83605 Hc Lactic Acid (Referred)	$21.70	$62.00	—	58% below	65%
Lactate (lactic acid) blood test CPT 83605 Hc Lactic Acid-Body Fluid	$36.75	$105.00	—	29% below	65%
Lactate (lactic acid) blood test CPT 83605 Hc D-Lactate	$36.75	$105.00	—	29% below	65%
Lactate (lactic acid) blood test CPT 83605 Hc Lactic Acid-Spinal Fluid	$36.75	$105.00	—	29% below	65%
Lactate (lactic acid) blood test CPT 83605 Hc Lactic Acid Whole Blood	$36.75	$105.00	—	29% below	65%
Lactate (lactic acid) blood test inpatient CPT 83605 Hc Lactic Acid (Referred)	$21.70	$62.00	—	—	65%
Lactate (lactic acid) blood test inpatient CPT 83605 Hc Lactic Acid Whole Blood	$36.75	$105.00	—	—	65%
Lactate (lactic acid) blood test inpatient CPT 83605 Hc D-Lactate	$36.75	$105.00	—	—	65%
Lactate (lactic acid) blood test inpatient CPT 83605 Hc Lactic Acid-Spinal Fluid	$36.75	$105.00	—	—	65%
Lactate (lactic acid) blood test inpatient CPT 83605 Hc Lactic Acid-Body Fluid	$36.75	$105.00	—	—	65%
Lactate dehydrogenase (LDH) blood test CPT 83615 Hc Lactate Dehydrogenase	$15.05	$43.00	—	45% below	65%
Lactate dehydrogenase (LDH) blood test CPT 83615 Hc Lactate Dehydrog-Body Fluid	$16.10	$46.00	—	41% below	65%
Lactate dehydrogenase (LDH) blood test CPT 83615 Hc Ldh Lactate Dehydrogenase	$16.10	$46.00	—	41% below	65%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Hc Lactate Dehydrogenase	$15.05	$43.00	—	—	65%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Hc Ldh Lactate Dehydrogenase	$16.10	$46.00	—	—	65%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Hc Lactate Dehydrog-Body Fluid	$16.10	$46.00	—	—	65%
Lipase blood test (pancreas enzyme) CPT 83690 Hc Lipase-Body Fluid	$37.45	$107.00	—	36% below	65%
Lipase blood test (pancreas enzyme) CPT 83690 Hc Lipase	$37.45	$107.00	—	36% below	65%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Hc Lipase-Body Fluid	$37.45	$107.00	—	—	65%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Hc Lipase	$37.45	$107.00	—	—	65%
Liver function blood test panel CPT 80076 Hc Hepatic Function Panel	$45.15	$129.00	—	25% below	65%
Liver function blood test panel inpatient CPT 80076 Hc Hepatic Function Panel	$45.15	$129.00	—	—	65%
Lyme disease antibody test CPT 86618 Hc Lyme Disease Igg	$40.60	$116.00	—	47% below	65%
Lyme disease antibody test CPT 86618 Hc Lyme Iga,Csf	$41.30	$118.00	—	46% below	65%
Lyme disease antibody test CPT 86618 Hc Lyme Igg,Csf	$41.30	$118.00	—	46% below	65%
Lyme disease antibody test inpatient CPT 86618 Hc Lyme Disease Igg	$40.60	$116.00	—	—	65%
Lyme disease antibody test inpatient CPT 86618 Hc Lyme Igg,Csf	$41.30	$118.00	—	—	65%
Lyme disease antibody test inpatient CPT 86618 Hc Lyme Iga,Csf	$41.30	$118.00	—	—	65%
Magnesium blood test CPT 83735 Hc Magnesium, Stool	$10.50	$30.00	—	69% below	65%
Magnesium blood test CPT 83735 Hc Magnesium Rbc	$19.60	$56.00	—	42% below	65%
Magnesium blood test CPT 83735 Hc Magnesium Urine	$22.40	$64.00	—	34% below	65%
Magnesium blood test CPT 83735 Hc Magnesium Blood	$38.15	$109.00	—	13% above	65%
Magnesium blood test inpatient CPT 83735 Hc Magnesium, Stool	$10.50	$30.00	—	—	65%
Magnesium blood test inpatient CPT 83735 Hc Magnesium Rbc	$19.60	$56.00	—	—	65%
Magnesium blood test inpatient CPT 83735 Hc Magnesium Urine	$22.40	$64.00	—	—	65%
Magnesium blood test inpatient CPT 83735 Hc Magnesium Blood	$38.15	$109.00	—	—	65%
Measles (rubeola) antibody test CPT 86765 Hc Rubeola Antibody Igg	$33.95	$97.00	—	41% below	65%
Measles (rubeola) antibody test CPT 86765 Hc Measles Igm Antibody	$33.95	$97.00	—	41% below	65%
Measles (rubeola) antibody test inpatient CPT 86765 Hc Rubeola Antibody Igg	$33.95	$97.00	—	—	65%
Measles (rubeola) antibody test inpatient CPT 86765 Hc Measles Igm Antibody	$33.95	$97.00	—	—	65%
Mono test (heterophile antibody, Monospot) CPT 86308 Hc Monospot	$22.05	$63.00	—	59% below	65%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Hc Monospot	$22.05	$63.00	—	—	65%
Mumps immunity blood test CPT 86735 Hc Mumps Igg	$38.50	$110.00	—	34% below	65%
Mumps immunity blood test CPT 86735 Hc Mumps Igm	$38.85	$111.00	—	34% below	65%
Mumps immunity blood test inpatient CPT 86735 Hc Mumps Igg	$38.50	$110.00	—	—	65%
Mumps immunity blood test inpatient CPT 86735 Hc Mumps Igm	$38.85	$111.00	—	—	65%
PSA (prostate-specific antigen) blood test, free CPT 84154 Hc Psa Prostatic Specif Ag-Free	$44.45	$127.00	—	46% below	65%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Hc Psa Prostatic Specif Ag-Free	$44.45	$127.00	—	—	65%
PSA (prostate-specific antigen) blood test, total CPT 84153 Hc Prostate Specific Antign Total	$57.75	$165.00	—	27% below	65%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Hc Prostate Specific Antign Total	$57.75	$165.00	—	—	65%
Pap test (liquid-based, automated screening with review) CPT 88175 Hc Automated Screening/Manual Rescreening Of Pap Test Slide	$53.55	$153.00	—	45% below	65%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Hc Automated Screening/Manual Rescreening Of Pap Test Slide	$53.55	$153.00	—	—	65%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Hc Cyto Pap Thinprep Diagnostic	$59.15	$169.00	—	35% below	65%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Hc Cyto Pap Thinprep Screening	$59.15	$169.00	—	35% below	65%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Hc Cyto Pap Thinprep Diagnostic	$59.15	$169.00	—	—	65%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Hc Cyto Pap Thinprep Screening	$59.15	$169.00	—	—	65%
Parathyroid hormone (PTH) blood test CPT 83970 Hc Parathyroid Hormone	$120.40	$344.00	—	15% below	65%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Hc Parathyroid Hormone	$120.40	$344.00	—	—	65%
Partial thromboplastin time (PTT) clotting test CPT 85730 Hc Ptt	$25.90	$74.00	—	31% below	65%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Hc Ptt	$25.90	$74.00	—	—	65%
Phosphorus (phosphate) blood test CPT 84100 Hc Phosphate, Stool	$9.45	$27.00	—	74% below	65%
Phosphorus (phosphate) blood test CPT 84100 Hc Phosphorus Blood	$16.45	$47.00	—	54% below	65%
Phosphorus (phosphate) blood test inpatient CPT 84100 Hc Phosphate, Stool	$9.45	$27.00	—	—	65%
Phosphorus (phosphate) blood test inpatient CPT 84100 Hc Phosphorus Blood	$16.45	$47.00	—	—	65%
Potassium blood test CPT 84132 Hc Potassium Blood	$15.05	$43.00	—	36% below	65%
Potassium blood test CPT 84132 Hc Potassium Whole Blood	$15.05	$43.00	—	36% below	65%
Potassium blood test inpatient CPT 84132 Hc Potassium Whole Blood	$15.05	$43.00	—	—	65%
Potassium blood test inpatient CPT 84132 Hc Potassium Blood	$15.05	$43.00	—	—	65%
Progesterone blood test CPT 84144 Hc Progesterone	$51.45	$147.00	—	36% below	65%
Progesterone blood test inpatient CPT 84144 Hc Progesterone	$51.45	$147.00	—	—	65%
Prolactin blood test CPT 84146 Hc Prolactin	$64.75	$185.00	—	26% below	65%
Prolactin blood test inpatient CPT 84146 Hc Prolactin	$64.75	$185.00	—	—	65%
Prothrombin time (PT/INR) clotting test CPT 85610 Hc Prothromibin Time Cc	$19.95	$57.00	—	17% below	65%
Prothrombin time (PT/INR) clotting test CPT 85610 Hc Prothrombin Time	$19.95	$57.00	—	17% below	65%
Prothrombin time (PT/INR) clotting test CPT 85610 Hc Prothrombin Time Poct	$19.95	$57.00	—	17% below	65%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Hc Prothromibin Time Cc	$19.95	$57.00	—	—	65%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Hc Prothrombin Time	$19.95	$57.00	—	—	65%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Hc Prothrombin Time Poct	$19.95	$57.00	—	—	65%
Rapid flu test (influenza antigen) CPT 87804 Hc Rapid Influenza A Or B	$20.30	$58.00	—	69% below	65%
Rapid flu test (influenza antigen) inpatient CPT 87804 Hc Rapid Influenza A Or B	$20.30	$58.00	—	—	65%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Hc Rapid Strep Test	$26.60	$76.00	—	53% below	65%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Hc Rapid Strep Test	$26.60	$76.00	—	—	65%
Renin blood test CPT 84244 Hc Renin	$42.70	$122.00	—	50% below	65%
Renin blood test inpatient CPT 84244 Hc Renin	$42.70	$122.00	—	—	65%
Rh blood typing CPT 86901 Hc Blood Typing-Rh(D)	$21.70	$62.00	—	42% below	65%
Rh blood typing inpatient CPT 86901 Hc Blood Typing-Rh(D)	$21.70	$62.00	—	—	65%
Rheumatoid factor (RF) test CPT 86431 Hc Rhematoid Factor, Body Fluid	$20.30	$58.00	—	39% below	65%
Rheumatoid factor (RF) test CPT 86431 Hc Rheumatoid Factor, Body Fluid	$25.20	$72.00	—	24% below	65%
Rheumatoid factor (RF) test CPT 86431 Hc Rheumatoid Factor Quant	$25.20	$72.00	—	24% below	65%
Rheumatoid factor (RF) test inpatient CPT 86431 Hc Rhematoid Factor, Body Fluid	$20.30	$58.00	—	—	65%
Rheumatoid factor (RF) test inpatient CPT 86431 Hc Rheumatoid Factor Quant	$25.20	$72.00	—	—	65%
Rheumatoid factor (RF) test inpatient CPT 86431 Hc Rheumatoid Factor, Body Fluid	$25.20	$72.00	—	—	65%
Rubella antibody test (immunity check) CPT 86762 Hc Rubella Igm	$38.50	$110.00	—	22% below	65%
Rubella antibody test (immunity check) CPT 86762 Hc Rubella Antibody Igg	$41.65	$119.00	—	15% below	65%
Rubella antibody test (immunity check) inpatient CPT 86762 Hc Rubella Igm	$38.50	$110.00	—	—	65%
Rubella antibody test (immunity check) inpatient CPT 86762 Hc Rubella Antibody Igg	$41.65	$119.00	—	—	65%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Hc Sedimentation Rate, Erythrocyte Automated	$22.40	$64.00	—	41% below	65%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Hc Sedimentation Rate, Erythrocyte Automated	$22.40	$64.00	—	—	65%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Hc Semen Analysis	$68.25	$195.00	—	49% below	65%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Hc Semen Analysis	$68.25	$195.00	—	—	65%
Sodium blood test CPT 84295 Hc Sodium Blood	$14.00	$40.00	—	49% below	65%
Sodium blood test inpatient CPT 84295 Hc Sodium Blood	$14.00	$40.00	—	—	65%
Stool ova and parasites exam CPT 87177 Hc O&P Exam Concentration Smear	$31.15	$89.00	—	21% below	65%
Stool ova and parasites exam inpatient CPT 87177 Hc O&P Exam Concentration Smear	$31.15	$89.00	—	—	65%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Hc Occult Blood - Stool	$15.75	$45.00	—	45% below	65%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Hc Hemocult - In Office	$15.75	$45.00	—	45% below	65%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Hc Occult Blood - Stool	$15.75	$45.00	—	—	65%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Hc Hemocult - In Office	$15.75	$45.00	—	—	65%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Hc Occult Blood - Fecal	$47.95	$137.00	—	10% below	65%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Hc Occult Blood - Fecal	$47.95	$137.00	—	—	65%
Syphilis antibody test (Treponema pallidum) CPT 86780 Hc Syphilis Igg	$26.95	$77.00	—	53% below	65%
Syphilis antibody test (Treponema pallidum) CPT 86780 Hc Syphllis	$27.30	$78.00	—	53% below	65%
Syphilis antibody test (Treponema pallidum) CPT 86780 Hc Treponema Pallidum	$35.70	$102.00	—	38% below	65%
Syphilis antibody test (Treponema pallidum) CPT 86780 Hc Fta Treponema Ab-Spinal Fluid	$35.70	$102.00	—	38% below	65%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Hc Syphilis Igg	$26.95	$77.00	—	—	65%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Hc Syphllis	$27.30	$78.00	—	—	65%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Hc Treponema Pallidum	$35.70	$102.00	—	—	65%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Hc Fta Treponema Ab-Spinal Fluid	$35.70	$102.00	—	—	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Hc Rpr Qualitative	$17.15	$49.00	—	28% below	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Hc Vdrl Qualitative-Spinal Fluid	$17.15	$49.00	—	28% below	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Hc Vdrl Qualitative-Blood	$17.15	$49.00	—	28% below	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Hc Rpr Qualitative	$17.15	$49.00	—	—	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Hc Vdrl Qualitative-Spinal Fluid	$17.15	$49.00	—	—	65%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Hc Vdrl Qualitative-Blood	$17.15	$49.00	—	—	65%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Hc Tuberculosis-Cell Mediated Imm	$98.70	$282.00	—	16% below	65%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Hc Tuberculosis-Cell Mediated Imm	$98.70	$282.00	—	—	65%
Testosterone blood test, total (not free testosterone) CPT 84403 Hc Testosterone Blood Total	$71.05	$203.00	—	23% below	65%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Hc Testosterone Blood Total	$71.05	$203.00	—	—	65%
Thyroid peroxidase (TPO) antibody test CPT 86376 Hc Antimicrosomal Antibody	$52.15	$149.00	—	20% below	65%
Thyroid peroxidase (TPO) antibody test CPT 86376 Hc Lkm Liver-Kidney Microsomal Ab	$54.60	$156.00	—	16% below	65%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Hc Antimicrosomal Antibody	$52.15	$149.00	—	—	65%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Hc Lkm Liver-Kidney Microsomal Ab	$54.60	$156.00	—	—	65%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Hc Tsh Thyroid Stim Hormone	$55.65	$159.00	—	26% below	65%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Hc Nbs- Tsh	$55.65	$159.00	—	26% below	65%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Hc Tsh Thyroid Stim Hormone	$55.65	$159.00	—	—	65%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Hc Nbs- Tsh	$55.65	$159.00	—	—	65%
Total IgE blood test CPT 82785 Hc Ige, Serum	$44.45	$127.00	—	28% below	65%
Total IgE blood test inpatient CPT 82785 Hc Ige, Serum	$44.45	$127.00	—	—	65%
Total cholesterol blood test CPT 82465 Hc Cholesterol Total Serum	$20.30	$58.00	—	45% below	65%
Total cholesterol blood test inpatient CPT 82465 Hc Cholesterol Total Serum	$20.30	$58.00	—	—	65%
Total thyroxine (T4) blood test CPT 84436 Hc T4 Total	$10.50	$30.00	—	75% below	65%
Total thyroxine (T4) blood test CPT 84436 Hc Thyroxine Total	$13.65	$39.00	—	67% below	65%
Total thyroxine (T4) blood test inpatient CPT 84436 Hc T4 Total	$10.50	$30.00	—	—	65%
Total thyroxine (T4) blood test inpatient CPT 84436 Hc Thyroxine Total	$13.65	$39.00	—	—	65%
Total triiodothyronine (T3) blood test CPT 84480 Hc T3 Total	$21.35	$61.00	—	64% below	65%
Total triiodothyronine (T3) blood test CPT 84480 Hc T3 Triiodothyronine Total	$47.25	$135.00	—	21% below	65%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Hc T3 Total	$21.35	$61.00	—	—	65%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Hc T3 Triiodothyronine Total	$47.25	$135.00	—	—	65%
Transferrin blood test CPT 84466 Hc Transferrin	$37.80	$108.00	—	49% below	65%
Transferrin blood test inpatient CPT 84466 Hc Transferrin	$37.80	$108.00	—	—	65%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginal Amplif	$80.15	$229.00	—	7% below	65%
Trichomonas test (NAAT) CPT 87661 Hc Trichomonas Vaginal Amplif	$80.15	$229.00	—	7% below	65%
Trichomonas test (NAAT) inpatient CPT 87661 Hc Trichomonas Vaginal Amplif	$80.15	$229.00	—	—	65%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginal Amplif	$80.15	$229.00	—	—	65%
Triglycerides blood test CPT 84478 Hc Triglycerides	$27.30	$78.00	—	21% below	65%
Triglycerides blood test inpatient CPT 84478 Hc Triglycerides	$27.30	$78.00	—	—	65%
Troponin test, quantitative CPT 84484 Hc Troponin I Quant	$56.35	$161.00	—	33% below	65%
Troponin test, quantitative CPT 84484 Hc Troponin	$56.35	$161.00	—	33% below	65%
Troponin test, quantitative inpatient CPT 84484 Hc Troponin I Quant	$56.35	$161.00	—	—	65%
Troponin test, quantitative inpatient CPT 84484 Hc Troponin	$56.35	$161.00	—	—	65%
Uric acid blood test CPT 84550 Hc Uric Acid Blood	$32.20	$92.00	—	9% below	65%
Uric acid blood test inpatient CPT 84550 Hc Uric Acid Blood	$32.20	$92.00	—	—	65%
Urinalysis with microscope exam, automated CPT 81001 Hc Urinalysis With Micropsy	$5.25	$15.00	—	81% below	65%
Urinalysis with microscope exam, automated CPT 81001 Hc Urinalysis With Microscopy	$20.65	$59.00	—	24% below	65%
Urinalysis with microscope exam, automated inpatient CPT 81001 Hc Urinalysis With Micropsy	$5.25	$15.00	—	—	65%
Urinalysis with microscope exam, automated inpatient CPT 81001 Hc Urinalysis With Microscopy	$20.65	$59.00	—	—	65%
Urinalysis without microscope exam, automated CPT 81003 Hc Urine Dipstick Auto Wo/Micro	$9.45	$27.00	—	60% below	65%
Urinalysis without microscope exam, automated CPT 81003 Hc Urine Dip Clinitek-50	$15.40	$44.00	—	34% below	65%
Urinalysis without microscope exam, automated CPT 81003 Hc Urinalysis Wo/Microscopy	$16.10	$46.00	—	31% below	65%
Urinalysis without microscope exam, automated inpatient CPT 81003 Hc Urine Dipstick Auto Wo/Micro	$9.45	$27.00	—	—	65%
Urinalysis without microscope exam, automated inpatient CPT 81003 Hc Urine Dip Clinitek-50	$15.40	$44.00	—	—	65%
Urinalysis without microscope exam, automated inpatient CPT 81003 Hc Urinalysis Wo/Microscopy	$16.10	$46.00	—	—	65%
Urinalysis without microscope exam, manual CPT 81002 Hc Ictotest Bilirubin Test	$9.80	$28.00	—	40% below	65%
Urinalysis without microscope exam, manual CPT 81002 Hc Urinalysis Dipstick Wo/Micro	$10.15	$29.00	—	37% below	65%
Urinalysis without microscope exam, manual CPT 81002 Hc Reducing Substance Urine	$10.15	$29.00	—	37% below	65%
Urinalysis without microscope exam, manual inpatient CPT 81002 Hc Ictotest Bilirubin Test	$9.80	$28.00	—	—	65%
Urinalysis without microscope exam, manual inpatient CPT 81002 Hc Reducing Substance Urine	$10.15	$29.00	—	—	65%
Urinalysis without microscope exam, manual inpatient CPT 81002 Hc Urinalysis Dipstick Wo/Micro	$10.15	$29.00	—	—	65%
Urine culture for bacteria, with colony count CPT 87086 Hc Culture Urine	$30.45	$87.00	—	46% below	65%
Urine culture for bacteria, with colony count inpatient CPT 87086 Hc Culture Urine	$30.45	$87.00	—	—	65%
Urine microalbumin (albumin) test CPT 82043 Hc Albumin Microalbum Urine Quant	$36.75	$105.00	—	28% below	65%
Urine microalbumin (albumin) test inpatient CPT 82043 Hc Albumin Microalbum Urine Quant	$36.75	$105.00	—	—	65%
Urine pregnancy test, read by color change CPT 81025 Hc Hcg Qual Urine	$29.05	$83.00	—	40% below	65%
Urine pregnancy test, read by color change CPT 81025 Hc Urine Pregnancy Test	$29.05	$83.00	—	40% below	65%
Urine pregnancy test, read by color change inpatient CPT 81025 Hc Hcg Qual Urine	$29.05	$83.00	—	—	65%
Urine pregnancy test, read by color change inpatient CPT 81025 Hc Urine Pregnancy Test	$29.05	$83.00	—	—	65%
Vitamin B12 (cobalamin) blood test CPT 82607 Hc Vitamin B12	$49.35	$141.00	—	34% below	65%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Hc Vitamin B12	$49.35	$141.00	—	—	65%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Hc Vitamin D - 25 Hydroxy	$84.35	$241.00	—	11% below	65%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Hc Vitamin D - 25 Hydroxy	$84.35	$241.00	—	—	65%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Hc Vitamin-D 1-25-Dihydroxy	$92.05	$263.00	—	40% below	65%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Hc Vitamin-D 1-25-Dihydroxy	$92.05	$263.00	—	—	65%
Zinc blood test CPT 84630 Hc Zinc Assay	$26.95	$77.00	—	48% below	65%
Zinc blood test inpatient CPT 84630 Hc Zinc Assay	$26.95	$77.00	—	—	65%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hc Hcg Quant	$49.70	$142.00	—	26% below	65%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hc Hcg Quant	$49.70	$142.00	—	—	65%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Botox injections for chronic migraine CPT 64615 Hc Chemodenerv Musc Migraine	$595.77	$1,702.20	—	7% above	65%
Botox injections for chronic migraine inpatient CPT 64615 Hc Chemodenerv Musc Migraine	$595.77	$1,702.20	—	—	65%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Hc Bx Breast 1St Lesion Strtctc	$2,302.75	$6,579.28	—	42% below	65%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 Hc Bx Breast 1St Lesion Strtctc Right	$2,302.75	$6,579.28	—	42% below	65%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 Hc Bx Breast 1St Lesion Strtctc Left	$2,302.75	$6,579.28	—	42% below	65%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Hc Bx Breast 1St Lesion Strtctc	$2,302.75	$6,579.28	—	—	65%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 Hc Bx Breast 1St Lesion Strtctc Left	$2,302.75	$6,579.28	—	—	65%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 Hc Bx Breast 1St Lesion Strtctc Right	$2,302.75	$6,579.28	—	—	65%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Hc Treat Distal Fib Frac W/O Manip	$460.60	$1,316.00	—	22% above	65%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Hc Treat Distal Fib Frac W/O Manip	$460.60	$1,316.00	—	—	65%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Hc Treat Metatarsal Fracture W/O Manip	$460.60	$1,316.00	—	27% above	65%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Hc Treat Metatarsal Fracture W/O Manip	$460.60	$1,316.00	—	—	65%
Cardiac catheterization with coronary angiogram CPT 93458 Hc Lhrt Artery/Ventricle Angio	$6,857.90	$19,594.00	—	43% below	65%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 Hc Lhrt Artery/Ventricle Angio	$6,857.90	$19,594.00	—	—	65%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Hc Cardioversion Electric Ext	$1,070.04	$3,057.27	—	48% below	65%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Hc Cardioversion Electric Ext	$1,070.04	$3,057.27	—	—	65%
Carpal tunnel release, open surgery CPT 64721 Neuroplasty &/Or Transposition; Median Nerve At Carpal Tunnel	$1,234.12	$3,526.07	—	85% below	65%
Carpal tunnel release, open surgery CPT 64721 Hc Carpal Tunnel Surgery	$2,853.06	$8,151.60	—	65% below	65%
Carpal tunnel release, open surgery inpatient CPT 64721 Neuroplasty &/Or Transposition; Median Nerve At Carpal Tunnel	$1,234.12	$3,526.07	—	—	65%
Carpal tunnel release, open surgery inpatient CPT 64721 Hc Carpal Tunnel Surgery	$2,853.06	$8,151.60	—	—	65%
Catheter ablation for atrial fibrillation CPT 93656 Hc Comprehensive Ep And Ablation For Atrial Fibrillation By Pulm Vein Isolation, Including 3-D Mappi	$18,164.65	$51,899.00	—	47% below	65%
Catheter ablation for atrial fibrillation inpatient CPT 93656 Hc Comprehensive Ep And Ablation For Atrial Fibrillation By Pulm Vein Isolation, Including 3-D Mappi	$18,164.65	$51,899.00	—	—	65%
Cervical biopsy CPT 57500 Hc Biopsy Of Cervix	$1,101.30	$3,146.56	—	37% below	65%
Cervical biopsy inpatient CPT 57500 Hc Biopsy Of Cervix	$1,101.30	$3,146.56	—	—	65%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Hc Circumcision W/Regionl Block	$1,026.29	$2,932.25	—	42% below	65%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Hc Circumcision W/Regionl Block	$1,026.29	$2,932.25	—	—	65%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Closed Treatment, Distal Radial Fracture/Epiphyseal Separation; W/O Manipulation	$307.07	$877.33	—	25% below	65%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Hc Trt Fract Distal Radius & Ulna W/O Manip	$460.60	$1,316.00	—	12% above	65%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Closed Treatment, Distal Radial Fracture/Epiphyseal Separation; W/O Manipulation	$307.07	$877.33	—	—	65%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Hc Trt Fract Distal Radius & Ulna W/O Manip	$460.60	$1,316.00	—	—	65%
Colonoscopy with endoscopic ultrasound CPT 45391 Hc Colonoscopy W/Endoscopic U/S	$966.70	$2,762.00	—	69% below	65%
Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Hc Colonoscopy W/Endoscopic U/S	$966.70	$2,762.00	—	—	65%
Colonoscopy with polyp removal CPT 45385 Hc Lesion Removal Colonoscopy 2	$1,518.65	$4,339.00	—	55% below	65%
Colonoscopy with polyp removal inpatient CPT 45385 Hc Lesion Removal Colonoscopy 2	$1,518.65	$4,339.00	—	—	65%
Colonoscopy with tissue sample CPT 45380 Hc Colonoscopy And Biopsy	$1,518.65	$4,339.00	—	54% below	65%
Colonoscopy with tissue sample inpatient CPT 45380 Hc Colonoscopy And Biopsy	$1,518.65	$4,339.00	—	—	65%
Colonoscopy, diagnostic CPT 45378 Hc Diagnostic Colonoscopy	$1,177.40	$3,364.00	—	57% below	65%
Colonoscopy, diagnostic inpatient CPT 45378 Hc Diagnostic Colonoscopy	$1,177.40	$3,364.00	—	—	65%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 Hc Bx Of Cervix W/Scope Leep	$2,238.25	$6,395.00	—	42% below	65%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 Hc Bx Of Cervix W/Scope Leep	$2,238.25	$6,395.00	—	—	65%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Hc Bx/Curett Of Cervix W/Scope	$573.30	$1,638.00	—	37% below	65%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 Hc Bx/Curett Of Cervix W/Scope	$573.30	$1,638.00	—	—	65%
Coronary stent placement, one artery CPT 92928 Hc Prq Card Stent W/Angio 1 Vsl	$11,413.15	$32,609.00	—	12% below	65%
Coronary stent placement, one artery inpatient CPT 92928 Hc Prq Card Stent W/Angio 1 Vsl	$11,413.15	$32,609.00	—	—	65%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Hc Cystoscopy	$1,012.20	$2,892.00	—	49% below	65%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Hc Cystoscopy	$1,012.20	$2,892.00	—	—	65%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruction,Benign/Premalig Lesions, 1St Lesion	$52.74	$150.69	—	74% below	65%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Hc Destruct Premalg Lesion	$136.34	$389.55	—	33% below	65%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Destruction,Benign/Premalig Lesions, 1St Lesion	$52.74	$150.69	—	—	65%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Hc Destruct Premalg Lesion	$136.34	$389.55	—	—	65%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 Hc Create Eardrum Opening	$897.76	$2,565.02	—	32% below	65%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 Hc Create Eardrum Opening	$897.76	$2,565.02	—	—	65%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Hc Removal Of Impacted Cerumen Using Irrigation/Lavage	$115.64	$330.39	—	25% below	65%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Removal Of Impacted Cerumen (Or Wax) Using Irrgation/Lavage- Unilateral	$14.06	$40.18	—	91% below	65%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Hc Removal Of Impacted Cerumen Using Irrigation/Lavage	$115.64	$330.39	—	—	65%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 Removal Of Impacted Cerumen (Or Wax) Using Irrgation/Lavage- Unilateral	$14.06	$40.18	—	—	65%
Earwax removal with instruments, one ear CPT 69210 Removal Of Impacted Cerumen (Or Wax) Using Instrument On Same Dos As Audio Func Test	$39.85	$113.85	—	74% below	65%
Earwax removal with instruments, one ear CPT 69210 Hc Removal Of Impacted Cerumen (Or Wax) Using Instrumentation	$170.72	$487.78	—	10% above	65%
Earwax removal with instruments, one ear one side CPT 69210 Removal Of Impacted Cerumen (Or Wax) Using Instrumentation- Unilateral	$49.22	$140.64	—	68% below	65%
Earwax removal with instruments, one ear inpatient CPT 69210 Removal Of Impacted Cerumen (Or Wax) Using Instrument On Same Dos As Audio Func Test	$39.85	$113.85	—	—	65%
Earwax removal with instruments, one ear inpatient CPT 69210 Hc Removal Of Impacted Cerumen (Or Wax) Using Instrumentation	$170.72	$487.78	—	—	65%
Earwax removal with instruments, one ear inpatient one side CPT 69210 Removal Of Impacted Cerumen (Or Wax) Using Instrumentation- Unilateral	$49.22	$140.64	—	—	65%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Endometrial Biopsy W/Wo Endocervical Biopsy, W/O Dilation, Any Method (Sep Proc)	$110.95	$317.00	—	71% below	65%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Hc Biopsy Of Uterus Lining	$390.67	$1,116.20	—	2% above	65%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Endometrial Biopsy W/Wo Endocervical Biopsy, W/O Dilation, Any Method (Sep Proc)	$110.95	$317.00	—	—	65%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Hc Biopsy Of Uterus Lining	$390.67	$1,116.20	—	—	65%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Hc Njx Interlaminar Crv/Thrc W/ Imaging Guidance	$1,115.36	$3,186.75	—	50% below	65%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Hc Njx Interlaminar Crv/Thrc W/ Imaging Guidance	$1,115.36	$3,186.75	—	—	65%
Eye injection into the vitreous (intravitreal injection) CPT 67028 Hc Injection Eye Drug	$943.13	$2,694.67	—	140% above	65%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 Hc Injection Eye Drug	$943.13	$2,694.67	—	—	65%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj Paravert F Jnt L/S 1 Lev	$218.39	$623.96	—	90% below	65%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Hc Inj Paravert F Jnt L/S 1 Lev	$1,333.74	$3,810.70	—	39% below	65%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Inj Paravert F Jnt L/S 1 Lev	$218.39	$623.96	—	—	65%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Hc Inj Paravert F Jnt L/S 1 Lev	$1,333.74	$3,810.70	—	—	65%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Hc Diagnostic Sigmoidoscopy	$929.95	$2,657.00	—	64% below	65%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Hc Diagnostic Sigmoidoscopy	$929.95	$2,657.00	—	—	65%
Hemorrhoid banding (rubber band ligation) CPT 46221 Hc Ligation Of Hemorrhoid(S)	$900.49	$2,572.84	—	53% below	65%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 Hc Ligation Of Hemorrhoid(S)	$900.49	$2,572.84	—	—	65%
Hysterectomy through an abdominal incision (total) CPT 58150 Hc Total Hysterectomy	$2,824.01	$8,068.59	—	6% below	65%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 Hc Total Hysterectomy	$2,824.01	$8,068.59	—	—	65%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Hc Su Fdc Us Sonohysterogram	$270.20	$772.00	—	29% below	65%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Hc Catheter For Sonohysterography	$270.20	$772.00	—	29% below	65%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Hc Catheter For Hysterography	$270.20	$772.00	—	29% below	65%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Hc Su Fdc Us Sonohysterogram	$270.20	$772.00	—	—	65%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Hc Catheter For Hysterography	$270.20	$772.00	—	—	65%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Hc Catheter For Sonohysterography	$270.20	$772.00	—	—	65%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hc Hysteroscopy Biopsy	$3,171.46	$9,061.30	—	67% below	65%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 Hc Hysteroscopy Biopsy	$3,171.46	$9,061.30	—	—	65%
IUD insertion (the device itself billed separately) CPT 58300 Hc Insert Intrauterine Device	$393.40	$1,124.01	—	22% below	65%
IUD insertion (the device itself billed separately) inpatient CPT 58300 Hc Insert Intrauterine Device	$393.40	$1,124.01	—	—	65%
Incision and drainage of a simple or single skin abscess CPT 10060 Incision & Drainage, Abscess; Simple/Single	$91.02	$260.07	—	77% below	65%
Incision and drainage of a simple or single skin abscess CPT 10060 Hc Drainage Of Skin Abscess, Simple/Single	$401.61	$1,147.45	—	4% above	65%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Incision & Drainage, Abscess; Simple/Single	$91.02	$260.07	—	—	65%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Hc Drainage Of Skin Abscess, Simple/Single	$401.61	$1,147.45	—	—	65%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection(S); Single Tendon Sheath, Ligament, Aponeurosis	$66.41	$189.75	—	80% below	65%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Hc Inj Tendon Sheath/Ligament	$595.77	$1,702.20	—	76% above	65%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Injection(S); Single Tendon Sheath, Ligament, Aponeurosis	$66.41	$189.75	—	—	65%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Hc Inj Tendon Sheath/Ligament	$595.77	$1,702.20	—	—	65%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis, Aspiration &/Or Injection; Major Joint/Bursa	$75.40	$215.43	—	89% below	65%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Hc Drain/Inject Joint/Bursa Maj Jnt	$489.51	$1,398.60	—	30% below	65%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis, Aspiration &/Or Injection; Major Joint/Bursa	$75.40	$215.43	—	—	65%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Hc Drain/Inject Joint/Bursa Maj Jnt	$489.51	$1,398.60	—	—	65%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Hc Insertion Drug Delivery Implant (Ie Bioresobable, Biodegradable, Non-Biodegradable)	$360.20	$1,029.14	—	5% below	65%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Hc Insertion Drug Delivery Implant (Ie Bioresobable, Biodegradable, Non-Biodegradable)	$360.20	$1,029.14	—	—	65%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis, Aspiration &/Or Injection; Intermediate Joint/Bursa	$62.12	$177.48	—	90% below	65%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Hc Drain/Inject Joint/Bursa Int Jnt	$489.51	$1,398.60	—	21% below	65%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis, Aspiration &/Or Injection; Intermediate Joint/Bursa	$62.12	$177.48	—	—	65%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Hc Drain/Inject Joint/Bursa Int Jnt	$489.51	$1,398.60	—	—	65%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis, Aspiration &/Or Injection; Small Joint/Bursa	$58.21	$166.31	—	88% below	65%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Hc Drain/Inject Joint/Bursa Sm Jnt	$489.51	$1,398.60	—	1% below	65%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis, Aspiration &/Or Injection; Small Joint/Bursa	$58.21	$166.31	—	—	65%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Hc Drain/Inject Joint/Bursa Sm Jnt	$489.51	$1,398.60	—	—	65%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Hc After Cataract Laser Surgery	$1,209.86	$3,456.75	—	14% below	65%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Hc After Cataract Laser Surgery	$1,209.86	$3,456.75	—	—	65%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Layer Closure, Wounds, Scalp/Axillae/Trunk/Extremities; 2.5 Cm/<	$164.47	$469.92	—	69% below	65%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Hc Intmd Rpr S/A/T/Ext 2.5 Cm/<	$817.67	$2,336.20	—	53% above	65%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Layer Closure, Wounds, Scalp/Axillae/Trunk/Extremities; 2.5 Cm/<	$164.47	$469.92	—	—	65%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Hc Intmd Rpr S/A/T/Ext 2.5 Cm/<	$817.67	$2,336.20	—	—	65%
Left heart catheterization, diagnostic one side CPT 93452 Hc Left Hrt Cath W/Ventrclgrphy	$4,002.25	$11,435.00	—	57% below	65%
Left heart catheterization, diagnostic inpatient one side CPT 93452 Hc Left Hrt Cath W/Ventrclgrphy	$4,002.25	$11,435.00	—	—	65%
Lower-back epidural injection, with imaging guidance CPT 62323 Hc Njx Interlaminar Lmbr/Sac W/ Imaging Guidance	$1,014.96	$2,899.88	—	50% below	65%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Hc Njx Interlaminar Lmbr/Sac W/ Imaging Guidance	$1,014.96	$2,899.88	—	—	65%
Lower-back epidural injection, without imaging guidance CPT 62322 Hcnjx Interlaminar Lmbr/Sac W/O Imaging Guidance	$1,667.38	$4,763.94	—	3% above	65%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Hcnjx Interlaminar Lmbr/Sac W/O Imaging Guidance	$1,667.38	$4,763.94	—	—	65%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection, Anesthetic/Steroid, Transforaminal Epidural; Lumbar/Sacral, Single Level	$228.54	$652.98	—	89% below	65%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Hc Inj Foramen Epidural L/S	$1,333.74	$3,810.70	—	36% below	65%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Hc Inj Foramen Epidural Lumbar/Sacral, Single Level, Image Guided	$1,333.74	$3,810.70	—	36% below	65%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Injection, Anesthetic/Steroid, Transforaminal Epidural; Lumbar/Sacral, Single Level	$228.54	$652.98	—	—	65%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Hc Inj Foramen Epidural L/S	$1,333.74	$3,810.70	—	—	65%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Hc Inj Foramen Epidural Lumbar/Sacral, Single Level, Image Guided	$1,333.74	$3,810.70	—	—	65%
Miscarriage treatment with D&C, first trimester CPT 59820 Hc Care Of Miscarriage	$3,248.03	$9,280.08	—	54% below	65%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 Hc Care Of Miscarriage	$3,248.03	$9,280.08	—	—	65%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 Hc Mohs 1 Stage H/N/Hf/G	$1,216.94	$3,476.96	—	1% above	65%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 Hc Mohs 1 Stage H/N/Hf/G	$1,216.94	$3,476.96	—	—	65%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Excise, Benign Skin Lesion, Incl Margins, Except Skin Tag, Trunk/Arms/Legs; Excised Diam 0.5 Cm/<	$80.09	$228.82	—	94% below	65%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Hc Exc Tr-Ext B9+Marg 0.5 Cm<	$611.40	$1,746.85	—	55% below	65%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Excise, Benign Skin Lesion, Incl Margins, Except Skin Tag, Trunk/Arms/Legs; Excised Diam 0.5 Cm/<	$80.09	$228.82	—	—	65%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Hc Exc Tr-Ext B9+Marg 0.5 Cm<	$611.40	$1,746.85	—	—	65%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Excise, Benign Skin Lesion, Incl Margins, Face/Ears/Eyelids/Nose/Lips/Muco; Excised Diam 0.5 Cm/<	$109.39	$312.54	—	92% below	65%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Hc Exc Face-Mm B9+Marg 0.5 Cm/<	$1,216.94	$3,476.96	—	11% below	65%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Excise, Benign Skin Lesion, Incl Margins, Face/Ears/Eyelids/Nose/Lips/Muco; Excised Diam 0.5 Cm/<	$109.39	$312.54	—	—	65%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Hc Exc Face-Mm B9+Marg 0.5 Cm/<	$1,216.94	$3,476.96	—	—	65%
Nail removal (partial or complete), one nail CPT 11730 Avulsion, Nail Plate, Partial/Complete, Simple; Single	$89.07	$254.49	—	72% below	65%
Nail removal (partial or complete), one nail CPT 11730 Hc Removal Of Nail Plate	$281.67	$804.78	—	12% below	65%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion, Nail Plate, Partial/Complete, Simple; Single	$89.07	$254.49	—	—	65%
Nail removal (partial or complete), one nail inpatient CPT 11730 Hc Removal Of Nail Plate	$281.67	$804.78	—	—	65%
Occipital nerve block (injection for headaches) CPT 64405 Injection, Anesthetic Agent; Greater Occipital Nerve	$120.33	$343.79	—	85% below	65%
Occipital nerve block (injection for headaches) CPT 64405 Hc N Block Inj Occipital	$751.65	$2,147.57	—	5% below	65%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Injection, Anesthetic Agent; Greater Occipital Nerve	$120.33	$343.79	—	—	65%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Hc N Block Inj Occipital	$751.65	$2,147.57	—	—	65%
Pacemaker implant (dual chamber) CPT 33208 Hc Pacemk Dual Insrt/Repl W/Lead	$16,254.00	$46,440.00	—	4% above	65%
Pacemaker implant (dual chamber) inpatient CPT 33208 Hc Pacemk Dual Insrt/Repl W/Lead	$16,254.00	$46,440.00	—	—	65%
Paracentesis with imaging guidance CPT 49083 Hc Abd Paracentesis W/Imaging	$1,385.00	$3,957.14	—	20% below	65%
Paracentesis with imaging guidance CPT 49083 Hc Pocus Paracentesis With Us Guidance	$1,385.00	$3,957.14	—	20% below	65%
Paracentesis with imaging guidance inpatient CPT 49083 Hc Pocus Paracentesis With Us Guidance	$1,385.00	$3,957.14	—	—	65%
Paracentesis with imaging guidance inpatient CPT 49083 Hc Abd Paracentesis W/Imaging	$1,385.00	$3,957.14	—	—	65%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision, Nail/Nail Matrix, Permanent Removal	$181.66	$519.03	—	77% below	65%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Hc Removal Of Nail Bed	$817.67	$2,336.20	—	5% above	65%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excision, Nail/Nail Matrix, Permanent Removal	$181.66	$519.03	—	—	65%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Hc Removal Of Nail Bed	$817.67	$2,336.20	—	—	65%
Prostate biopsy CPT 55700 Hc Biopsy Of Prostate	$1,636.90	$4,676.87	—	19% below	65%
Prostate biopsy inpatient CPT 55700 Hc Biopsy Of Prostate	$1,636.90	$4,676.87	—	—	65%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Hc Destroy Lumb/Sac Facet Jnt	$2,167.93	$6,194.09	—	35% below	65%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Hc Destroy Lumb/Sac Facet Jnt	$2,167.93	$6,194.09	—	—	65%
Removal of a breast lump, open surgery CPT 19120 Hc Removal Of Breast Lesion	$3,710.97	$10,602.77	—	17% below	65%
Removal of a breast lump, open surgery inpatient CPT 19120 Hc Removal Of Breast Lesion	$3,710.97	$10,602.77	—	—	65%
Removal of a foreign object under the skin, simple CPT 10120 Incision & Removal, Foreign Body, Subq Tissues; Simple	$96.10	$274.58	—	86% below	65%
Removal of a foreign object under the skin, simple CPT 10120 Hc Remove Foreign Body Simple	$913.00	$2,608.56	—	36% above	65%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision & Removal, Foreign Body, Subq Tissues; Simple	$96.10	$274.58	—	—	65%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Hc Remove Foreign Body Simple	$913.00	$2,608.56	—	—	65%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Hc Colon Ca Scrn Not High Rsk Ind	$1,071.00	$3,060.00	—	59% below	65%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 Hc Colon Ca Scrn Not High Rsk Ind	$1,071.00	$3,060.00	—	—	65%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal Ca Screen Colonosco	$507.85	$1,451.00	—	80% below	65%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Hc Colorectal Scrn; Hi Risk Ind	$1,071.00	$3,060.00	—	59% below	65%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 Colorectal Ca Screen Colonosco	$507.85	$1,451.00	—	—	65%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 Hc Colorectal Scrn; Hi Risk Ind	$1,071.00	$3,060.00	—	—	65%
Short arm cast (elbow to hand) CPT 29075 Application, Cast; Elbow To Finger (Short Arm)	$87.90	$251.14	—	71% below	65%
Short arm cast (elbow to hand) CPT 29075 Hc Application Of Forearm Cast	$539.51	$1,541.47	—	79% above	65%
Short arm cast (elbow to hand) inpatient CPT 29075 Application, Cast; Elbow To Finger (Short Arm)	$87.90	$251.14	—	—	65%
Short arm cast (elbow to hand) inpatient CPT 29075 Hc Application Of Forearm Cast	$539.51	$1,541.47	—	—	65%
Short arm splint (forearm and hand) CPT 29125 Application, Short Arm Splint (Forearm To Hand); Static	$59.38	$169.66	—	80% below	65%
Short arm splint (forearm and hand) CPT 29125 Hc Apply Forearm Splint: Static	$289.88	$828.22	—	at median	65%
Short arm splint (forearm and hand) inpatient CPT 29125 Application, Short Arm Splint (Forearm To Hand); Static	$59.38	$169.66	—	—	65%
Short arm splint (forearm and hand) inpatient CPT 29125 Hc Apply Forearm Splint: Static	$289.88	$828.22	—	—	65%
Short leg cast (below the knee) CPT 29405 Hc Apply Short Leg Cast	$539.51	$1,541.47	—	42% above	65%
Short leg cast (below the knee) inpatient CPT 29405 Hc Apply Short Leg Cast	$539.51	$1,541.47	—	—	65%
Short leg splint (calf to foot) CPT 29515 Hc Application Lower Leg Splint	$319.57	$913.05	—	8% above	65%
Short leg splint (calf to foot) inpatient CPT 29515 Hc Application Lower Leg Splint	$319.57	$913.05	—	—	65%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Arthroscopy, Shoulder, Surgical; Decompression, Subacromial Space W/Partial Acromioplasty	$1,103.55	$3,153.00	—	95% below	65%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Arthroscopy, Shoulder, Surgical; Decompression, Subacromial Space W/Partial Acromioplasty	$1,103.55	$3,153.00	—	—	65%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple Repair, Superficial Wounds, Scalp/Neck/Axillae/Genitalia/Trunk/Extremities; 2.5 Cm/<	$131.26	$375.04	—	60% below	65%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Hc Rpr S/N/Ax/Gen/Trnk 2.5Cm/<	$388.32	$1,109.50	—	18% above	65%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple Repair, Superficial Wounds, Scalp/Neck/Axillae/Genitalia/Trunk/Extremities; 2.5 Cm/<	$131.26	$375.04	—	—	65%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Hc Rpr S/N/Ax/Gen/Trnk 2.5Cm/<	$388.32	$1,109.50	—	—	65%
Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy Skin Single Lesion	$721.96	$2,062.74	—	62% above	65%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Biopsy Skin Single Lesion	$721.96	$2,062.74	—	—	65%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Excision, Malignant Lesion, Incl Margins, Trunk/Arms/Legs; Excised Diam 0.5 Cm/<	$130.09	$371.69	—	91% below	65%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Hc Exc Tr-Ext Mal+Marg 0.5 Cm/<	$489.90	$1,399.71	—	64% below	65%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Excision, Malignant Lesion, Incl Margins, Trunk/Arms/Legs; Excised Diam 0.5 Cm/<	$130.09	$371.69	—	—	65%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Hc Exc Tr-Ext Mal+Marg 0.5 Cm/<	$489.90	$1,399.71	—	—	65%
Skin tag removal, up to 15 tags CPT 11200 Removal, Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To & Incl 15 Lesions	$64.85	$185.29	—	78% below	65%
Skin tag removal, up to 15 tags CPT 11200 Hc Removal Of Skin Tags <W/15	$381.29	$1,089.41	—	30% above	65%
Skin tag removal, up to 15 tags inpatient CPT 11200 Removal, Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To & Incl 15 Lesions	$64.85	$185.29	—	—	65%
Skin tag removal, up to 15 tags inpatient CPT 11200 Hc Removal Of Skin Tags <W/15	$381.29	$1,089.41	—	—	65%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Puncture, Lumbar, Dx	$117.98	$337.09	—	89% below	65%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar Puncture Procedure	$913.00	$2,608.56	—	15% below	65%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Hc Spinal Fluid Tap Diagnostic	$920.42	$2,629.76	—	14% below	65%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal Puncture, Lumbar, Dx	$117.98	$337.09	—	—	65%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Lumbar Puncture Procedure	$913.00	$2,608.56	—	—	65%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Hc Spinal Fluid Tap Diagnostic	$920.42	$2,629.76	—	—	65%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple Repair, Superficial Wounds, Scalp/Neck/Axillae/Genitalia/Trunk/Extremities; 2.6-7.5 Cm	$155.10	$443.13	—	56% below	65%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Hc Rpr S/N/Ax/Gen/Trnk2.6-7.5Cm	$457.47	$1,307.07	—	30% above	65%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Simple Repair, Superficial Wounds, Scalp/Neck/Axillae/Genitalia/Trunk/Extremities; 2.6-7.5 Cm	$155.10	$443.13	—	—	65%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Hc Rpr S/N/Ax/Gen/Trnk2.6-7.5Cm	$457.47	$1,307.07	—	—	65%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple Repair, Superficial Wounds, Face/Ears/Eyelids/Nose/Lips/Mucous Membranes; 2.5 Cm/<	$146.11	$417.46	—	54% below	65%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Hc Rpr F/E/E/N/L/M 2.5 Cm/<	$292.22	$834.92	—	8% below	65%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Simple Repair, Superficial Wounds, Face/Ears/Eyelids/Nose/Lips/Mucous Membranes; 2.5 Cm/<	$146.11	$417.46	—	—	65%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Hc Rpr F/E/E/N/L/M 2.5 Cm/<	$292.22	$834.92	—	—	65%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential Biopsy Skin, 1St Lesion	$401.61	$1,147.45	—	33% above	65%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential Biopsy Skin, 1St Lesion	$401.61	$1,147.45	—	—	65%
Thoracentesis with imaging guidance CPT 32555 Hc Xa Thoracentesis W/Image Guide	$1,223.19	$3,494.82	—	30% below	65%
Thoracentesis with imaging guidance CPT 32555 Hc Pocus Thoracentesis With Us Guidance	$1,223.19	$3,494.82	—	30% below	65%
Thoracentesis with imaging guidance inpatient CPT 32555 Hc Xa Thoracentesis W/Image Guide	$1,223.19	$3,494.82	—	—	65%
Thoracentesis with imaging guidance inpatient CPT 32555 Hc Pocus Thoracentesis With Us Guidance	$1,223.19	$3,494.82	—	—	65%
Trigger finger release surgery CPT 26055 Tendon Sheath Incision	$433.64	$1,238.98	—	87% below	65%
Trigger finger release surgery CPT 26055 Hc Incise Finger Tendon Sheath	$2,127.20	$6,077.70	—	35% below	65%
Trigger finger release surgery inpatient CPT 26055 Tendon Sheath Incision	$433.64	$1,238.98	—	—	65%
Trigger finger release surgery inpatient CPT 26055 Hc Incise Finger Tendon Sheath	$2,127.20	$6,077.70	—	—	65%
Trigger point injections, 1 or 2 muscles CPT 20552 Injection(S); Single/Multiple Trigger Point(S), 1-2 Muscles	$92.20	$263.42	—	87% below	65%
Trigger point injections, 1 or 2 muscles CPT 20552 Hc Inj Trigger Point 1/2 Muscl	$382.07	$1,091.64	—	45% below	65%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Injection(S); Single/Multiple Trigger Point(S), 1-2 Muscles	$92.20	$263.42	—	—	65%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Hc Inj Trigger Point 1/2 Muscl	$382.07	$1,091.64	—	—	65%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Hc Bx Breast 1St Lesion Us Imag	$2,302.75	$6,579.28	—	31% below	65%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 Hc Mg Breast Core Bx Rt W/Us	$2,302.75	$6,579.28	—	31% below	65%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 Hc Mg Breast Core Bx Lt W/Us	$2,302.75	$6,579.28	—	31% below	65%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Hc Bx Breast 1St Lesion Us Imag	$2,302.75	$6,579.28	—	—	65%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 Hc Mg Breast Core Bx Lt W/Us	$2,302.75	$6,579.28	—	—	65%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 Hc Mg Breast Core Bx Rt W/Us	$2,302.75	$6,579.28	—	—	65%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Hc Esoph Endoscopy Dilation	$1,481.57	$4,233.06	—	58% below	65%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 Hc Esoph Endoscopy Dilation	$1,481.57	$4,233.06	—	—	65%
Upper endoscopy (EGD) with biopsy CPT 43239 Hc Upper Gi Endoscopy Biopsy	$1,184.11	$3,383.18	—	58% below	65%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Hc Upper Gi Endoscopy Biopsy	$1,184.11	$3,383.18	—	—	65%
Upper endoscopy (EGD) with injection into the lining CPT 43236 Hc Uppr Gi Scope W/Submuc Inj	$1,184.11	$3,383.18	—	58% below	65%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 Hc Uppr Gi Scope W/Submuc Inj	$1,184.11	$3,383.18	—	—	65%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Hc Operative Upper Gi Endoscopy	$1,404.25	$4,012.15	—	57% below	65%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 Hc Operative Upper Gi Endoscopy	$1,404.25	$4,012.15	—	—	65%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Hc Uppr Gi Endoscopy/Guide Wire	$1,142.95	$3,265.56	—	59% below	65%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 Hc Uppr Gi Endoscopy/Guide Wire	$1,142.95	$3,265.56	—	—	65%
Upper endoscopy (EGD), diagnostic CPT 43235 Hc Uppr Gi Endoscopy Diagnosis	$1,184.11	$3,383.18	—	54% below	65%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Hc Uppr Gi Endoscopy Diagnosis	$1,184.11	$3,383.18	—	—	65%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 Hc Esoph Endoscope W/Drain Cyst	$1,198.43	$3,424.09	—	74% below	65%
Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 Hc Esoph Endoscope W/Drain Cyst	$1,198.43	$3,424.09	—	—	65%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 Hc Cysto/Uretero W/Lithotripsy	$3,468.50	$9,910.00	—	77% below	65%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 Hc Cysto/Uretero W/Lithotripsy	$3,468.50	$9,910.00	—	—	65%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Hc Removal Of Sperm Duct(S)	$2,960.92	$8,459.76	—	14% below	65%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 Hc Removal Of Sperm Duct(S)	$2,960.92	$8,459.76	—	—	65%
Vein ablation, radiofrequency, first vein CPT 36475 Hc Endovenous Rf 1St Vein	$4,725.66	$13,501.88	—	28% below	65%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 Hc Endovenous Rf 1St Vein	$4,725.66	$13,501.88	—	—	65%
Wart removal, up to 14 warts CPT 17110 Destruct;Benign Lesion;Up To 14 L	$54.69	$156.27	—	83% below	65%
Wart removal, up to 14 warts CPT 17110 Hc Destruct B9 Lesion 1-14	$166.03	$474.38	—	47% below	65%
Wart removal, up to 14 warts inpatient CPT 17110 Destruct;Benign Lesion;Up To 14 L	$54.69	$156.27	—	—	65%
Wart removal, up to 14 warts inpatient CPT 17110 Hc Destruct B9 Lesion 1-14	$166.03	$474.38	—	—	65%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debridement; Skin, & Subq Tissue	$94.93	$271.24	—	88% below	65%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Hc Deb Subq Tissue 20 Sq Cm/<	$955.58	$2,730.22	—	23% above	65%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debridement; Skin, & Subq Tissue	$94.93	$271.24	—	—	65%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Hc Deb Subq Tissue 20 Sq Cm/<	$955.58	$2,730.22	—	—	65%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Blood Component Transfusion	$893.85	$2,553.86	—	20% below	65%
Blood transfusion (giving blood or blood components) CPT 36430 Hc Blood Transfusion Service	$893.85	$2,553.86	—	20% below	65%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Component Transfusion	$893.85	$2,553.86	—	—	65%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Hc Blood Transfusion Service	$893.85	$2,553.86	—	—	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hyperinflation-Ippb Subsequent	$28.52	$81.48	—	84% below	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hyperinflation-Ippb Initial	$44.54	$127.25	—	75% below	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Bronchdilatr Subsquent	$147.28	$420.81	—	16% below	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Aerosol Inhalation Subsequent	$147.28	$420.81	—	16% below	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Bronchodilator Initial	$287.14	$820.41	—	64% above	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Airway Inhalation Treatment	$287.14	$820.41	—	64% above	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hyperinflation-Ippb Subsequent	$28.52	$81.48	—	—	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hyperinflation-Ippb Initial	$44.54	$127.25	—	—	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Bronchdilatr Subsquent	$147.28	$420.81	—	—	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Aerosol Inhalation Subsequent	$147.28	$420.81	—	—	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Airway Inhalation Treatment	$287.14	$820.41	—	—	65%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Bronchodilator Initial	$287.14	$820.41	—	—	65%
Chemotherapy IV infusion, first hour CPT 96413 Hc Chemo Iv Infusion 1 Hr	$466.55	$1,333.00	—	39% below	65%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Hc Chemo Iv Infusion 1 Hr	$466.55	$1,333.00	—	—	65%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 Eye Exam Comprehensive, New Patient	$93.10	$266.00	—	64% below	65%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 Hc Eye Exam Comp New Patient	$172.90	$494.00	—	33% below	65%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 Eye Exam Comprehensive, New Patient	$93.10	$266.00	—	—	65%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 Hc Eye Exam Comp New Patient	$172.90	$494.00	—	—	65%
Comprehensive eye exam, returning patient CPT 92014 Eye Exam Comprehensive, Established Patient	$71.05	$203.00	—	69% below	65%
Comprehensive eye exam, returning patient CPT 92014 Hc Eye Exam Comp Estab Patient	$173.25	$495.00	—	25% below	65%
Comprehensive eye exam, returning patient inpatient CPT 92014 Eye Exam Comprehensive, Established Patient	$71.05	$203.00	—	—	65%
Comprehensive eye exam, returning patient inpatient CPT 92014 Hc Eye Exam Comp Estab Patient	$173.25	$495.00	—	—	65%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 Comprehensive Audio Eval	$49.88	$142.50	—	81% below	65%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 Hc Comprehensive Hearing Test	$266.18	$760.50	—	2% above	65%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 Comprehensive Audio Eval	$49.88	$142.50	—	—	65%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 Hc Comprehensive Hearing Test	$266.18	$760.50	—	—	65%
Critical care, first 30 to 74 minutes CPT 99291 Hc Critical Care First Hour	$1,555.75	$4,445.00	—	47% below	65%
Critical care, first 30 to 74 minutes CPT 99291 Hc Trauma 3 Activation W Cc	$3,309.60	$9,456.00	—	13% above	65%
Critical care, first 30 to 74 minutes CPT 99291 Hc Trauma 2 Activation W/Cc	$5,368.65	$15,339.00	—	83% above	65%
Critical care, first 30 to 74 minutes CPT 99291 Hc Trauma 1 Activation W/Cc	$5,905.72	$16,873.50	—	101% above	65%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Hc Critical Care First Hour	$1,555.75	$4,445.00	—	—	65%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Hc Trauma 3 Activation W Cc	$3,309.60	$9,456.00	—	—	65%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Hc Trauma 2 Activation W/Cc	$5,368.65	$15,339.00	—	—	65%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Hc Trauma 1 Activation W/Cc	$5,905.72	$16,873.50	—	—	65%
EEG (brain wave test), awake and drowsy, routine CPT 95816 Hc Eeg Awake And Drowsy	$424.90	$1,214.00	—	56% below	65%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Hc Eeg Awake And Drowsy	$424.90	$1,214.00	—	—	65%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Ecg-Tracing&Interpretation	$51.10	$146.00	—	80% below	65%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Ecg-Tracing&Interpretation	$51.10	$146.00	—	—	65%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Hc Electrocardiogram Tracing	$112.00	$320.00	—	40% below	65%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Hc Electrocardiogram Tracing	$112.00	$320.00	—	—	65%
Electroconvulsive therapy (ECT), one session CPT 90870 Hc Electroconvulsive Therapy	$835.27	$2,386.48	—	38% below	65%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 Hc Electroconvulsive Therapy	$835.27	$2,386.48	—	—	65%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Level 1 Emerg Dept Visit	$136.85	$391.00	—	56% below	65%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Level 1 Emerg Dept Visit	$136.85	$391.00	—	—	65%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Level 2 Emerg Dept Visit	$226.10	$646.00	—	56% below	65%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Level 2 Emerg Dept Visit	$226.10	$646.00	—	—	65%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Level 3 Emerg Dept Visit	$422.10	$1,206.00	—	50% below	65%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Level 3 Emerg Dept Visit	$422.10	$1,206.00	—	—	65%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Level 4 Emerg Dept Visit	$742.00	$2,120.00	—	44% below	65%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Level 4 Emerg Dept Visit	$742.00	$2,120.00	—	—	65%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Hc Trauma 3 Activation Wo Cc	$3,309.60	$9,456.00	—	90% above	65%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Hc Trauma 2 Activation W/O Cc	$5,368.65	$15,339.00	—	209% above	65%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Hc Trauma 1 Activation W/O Cc	$5,905.72	$16,873.50	—	240% above	65%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Hc Trauma 3 Activation Wo Cc	$3,309.60	$9,456.00	—	—	65%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Hc Trauma 2 Activation W/O Cc	$5,368.65	$15,339.00	—	—	65%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Hc Trauma 1 Activation W/O Cc	$5,905.72	$16,873.50	—	—	65%
Exercise stress test, tracing only, the hospital charge CPT 93017 Hc Stress Test Exer/Echo-Tracing	$474.60	$1,356.00	—	47% below	65%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Hc Stress Test Exer/Echo-Tracing	$474.60	$1,356.00	—	—	65%
Eye exam, returning patient, intermediate CPT 92012 Eye Exam Limited, Established Patient	$45.15	$129.00	—	85% below	65%
Eye exam, returning patient, intermediate CPT 92012 Hc Eye Exam Interm Estab Patient	$173.25	$495.00	—	43% below	65%
Eye exam, returning patient, intermediate inpatient CPT 92012 Eye Exam Limited, Established Patient	$45.15	$129.00	—	—	65%
Eye exam, returning patient, intermediate inpatient CPT 92012 Hc Eye Exam Interm Estab Patient	$173.25	$495.00	—	—	65%
Family therapy with the patient, 50 minutes CPT 90847 Special Family Therapy W/Pt	$105.00	$300.00	—	65% below	65%
Family therapy with the patient, 50 minutes CPT 90847 Hc Family Therapy W Patient	$204.40	$584.00	—	31% below	65%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Special Family Therapy W/Pt	$105.00	$300.00	—	—	65%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Hc Family Therapy W Patient	$204.40	$584.00	—	—	65%
Family therapy without the patient, 50 minutes CPT 90846 Special Family Therapy Wo/Pt	$91.70	$262.00	—	70% below	65%
Family therapy without the patient, 50 minutes CPT 90846 Hc Family Therapy Wo Patient	$204.40	$584.00	—	34% below	65%
Family therapy without the patient, 50 minutes inpatient CPT 90846 Special Family Therapy Wo/Pt	$91.70	$262.00	—	—	65%
Family therapy without the patient, 50 minutes inpatient CPT 90846 Hc Family Therapy Wo Patient	$204.40	$584.00	—	—	65%
Group psychotherapy session CPT 90853 Special Group Therapy 1 Hr	$33.60	$96.00	—	80% below	65%
Group psychotherapy session CPT 90853 Hc Group Therapy	$136.15	$389.00	—	20% below	65%
Group psychotherapy session inpatient CPT 90853 Special Group Therapy 1 Hr	$33.60	$96.00	—	—	65%
Group psychotherapy session inpatient CPT 90853 Hc Group Therapy	$136.15	$389.00	—	—	65%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hc Hydration Iv Infusion Init	$292.60	$836.00	—	30% below	65%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hc Hydration Iv Infusion Init	$292.60	$836.00	—	—	65%
IV infusion of a medicine, first hour CPT 96365 Hc Ther/Proph/Diag Iv Inf Init	$296.45	$847.00	—	32% below	65%
IV infusion of a medicine, first hour inpatient CPT 96365 Hc Ther/Proph/Diag Iv Inf Init	$296.45	$847.00	—	—	65%
IV push of a medicine, first drug CPT 96374 Hc Ther/Proph/Diag Inj Iv Push	$292.60	$836.00	—	14% above	65%
IV push of a medicine, first drug inpatient CPT 96374 Hc Ther/Proph/Diag Inj Iv Push	$292.60	$836.00	—	—	65%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection; Subcutaneous Or Intramuscular	$84.70	$242.00	—	40% below	65%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Hc Ther/Proph/Diag Inj Sc/Im	$84.70	$242.00	—	40% below	65%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Hc Ther/Proph/Diag Inj Sc/Im	$84.70	$242.00	—	—	65%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection; Subcutaneous Or Intramuscular	$84.70	$242.00	—	—	65%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psych Diagnostic Evaluation	$130.90	$374.00	—	58% below	65%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Hc Psych Diagnostic Evaluation	$204.40	$584.00	—	35% below	65%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psych Diagnostic Evaluation	$130.90	$374.00	—	—	65%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Hc Psych Diagnostic Evaluation	$204.40	$584.00	—	—	65%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 Hc Nrv Cndj Test 7-8 Studies	$1,611.75	$4,605.00	—	17% above	65%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 Hc Nrv Cndj Test 7-8 Studies	$1,611.75	$4,605.00	—	—	65%
Neuromuscular re-education, 15 minutes CPT 97112 Hc Neuromuscular Reeducation	$73.50	$210.00	—	33% below	65%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Hc Neuromuscular Reeducation	$73.50	$210.00	—	—	65%
New patient office visit, about 30 minutes CPT 99203 Lvl 3 New Pt, Low Mdm, Minimum Of 30 Minutes	$68.60	$196.00	—	37% below	65%
New patient office visit, about 30 minutes inpatient CPT 99203 Lvl 3 New Pt, Low Mdm, Minimum Of 30 Minutes	$68.60	$196.00	—	—	65%
New patient office visit, about 45 minutes CPT 99204 Lvl 4 New Pt, Moderate Mdm, Minimum Of 45 Minutes	$85.40	$244.00	—	30% below	65%
New patient office visit, about 45 minutes inpatient CPT 99204 Lvl 4 New Pt, Moderate Mdm, Minimum Of 45 Minutes	$85.40	$244.00	—	—	65%
New patient office visit, about 60 minutes CPT 99205 Lvl 5 New Pt, High Mdm , 60-74 Minutes	$108.85	$311.00	—	37% below	65%
New patient office visit, about 60 minutes inpatient CPT 99205 Lvl 5 New Pt, High Mdm , 60-74 Minutes	$108.85	$311.00	—	—	65%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Lvl 2 New Pt, Straightfwd Mdm, Minimum Of 15 Minutes	$44.80	$128.00	—	56% below	65%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Lvl 2 New Pt, Straightfwd Mdm, Minimum Of 15 Minutes	$44.80	$128.00	—	—	65%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Med Nutr Ther, 1St, Indiv, Ea 15 Min	$33.60	$95.99	—	48% below	65%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Hc Medical Nutrition Indiv In	$46.49	$132.83	—	28% below	65%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Med Nutr Ther, 1St, Indiv, Ea 15 Min	$33.60	$95.99	—	—	65%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Hc Medical Nutrition Indiv In	$46.49	$132.83	—	—	65%
Occupational therapy evaluation, low complexity CPT 97165 Hc Driver Eval, Low Complexity	$113.75	$325.00	—	56% below	65%
Occupational therapy evaluation, low complexity CPT 97165 Hc Ot Eval Low Complex 30 Min	$113.75	$325.00	—	56% below	65%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Low Complex 30 Min	$139.65	$399.00	—	47% below	65%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Hc Driver Eval, Low Complexity	$113.75	$325.00	—	—	65%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Hc Ot Eval Low Complex 30 Min	$113.75	$325.00	—	—	65%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Ot Eval Low Complex 30 Min	$139.65	$399.00	—	—	65%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Hc Pt Eval High Complex 45 Min	$117.95	$337.00	—	61% below	65%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval High Complex 45 Min	$139.65	$399.00	—	54% below	65%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Hc Pt Eval High Complex 45 Min	$117.95	$337.00	—	—	65%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Pt Eval High Complex 45 Min	$139.65	$399.00	—	—	65%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Hc Pt Eval Low Complex 20 Min	$117.95	$337.00	—	55% below	65%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Low Complex 20 Min	$139.65	$399.00	—	46% below	65%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Hc Pt Eval Low Complex 20 Min	$117.95	$337.00	—	—	65%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Pt Eval Low Complex 20 Min	$139.65	$399.00	—	—	65%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Hc Pt Eval Mod Complex 30 Min	$117.95	$337.00	—	58% below	65%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Mod Complex 30 Min	$139.65	$399.00	—	50% below	65%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Hc Pt Eval Mod Complex 30 Min	$117.95	$337.00	—	—	65%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Pt Eval Mod Complex 30 Min	$139.65	$399.00	—	—	65%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Hc Manual Therapy	$66.15	$189.00	—	40% below	65%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Hc Manual Therapy	$66.15	$189.00	—	—	65%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercises	$16.45	$47.00	—	86% below	65%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise	$32.90	$94.00	—	72% below	65%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Hc Therapeutic Exercise	$80.50	$230.00	—	32% below	65%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercises	$16.45	$47.00	—	—	65%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise	$32.90	$94.00	—	—	65%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Hc Therapeutic Exercise	$80.50	$230.00	—	—	65%
Preventive checkup, new patient aged 18–39 CPT 99385 Preventive, Age 18-39 Yrs, New	$60.90	$174.00	—	49% below	65%
Preventive checkup, new patient aged 18–39 CPT 99385 Prevent E/M, New Pat 18-39 Yrs	$119.00	$340.00	—	1% below	65%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Preventive, Age 18-39 Yrs, New	$60.90	$174.00	—	—	65%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Prevent E/M, New Pat 18-39 Yrs	$119.00	$340.00	—	—	65%
Preventive checkup, new patient aged 40–64 CPT 99386 Preventive, Age 40-64 Yrs, New	$66.15	$189.00	—	55% below	65%
Preventive checkup, new patient aged 40–64 CPT 99386 Prevent E/M, New Pat 40-64 Yrs	$119.00	$340.00	—	18% below	65%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Preventive, Age 40-64 Yrs, New	$66.15	$189.00	—	—	65%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Prevent E/M, New Pat 40-64 Yrs	$119.00	$340.00	—	—	65%
Preventive checkup, new patient aged 65 or older CPT 99387 Preventive, Age >64 Yrs, New	$68.60	$196.00	—	56% below	65%
Preventive checkup, new patient aged 65 or older CPT 99387 Prevent E/M, New Pat 65+ Yrs	$119.00	$340.00	—	24% below	65%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 Preventive, Age >64 Yrs, New	$68.60	$196.00	—	—	65%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 Prevent E/M, New Pat 65+ Yrs	$119.00	$340.00	—	—	65%
Preventive checkup, returning patient aged 18–39 CPT 99395 Preventive, Age 18-39 Yrs, Est	$56.35	$161.00	—	55% below	65%
Preventive checkup, returning patient aged 18–39 CPT 99395 Prevent E/M, Estab Pat 18-39 Yrs	$119.00	$340.00	—	5% below	65%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 Preventive, Age 18-39 Yrs, Est	$56.35	$161.00	—	—	65%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 Prevent E/M, Estab Pat 18-39 Yrs	$119.00	$340.00	—	—	65%
Preventive checkup, returning patient aged 40–64 CPT 99396 Preventive, Age 40-64 Yrs, Est	$60.90	$174.00	—	52% below	65%
Preventive checkup, returning patient aged 40–64 CPT 99396 Prevent E/M, Estab Pat 40-64 Yrs	$119.00	$340.00	—	6% below	65%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 Preventive, Age 40-64 Yrs, Est	$60.90	$174.00	—	—	65%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 Prevent E/M, Estab Pat 40-64 Yrs	$119.00	$340.00	—	—	65%
Preventive checkup, returning patient aged 65 or older CPT 99397 Preventive, Age >64 Yrs, Est	$66.15	$189.00	—	49% below	65%
Preventive checkup, returning patient aged 65 or older CPT 99397 Prevent E/M, Estab Pat 65+ Yrs	$119.00	$340.00	—	8% below	65%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 Preventive, Age >64 Yrs, Est	$66.15	$189.00	—	—	65%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 Prevent E/M, Estab Pat 65+ Yrs	$119.00	$340.00	—	—	65%
Psychiatric evaluation with medical services CPT 90792 Psych Diag Eval W/Med Srvcs	$130.90	$374.00	—	63% below	65%
Psychiatric evaluation with medical services CPT 90792 Hc Psych Diag Eval W/Med Srvcs	$204.40	$584.00	—	42% below	65%
Psychiatric evaluation with medical services inpatient CPT 90792 Psych Diag Eval W/Med Srvcs	$130.90	$374.00	—	—	65%
Psychiatric evaluation with medical services inpatient CPT 90792 Hc Psych Diag Eval W/Med Srvcs	$204.40	$584.00	—	—	65%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 Psychological Test Evaluation Services Phys/Qhp First Hour	$589.05	$1,683.00	—	39% above	65%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 Psychological Test Evaluation Services Phys/Qhp First Hour	$589.05	$1,683.00	—	—	65%
Psychotherapy for crisis, first 60 minutes CPT 90839 Psytx Crisis Initial 60 Min	$120.40	$344.00	—	62% below	65%
Psychotherapy for crisis, first 60 minutes CPT 90839 Hc Psytx Crisis Initial 60 Min	$255.50	$730.00	—	18% below	65%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 Psytx Crisis Initial 60 Min	$120.40	$344.00	—	—	65%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 Hc Psytx Crisis Initial 60 Min	$255.50	$730.00	—	—	65%
Psychotherapy session, 30 minutes CPT 90832 Individual Psychotherapy 16-37 Minutes	$59.50	$170.00	—	69% below	65%
Psychotherapy session, 30 minutes CPT 90832 Hc Individual Psychotherapy 16-37 Minutes	$204.40	$584.00	—	8% above	65%
Psychotherapy session, 30 minutes inpatient CPT 90832 Individual Psychotherapy 16-37 Minutes	$59.50	$170.00	—	—	65%
Psychotherapy session, 30 minutes inpatient CPT 90832 Hc Individual Psychotherapy 16-37 Minutes	$204.40	$584.00	—	—	65%
Psychotherapy session, 45 minutes CPT 90834 Individual Psychotherapy 38-52 Minutes	$91.00	$260.00	—	66% below	65%
Psychotherapy session, 45 minutes CPT 90834 Hc Individual Psychotherapy 38-52 Minutes	$204.40	$584.00	—	23% below	65%
Psychotherapy session, 45 minutes inpatient CPT 90834 Individual Psychotherapy 38-52 Minutes	$91.00	$260.00	—	—	65%
Psychotherapy session, 45 minutes inpatient CPT 90834 Hc Individual Psychotherapy 38-52 Minutes	$204.40	$584.00	—	—	65%
Psychotherapy session, 60 minutes CPT 90837 Individual Psychotherapy 53 Or More Minutes	$96.95	$277.00	—	69% below	65%
Psychotherapy session, 60 minutes CPT 90837 Hc Individual Psychotherapy 53 Or More Minutes	$204.40	$584.00	—	35% below	65%
Psychotherapy session, 60 minutes inpatient CPT 90837 Individual Psychotherapy 53 Or More Minutes	$96.95	$277.00	—	—	65%
Psychotherapy session, 60 minutes inpatient CPT 90837 Hc Individual Psychotherapy 53 Or More Minutes	$204.40	$584.00	—	—	65%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Hc Smoking Cessation 3 Min-10 Min	$49.00	$140.00	—	12% above	65%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Hc Smoking Cessation 3 Min-10 Min	$49.00	$140.00	—	—	65%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Lvl 5 Est Pt, High Mdm, 40-54 Minutes	$81.20	$232.00	—	52% below	65%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Lvl 5 Est Pt, High Mdm, 40-54 Minutes	$81.20	$232.00	—	—	65%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Lvl 3 Est Pt, Low Mdm, Minimum Of 20 Minutes	$38.15	$109.00	—	67% below	65%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Lvl 3 Est Pt, Low Mdm, Minimum Of 20 Minutes	$38.15	$109.00	—	—	65%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Lvl 4 Est Pt, Moderate Mdm, Minimum Of 30 Minutes	$52.85	$151.00	—	61% below	65%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Lvl 4 Est Pt, Moderate Mdm, Minimum Of 30 Minutes	$52.85	$151.00	—	—	65%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Lvl 2 Est Pt, Straightfwd Mdm, Minimum Of 10 Minutes	$26.95	$77.00	—	73% below	65%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Pe For Tap Research Study	$26.95	$77.00	—	73% below	65%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Pe For Tap Research Study	$26.95	$77.00	—	—	65%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Lvl 2 Est Pt, Straightfwd Mdm, Minimum Of 10 Minutes	$26.95	$77.00	—	—	65%
Specialist consultation, low complexity or 30+ minutes CPT 99243 Office Or Other Outpatient, Consult, Low Mdm, 30-39 Minutes	$115.85	$331.00	—	6% above	65%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office Or Other Outpatient, Consult, Low Mdm, 30-39 Minutes	$115.85	$331.00	—	—	65%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office Or Other Outpatient, Consult, Moderate Mdm, 40-54 Minutes	$162.05	$463.00	—	22% above	65%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Or Other Outpatient, Consult, Moderate Mdm, 40-54 Minutes	$162.05	$463.00	—	—	65%
Speech and language evaluation CPT 92523 Speech Sound Lang Comprehen	$196.00	$560.00	—	42% below	65%
Speech and language evaluation CPT 92523 Hc Speech Sound Lang Comprehen	$236.95	$677.00	—	30% below	65%
Speech and language evaluation inpatient CPT 92523 Speech Sound Lang Comprehen	$196.00	$560.00	—	—	65%
Speech and language evaluation inpatient CPT 92523 Hc Speech Sound Lang Comprehen	$236.95	$677.00	—	—	65%
Speech therapy session, individual CPT 92507 Hc Speech/Hearing Therapy	$136.15	$389.00	—	38% below	65%
Speech therapy session, individual inpatient CPT 92507 Hc Speech/Hearing Therapy	$136.15	$389.00	—	—	65%
Spirometry (breathing test) CPT 94010 Hc Breathing Capacity Test	$286.65	$819.00	—	8% below	65%
Spirometry (breathing test) inpatient CPT 94010 Hc Breathing Capacity Test	$286.65	$819.00	—	—	65%
Spirometry before and after a bronchodilator CPT 94060 Hc Evaluation Of Wheezing; Admin Post-Bronch	$589.05	$1,683.00	—	3% above	65%
Spirometry before and after a bronchodilator inpatient CPT 94060 Hc Evaluation Of Wheezing; Admin Post-Bronch	$589.05	$1,683.00	—	—	65%
TMS (transcranial magnetic stimulation), first session with mapping CPT 90867 Hc Therapeutic Repetitive Transcranial Magnetic Stimulation (Tms) Treatment, Initial	$434.70	$1,242.00	—	3% below	65%
TMS (transcranial magnetic stimulation), first session with mapping inpatient CPT 90867 Hc Therapeutic Repetitive Transcranial Magnetic Stimulation (Tms) Treatment, Initial	$434.70	$1,242.00	—	—	65%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activity Ea 15Min	$35.35	$101.00	—	71% below	65%
Therapeutic activities (functional training), 15 minutes CPT 97530 Hc Therapeutic Activity	$75.25	$215.00	—	38% below	65%
Therapeutic activities (functional training), 15 minutes CPT 97530 Hc Functional Activity	$75.25	$215.00	—	38% below	65%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activity Ea 15Min	$35.35	$101.00	—	—	65%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Hc Functional Activity	$75.25	$215.00	—	—	65%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Hc Therapeutic Activity	$75.25	$215.00	—	—	65%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Hc Therapeutic Phlebotomy	$235.96	$674.18	—	at median	65%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Hc Phlebotomy	$235.96	$674.18	—	at median	65%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Hc Therapeutic Phlebotomy	$235.96	$674.18	—	—	65%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Hc Phlebotomy	$235.96	$674.18	—	—	65%
Visual field test, extended CPT 92083 Hc Visual Field Examination(S) Extend	$154.35	$441.00	—	at median	65%
Visual field test, extended inpatient CPT 92083 Hc Visual Field Examination(S) Extend	$154.35	$441.00	—	—	65%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 Influenza Vaccine, Inactivated, Subunit, Adjuvanted (Im,Once)	$15.75	$45.00	—	79% below	65%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 Influenza Vaccine, Inactivated, Subunit, Adjuvanted (Im,Once)	$15.75	$45.00	—	—	65%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Moderna COVID-19 Vaccine: 10 VIAL in 1 CARTON (80777-275-99) / 2.5 mL in 1 VIAL (80777-275-05)	$46.90	$134.00	—	77% below	65%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Spikevax: 10 Syringe, Plastic In 1 Carton (80777-110-93) / .5 Ml In 1 Syringe, Plastic (80777-110-01)	$46.90	$134.00	—	77% below	65%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Covid-19 (12+ Yrs, Moderna) Immunization, 50 Mcg/0.5 Ml	$46.90	$134.00	—	77% below	65%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Moderna COVID-19 Vaccine: 10 VIAL in 1 CARTON (80777-275-99) / 2.5 mL in 1 VIAL (80777-275-05)	$46.90	$134.00	—	—	65%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Covid-19 (12+ Yrs, Moderna) Immunization, 50 Mcg/0.5 Ml	$46.90	$134.00	—	—	65%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Spikevax: 10 Syringe, Plastic In 1 Carton (80777-110-93) / .5 Ml In 1 Syringe, Plastic (80777-110-01)	$46.90	$134.00	—	—	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 Comirnaty: 10 Vial, Single-Dose In 1 Carton (0069-2362-10) / .48 Ml In 1 Vial, Single-Dose (0069-2362-01)	$44.45	$127.00	—	87% below	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 Covid-19 (12+ Yrs, Pfizer) Immunization, 30Mcg/0.3Ml Tris-Sucrose	$44.45	$127.00	—	87% below	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 Comirnaty: 10 VIAL, GLASS in 1 CARTON (0069-2025-10) / 2.25 mL in 1 VIAL, GLASS (0069-2025-01)	$44.45	$127.00	—	87% below	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 NDC Description Not Available	$44.45	$127.00	—	87% below	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 Pfizer-BioNTech Covid-19 Vaccine: 10 VIAL, GLASS in 1 CARTON (59267-1025-4) / 2.25 mL in 1 VIAL, GLASS (59267-1025-1)	$44.45	$127.00	—	87% below	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 Comirnaty: 10 Syringe, Glass In 1 Carton (0069-2432-10) / .418 Ml In 1 Syringe, Glass (0069-2432-01)	$44.45	$127.00	—	87% below	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 Comirnaty: 10 Syringe, Glass In 1 Carton (0069-2377-10) / .418 Ml In 1 Syringe, Glass (0069-2377-01)	$44.45	$127.00	—	87% below	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 Comirnaty: 10 Vial, Single-Dose In 1 Carton (0069-2362-10) / .48 Ml In 1 Vial, Single-Dose (0069-2362-01)	$44.45	$127.00	—	—	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 NDC Description Not Available	$44.45	$127.00	—	—	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 Comirnaty: 10 VIAL, GLASS in 1 CARTON (0069-2025-10) / 2.25 mL in 1 VIAL, GLASS (0069-2025-01)	$44.45	$127.00	—	—	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 Pfizer-BioNTech Covid-19 Vaccine: 10 VIAL, GLASS in 1 CARTON (59267-1025-4) / 2.25 mL in 1 VIAL, GLASS (59267-1025-1)	$44.45	$127.00	—	—	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 Comirnaty: 10 Syringe, Glass In 1 Carton (0069-2432-10) / .418 Ml In 1 Syringe, Glass (0069-2432-01)	$44.45	$127.00	—	—	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 Comirnaty: 10 Syringe, Glass In 1 Carton (0069-2377-10) / .418 Ml In 1 Syringe, Glass (0069-2377-01)	$44.45	$127.00	—	—	65%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 Covid-19 (12+ Yrs, Pfizer) Immunization, 30Mcg/0.3Ml Tris-Sucrose	$44.45	$127.00	—	—	65%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella Vaccine, Live Sq	$64.05	$183.00	—	83% below	65%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varivax: 10 Vial, Single-Dose In 1 Carton (0006-4827-00) / .5 Ml In 1 Vial, Single-Dose (0006-4827-01)	$161.00	$460.00	—	57% below	65%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 NDC Description Not Available	$166.37	$475.33	—	55% below	65%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML INJ SUSR [130317]	$329.55	$507.00	—	12% below	35%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varicella Vaccine, Live Sq	$64.05	$183.00	—	—	65%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varivax: 10 Vial, Single-Dose In 1 Carton (0006-4827-00) / .5 Ml In 1 Vial, Single-Dose (0006-4827-01)	$161.00	$460.00	—	—	65%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 NDC Description Not Available	$166.37	$475.33	—	—	65%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML INJ SUSR [130317]	$329.55	$507.00	—	—	35%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 NDC Description Not Available	$26.60	$76.00	—	79% below	65%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 Dtap/Ipv, Vaccine 4-6Yo Im	$26.60	$76.00	—	79% below	65%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 Kinrix: 10 Syringe In 1 Carton (58160-812-52) / .5 Ml In 1 Syringe (58160-812-43)	$56.00	$160.00	—	57% below	65%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV VACCINE 0.5 ML IM SUSY [159805]	$107.25	$165.00	—	17% below	35%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV VACCINE IM SUSP [107845]	$110.50	$170.00	—	14% below	35%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 NDC Description Not Available	$26.60	$76.00	—	—	65%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 Dtap/Ipv, Vaccine 4-6Yo Im	$26.60	$76.00	—	—	65%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 Kinrix: 10 Syringe In 1 Carton (58160-812-52) / .5 Ml In 1 Syringe (58160-812-43)	$56.00	$160.00	—	—	65%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP-IPV VACCINE 0.5 ML IM SUSY [159805]	$107.25	$165.00	—	—	35%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP-IPV VACCINE IM SUSP [107845]	$110.50	$170.00	—	—	35%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Dtap Vaccine-Im <7Yo	$12.60	$36.00	—	81% below	65%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 NDC Description Not Available	$27.07	$77.33	—	58% below	65%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Infanrix: 10 Syringe In 1 Carton (58160-810-52) / .5 Ml In 1 Syringe (58160-810-43)	$27.30	$78.00	—	58% below	65%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP [10166]	$50.70	$78.00	—	22% below	35%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP-IPV-HIB VACCINE IM SUSR [107645]	$181.35	$279.00	—	180% above	35%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Dtap Vaccine-Im <7Yo	$12.60	$36.00	—	—	65%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 NDC Description Not Available	$27.07	$77.33	—	—	65%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Infanrix: 10 Syringe In 1 Carton (58160-810-52) / .5 Ml In 1 Syringe (58160-810-43)	$27.30	$78.00	—	—	65%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP [10166]	$50.70	$78.00	—	—	35%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP-IPV-HIB VACCINE IM SUSR [107645]	$181.35	$279.00	—	—	35%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 Pediarix: 10 Syringe In 1 Carton (58160-811-52) / .5 Ml In 1 Syringe (58160-811-43)	$40.25	$115.00	—	79% below	65%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 NDC Description Not Available	$40.25	$115.00	—	79% below	65%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 Dtap/Hepb/Ipv Vaccine,Im	$40.25	$115.00	—	79% below	65%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 NDC Description Not Available	$40.25	$115.00	—	—	65%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 Pediarix: 10 Syringe In 1 Carton (58160-811-52) / .5 Ml In 1 Syringe (58160-811-43)	$40.25	$115.00	—	—	65%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 Dtap/Hepb/Ipv Vaccine,Im	$40.25	$115.00	—	—	65%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 Dtap - Hib - Ipv Vaccine, Im Use	$86.80	$248.00	—	45% below	65%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 Pentacel: 1 Kit In 1 Package (49281-511-05) * .5 Ml In 1 Vial, Single-Dose (49281-561-01) * .5 Ml In 1 Vial, Single-Dose (49281-544-58)	$86.80	$248.00	—	45% below	65%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 Dtap - Hib - Ipv Vaccine, Im Use	$86.80	$248.00	—	—	65%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 Pentacel: 1 Kit In 1 Package (49281-511-05) * .5 Ml In 1 Vial, Single-Dose (49281-561-01) * .5 Ml In 1 Vial, Single-Dose (49281-544-58)	$86.80	$248.00	—	—	65%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 Vaxelis: 10 Syringe In 1 Package (63361-243-15) / .5 Ml In 1 Syringe (63361-243-88)	$62.65	$179.00	—	82% below	65%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 Dtap-Ipv-Hib-Hepb Vaccine Im	$62.65	$179.00	—	82% below	65%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 NDC Description Not Available	$144.20	$412.00	—	58% below	65%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 DTAP-IPV-HIB-HEPATITIS B RECMB IM SUSY [157761]	$267.80	$412.00	—	22% below	35%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 Vaxelis: 10 Syringe In 1 Package (63361-243-15) / .5 Ml In 1 Syringe (63361-243-88)	$62.65	$179.00	—	—	65%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 Dtap-Ipv-Hib-Hepb Vaccine Im	$62.65	$179.00	—	—	65%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 NDC Description Not Available	$144.20	$412.00	—	—	65%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 DTAP-IPV-HIB-HEPATITIS B RECMB IM SUSY [157761]	$267.80	$412.00	—	—	35%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 Flublok Trivalent Northern Hemisphere: 10 Syringe In 1 Carton (49281-724-10) / .5 Ml In 1 Syringe (49281-724-88)	$32.20	$92.00	—	83% below	65%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 Influenza Virus Vaccine, Trivalent (Riv3), Derived From Recombinant Dna, Hemagglutnin (Ha) Protein O	$32.20	$92.00	—	83% below	65%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 NDC Description Not Available	$32.20	$92.00	—	83% below	65%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 Influenza Virus Vaccine, Trivalent (Riv3), Derived From Recombinant Dna, Hemagglutnin (Ha) Protein O	$32.20	$92.00	—	—	65%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 NDC Description Not Available	$32.20	$92.00	—	—	65%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 Flublok Trivalent Northern Hemisphere: 10 Syringe In 1 Carton (49281-724-10) / .5 Ml In 1 Syringe (49281-724-88)	$32.20	$92.00	—	—	65%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza Vaccine, Trivalent, Split, Preservative Free, 0.5Ml, Im Use	$8.75	$25.00	—	81% below	65%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Beyfortus: 1 Syringe In 1 Carton (49281-574-88) / 1 Ml In 1 Syringe	$8.75	$25.00	—	81% below	65%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Fluzone Trivalent Northern Hemisphere: 10 Syringe, Glass In 1 Package (49281-424-50) / .5 Ml In 1 Syringe, Glass (49281-424-88)	$8.75	$25.00	—	81% below	65%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 NDC Description Not Available	$18.20	$52.00	—	60% below	65%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Flulaval 2024/2025: 10 Syringe In 1 Carton (19515-810-52) / .5 Ml In 1 Syringe (19515-810-41)	$18.20	$52.00	—	60% below	65%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY [139810]	$35.10	$54.00	—	23% below	35%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Influenza Vaccine, Trivalent, Split, Preservative Free, 0.5Ml, Im Use	$8.75	$25.00	—	—	65%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Fluzone Trivalent Northern Hemisphere: 10 Syringe, Glass In 1 Package (49281-424-50) / .5 Ml In 1 Syringe, Glass (49281-424-88)	$8.75	$25.00	—	—	65%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Beyfortus: 1 Syringe In 1 Carton (49281-574-88) / 1 Ml In 1 Syringe	$8.75	$25.00	—	—	65%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Flulaval 2024/2025: 10 Syringe In 1 Carton (19515-810-52) / .5 Ml In 1 Syringe (19515-810-41)	$18.20	$52.00	—	—	65%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 NDC Description Not Available	$18.20	$52.00	—	—	65%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY [139810]	$35.10	$54.00	—	—	35%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Human Papilloma Virus Vaccine,Types 6,11,16,18,31,33,45,52,58 (9-Valent)	$107.45	$307.00	—	79% below	65%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Gardasil 9: 10 Vial, Single-Dose In 1 Carton (0006-4119-03) / .5 Ml In 1 Vial, Single-Dose (0006-4119-01)	$107.45	$307.00	—	79% below	65%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Gardasil 9: 10 Syringe, Glass In 1 Carton (0006-4121-02) / .5 Ml In 1 Syringe, Glass (0006-4121-01)	$107.45	$307.00	—	79% below	65%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 NDC Description Not Available	$265.65	$759.00	—	49% below	65%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSP [139333]	$564.85	$869.00	—	9% above	35%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Gardasil 9: 10 Vial, Single-Dose In 1 Carton (0006-4119-03) / .5 Ml In 1 Vial, Single-Dose (0006-4119-01)	$107.45	$307.00	—	—	65%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Human Papilloma Virus Vaccine,Types 6,11,16,18,31,33,45,52,58 (9-Valent)	$107.45	$307.00	—	—	65%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Gardasil 9: 10 Syringe, Glass In 1 Carton (0006-4121-02) / .5 Ml In 1 Syringe, Glass (0006-4121-01)	$107.45	$307.00	—	—	65%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 NDC Description Not Available	$265.65	$759.00	—	—	65%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSP [139333]	$564.85	$869.00	—	—	35%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Hep A/Hep B Vaccine Adult Im	$53.20	$152.00	—	83% below	65%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Twinrix: 10 Syringe In 1 Carton (50090-1645-0) / 1 Ml In 1 Syringe (50090-1645-9)	$103.60	$296.00	—	66% below	65%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 NDC Description Not Available	$117.16	$334.75	—	62% below	65%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Twinrix: 10 Syringe In 1 Carton (58160-815-52) / 1 Ml In 1 Syringe (58160-815-43)	$117.22	$334.90	—	62% below	65%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY [151158]	$226.85	$349.00	—	26% below	35%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 Hep A/Hep B Vaccine Adult Im	$53.20	$152.00	—	—	65%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 Twinrix: 10 Syringe In 1 Carton (50090-1645-0) / 1 Ml In 1 Syringe (50090-1645-9)	$103.60	$296.00	—	—	65%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 NDC Description Not Available	$117.16	$334.75	—	—	65%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 Twinrix: 10 Syringe In 1 Carton (58160-815-52) / 1 Ml In 1 Syringe (58160-815-43)	$117.22	$334.90	—	—	65%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY [151158]	$226.85	$349.00	—	—	35%
Hepatitis A vaccine, adult dose CPT 90632 Travelers Clinic-Hepatitis A Vaccine Adult	$17.50	$50.00	—	91% below	65%
Hepatitis A vaccine, adult dose CPT 90632 Vaqta: 10 Vial, Single-Dose In 1 Carton (0006-4841-41) / 1 Ml In 1 Vial, Single-Dose (0006-4841-01)	$30.80	$88.00	—	84% below	65%
Hepatitis A vaccine, adult dose CPT 90632 Havrix: 10 Syringe In 1 Carton (50090-1502-0) / 1 Ml In 1 Syringe (50090-1502-9)	$30.80	$88.00	—	84% below	65%
Hepatitis A vaccine, adult dose CPT 90632 Hep A Vaccine Adult Im (1.0 Cc,Once)	$30.80	$88.00	—	84% below	65%
Hepatitis A vaccine, adult dose CPT 90632 NDC Description Not Available	$68.25	$195.00	—	65% below	65%
Hepatitis A vaccine, adult dose CPT 90632 Havrix: 10 Syringe In 1 Carton (58160-826-52) / 1 Ml In 1 Syringe (58160-826-43)	$76.84	$219.53	—	60% below	65%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSP [106130]	$126.75	$195.00	—	35% below	35%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSY [172173]	$148.20	$228.00	—	24% below	35%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Travelers Clinic-Hepatitis A Vaccine Adult	$17.50	$50.00	—	—	65%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hep A Vaccine Adult Im (1.0 Cc,Once)	$30.80	$88.00	—	—	65%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Vaqta: 10 Vial, Single-Dose In 1 Carton (0006-4841-41) / 1 Ml In 1 Vial, Single-Dose (0006-4841-01)	$30.80	$88.00	—	—	65%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Havrix: 10 Syringe In 1 Carton (50090-1502-0) / 1 Ml In 1 Syringe (50090-1502-9)	$30.80	$88.00	—	—	65%
Hepatitis A vaccine, adult dose inpatient CPT 90632 NDC Description Not Available	$68.25	$195.00	—	—	65%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Havrix: 10 Syringe In 1 Carton (58160-826-52) / 1 Ml In 1 Syringe (58160-826-43)	$76.84	$219.53	—	—	65%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSP [106130]	$126.75	$195.00	—	—	35%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSY [172173]	$148.20	$228.00	—	—	35%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Havrix: 10 Syringe In 1 Carton (58160-825-52) / .5 Ml In 1 Syringe (58160-825-43)	$16.80	$48.00	—	81% below	65%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Hep A Vaccine Ped/Adol-2 Dose	$16.80	$48.00	—	81% below	65%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Vaqta: 10 Syringe In 1 Carton (0006-4095-02) / .5 Ml In 1 Syringe (0006-4095-01)	$16.80	$48.00	—	81% below	65%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Havrix: 10 Syringe In 1 Carton (58160-826-52) / 1 Ml In 1 Syringe (58160-826-43)	$16.80	$48.00	—	81% below	65%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 NDC Description Not Available	$16.80	$48.00	—	81% below	65%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Travelers Clinic-Hepatitis A Vac Peds/Adolescet	$17.50	$50.00	—	80% below	65%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Hep A Vaccine Ped/Adol-2 Dose	$16.80	$48.00	—	—	65%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Havrix: 10 Syringe In 1 Carton (58160-826-52) / 1 Ml In 1 Syringe (58160-826-43)	$16.80	$48.00	—	—	65%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Havrix: 10 Syringe In 1 Carton (58160-825-52) / .5 Ml In 1 Syringe (58160-825-43)	$16.80	$48.00	—	—	65%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Vaqta: 10 Syringe In 1 Carton (0006-4095-02) / .5 Ml In 1 Syringe (0006-4095-01)	$16.80	$48.00	—	—	65%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 NDC Description Not Available	$16.80	$48.00	—	—	65%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Travelers Clinic-Hepatitis A Vac Peds/Adolescet	$17.50	$50.00	—	—	65%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hep B Vaccine, Adult Dosage	$34.30	$98.00	—	78% below	65%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Recombivax Hb: 1 Vial, Single-Dose In 1 Carton (0006-4995-00) / 1 Ml In 1 Vial, Single-Dose (0006-4995-01)	$34.30	$98.00	—	78% below	65%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Recombivax Hb: 10 Vial, Single-Dose In 1 Carton (0006-4995-41) / 1 Ml In 1 Vial, Single-Dose (0006-4995-01)	$34.30	$98.00	—	78% below	65%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 NDC Description Not Available	$57.05	$163.00	—	63% below	65%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Engerix-B: 10 Vial In 1 Carton (58160-821-11) / 1 Ml In 1 Vial (58160-821-01)	$64.40	$184.00	—	59% below	65%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Engerix-B: 10 Syringe In 1 Carton (58160-821-52) / 1 Ml In 1 Syringe (58160-821-43)	$64.84	$185.27	—	58% below	65%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML INJ SUSY [162335]	$124.15	$191.00	—	20% below	35%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hep B Vaccine, Adult Dosage	$34.30	$98.00	—	—	65%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Recombivax Hb: 1 Vial, Single-Dose In 1 Carton (0006-4995-00) / 1 Ml In 1 Vial, Single-Dose (0006-4995-01)	$34.30	$98.00	—	—	65%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Recombivax Hb: 10 Vial, Single-Dose In 1 Carton (0006-4995-41) / 1 Ml In 1 Vial, Single-Dose (0006-4995-01)	$34.30	$98.00	—	—	65%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 NDC Description Not Available	$57.05	$163.00	—	—	65%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Engerix-B: 10 Vial In 1 Carton (58160-821-11) / 1 Ml In 1 Vial (58160-821-01)	$64.40	$184.00	—	—	65%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Engerix-B: 10 Syringe In 1 Carton (58160-821-52) / 1 Ml In 1 Syringe (58160-821-43)	$64.84	$185.27	—	—	65%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML INJ SUSY [162335]	$124.15	$191.00	—	—	35%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 Heplisav-B: 5 Syringe In 1 Carton (50090-4526-0) / .5 Ml In 1 Syringe (50090-4526-1)	$116.90	$334.00	—	47% below	65%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 Engerix-B: 10 Syringe In 1 Carton (58160-821-52) / 1 Ml In 1 Syringe (58160-821-43)	$123.90	$354.00	—	43% below	65%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 Hepatitis B Vaccine, Cpg-Adjuvanted, Adult 2-Dose Or Mixed 4-Dose Schedule, 0.5 Ml Im	$123.90	$354.00	—	43% below	65%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 NDC Description Not Available	$137.31	$392.32	—	37% below	65%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 Heplisav-B: 5 Syringe In 1 Carton (43528-003-05) / .5 Ml In 1 Syringe (43528-003-01)	$137.39	$392.54	—	37% below	65%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY [149467]	$267.80	$412.00	—	22% above	35%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 Heplisav-B: 5 Syringe In 1 Carton (50090-4526-0) / .5 Ml In 1 Syringe (50090-4526-1)	$116.90	$334.00	—	—	65%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 Engerix-B: 10 Syringe In 1 Carton (58160-821-52) / 1 Ml In 1 Syringe (58160-821-43)	$123.90	$354.00	—	—	65%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 Hepatitis B Vaccine, Cpg-Adjuvanted, Adult 2-Dose Or Mixed 4-Dose Schedule, 0.5 Ml Im	$123.90	$354.00	—	—	65%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 NDC Description Not Available	$137.31	$392.32	—	—	65%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 Heplisav-B: 5 Syringe In 1 Carton (43528-003-05) / .5 Ml In 1 Syringe (43528-003-01)	$137.39	$392.54	—	—	65%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY [149467]	$267.80	$412.00	—	—	35%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Recombivax Hb: 10 Syringe In 1 Carton (0006-4093-02) / .5 Ml In 1 Syringe (0006-4093-01)	$13.65	$39.00	—	77% below	65%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hep B Vaccine,Ped/Adol,Im	$13.65	$39.00	—	77% below	65%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 NDC Description Not Available	$13.65	$39.00	—	77% below	65%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML INJ SUSY [162339]	$50.05	$77.00	—	17% below	35%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hep B Vaccine,Ped/Adol,Im	$13.65	$39.00	—	—	65%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Recombivax Hb: 10 Syringe In 1 Carton (0006-4093-02) / .5 Ml In 1 Syringe (0006-4093-01)	$13.65	$39.00	—	—	65%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 NDC Description Not Available	$13.65	$39.00	—	—	65%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML INJ SUSY [162339]	$50.05	$77.00	—	—	35%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 Pedvaxhib: 10 Vial, Single-Dose In 1 Carton (0006-4897-00) / .5 Ml In 1 Vial, Single-Dose (0006-4897-01)	$53.90	$154.00	—	23% below	65%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 Hib Vaccine, Prp-Omp, Im	$53.90	$154.00	—	23% below	65%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 Hib Vaccine, Prp-Omp, Im	$53.90	$154.00	—	—	65%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 Pedvaxhib: 10 Vial, Single-Dose In 1 Carton (0006-4897-00) / .5 Ml In 1 Vial, Single-Dose (0006-4897-01)	$53.90	$154.00	—	—	65%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Hib Vaccine, Prp-T, Im	$5.60	$16.00	—	82% below	65%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Acthib: 1 Kit In 1 Carton (49281-545-03) * .5 Ml In 1 Vial, Single-Dose (49281-547-58) * .6 Ml In 1 Vial, Single-Dose (49281-546-58)	$5.60	$16.00	—	82% below	65%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Hiberix: 1 Kit In 1 Carton (58160-818-11) * 10 Vial In 1 Carton (58160-816-05) / .5 Ml In 1 Vial (58160-816-01) * 10 Vial In 1 Package (58160-817-05) / .85 Ml In 1 Vial (58160-817-01)	$11.90	$34.00	—	61% below	65%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 NDC Description Not Available	$11.90	$34.00	—	61% below	65%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC 10 MCG INJ SOLR [119057]	$22.75	$35.00	—	26% below	35%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Hiberix: 1 Kit In 1 Carton (58160-726-15) * .5 Ml In 1 Vial (58160-816-03) * .85 Ml In 1 Syringe (58160-817-02)	$57.74	$164.96	—	89% above	65%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 Acthib: 1 Kit In 1 Carton (49281-545-03) * .5 Ml In 1 Vial, Single-Dose (49281-547-58) * .6 Ml In 1 Vial, Single-Dose (49281-546-58)	$5.60	$16.00	—	—	65%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 Hib Vaccine, Prp-T, Im	$5.60	$16.00	—	—	65%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 NDC Description Not Available	$11.90	$34.00	—	—	65%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 Hiberix: 1 Kit In 1 Carton (58160-818-11) * 10 Vial In 1 Carton (58160-816-05) / .5 Ml In 1 Vial (58160-816-01) * 10 Vial In 1 Package (58160-817-05) / .85 Ml In 1 Vial (58160-817-01)	$11.90	$34.00	—	—	65%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC 10 MCG INJ SOLR [119057]	$22.75	$35.00	—	—	35%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 Hiberix: 1 Kit In 1 Carton (58160-726-15) * .5 Ml In 1 Vial (58160-816-03) * .85 Ml In 1 Syringe (58160-817-02)	$57.74	$164.96	—	—	65%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VAC SPLIT QUAD 9 MCG/STRAIN INTRADERMAL SUPN [139375]	$13.00	$20.00	—	87% below	35%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUAD: 10 SYRINGE, GLASS in 1 CARTON (70461-020-03) / .5 mL in 1 SYRINGE, GLASS (70461-020-04)	$20.65	$59.00	—	80% below	65%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High-Dose Quadrivalent Northern Hemisphere: 10 SYRINGE, GLASS in 1 PACKAGE (49281-123-65) / .7 mL in 1 SYRINGE, GLASS (49281-123-88)	$23.10	$66.00	—	78% below	65%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza Virus Vaccine, Split Virus, Enhanced Immunogenicity, Intramuscular	$32.20	$92.00	—	69% below	65%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Flulaval 2024/2025: 10 Syringe In 1 Carton (19515-810-52) / .5 Ml In 1 Syringe (19515-810-41)	$32.20	$92.00	—	69% below	65%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 NDC Description Not Available	$67.90	$194.00	—	34% below	65%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High Dose Northern Hemisphere: 5 Syringe, Glass In 1 Package (49281-124-65) / .5 Ml In 1 Syringe, Glass (49281-124-88)	$67.90	$194.00	—	34% below	65%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY [139811]	$148.20	$228.00	—	43% above	35%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VAC SPLIT QUAD 9 MCG/STRAIN INTRADERMAL SUPN [139375]	$13.00	$20.00	—	—	35%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUAD: 10 SYRINGE, GLASS in 1 CARTON (70461-020-03) / .5 mL in 1 SYRINGE, GLASS (70461-020-04)	$20.65	$59.00	—	—	65%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone High-Dose Quadrivalent Northern Hemisphere: 10 SYRINGE, GLASS in 1 PACKAGE (49281-123-65) / .7 mL in 1 SYRINGE, GLASS (49281-123-88)	$23.10	$66.00	—	—	65%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Flulaval 2024/2025: 10 Syringe In 1 Carton (19515-810-52) / .5 Ml In 1 Syringe (19515-810-41)	$32.20	$92.00	—	—	65%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Influenza Virus Vaccine, Split Virus, Enhanced Immunogenicity, Intramuscular	$32.20	$92.00	—	—	65%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone High Dose Northern Hemisphere: 5 Syringe, Glass In 1 Package (49281-124-65) / .5 Ml In 1 Syringe, Glass (49281-124-88)	$67.90	$194.00	—	—	65%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 NDC Description Not Available	$67.90	$194.00	—	—	65%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY [139811]	$148.20	$228.00	—	—	35%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 Ixiaro: .5 Ml In 1 Syringe (42515-002-01)	$235.55	$673.00	—	83% below	65%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 Japanese Encephalitis Virus Vaccine, Inactivated, For Intramuscular Use	$235.55	$673.00	—	83% below	65%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule inpatient CPT 90738 Ixiaro: .5 Ml In 1 Syringe (42515-002-01)	$235.55	$673.00	—	—	65%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule inpatient CPT 90738 Japanese Encephalitis Virus Vaccine, Inactivated, For Intramuscular Use	$235.55	$673.00	—	—	65%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Travelers Clinic-Measles, Mumps, Rubella Vaccine	$19.60	$56.00	—	91% below	65%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Mmr Vaccine-Live-Sq	$37.10	$106.00	—	82% below	65%
MMR vaccine (measles, mumps and rubella), live CPT 90707 M-M-R Ii: 10 Vial, Single-Dose In 1 Carton (0006-4681-00) / .5 Ml In 1 Vial, Single-Dose (0006-4681-01)	$85.87	$245.35	—	59% below	65%
MMR vaccine (measles, mumps and rubella), live CPT 90707 NDC Description Not Available	$86.64	$247.55	—	59% below	65%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC INJ SOLR [153972]	$167.70	$258.00	—	20% below	35%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Travelers Clinic-Measles, Mumps, Rubella Vaccine	$19.60	$56.00	—	—	65%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Mmr Vaccine-Live-Sq	$37.10	$106.00	—	—	65%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 M-M-R Ii: 10 Vial, Single-Dose In 1 Carton (0006-4681-00) / .5 Ml In 1 Vial, Single-Dose (0006-4681-01)	$85.87	$245.35	—	—	65%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 NDC Description Not Available	$86.64	$247.55	—	—	65%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC INJ SOLR [153972]	$167.70	$258.00	—	—	35%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 Proquad: 10 Vial, Single-Dose In 1 Carton (0006-4171-00) / .5 Ml In 1 Vial, Single-Dose (0006-4171-01)	$106.40	$304.00	—	79% below	65%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 Mmrv (Proquad)Vac, Live, Sc	$106.40	$304.00	—	79% below	65%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 NDC Description Not Available	$106.40	$304.00	—	79% below	65%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MEASLES-MUMPS-RUBELLA-VARICELL SUBCUTANEOUS SUSR [149736]	$495.95	$763.00	—	3% below	35%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 Proquad: 10 Vial, Single-Dose In 1 Carton (0006-4171-00) / .5 Ml In 1 Vial, Single-Dose (0006-4171-01)	$106.40	$304.00	—	—	65%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 NDC Description Not Available	$106.40	$304.00	—	—	65%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 Mmrv (Proquad)Vac, Live, Sc	$106.40	$304.00	—	—	65%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MEASLES-MUMPS-RUBELLA-VARICELL SUBCUTANEOUS SUSR [149736]	$495.95	$763.00	—	—	35%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Travelers Clinic-Meningococcal Conjugate Vaccine	$43.40	$124.00	—	86% below	65%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 NDC Description Not Available	$58.45	$167.00	—	82% below	65%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal Conjugate Vaccine, Serogroups A,C,Y & W-135 (4-Valent), Im Use	$60.90	$174.00	—	81% below	65%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Menveo: 10 Vial In 1 Carton (58160-827-30) / .5 Ml In 1 Vial (58160-827-03)	$60.90	$174.00	—	81% below	65%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Menveo: 1 Kit In 1 Carton (58160-955-09) * .5 Ml In 1 Vial, Single-Dose (58160-958-01) * .5 Ml In 1 Vial, Single-Dose (58160-959-01)	$91.35	$261.00	—	71% below	65%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR [121194]	$108.55	$167.00	—	66% below	35%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Travelers Clinic-Meningococcal Conjugate Vaccine	$43.40	$124.00	—	—	65%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 NDC Description Not Available	$58.45	$167.00	—	—	65%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Menveo: 10 Vial In 1 Carton (58160-827-30) / .5 Ml In 1 Vial (58160-827-03)	$60.90	$174.00	—	—	65%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Meningococcal Conjugate Vaccine, Serogroups A,C,Y & W-135 (4-Valent), Im Use	$60.90	$174.00	—	—	65%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Menveo: 1 Kit In 1 Carton (58160-955-09) * .5 Ml In 1 Vial, Single-Dose (58160-958-01) * .5 Ml In 1 Vial, Single-Dose (58160-959-01)	$91.35	$261.00	—	—	65%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR [121194]	$108.55	$167.00	—	—	35%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 Menacwy-Tt Vaccine Im	$38.15	$109.00	—	90% below	65%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 Menacwy-Tt Vaccine Im	$38.15	$109.00	—	—	65%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal Group B Vaccine, Omv, Recombinant (Meningb)	$87.15	$249.00	—	84% below	65%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 NDC Description Not Available	$209.38	$598.24	—	62% below	65%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Bexsero: 10 Syringe In 1 Carton (58160-976-20) / .5 Ml In 1 Syringe (58160-976-02)	$210.35	$601.00	—	62% below	65%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY [139438]	$406.90	$626.00	—	26% below	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Meningococcal Group B Vaccine, Omv, Recombinant (Meningb)	$87.15	$249.00	—	—	65%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 NDC Description Not Available	$209.38	$598.24	—	—	65%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Bexsero: 10 Syringe In 1 Carton (58160-976-20) / .5 Ml In 1 Syringe (58160-976-02)	$210.35	$601.00	—	—	65%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY [139438]	$406.90	$626.00	—	—	35%
Meningococcal B vaccine (Trumenba) CPT 90621 Meningococcal Group B Vaccine, Recombinant (Meningb)	$135.10	$386.00	—	66% below	65%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 Meningococcal Group B Vaccine, Recombinant (Meningb)	$135.10	$386.00	—	—	65%
Mpox and smallpox vaccine (Jynneos), 2-dose schedule CPT 90611 SMALLPOX & MONKEYPOX VAC, LIVE 0.5 ML SUBCUTANEOUS SUSP [161688]	$463.45	$713.00	—	9% below	35%
Mpox and smallpox vaccine (Jynneos), 2-dose schedule inpatient CPT 90611 SMALLPOX & MONKEYPOX VAC, LIVE 0.5 ML SUBCUTANEOUS SUSP [161688]	$463.45	$713.00	—	—	35%
Nasal spray flu vaccine, live (FluMist) CPT 90660 Flumist: 10 Applicator In 1 Package (66019-311-10) / .2 Ml In 1 Applicator (66019-311-00)	$11.20	$32.00	—	72% below	65%
Nasal spray flu vaccine, live (FluMist) CPT 90660 Flu Vaccine, Nasal, Live, Trivalent (Laiv3)	$11.20	$32.00	—	72% below	65%
Nasal spray flu vaccine, live (FluMist) CPT 90660 NDC Description Not Available	$11.20	$32.00	—	72% below	65%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 Flu Vaccine, Nasal, Live, Trivalent (Laiv3)	$11.20	$32.00	—	—	65%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 Flumist: 10 Applicator In 1 Package (66019-311-10) / .2 Ml In 1 Applicator (66019-311-00)	$11.20	$32.00	—	—	65%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 NDC Description Not Available	$11.20	$32.00	—	—	65%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 NDC Description Not Available	$107.80	$308.00	—	75% below	65%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal 13 Valent Vac	$107.80	$308.00	—	75% below	65%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL 13-VAL CONJ VACC IM SUSP [121387]	$388.70	$598.00	—	11% below	35%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 NDC Description Not Available	$107.80	$308.00	—	—	65%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Pneumococcal 13 Valent Vac	$107.80	$308.00	—	—	65%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL 13-VAL CONJ VACC IM SUSP [121387]	$388.70	$598.00	—	—	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal 20 Valent Vac	$237.30	$678.00	—	64% below	65%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Gardasil 9: 10 Syringe, Glass In 1 Carton (0006-4121-02) / .5 Ml In 1 Syringe, Glass (0006-4121-01)	$237.30	$678.00	—	64% below	65%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 NDC Description Not Available	$243.66	$696.16	—	63% below	65%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Prevnar 20: 10 Syringe In 1 Carton (0005-2000-10) / .5 Ml In 1 Syringe (0005-2000-01)	$243.80	$696.56	—	63% below	65%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02) / .5 Ml In 1 Syringe (0005-2000-01)	$249.20	$712.00	—	62% below	65%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY [159563]	$471.25	$725.00	—	29% below	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumococcal 20 Valent Vac	$237.30	$678.00	—	—	65%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Gardasil 9: 10 Syringe, Glass In 1 Carton (0006-4121-02) / .5 Ml In 1 Syringe, Glass (0006-4121-01)	$237.30	$678.00	—	—	65%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 NDC Description Not Available	$243.66	$696.16	—	—	65%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Prevnar 20: 10 Syringe In 1 Carton (0005-2000-10) / .5 Ml In 1 Syringe (0005-2000-01)	$243.80	$696.56	—	—	65%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02) / .5 Ml In 1 Syringe (0005-2000-01)	$249.20	$712.00	—	—	65%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY [159563]	$471.25	$725.00	—	—	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal 23 Valent Vaccine(0.5Ml,Im,Once)	$41.65	$119.00	—	85% below	65%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumovax 23: 10 Vial, Single-Dose In 1 Carton (0006-4943-00) / .5 Ml In 1 Vial, Single-Dose (0006-4943-01)	$56.70	$162.00	—	79% below	65%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Ptap Pneumovax	$102.20	$292.00	—	63% below	65%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumovax 23: 10 Syringe, Glass In 1 Carton (0006-4837-03) / .5 Ml In 1 Syringe, Glass (0006-4837-01)	$108.50	$310.00	—	61% below	65%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 NDC Description Not Available	$108.50	$310.00	—	61% below	65%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML INJ SOSY [168448]	$201.50	$310.00	—	27% below	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal 23 Valent Vaccine(0.5Ml,Im,Once)	$41.65	$119.00	—	—	65%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumovax 23: 10 Vial, Single-Dose In 1 Carton (0006-4943-00) / .5 Ml In 1 Vial, Single-Dose (0006-4943-01)	$56.70	$162.00	—	—	65%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Ptap Pneumovax	$102.20	$292.00	—	—	65%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 NDC Description Not Available	$108.50	$310.00	—	—	65%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumovax 23: 10 Syringe, Glass In 1 Carton (0006-4837-03) / .5 Ml In 1 Syringe, Glass (0006-4837-01)	$108.50	$310.00	—	—	65%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML INJ SOSY [168448]	$201.50	$310.00	—	—	35%
Polio vaccine, inactivated (IPV) CPT 90713 Polio Vaccine, Inactive Sq	$16.80	$48.00	—	74% below	65%
Polio vaccine, inactivated (IPV) CPT 90713 Travelers Clinic-Polio Vaccine Injection	$21.00	$60.00	—	67% below	65%
Polio vaccine, inactivated (IPV) CPT 90713 Ipol: 1 Vial, Multi-Dose In 1 Package (49281-860-10) / 5 Ml In 1 Vial, Multi-Dose (49281-860-78)	$39.84	$113.83	—	37% below	65%
Polio vaccine, inactivated (IPV) CPT 90713 NDC Description Not Available	$39.90	$114.00	—	37% below	65%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 Polio Vaccine, Inactive Sq	$16.80	$48.00	—	—	65%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 Travelers Clinic-Polio Vaccine Injection	$21.00	$60.00	—	—	65%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 Ipol: 1 Vial, Multi-Dose In 1 Package (49281-860-10) / 5 Ml In 1 Vial, Multi-Dose (49281-860-78)	$39.84	$113.83	—	—	65%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 NDC Description Not Available	$39.90	$114.00	—	—	65%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Beyfortus: 5 Syringe In 1 Carton (49281-574-15) / 1 Ml In 1 Syringe	$355.60	$1,016.00	—	66% below	65%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Beyfortus: 1 Syringe In 1 Carton (49281-574-88) / 1 Ml In 1 Syringe	$355.60	$1,016.00	—	66% below	65%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Respiratory Syncytial Virus (Rsv), Monoclonal Antibody, Seasonal Dose; 1Ml, Im Use	$355.60	$1,016.00	—	66% below	65%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Beyfortus: 5 Syringe In 1 Carton (49281-574-15) / 1 Ml In 1 Syringe	$355.60	$1,016.00	—	—	65%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Beyfortus: 1 Syringe In 1 Carton (49281-574-88) / 1 Ml In 1 Syringe	$355.60	$1,016.00	—	—	65%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Respiratory Syncytial Virus (Rsv), Monoclonal Antibody, Seasonal Dose; 1Ml, Im Use	$355.60	$1,016.00	—	—	65%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Respiratory Syncytial Virus (Rsv), Monoclonal Antibody, Seasonal Dose; 0.5Ml, Im Use	$177.80	$508.00	—	87% below	65%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Beyfortus: 5 Syringe In 1 Carton (49281-575-15) / .5 Ml In 1 Syringe	$177.80	$508.00	—	87% below	65%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Beyfortus: 1 Syringe In 1 Carton (49281-575-00) / .5 Ml In 1 Syringe	$177.80	$508.00	—	87% below	65%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 Respiratory Syncytial Virus (Rsv), Monoclonal Antibody, Seasonal Dose; 0.5Ml, Im Use	$177.80	$508.00	—	—	65%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 Beyfortus: 5 Syringe In 1 Carton (49281-575-15) / .5 Ml In 1 Syringe	$177.80	$508.00	—	—	65%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 Beyfortus: 1 Syringe In 1 Carton (49281-575-00) / .5 Ml In 1 Syringe	$177.80	$508.00	—	—	65%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 Abrysvo: 10 Vial In 1 Carton (0069-2465-10) / .5 Ml In 1 Vial (0069-2465-19)	$103.95	$297.00	—	86% below	65%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 Abrysvo: 1 Tray In 1 Carton (0069-0344-01) / 1 Kit In 1 Tray (0069-0344-21) * .5 Ml In 1 Vial, Glass (0069-0207-01) * .69 Ml In 1 Syringe, Glass (0069-0250-01)	$103.95	$297.00	—	86% below	65%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 Respiratory Syncytial Virus (Rsv) Vaccine, Pref, Subunit, Bivalent, Im Use	$103.95	$297.00	—	86% below	65%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 Abrysvo: 5 Tray In 1 Carton (0069-0344-05) / 1 Kit In 1 Tray (0069-0344-21) * .5 Ml In 1 Vial, Glass (0069-0207-01) * .69 Ml In 1 Syringe, Glass (0069-0250-01)	$272.65	$779.00	—	62% below	65%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 NDC Description Not Available	$273.24	$780.68	—	62% below	65%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR [165076]	$526.50	$810.00	—	27% below	35%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 Respiratory Syncytial Virus (Rsv) Vaccine, Pref, Subunit, Bivalent, Im Use	$103.95	$297.00	—	—	65%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 Abrysvo: 1 Tray In 1 Carton (0069-0344-01) / 1 Kit In 1 Tray (0069-0344-21) * .5 Ml In 1 Vial, Glass (0069-0207-01) * .69 Ml In 1 Syringe, Glass (0069-0250-01)	$103.95	$297.00	—	—	65%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 Abrysvo: 10 Vial In 1 Carton (0069-2465-10) / .5 Ml In 1 Vial (0069-2465-19)	$103.95	$297.00	—	—	65%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 Abrysvo: 5 Tray In 1 Carton (0069-0344-05) / 1 Kit In 1 Tray (0069-0344-21) * .5 Ml In 1 Vial, Glass (0069-0207-01) * .69 Ml In 1 Syringe, Glass (0069-0250-01)	$272.65	$779.00	—	—	65%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 NDC Description Not Available	$273.24	$780.68	—	—	65%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR [165076]	$526.50	$810.00	—	—	35%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 Arexvy: 1 Kit In 1 Carton (58160-848-11) * .5 Ml In 1 Vial (58160-723-03) * .5 Ml In 1 Vial (58160-744-03)	$99.40	$284.00	—	72% below	65%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 Respiratory Syncytial Virus (Rsv) Vaccine, Pref, Recomb, Subunit, Adjuvanted, Im Use	$99.40	$284.00	—	72% below	65%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 Respiratory Syncytial Virus (Rsv) Vaccine, Pref, Recomb, Subunit, Adjuvanted, Im Use	$99.40	$284.00	—	—	65%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 Arexvy: 1 Kit In 1 Carton (58160-848-11) * .5 Ml In 1 Vial (58160-723-03) * .5 Ml In 1 Vial (58160-744-03)	$99.40	$284.00	—	—	65%
Rabies vaccine, one dose CPT 90675 Travelers Clinic-Rabies Im	$109.20	$312.00	—	89% below	65%
Rabies vaccine, one dose CPT 90675 Imovax Rabies: 1 Kit In 1 Package (49281-252-51) * 1 Ml In 1 Vial, Single-Use (49281-246-58) * 1 Ml In 1 Syringe (49281-263-58)	$290.50	$830.00	—	69% below	65%
Rabies vaccine, one dose CPT 90675 Rabies Vaccine Im	$290.50	$830.00	—	69% below	65%
Rabies vaccine, one dose CPT 90675 Rabavert: 1 Kit In 1 Carton (50632-010-01) * 1 Ml In 1 Syringe (50632-011-01) * 1 Ml In 1 Vial, Glass (50632-013-01)	$382.55	$1,093.00	—	60% below	65%
Rabies vaccine, one dose CPT 90675 NDC Description Not Available	$382.55	$1,093.00	—	60% below	65%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR [22094]	$746.20	$1,148.00	—	22% below	35%
Rabies vaccine, one dose CPT 90675 RABIES VIRUS VACCINE, HDC IM SUSR [162332]	$774.80	$1,192.00	—	19% below	35%
Rabies vaccine, one dose inpatient CPT 90675 Travelers Clinic-Rabies Im	$109.20	$312.00	—	—	65%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vaccine Im	$290.50	$830.00	—	—	65%
Rabies vaccine, one dose inpatient CPT 90675 Imovax Rabies: 1 Kit In 1 Package (49281-252-51) * 1 Ml In 1 Vial, Single-Use (49281-246-58) * 1 Ml In 1 Syringe (49281-263-58)	$290.50	$830.00	—	—	65%
Rabies vaccine, one dose inpatient CPT 90675 NDC Description Not Available	$382.55	$1,093.00	—	—	65%
Rabies vaccine, one dose inpatient CPT 90675 Rabavert: 1 Kit In 1 Carton (50632-010-01) * 1 Ml In 1 Syringe (50632-011-01) * 1 Ml In 1 Vial, Glass (50632-013-01)	$382.55	$1,093.00	—	—	65%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC IM SUSR [22094]	$746.20	$1,148.00	—	—	35%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VIRUS VACCINE, HDC IM SUSR [162332]	$774.80	$1,192.00	—	—	35%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 Rotavirus Vacc, Attenuated-(Rotarix)	$124.25	$355.00	—	52% below	65%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 NDC Description Not Available	$124.25	$355.00	—	52% below	65%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 Rotarix: 10 Applicator In 1 Carton (58160-740-21) / 1.5 Ml In 1 Applicator (58160-740-02)	$124.25	$355.00	—	52% below	65%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 Rotarix: 10 Applicator In 1 Carton (58160-740-21) / 1.5 Ml In 1 Applicator (58160-740-02)	$124.25	$355.00	—	—	65%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 NDC Description Not Available	$124.25	$355.00	—	—	65%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 Rotavirus Vacc, Attenuated-(Rotarix)	$124.25	$355.00	—	—	65%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Rotavirus Vaccine-(Rotateq)	$43.40	$124.00	—	68% below	65%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Rotateq: 25 Pouch In 1 Carton (0006-4047-20) / 1 Tube In 1 Pouch (0006-4047-02) / 2 Ml In 1 Tube (0006-4047-01)	$43.40	$124.00	—	68% below	65%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Rotateq: 10 Pouch In 1 Carton (0006-4047-41) / 1 Tube In 1 Pouch (0006-4047-02) / 2 Ml In 1 Tube (0006-4047-01)	$43.40	$124.00	—	68% below	65%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 NDC Description Not Available	$43.40	$124.00	—	68% below	65%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VAC LIVE PENTAVALENT ORAL SOLN [136024]	$176.15	$271.00	—	30% above	35%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 Rotavirus Vaccine-(Rotateq)	$43.40	$124.00	—	—	65%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 NDC Description Not Available	$43.40	$124.00	—	—	65%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 Rotateq: 25 Pouch In 1 Carton (0006-4047-20) / 1 Tube In 1 Pouch (0006-4047-02) / 2 Ml In 1 Tube (0006-4047-01)	$43.40	$124.00	—	—	65%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 Rotateq: 10 Pouch In 1 Carton (0006-4047-41) / 1 Tube In 1 Pouch (0006-4047-02) / 2 Ml In 1 Tube (0006-4047-01)	$43.40	$124.00	—	—	65%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS VAC LIVE PENTAVALENT ORAL SOLN [136024]	$176.15	$271.00	—	—	35%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Zoster (Shingles) Vaccine (Rzv), Recombinant, Sub-Unit, Adjuvanted, For Intramuscular Use	$73.50	$210.00	—	85% below	65%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Shingrix: 1 Kit In 1 Carton (58160-819-12) * .5 Ml In 1 Vial (58160-828-01) * .5 Ml In 1 Vial (58160-829-01)	$183.05	$523.00	—	64% below	65%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Shingrix: 1 Kit In 1 Carton (58160-823-11) * .5 Ml In 1 Vial (58160-828-03) * .5 Ml In 1 Vial (58160-829-03)	$184.57	$527.34	—	63% below	65%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 NDC Description Not Available	$186.00	$531.43	—	63% below	65%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR [147434]	$369.85	$569.00	—	27% below	35%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Zoster (Shingles) Vaccine (Rzv), Recombinant, Sub-Unit, Adjuvanted, For Intramuscular Use	$73.50	$210.00	—	—	65%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Shingrix: 1 Kit In 1 Carton (58160-819-12) * .5 Ml In 1 Vial (58160-828-01) * .5 Ml In 1 Vial (58160-829-01)	$183.05	$523.00	—	—	65%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Shingrix: 1 Kit In 1 Carton (58160-823-11) * .5 Ml In 1 Vial (58160-828-03) * .5 Ml In 1 Vial (58160-829-03)	$184.57	$527.34	—	—	65%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 NDC Description Not Available	$186.00	$531.43	—	—	65%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR [147434]	$369.85	$569.00	—	—	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Boostrix: 10 Vial In 1 Carton (58160-842-11) / .5 Ml In 1 Vial (58160-842-01)	$12.25	$35.00	—	86% below	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Td Adsorbed, Preservative Free, For Use In Individuals 7 Years Or Older, Im	$12.25	$35.00	—	86% below	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 NDC Description Not Available	$34.64	$98.98	—	61% below	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tenivac: 10 Vial, Single-Dose In 1 Package (49281-215-10) / .5 Ml In 1 Vial, Single-Dose (49281-215-58)	$34.65	$99.00	—	61% below	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tenivac: 10 Syringe In 1 Package (49281-215-15) / .5 Ml In 1 Syringe (49281-215-88)	$36.17	$103.33	—	60% below	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP [31151]	$72.15	$111.00	—	20% below	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 DIPHTHERIA-TETANUS TOXOIDS DT 25-5 LFU/0.5ML IM SUSP [132192]	$113.10	$174.00	—	26% above	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Boostrix: 10 Vial In 1 Carton (58160-842-11) / .5 Ml In 1 Vial (58160-842-01)	$12.25	$35.00	—	—	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Td Adsorbed, Preservative Free, For Use In Individuals 7 Years Or Older, Im	$12.25	$35.00	—	—	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 NDC Description Not Available	$34.64	$98.98	—	—	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tenivac: 10 Vial, Single-Dose In 1 Package (49281-215-10) / .5 Ml In 1 Vial, Single-Dose (49281-215-58)	$34.65	$99.00	—	—	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tenivac: 10 Syringe In 1 Package (49281-215-15) / .5 Ml In 1 Syringe (49281-215-88)	$36.17	$103.33	—	—	65%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP [31151]	$72.15	$111.00	—	—	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 DIPHTHERIA-TETANUS TOXOIDS DT 25-5 LFU/0.5ML IM SUSP [132192]	$113.10	$174.00	—	—	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Infanrix: 10 Syringe In 1 Carton (58160-810-52) / .5 Ml In 1 Syringe (58160-810-43)	$16.10	$46.00	—	85% below	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix: 1 Syringe In 1 Pouch (50090-1377-1) / .5 Ml In 1 Syringe	$16.10	$46.00	—	85% below	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus, Diphtheria Toxoids And Acellular Pertusis Vaccine (Tdap), >7 Years, Im Use	$16.10	$46.00	—	85% below	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Travelers Clinic-Teta,Diptheria,Pertussi (Tdap)	$17.50	$50.00	—	84% below	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix: 10 Vial In 1 Pouch (50090-1831-0) / .5 Ml In 1 Vial (50090-1831-9)	$40.25	$115.00	—	64% below	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix: 10 Vial In 1 Carton (58160-842-11) / .5 Ml In 1 Vial (58160-842-01)	$43.75	$125.00	—	60% below	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix: 10 Syringe In 1 Carton (58160-842-52) / .5 Ml In 1 Syringe (58160-842-43)	$43.94	$125.54	—	60% below	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 NDC Description Not Available	$43.96	$125.60	—	60% below	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Adacel Tdap: 5 Syringe In 1 Package (49281-400-20) / .5 Ml In 1 Syringe (49281-400-89)	$44.10	$126.00	—	60% below	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY [159806]	$83.20	$128.00	—	25% below	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSP [84154]	$83.20	$128.00	—	25% below	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Boostrix: 1 Syringe In 1 Pouch (50090-1377-1) / .5 Ml In 1 Syringe	$16.10	$46.00	—	—	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Infanrix: 10 Syringe In 1 Carton (58160-810-52) / .5 Ml In 1 Syringe (58160-810-43)	$16.10	$46.00	—	—	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tetanus, Diphtheria Toxoids And Acellular Pertusis Vaccine (Tdap), >7 Years, Im Use	$16.10	$46.00	—	—	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Travelers Clinic-Teta,Diptheria,Pertussi (Tdap)	$17.50	$50.00	—	—	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Boostrix: 10 Vial In 1 Pouch (50090-1831-0) / .5 Ml In 1 Vial (50090-1831-9)	$40.25	$115.00	—	—	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Boostrix: 10 Vial In 1 Carton (58160-842-11) / .5 Ml In 1 Vial (58160-842-01)	$43.75	$125.00	—	—	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Boostrix: 10 Syringe In 1 Carton (58160-842-52) / .5 Ml In 1 Syringe (58160-842-43)	$43.94	$125.54	—	—	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 NDC Description Not Available	$43.96	$125.60	—	—	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Adacel Tdap: 5 Syringe In 1 Package (49281-400-20) / .5 Ml In 1 Syringe (49281-400-89)	$44.10	$126.00	—	—	65%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSP [84154]	$83.20	$128.00	—	—	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY [159806]	$83.20	$128.00	—	—	35%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Travelers Clinic-Typhoid	$53.90	$154.00	—	81% below	65%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Typhoid Vaccine Vi Capsular Polysaccharide Im	$67.55	$193.00	—	76% below	65%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Typhim Vi: 1 Syringe In 1 Package (49281-790-51) / .5 Ml In 1 Syringe (49281-790-88)	$122.85	$351.00	—	57% below	65%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 NDC Description Not Available	$135.45	$387.00	—	53% below	65%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOSY [161012]	$264.55	$407.00	—	8% below	35%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 Travelers Clinic-Typhoid	$53.90	$154.00	—	—	65%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 Typhoid Vaccine Vi Capsular Polysaccharide Im	$67.55	$193.00	—	—	65%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 Typhim Vi: 1 Syringe In 1 Package (49281-790-51) / .5 Ml In 1 Syringe (49281-790-88)	$122.85	$351.00	—	—	65%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 NDC Description Not Available	$135.45	$387.00	—	—	65%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOSY [161012]	$264.55	$407.00	—	—	35%
Typhoid vaccine, oral capsules (Vivotif) CPT 90690 Typhoid Vaccine, Oral	$80.50	$230.00	—	62% above	65%
Typhoid vaccine, oral capsules (Vivotif) inpatient CPT 90690 Typhoid Vaccine, Oral	$80.50	$230.00	—	—	65%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin, Single	$56.35	$161.00	—	38% above	65%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Flu Vaccine-Medicare	$78.75	$225.00	—	94% above	65%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Pneumococcal Vac-Medicare	$78.75	$225.00	—	94% above	65%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin, Single	$56.35	$161.00	—	—	65%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Admin Pneumococcal Vac-Medicare	$78.75	$225.00	—	—	65%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Admin Flu Vaccine-Medicare	$78.75	$225.00	—	—	65%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin, Each Add'l	$32.20	$92.00	—	7% below	65%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Admin, Each Add'l	$32.20	$92.00	—	—	65%
Yellow fever vaccine, live CPT 90717 Travelers Clinic-Yellow Fever Vaccine	$87.50	$250.00	—	79% below	65%
Yellow fever vaccine, live CPT 90717 Yellow Fever Immunization	$170.45	$487.00	—	60% below	65%
Yellow fever vaccine, live CPT 90717 Yf-Vax: 5 Vial, Single-Dose In 1 Package (49281-915-01) / .5 Ml In 1 Vial, Single-Dose (49281-915-58)	$194.08	$554.50	—	54% below	65%
Yellow fever vaccine, live CPT 90717 NDC Description Not Available	$207.20	$592.00	—	51% below	65%
Yellow fever vaccine, live CPT 90717 YELLOW FEVER VACCINE SUBCUTANEOUS SUSR [172184]	$403.65	$621.00	—	4% below	35%
Yellow fever vaccine, live inpatient CPT 90717 Travelers Clinic-Yellow Fever Vaccine	$87.50	$250.00	—	—	65%
Yellow fever vaccine, live inpatient CPT 90717 Yellow Fever Immunization	$170.45	$487.00	—	—	65%
Yellow fever vaccine, live inpatient CPT 90717 Yf-Vax: 5 Vial, Single-Dose In 1 Package (49281-915-01) / .5 Ml In 1 Vial, Single-Dose (49281-915-58)	$194.08	$554.50	—	—	65%
Yellow fever vaccine, live inpatient CPT 90717 NDC Description Not Available	$207.20	$592.00	—	—	65%
Yellow fever vaccine, live inpatient CPT 90717 YELLOW FEVER VACCINE SUBCUTANEOUS SUSR [172184]	$403.65	$621.00	—	—	35%

Dental

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Deep cleaning (scaling and root planing), 4 or more teeth in one quadrant CDT D4341 Hc Periodontal Scaling & Root	$458.85	$1,311.00	—	—	65%
Deep cleaning (scaling and root planing), 4 or more teeth in one quadrant inpatient CDT D4341 Hc Periodontal Scaling & Root	$458.85	$1,311.00	—	—	65%
Dental implant, surgical placement CDT D6010 Surg Placement Of Implant Body	$720.30	$2,058.00	—	—	65%
Dental implant, surgical placement inpatient CDT D6010 Surg Placement Of Implant Body	$720.30	$2,058.00	—	—	65%
Porcelain crown CDT D2740 Crown - Porcelain/Ceramic Sub*	$455.00	$1,300.00	—	—	65%
Porcelain crown CDT D2740 Hc Crown - Porcelain/Ceramic	$458.85	$1,311.00	—	—	65%
Porcelain crown inpatient CDT D2740 Crown - Porcelain/Ceramic Sub*	$455.00	$1,300.00	—	—	65%
Porcelain crown inpatient CDT D2740 Hc Crown - Porcelain/Ceramic	$458.85	$1,311.00	—	—	65%
Root canal treatment on a molar (back tooth), not including the final crown CDT D3330 Molar (Excl Final Restoration)	$423.50	$1,210.00	—	—	65%
Root canal treatment on a molar (back tooth), not including the final crown CDT D3330 Hc Molar (Excl Final Restoration)	$458.85	$1,311.00	—	—	65%
Root canal treatment on a molar (back tooth), not including the final crown inpatient CDT D3330 Molar (Excl Final Restoration)	$423.50	$1,210.00	—	—	65%
Root canal treatment on a molar (back tooth), not including the final crown inpatient CDT D3330 Hc Molar (Excl Final Restoration)	$458.85	$1,311.00	—	—	65%
Routine teeth cleaning (prophylaxis), adult or teen CDT D1110 Prophylaxis - Adult	$36.75	$105.00	—	—	65%
Routine teeth cleaning (prophylaxis), adult or teen CDT D1110 Hc Prophylaxis - Adult	$458.85	$1,311.00	—	—	65%
Routine teeth cleaning (prophylaxis), adult or teen inpatient CDT D1110 Prophylaxis - Adult	$36.75	$105.00	—	—	65%
Routine teeth cleaning (prophylaxis), adult or teen inpatient CDT D1110 Hc Prophylaxis - Adult	$458.85	$1,311.00	—	—	65%
Simple extraction of a tooth or exposed root that is above the gum CDT D7140 Hc Extraction Erupted Tooth/Exr	$458.85	$1,311.00	—	65% below	65%
Simple extraction of a tooth or exposed root that is above the gum inpatient CDT D7140 Hc Extraction Erupted Tooth/Exr	$458.85	$1,311.00	—	—	65%

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

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

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

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

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

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

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

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

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

Source file: https://www.metrohealth.org/globalassets/metrohealth-documents/patients-and-visitors/pricing-transparency-2026/346004382_metrohealth-system_standardcharges.csv