Hospital Vallejo, CA

NorthBay Medical Center

NorthBay Medical Center in Fairfield, CA publishes cash prices for 373 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 above the California median for 275 of 372 procedures and below it for 92. By typical cash price it ranks #194 of 226 California hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

1200 B Gale Wilson Blvd, Fairfield, CA 94533 Collected Sep 23, 2026 Source price file Check a bill from this hospital (707) 646-5000

Acute care hospital Nonprofit hospital Emergency department CMS star rating 2 of 5 CCN 050367 · CMS hospital register NPI 1821147786

The price file shows no self-pay discount

For 1274 of the 1274 prices listed here, the cash price in NorthBay Medical Center's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing. Other US hospitals whose cash price is their full list price.

Financial assistance

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

NorthBay Medical Center 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

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Abdominal CT scan without and with contrast CPT 74170 Ct Quad Phase Abd W And W/O, L	$8,473.00	$8,473.00	—	199% above	—
Abdominal CT scan without and with contrast CPT 74170 Ct Abdomen W & Wo Contrast	$10,591.00	$10,591.00	—	274% above	—
Abdominal CT scan without and with contrast inpatient CPT 74170 Ct Quad Phase Abd W And W/O, L	$8,473.00	$8,473.00	—	—	—
Abdominal CT scan without and with contrast inpatient CPT 74170 Ct Abdomen W & Wo Contrast	$10,591.00	$10,591.00	—	—	—
Abdominal X-ray, 2 views CPT 74019 Dx Sitz Marker Study	$631.00	$631.00	—	46% above	—
Abdominal X-ray, 2 views CPT 74019 Abdomen Complete	$842.00	$842.00	—	95% above	—
Abdominal X-ray, 2 views inpatient CPT 74019 Dx Sitz Marker Study	$631.00	$631.00	—	—	—
Abdominal X-ray, 2 views inpatient CPT 74019 Abdomen Complete	$842.00	$842.00	—	—	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 Dx Ankle Complete Right	$987.00	$987.00	—	92% above	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 Dx Ankle Complete Left	$987.00	$987.00	—	92% above	—
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Dx Ankle Complete Right	$987.00	$987.00	—	—	—
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Dx Ankle Complete Left	$987.00	$987.00	—	—	—
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Upr/L Xtremity Art 2 Levels	$200.00	$200.00	—	64% below	—
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Upr/L Xtremity Art 2 Levels	$200.00	$200.00	—	—	—
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Upper Ext W/O Contrast Rt	$6,491.00	$6,491.00	—	185% above	—
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Upper Ext W/O Contrast Lt	$6,491.00	$6,491.00	—	185% above	—
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Upper Ext W/O Contrast Lt	$6,491.00	$6,491.00	—	—	—
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct Upper Ext W/O Contrast Rt	$6,491.00	$6,491.00	—	—	—
Barium swallow (esophagus X-ray with contrast) CPT 74220 X-Ray Esophagus 1 Contrst Stdy	$865.00	$865.00	—	43% above	—
Barium swallow (esophagus X-ray with contrast) CPT 74220 Esophagus	$1,145.00	$1,145.00	—	89% above	—
Barium swallow (esophagus X-ray with contrast) CPT 74220 Ct Esophagus	$9,175.00	$9,175.00	—	1415% above	—
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 X-Ray Esophagus 1 Contrst Stdy	$865.00	$865.00	—	—	—
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Esophagus	$1,145.00	$1,145.00	—	—	—
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Ct Esophagus	$9,175.00	$9,175.00	—	—	—
Bone scan, whole body (nuclear medicine) CPT 78306 Bone Scan Whole Body	$2,945.00	$2,945.00	—	39% above	—
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Bone Scan Whole Body	$2,945.00	$2,945.00	—	—	—
Breast ultrasound, complete, one breast one side CPT 76641 Us Breast Right Complete	$2,316.00	$2,316.00	—	228% above	—
Breast ultrasound, complete, one breast one side CPT 76641 Us Breast Left Complete	$2,316.00	$2,316.00	—	228% above	—
Breast ultrasound, complete, one breast inpatient one side CPT 76641 Us Breast Right Complete	$2,316.00	$2,316.00	—	—	—
Breast ultrasound, complete, one breast inpatient one side CPT 76641 Us Breast Left Complete	$2,316.00	$2,316.00	—	—	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us Breast Right Limited	$2,316.00	$2,316.00	—	333% above	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us Breast Left Limited	$2,316.00	$2,316.00	—	333% above	—
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Us Breast Right Limited	$2,316.00	$2,316.00	—	—	—
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Us Breast Left Limited	$2,316.00	$2,316.00	—	—	—
CT angiography (CTA) of the abdomen and pelvis CPT 74174 Ct Angiography, Abdomen/Pelvis	$10,817.00	$10,817.00	—	100% above	—
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 Ct Angiography, Abdomen/Pelvis	$10,817.00	$10,817.00	—	—	—
CT angiography (CTA) of the head CPT 70496 Ct Venography Head	$4,893.00	$4,893.00	—	64% above	—
CT angiography (CTA) of the head CPT 70496 Ct Angiography,Head	$4,893.00	$4,893.00	—	64% above	—
CT angiography (CTA) of the head inpatient CPT 70496 Ct Venography Head	$4,893.00	$4,893.00	—	—	—
CT angiography (CTA) of the head inpatient CPT 70496 Ct Angiography,Head	$4,893.00	$4,893.00	—	—	—
CT angiography (CTA) of the neck CPT 70498 Ct Angiography,Neck	$5,866.00	$5,866.00	—	98% above	—
CT angiography (CTA) of the neck inpatient CPT 70498 Ct Angiography,Neck	$5,866.00	$5,866.00	—	—	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct Angiography Pulmonary	$5,586.00	$5,586.00	—	63% above	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct Angiography,Chest	$5,586.00	$5,586.00	—	63% above	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Ct Angiography Pulmonary	$5,586.00	$5,586.00	—	—	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Ct Angiography,Chest	$5,586.00	$5,586.00	—	—	—
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Ct Heart With Coronarly Angiog	$11,351.00	$11,351.00	—	320% above	—
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 Ct Heart With Coronarly Angiog	$11,351.00	$11,351.00	—	—	—
CT of the heart without contrast dye to measure coronary calcium CPT 75571 Ct Heart W/O Contrast	$3,815.00	$3,815.00	—	913% above	—
CT of the heart without contrast dye to measure coronary calcium CPT 75571 Ct Heart Coronary Scoring W/O	$4,541.00	$4,541.00	—	1105% above	—
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 Ct Heart W/O Contrast	$3,815.00	$3,815.00	—	—	—
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 Ct Heart Coronary Scoring W/O	$4,541.00	$4,541.00	—	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Enterography W/O Iv W Oral	$4,218.00	$4,218.00	—	32% above	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abd Pelvis Wo Contrast	$4,218.00	$4,218.00	—	32% above	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Ct Enterography W/O Iv W Oral	$4,218.00	$4,218.00	—	—	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Ct Abd Pelvis Wo Contrast	$4,218.00	$4,218.00	—	—	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct Abd Pelvis W Contrast	$16,630.00	$16,630.00	—	303% above	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct Enterography Wiv And W Oral	$16,630.00	$16,630.00	—	303% above	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct Enterography Wiv And W Oral	$16,630.00	$16,630.00	—	—	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct Abd Pelvis W Contrast	$16,630.00	$16,630.00	—	—	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Quad Abd/Pel W And Wo Liver	$14,193.00	$14,193.00	—	202% above	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd & Pelvis W And W/O Cont	$17,742.00	$17,742.00	—	277% above	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct Quad Abd/Pel W And Wo Liver	$14,193.00	$14,193.00	—	—	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct Abd & Pelvis W And W/O Cont	$17,742.00	$17,742.00	—	—	—
CT scan of the abdomen with contrast CPT 74160 Ct Abd Oral Contrast Only	$9,927.00	$9,927.00	—	294% above	—
CT scan of the abdomen with contrast CPT 74160 Ct Abd Iv Contrast Only	$9,927.00	$9,927.00	—	294% above	—
CT scan of the abdomen with contrast CPT 74160 Ct Abdomen W Both Iv & Oral Co	$9,927.00	$9,927.00	—	294% above	—
CT scan of the abdomen with contrast inpatient CPT 74160 Ct Abd Oral Contrast Only	$9,927.00	$9,927.00	—	—	—
CT scan of the abdomen with contrast inpatient CPT 74160 Ct Abd Iv Contrast Only	$9,927.00	$9,927.00	—	—	—
CT scan of the abdomen with contrast inpatient CPT 74160 Ct Abdomen W Both Iv & Oral Co	$9,927.00	$9,927.00	—	—	—
CT scan of the abdomen without contrast CPT 74150 Ct Abdomen Wo Iv Or Oral Contr	$9,599.00	$9,599.00	—	403% above	—
CT scan of the abdomen without contrast inpatient CPT 74150 Ct Abdomen Wo Iv Or Oral Contr	$9,599.00	$9,599.00	—	—	—
CT scan of the face and sinuses, no contrast dye CPT 70486 Maxillo Facial W/O Contrst	$3,568.00	$3,568.00	—	63% above	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Maxillo Facial W/O Contrst	$3,568.00	$3,568.00	—	—	—
CT scan of the head or brain, no contrast dye CPT 70450 Ct Sinus Stealth W/O Contrast	$3,484.00	$3,484.00	—	52% above	—
CT scan of the head or brain, no contrast dye CPT 70450 Ct Head Stealth W/O Contrast	$3,485.00	$3,485.00	—	52% above	—
CT scan of the head or brain, no contrast dye CPT 70450 Hd Sc W/O Cntrst	$3,485.00	$3,485.00	—	52% above	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct Sinus Stealth W/O Contrast	$3,484.00	$3,484.00	—	—	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 Hd Sc W/O Cntrst	$3,485.00	$3,485.00	—	—	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct Head Stealth W/O Contrast	$3,485.00	$3,485.00	—	—	—
CT scan of the head with contrast CPT 70460 Hd Sc W/Contrast	$4,754.00	$4,754.00	—	76% above	—
CT scan of the head with contrast inpatient CPT 70460 Hd Sc W/Contrast	$4,754.00	$4,754.00	—	—	—
CT scan of the head without and with contrast CPT 70470 Head W/Wo	$7,750.00	$7,750.00	—	151% above	—
CT scan of the head without and with contrast inpatient CPT 70470 Head W/Wo	$7,750.00	$7,750.00	—	—	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 L/Spine W/O	$8,244.00	$8,244.00	—	188% above	—
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 L/Spine W/O	$8,244.00	$8,244.00	—	—	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 C-Spine W/O	$7,577.00	$7,577.00	—	160% above	—
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 C-Spine W/O	$7,577.00	$7,577.00	—	—	—
CT scan of the pelvis, with contrast dye CPT 72193 Ct Pelvis W Iv & Oral Contrast	$10,223.00	$10,223.00	—	301% above	—
CT scan of the pelvis, with contrast dye CPT 72193 Ct Pelvis Oral Contrast Only	$10,223.00	$10,223.00	—	301% above	—
CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Pelvis W Iv & Oral Contrast	$10,223.00	$10,223.00	—	—	—
CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Pelvis Oral Contrast Only	$10,223.00	$10,223.00	—	—	—
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Carotid Doppler	$1,760.00	$1,760.00	—	44% above	—
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 Carotid Doppler	$1,760.00	$1,760.00	—	—	—
Chest CT scan without and with contrast CPT 71270 Chest W/ W/O Contrast	$13,443.00	$13,443.00	—	311% above	—
Chest CT scan without and with contrast inpatient CPT 71270 Chest W/ W/O Contrast	$13,443.00	$13,443.00	—	—	—
Chest X-ray, 2 views CPT 71046 Chest Sp View	$544.00	$544.00	—	34% above	—
Chest X-ray, 2 views CPT 71046 Chest 2 Views	$1,461.00	$1,461.00	—	259% above	—
Chest X-ray, 2 views inpatient CPT 71046 Chest Sp View	$544.00	$544.00	—	—	—
Chest X-ray, 2 views inpatient CPT 71046 Chest 2 Views	$1,461.00	$1,461.00	—	—	—
Chest X-ray, single view CPT 71045 Chest 1 View	$695.00	$695.00	—	91% above	—
Chest X-ray, single view inpatient CPT 71045 Chest 1 View	$695.00	$695.00	—	—	—
Collarbone (clavicle) X-ray, complete one side CPT 73000 Dx Clavicle Left	$1,717.00	$1,717.00	—	255% above	—
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Dx Clavicle Left	$1,717.00	$1,717.00	—	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Renal Sonogram	$3,370.00	$3,370.00	—	298% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Aortic Sonogram	$3,370.00	$3,370.00	—	298% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Renal Sonogram	$3,370.00	$3,370.00	—	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Aortic Sonogram	$3,370.00	$3,370.00	—	—	—
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Us Ob Detailed Complete;Single	$1,573.00	$1,573.00	—	74% above	—
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 Us Ob Detailed Complete;Single	$1,573.00	$1,573.00	—	—	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Chest W/O Cntrst	$9,175.00	$9,175.00	—	352% above	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Chest W/O Cntrst	$9,175.00	$9,175.00	—	—	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Chest W/Cnrst	$10,283.00	$10,283.00	—	257% above	—
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Chest W/Cnrst	$10,283.00	$10,283.00	—	—	—
Duplex ultrasound of the leg arteries, both legs CPT 93925 Art Doppler, Lower, Bil	$2,431.00	$2,431.00	—	132% above	—
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 Art Doppler, Lower, Bil	$2,431.00	$2,431.00	—	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Us Venous Doppler Bilateral	$2,075.00	$2,075.00	—	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Us Vein Mapping Bilateral	$5,680.00	$5,680.00	—	—	—
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Us Venous Doppler Bilateral	$2,075.00	$2,075.00	—	—	—
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Us Vein Mapping Bilateral	$5,680.00	$5,680.00	—	—	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Tte W/Doppler Complete	$10,165.00	$10,165.00	—	278% above	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Ped Tte W/Doppler Complete Int	$10,165.00	$10,165.00	—	278% above	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Tte W/Doppler Complete	$10,165.00	$10,165.00	—	—	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Ped Tte W/Doppler Complete Int	$10,165.00	$10,165.00	—	—	—
Elbow X-ray, 2 views one side CPT 73070 Dx Elbow Limited Left	$900.00	$900.00	—	126% above	—
Elbow X-ray, 2 views one side CPT 73070 Dx Elbow Limited Right	$900.00	$900.00	—	126% above	—
Elbow X-ray, 2 views inpatient one side CPT 73070 Dx Elbow Limited Right	$900.00	$900.00	—	—	—
Elbow X-ray, 2 views inpatient one side CPT 73070 Dx Elbow Limited Left	$900.00	$900.00	—	—	—
Elbow X-ray, complete, 3 or more views one side CPT 73080 Dx Elbow Complete Left	$1,676.00	$1,676.00	—	246% above	—
Elbow X-ray, complete, 3 or more views one side CPT 73080 Dx Elbow Complete Right	$1,676.00	$1,676.00	—	246% above	—
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Dx Elbow Complete Left	$1,676.00	$1,676.00	—	—	—
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Dx Elbow Complete Right	$1,676.00	$1,676.00	—	—	—
Eye socket (orbit) CT scan without contrast CPT 70480 Ct Temporal Bones W/O Contrast	$5,674.00	$5,674.00	—	148% above	—
Eye socket (orbit) CT scan without contrast CPT 70480 Orb W/O Contrast	$5,674.00	$5,674.00	—	148% above	—
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Orb W/O Contrast	$5,674.00	$5,674.00	—	—	—
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Ct Temporal Bones W/O Contrast	$5,674.00	$5,674.00	—	—	—
Facial bones X-ray, complete, 3 or more views CPT 70150 Facial Bones Complete	$4,246.00	$4,246.00	—	760% above	—
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 Facial Bones Complete	$4,246.00	$4,246.00	—	—	—
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Dx Forearm Left	$1,002.00	$1,002.00	—	134% above	—
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Dx Forearm Left	$1,002.00	$1,002.00	—	—	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary Scn	$3,331.00	$3,331.00	—	87% above	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hepatobiliary Scn	$3,331.00	$3,331.00	—	—	—
Hand X-ray, 2 views one side CPT 73120 Dx Hand Limited Left	$830.00	$830.00	—	104% above	—
Hand X-ray, 2 views one side CPT 73120 Dx Hand Limited Right	$830.00	$830.00	—	104% above	—
Hand X-ray, 2 views inpatient one side CPT 73120 Dx Hand Limited Right	$830.00	$830.00	—	—	—
Hand X-ray, 2 views inpatient one side CPT 73120 Dx Hand Limited Left	$830.00	$830.00	—	—	—
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Dx Os Calcis Left	$759.00	$759.00	—	115% above	—
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Dx Os Calcis Right	$759.00	$759.00	—	115% above	—
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Dx Os Calcis Left	$759.00	$759.00	—	—	—
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Dx Os Calcis Right	$759.00	$759.00	—	—	—
Knee X-ray, 3 views one side CPT 73562 Dx Knee Complete Right	$917.00	$917.00	—	100% above	—
Knee X-ray, 3 views one side CPT 73562 Dx Knee Complete Left	$917.00	$917.00	—	100% above	—
Knee X-ray, 3 views inpatient one side CPT 73562 Dx Knee Complete Right	$917.00	$917.00	—	—	—
Knee X-ray, 3 views inpatient one side CPT 73562 Dx Knee Complete Left	$917.00	$917.00	—	—	—
Knee X-ray, complete, 4 or more views one side CPT 73564 Dx Knee Mutiple Views Right	$969.00	$969.00	—	65% above	—
Knee X-ray, complete, 4 or more views one side CPT 73564 Dx Knee Multiple Views Left	$969.00	$969.00	—	65% above	—
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Dx Knee Mutiple Views Right	$969.00	$969.00	—	—	—
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Dx Knee Multiple Views Left	$969.00	$969.00	—	—	—
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Lower Ext W/O Contrast Rt	$4,755.00	$4,755.00	—	123% above	—
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Lower Ext W/O Contrast Lt	$4,755.00	$4,755.00	—	123% above	—
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Lower Ext W/O Contrast Rt	$4,755.00	$4,755.00	—	—	—
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct Lower Ext W/O Contrast Lt	$4,755.00	$4,755.00	—	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Hernia Limited	$1,507.00	$1,507.00	—	82% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Abd Sonogram (Lim)	$1,620.00	$1,620.00	—	95% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us Hernia Limited	$1,507.00	$1,507.00	—	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Abd Sonogram (Lim)	$1,620.00	$1,620.00	—	—	—
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Us Extremity Left	$1,782.00	$1,782.00	—	227% above	—
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Us Extremity Limited Right	$1,782.00	$1,782.00	—	227% above	—
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Us Extremity Limited Right	$1,782.00	$1,782.00	—	—	—
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Us Extremity Left	$1,782.00	$1,782.00	—	—	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct Cancer Screening Lungs	$389.00	$389.00	—	9% above	—
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Ct Cancer Screening Lungs	$389.00	$389.00	—	—	—
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Dx Tibia And Fibula Right	$759.00	$759.00	—	75% above	—
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Dx Tibia And Fibula Left	$759.00	$759.00	—	75% above	—
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Dx Tibia And Fibula Right	$759.00	$759.00	—	—	—
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Dx Tibia And Fibula Left	$759.00	$759.00	—	—	—
MR angiography (MRA) of the head without contrast CPT 70544 Mr Mra Head W/O Contrast	$6,128.00	$6,128.00	—	112% above	—
MR angiography (MRA) of the head without contrast CPT 70544 Mr Venogram Head W/O Contrast	$6,128.00	$6,128.00	—	112% above	—
MR angiography (MRA) of the head without contrast inpatient CPT 70544 Mr Mra Head W/O Contrast	$6,128.00	$6,128.00	—	—	—
MR angiography (MRA) of the head without contrast inpatient CPT 70544 Mr Venogram Head W/O Contrast	$6,128.00	$6,128.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mr Lower Ext Non-Joint W/O Lt	$6,820.00	$6,820.00	—	125% above	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mr Lower Ext (Joint) W/O Rt	$6,820.00	$6,820.00	—	125% above	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mr Lower Ext (Joint) W/O Lt	$6,820.00	$6,820.00	—	125% above	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mr Lower Ext Non-Joint W/O Lt	$6,820.00	$6,820.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mr Lower Ext (Joint) W/O Lt	$6,820.00	$6,820.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mr Lower Ext (Joint) W/O Rt	$6,820.00	$6,820.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mr Lower Ext (Joint) W/Wo Rt	$9,790.00	$9,790.00	—	112% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mr Lower Ext (Joint) W/Wo Lt	$9,790.00	$9,790.00	—	112% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mr Lower Ext (Joint) W/Wo Rt	$9,790.00	$9,790.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mr Lower Ext (Joint) W/Wo Lt	$9,790.00	$9,790.00	—	—	—
MRI of the abdomen without contrast CPT 74181 Mr Abdomen W/O Contrast	$6,820.00	$6,820.00	—	144% above	—
MRI of the abdomen without contrast inpatient CPT 74181 Mr Abdomen W/O Contrast	$6,820.00	$6,820.00	—	—	—
MRI of the abdomen, without and then with contrast dye CPT 74183 Mr Mri Abdomen W/Wo Contrast	$9,790.00	$9,790.00	—	124% above	—
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Mr Mri Abdomen W/Wo Contrast	$9,790.00	$9,790.00	—	—	—
MRI of the brain, no contrast dye CPT 70551 Mri Pituitary W/O Contrast	$6,128.00	$6,128.00	—	111% above	—
MRI of the brain, no contrast dye CPT 70551 Mri Iac W/O Contrast	$6,128.00	$6,128.00	—	111% above	—
MRI of the brain, no contrast dye CPT 70551 Mri Brain Wo/Contrast	$6,128.00	$6,128.00	—	111% above	—
MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain Wo/Contrast	$6,128.00	$6,128.00	—	—	—
MRI of the brain, no contrast dye inpatient CPT 70551 Mri Iac W/O Contrast	$6,128.00	$6,128.00	—	—	—
MRI of the brain, no contrast dye inpatient CPT 70551 Mri Pituitary W/O Contrast	$6,128.00	$6,128.00	—	—	—
MRI of the brain, with and without contrast dye CPT 70553 Mr Brain W/Wo Contrast	$8,797.00	$8,797.00	—	103% above	—
MRI of the brain, with and without contrast dye CPT 70553 Mri Iac W/Wo Contrast	$8,797.00	$8,797.00	—	103% above	—
MRI of the brain, with and without contrast dye CPT 70553 Mri Pituitary W/Wo Contrast	$8,797.00	$8,797.00	—	103% above	—
MRI of the brain, with and without contrast dye CPT 70553 Mr Neuro Brain Tumor W And W/O	$8,797.00	$8,797.00	—	103% above	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 Mr Neuro Brain Tumor W And W/O	$8,797.00	$8,797.00	—	—	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Iac W/Wo Contrast	$8,797.00	$8,797.00	—	—	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 Mr Brain W/Wo Contrast	$8,797.00	$8,797.00	—	—	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Pituitary W/Wo Contrast	$8,797.00	$8,797.00	—	—	—
MRI of the lower back, no contrast dye CPT 72148 Mri L-Spine Wo/Cont	$6,820.00	$6,820.00	—	123% above	—
MRI of the lower back, no contrast dye inpatient CPT 72148 Mri L-Spine Wo/Cont	$6,820.00	$6,820.00	—	—	—
MRI of the lower back, without and then with contrast dye CPT 72158 Mr Lumbar Spine W/Wo Contrast	$9,790.00	$9,790.00	—	117% above	—
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 Mr Lumbar Spine W/Wo Contrast	$9,790.00	$9,790.00	—	—	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri T-Spine Wo/Cont	$6,820.00	$6,820.00	—	136% above	—
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 Mri T-Spine Wo/Cont	$6,820.00	$6,820.00	—	—	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 Mr Cervical Spine W/Wo Contras	$8,797.00	$8,797.00	—	98% above	—
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 Mr Cervical Spine W/Wo Contras	$8,797.00	$8,797.00	—	—	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri C-Spine Wo/Contrast	$6,128.00	$6,128.00	—	104% above	—
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 Mri C-Spine Wo/Contrast	$6,128.00	$6,128.00	—	—	—
MRI of the pelvis without and with contrast CPT 72197 Mr Pelvis W/Wo Contrast	$9,790.00	$9,790.00	—	136% above	—
MRI of the pelvis without and with contrast inpatient CPT 72197 Mr Pelvis W/Wo Contrast	$9,790.00	$9,790.00	—	—	—
MRI of the pelvis, no contrast dye CPT 72195 Mr Pelvis W/O Contrast	$6,820.00	$6,820.00	—	165% above	—
MRI of the pelvis, no contrast dye inpatient CPT 72195 Mr Pelvis W/O Contrast	$6,820.00	$6,820.00	—	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mr Upper Ext (Joint) W/O Lt	$6,820.00	$6,820.00	—	160% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mr Upper Ext (Joint) W/O Rt	$6,820.00	$6,820.00	—	160% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mr Upper Ext (Joint) W/O Lt	$6,820.00	$6,820.00	—	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mr Upper Ext (Joint) W/O Rt	$6,820.00	$6,820.00	—	—	—
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Cervical Ap/Lat Complete	$1,936.00	$1,936.00	—	200% above	—
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 Cervical Ap/Lat Complete	$1,936.00	$1,936.00	—	—	—
Neck soft tissue CT scan with contrast CPT 70491 Neck W/Cntrst	$7,999.00	$7,999.00	—	193% above	—
Neck soft tissue CT scan with contrast inpatient CPT 70491 Neck W/Cntrst	$7,999.00	$7,999.00	—	—	—
Neck soft tissue CT scan without contrast CPT 70490 Neck W/O Cntrst	$6,901.00	$6,901.00	—	226% above	—
Neck soft tissue CT scan without contrast inpatient CPT 70490 Neck W/O Cntrst	$6,901.00	$6,901.00	—	—	—
Neck soft tissue X-ray CPT 70360 Neck Soft Tissue	$1,314.00	$1,314.00	—	304% above	—
Neck soft tissue X-ray inpatient CPT 70360 Neck Soft Tissue	$1,314.00	$1,314.00	—	—	—
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Dual Mpi Study Spect	$10,670.00	$10,670.00	—	163% above	—
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Dual Mpi Study Spect	$10,670.00	$10,670.00	—	—	—
Pelvic CT scan without contrast CPT 72192 Ct Pelvis Wo Iv Or Oral Contra	$8,279.00	$8,279.00	—	322% above	—
Pelvic CT scan without contrast inpatient CPT 72192 Ct Pelvis Wo Iv Or Oral Contra	$8,279.00	$8,279.00	—	—	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us Pelvic Limited	$1,257.00	$1,257.00	—	133% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Us Pelvic Limited	$1,257.00	$1,257.00	—	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Pelvic Sonogram	$2,260.00	$2,260.00	—	140% above	—
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Pelvic Sonogram	$2,260.00	$2,260.00	—	—	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Us Ob >14 Wks Single/1St Gesta	$4,774.00	$4,774.00	—	453% above	—
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Us Ob >14 Wks Single/1St Gesta	$4,774.00	$4,774.00	—	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Us Ob <14 Wks Single/1St Gesta	$3,554.00	$3,554.00	—	359% above	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Us Ob <14 Wks Single/1St Gesta	$3,554.00	$3,554.00	—	—	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Afi	$2,673.00	$2,673.00	—	342% above	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Ob Sonogram Limited	$2,673.00	$2,673.00	—	342% above	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Ob Sonogram Limited	$2,673.00	$2,673.00	—	—	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Us Ob Afi	$2,673.00	$2,673.00	—	—	—
Rib X-ray, one side, 2 views one side CPT 71100 Dx Ribs Unilateral Right	$1,329.00	$1,329.00	—	187% above	—
Rib X-ray, one side, 2 views one side CPT 71100 Dx Ribs Unilateral Left	$1,329.00	$1,329.00	—	187% above	—
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Dx Ribs Unilateral Right	$1,329.00	$1,329.00	—	—	—
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Dx Ribs Unilateral Left	$1,329.00	$1,329.00	—	—	—
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Dx Ribs Unilateral W/ Chest Lt	$1,754.00	$1,754.00	—	185% above	—
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Dx Ribs Unilateral W/ Chest Rt	$1,754.00	$1,754.00	—	185% above	—
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Dx Ribs Unilateral W/ Chest Rt	$1,754.00	$1,754.00	—	—	—
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Dx Ribs Unilateral W/ Chest Lt	$1,754.00	$1,754.00	—	—	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Dx Shoulder Complete Right	$1,400.00	$1,400.00	—	154% above	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Dx Shoulder Complete Left	$1,400.00	$1,400.00	—	154% above	—
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Dx Shoulder Complete Right	$1,400.00	$1,400.00	—	—	—
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Dx Shoulder Complete Left	$1,400.00	$1,400.00	—	—	—
Sinus X-ray, complete, 3 or more views CPT 70220 Sinuses Complete	$2,021.00	$2,021.00	—	342% above	—
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Sinuses Complete	$2,021.00	$2,021.00	—	—	—
Skull X-ray, fewer than 4 views CPT 70250 Skull Limited	$2,094.00	$2,094.00	—	416% above	—
Skull X-ray, fewer than 4 views inpatient CPT 70250 Skull Limited	$2,094.00	$2,094.00	—	—	—
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Stress Tte Complete	$9,922.00	$9,922.00	—	212% above	—
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Stress Tte Complete	$9,922.00	$9,922.00	—	—	—
Swallow study (modified barium swallow, video X-ray) CPT 74230 Swallowing Function	$1,194.00	$1,194.00	—	80% above	—
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Swallowing Function	$1,194.00	$1,194.00	—	—	—
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Dx Femur Right	$912.00	$912.00	—	124% above	—
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Dx Lwr Ext Lt 12 Mths 3 Yrs	$912.00	$912.00	—	124% above	—
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Dx Femur Left	$912.00	$912.00	—	124% above	—
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Dx Lwr Ext Lt 12 Mths 3 Yrs	$912.00	$912.00	—	—	—
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Dx Femur Left	$912.00	$912.00	—	—	—
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Dx Femur Right	$912.00	$912.00	—	—	—
Thoracic spine (mid back) CT scan without contrast CPT 72128 T-Spine W/O	$8,868.00	$8,868.00	—	216% above	—
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 T-Spine W/O	$8,868.00	$8,868.00	—	—	—
Toe X-ray, 2 or more views one side CPT 73660 Dx Toes Right	$592.00	$592.00	—	79% above	—
Toe X-ray, 2 or more views one side CPT 73660 Dx Toes Left	$592.00	$592.00	—	79% above	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 Dx Toes Left	$592.00	$592.00	—	—	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 Dx Toes Right	$592.00	$592.00	—	—	—
Transvaginal pelvic ultrasound CPT 76830 Endovaginal U/S	$1,647.00	$1,647.00	—	130% above	—
Transvaginal pelvic ultrasound inpatient CPT 76830 Endovaginal U/S	$1,647.00	$1,647.00	—	—	—
Transvaginal ultrasound during pregnancy CPT 76817 Us Ob Transvaginal	$1,407.00	$1,407.00	—	111% above	—
Transvaginal ultrasound during pregnancy inpatient CPT 76817 Us Ob Transvaginal	$1,407.00	$1,407.00	—	—	—
Ultrasound of the abdomen, complete CPT 76700 Abdomen Sonogram Complete	$3,277.00	$3,277.00	—	199% above	—
Ultrasound of the abdomen, complete inpatient CPT 76700 Abdomen Sonogram Complete	$3,277.00	$3,277.00	—	—	—
Ultrasound of the scrotum and testicles CPT 76870 Scrotum Sonogram	$3,377.00	$3,377.00	—	279% above	—
Ultrasound of the scrotum and testicles inpatient CPT 76870 Scrotum Sonogram	$3,377.00	$3,377.00	—	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Soft Tissue Neck/Head	$1,226.00	$1,226.00	—	48% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Thyroid	$3,067.00	$3,067.00	—	269% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Soft Tissue Neck/Head	$1,226.00	$1,226.00	—	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Us Thyroid	$3,067.00	$3,067.00	—	—	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 G I Series	$1,849.00	$1,849.00	—	200% above	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Xr Xm Upr Gi Trc 1Cntrst	$3,574.00	$3,574.00	—	480% above	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 G I Series	$1,849.00	$1,849.00	—	—	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Xr Xm Upr Gi Trc 1Cntrst	$3,574.00	$3,574.00	—	—	—
Upper arm X-ray (humerus), 2 views one side CPT 73060 Dx Upper Ext Rt 12 Mths 3 Yrs	$1,053.00	$1,053.00	—	146% above	—
Upper arm X-ray (humerus), 2 views one side CPT 73060 Dx Upper Ext Lt 12 Mths - 3	$1,053.00	$1,053.00	—	146% above	—
Upper arm X-ray (humerus), 2 views one side CPT 73060 Dx Humerus Right	$1,053.00	$1,053.00	—	146% above	—
Upper arm X-ray (humerus), 2 views one side CPT 73060 Dx Humerus Left	$1,053.00	$1,053.00	—	146% above	—
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Dx Humerus Left	$1,053.00	$1,053.00	—	—	—
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Dx Upper Ext Lt 12 Mths - 3	$1,053.00	$1,053.00	—	—	—
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Dx Upper Ext Rt 12 Mths 3 Yrs	$1,053.00	$1,053.00	—	—	—
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Dx Humerus Right	$1,053.00	$1,053.00	—	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Venous Doppler Unilat Right	$1,669.00	$1,669.00	—	85% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Venous Doppler Unilat Left	$1,669.00	$1,669.00	—	85% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Vein Mapping Unilat Right	$1,703.00	$1,703.00	—	89% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Vein Mapping Unilat Left	$1,703.00	$1,703.00	—	89% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Us Venous Doppler Unilat Left	$1,669.00	$1,669.00	—	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Us Venous Doppler Unilat Right	$1,669.00	$1,669.00	—	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Us Vein Mapping Unilat Left	$1,703.00	$1,703.00	—	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Us Vein Mapping Unilat Right	$1,703.00	$1,703.00	—	—	—
Wrist X-ray, 2 views one side CPT 73100 Dx Wrist Limited Left	$1,155.00	$1,155.00	—	197% above	—
Wrist X-ray, 2 views one side CPT 73100 Dx Wrist Limited Right	$1,155.00	$1,155.00	—	197% above	—
Wrist X-ray, 2 views inpatient one side CPT 73100 Dx Wrist Limited Right	$1,155.00	$1,155.00	—	—	—
Wrist X-ray, 2 views inpatient one side CPT 73100 Dx Wrist Limited Left	$1,155.00	$1,155.00	—	—	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 Dx Wrist Complete Left	$1,749.00	$1,749.00	—	248% above	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 Dx Wrist Complete Right	$1,749.00	$1,749.00	—	248% above	—
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Dx Wrist Complete Right	$1,749.00	$1,749.00	—	—	—
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Dx Wrist Complete Left	$1,749.00	$1,749.00	—	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Dx Hip Complete Unilateral Rt	$1,166.00	$1,166.00	—	190% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Dx Hip Complete Unilateral Lt	$1,166.00	$1,166.00	—	190% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Dx Hip Lt W Pelvis	$1,744.00	$1,744.00	—	334% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Dx Hip Rt W Pelvis	$1,744.00	$1,744.00	—	334% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Dx Hip Complete Unilateral Rt	$1,166.00	$1,166.00	—	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Dx Hip Complete Unilateral Lt	$1,166.00	$1,166.00	—	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Dx Hip Lt W Pelvis	$1,744.00	$1,744.00	—	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Dx Hip Rt W Pelvis	$1,744.00	$1,744.00	—	—	—
X-ray of the abdomen, 1 view CPT 74018 Abdomen 1 View	$692.00	$692.00	—	128% above	—
X-ray of the abdomen, 1 view inpatient CPT 74018 Abdomen 1 View	$692.00	$692.00	—	—	—
X-ray of the ankle, 2 views one side CPT 73600 Dx Ankle Limited Left	$692.00	$692.00	—	76% above	—
X-ray of the ankle, 2 views one side CPT 73600 Dx Ankle Limited Right	$692.00	$692.00	—	76% above	—
X-ray of the ankle, 2 views inpatient one side CPT 73600 Dx Ankle Limited Left	$692.00	$692.00	—	—	—
X-ray of the ankle, 2 views inpatient one side CPT 73600 Dx Ankle Limited Right	$692.00	$692.00	—	—	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Dx Fingers Right	$1,266.00	$1,266.00	—	247% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Dx Fingers Left	$1,266.00	$1,266.00	—	247% above	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Dx Fingers Right	$1,266.00	$1,266.00	—	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Dx Fingers Left	$1,266.00	$1,266.00	—	—	—
X-ray of the foot, 2 views one side CPT 73620 Dx Foot Limited Right	$561.00	$561.00	—	38% above	—
X-ray of the foot, 2 views one side CPT 73620 Dx Foot Limited Left	$561.00	$561.00	—	38% above	—
X-ray of the foot, 2 views inpatient one side CPT 73620 Dx Foot Limited Right	$561.00	$561.00	—	—	—
X-ray of the foot, 2 views inpatient one side CPT 73620 Dx Foot Limited Left	$561.00	$561.00	—	—	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 Dx Foot Complete Right	$933.00	$933.00	—	89% above	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 Dx Foot Complete Left	$933.00	$933.00	—	89% above	—
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Dx Foot Complete Right	$933.00	$933.00	—	—	—
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Dx Foot Complete Left	$933.00	$933.00	—	—	—
X-ray of the hand, 3 or more views one side CPT 73130 Dx Hand Complete Right	$1,580.00	$1,580.00	—	211% above	—
X-ray of the hand, 3 or more views one side CPT 73130 Dx Hand Complete Left	$1,580.00	$1,580.00	—	211% above	—
X-ray of the hand, 3 or more views inpatient one side CPT 73130 Dx Hand Complete Left	$1,580.00	$1,580.00	—	—	—
X-ray of the hand, 3 or more views inpatient one side CPT 73130 Dx Hand Complete Right	$1,580.00	$1,580.00	—	—	—
X-ray of the knee, 1 or 2 views one side CPT 73560 Dx Knee Limited Left	$844.00	$844.00	—	113% above	—
X-ray of the knee, 1 or 2 views one side CPT 73560 Dx Knee Limited Right	$844.00	$844.00	—	113% above	—
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Dx Knee Limited Left	$844.00	$844.00	—	—	—
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Dx Knee Limited Right	$844.00	$844.00	—	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Lumbar Limited	$1,676.00	$1,676.00	—	256% above	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Lumbar Limited	$1,676.00	$1,676.00	—	—	—
X-ray of the lower back, 4 or more views CPT 72110 Lumbosacral Complete	$2,328.00	$2,328.00	—	257% above	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 Lumbosacral Complete	$2,328.00	$2,328.00	—	—	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Thoracic	$1,431.00	$1,431.00	—	210% above	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Dx Neuro T-Spine Flex/Ext Stan	$1,527.00	$1,527.00	—	231% above	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Dx Neuro T-Spine Ap/Latera	$1,527.00	$1,527.00	—	231% above	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Thoracic	$1,431.00	$1,431.00	—	—	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Dx Neuro T-Spine Ap/Latera	$1,527.00	$1,527.00	—	—	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Dx Neuro T-Spine Flex/Ext Stan	$1,527.00	$1,527.00	—	—	—
X-ray of the nasal bones, 3 or more views CPT 70160 Nasal Bones	$5,947.00	$5,947.00	—	1275% above	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Nasal Bones	$5,947.00	$5,947.00	—	—	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Cervical 2 Views	$1,654.00	$1,654.00	—	267% above	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Dx Neuro C-Spine Lat Flex/Ext	$1,725.00	$1,725.00	—	283% above	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Dx Neuro C-Spine Ap/Lateral	$1,725.00	$1,725.00	—	283% above	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Cervical 2 Views	$1,654.00	$1,654.00	—	—	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Dx Neuro C-Spine Ap/Lateral	$1,725.00	$1,725.00	—	—	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Dx Neuro C-Spine Lat Flex/Ext	$1,725.00	$1,725.00	—	—	—
X-ray of the pelvis, 1 or 2 views CPT 72170 Pelvis Limited 1-2 View	$1,154.00	$1,154.00	—	200% above	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Pelvis Limited 1-2 View	$1,154.00	$1,154.00	—	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Sacrum And Coccyx	$1,384.00	$1,384.00	—	194% above	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Sacrum And Coccyx	$1,384.00	$1,384.00	—	—	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs California	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Sgpt	$238.00	$238.00	—	452% above	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Sgpt	$238.00	$238.00	—	—	—
AST (aspartate aminotransferase) enzyme test CPT 84450 Sgot	$288.00	$288.00	—	535% above	—
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Sgot	$288.00	$288.00	—	—	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel, Acute S.O.	$177.00	$177.00	—	35% below	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel, Acute	$322.00	$322.00	—	18% above	—
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Panel, Acute S.O.	$177.00	$177.00	—	—	—
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Panel, Acute	$322.00	$322.00	—	—	—
Albumin blood test CPT 82040 Assay Of Serum Albumin	$20.00	$20.00	—	20% below	—
Albumin blood test CPT 82040 Albumin	$96.00	$96.00	—	285% above	—
Albumin blood test inpatient CPT 82040 Assay Of Serum Albumin	$20.00	$20.00	—	—	—
Albumin blood test inpatient CPT 82040 Albumin	$96.00	$96.00	—	—	—
Alkaline phosphatase (ALP) blood test CPT 84075 Phosphatase-Alk	$99.00	$99.00	—	168% above	—
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Phosphatase-Alk	$99.00	$99.00	—	—	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy - Tree Nut	$9.00	$9.00	—	80% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Shellfish Panel	$21.00	$21.00	—	320% above	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy - Tree Nut	$9.00	$9.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Shellfish Panel	$21.00	$21.00	—	—	—
Ammonia blood test CPT 82140 Ammonia Blood	$438.00	$438.00	—	142% above	—
Ammonia blood test inpatient CPT 82140 Ammonia Blood	$438.00	$438.00	—	—	—
Amylase blood test CPT 82150 Amylase Urn Tmd Spec	$336.00	$336.00	—	558% above	—
Amylase blood test CPT 82150 Amylase	$369.00	$369.00	—	622% above	—
Amylase blood test CPT 82150 Amylase Urine Or Othr Body Flu	$369.00	$369.00	—	622% above	—
Amylase blood test inpatient CPT 82150 Amylase Urn Tmd Spec	$336.00	$336.00	—	—	—
Amylase blood test inpatient CPT 82150 Amylase Urine Or Othr Body Flu	$369.00	$369.00	—	—	—
Amylase blood test inpatient CPT 82150 Amylase	$369.00	$369.00	—	—	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Brain Natriuretic Peptide	$527.00	$527.00	—	185% above	—
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Brain Natriuretic Peptide	$527.00	$527.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial Culture Genital	$166.00	$166.00	—	38% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Water Analysis	$228.00	$228.00	—	89% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Environmental	$228.00	$228.00	—	89% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Cs Sterility Check	$228.00	$228.00	—	89% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial Culture Nasal	$228.00	$228.00	—	89% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial Culture Bone Marrow	$228.00	$228.00	—	89% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Throat De	$250.00	$250.00	—	107% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial Culture Csf	$250.00	$250.00	—	107% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial Culture Ear	$250.00	$250.00	—	107% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial Culture Eye	$250.00	$250.00	—	107% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial Culture Respiratory	$250.00	$250.00	—	107% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Catheters	$250.00	$250.00	—	107% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial Culture Medic Device	$250.00	$250.00	—	107% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial Culture Sputum	$250.00	$250.00	—	107% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) one side CPT 87070 Cult Rt Aerobic	$250.00	$250.00	—	107% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bacterial Culture Genital	$166.00	$166.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bacterial Culture Nasal	$228.00	$228.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Water Analysis	$228.00	$228.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Environmental	$228.00	$228.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Cs Sterility Check	$228.00	$228.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bacterial Culture Bone Marrow	$228.00	$228.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bacterial Culture Csf	$250.00	$250.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bacterial Culture Respiratory	$250.00	$250.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bacterial Culture Medic Device	$250.00	$250.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bacterial Culture Eye	$250.00	$250.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Catheters	$250.00	$250.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bacterial Culture Ear	$250.00	$250.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bacterial Culture Sputum	$250.00	$250.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Throat De	$250.00	$250.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient one side CPT 87070 Cult Rt Aerobic	$250.00	$250.00	—	—	—
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$457.00	$457.00	—	137% above	—
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel	$457.00	$457.00	—	—	—
Bilirubin blood test, total CPT 82247 Bilirubin Amniotic Fluid	$159.00	$159.00	—	251% above	—
Bilirubin blood test, total CPT 82247 Bilirubin-Total	$176.00	$176.00	—	289% above	—
Bilirubin blood test, total CPT 82247 Bilirubin Body Fluid	$176.00	$176.00	—	289% above	—
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Amniotic Fluid	$159.00	$159.00	—	—	—
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Body Fluid	$176.00	$176.00	—	—	—
Bilirubin blood test, total inpatient CPT 82247 Bilirubin-Total	$176.00	$176.00	—	—	—
Blood culture for bacteria CPT 87040 Culture Blood	$668.00	$668.00	—	145% above	—
Blood culture for bacteria inpatient CPT 87040 Culture Blood	$668.00	$668.00	—	—	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture	$10.00	$10.00	—	52% below	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Fac Fee Routine Venipuncture	$64.00	$64.00	—	204% above	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Rt Vbg Venipuncture	$140.00	$140.00	—	566% above	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture	$10.00	$10.00	—	—	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Fac Fee Routine Venipuncture	$64.00	$64.00	—	—	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Rt Vbg Venipuncture	$140.00	$140.00	—	—	—
Blood glucose (sugar) test CPT 82947 Poc Glucose	$50.00	$50.00	—	33% above	—
Blood glucose (sugar) test CPT 82947 Assay Glucose Blood Quant	$78.00	$78.00	—	108% above	—
Blood glucose (sugar) test CPT 82947 Rt Glucose	$109.00	$109.00	—	191% above	—
Blood glucose (sugar) test CPT 82947 Glucose	$109.00	$109.00	—	191% above	—
Blood glucose (sugar) test inpatient CPT 82947 Poc Glucose	$50.00	$50.00	—	—	—
Blood glucose (sugar) test inpatient CPT 82947 Assay Glucose Blood Quant	$78.00	$78.00	—	—	—
Blood glucose (sugar) test inpatient CPT 82947 Glucose	$109.00	$109.00	—	—	—
Blood glucose (sugar) test inpatient CPT 82947 Rt Glucose	$109.00	$109.00	—	—	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hcg,Serum Qualitative	$396.00	$396.00	—	148% above	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Hcg,Serum Qualitative	$396.00	$396.00	—	—	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo	$196.00	$196.00	—	90% above	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Abo	$196.00	$196.00	—	—	—
Blood urea nitrogen (BUN) test CPT 84520 Urea Nitrogen	$99.00	$99.00	—	199% above	—
Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea Nitrogen	$99.00	$99.00	—	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Crp	$191.00	$191.00	—	254% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 Crp	$191.00	$191.00	—	—	—
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium Difficile Pcr	$223.00	$223.00	—	46% above	—
C. difficile toxin gene test (stool PCR) CPT 87493 C Diff Amplified Probe	$448.00	$448.00	—	193% above	—
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Clostridium Difficile Pcr	$223.00	$223.00	—	—	—
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C Diff Amplified Probe	$448.00	$448.00	—	—	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Rapid Covid-19	$193.00	$193.00	—	104% above	—
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Rapid Covid-19	$193.00	$193.00	—	—	—
Calcium blood test, total CPT 82310 Calcium Blood	$202.00	$202.00	—	231% above	—
Calcium blood test, total inpatient CPT 82310 Calcium Blood	$202.00	$202.00	—	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlmyd Trach Dna Amp Probe	$33.00	$33.00	—	40% below	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia By Pcr	$270.00	$270.00	—	395% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlmyd Trach Dna Amp Probe	$33.00	$33.00	—	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia By Pcr	$270.00	$270.00	—	—	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$42.00	$42.00	—	59% below	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lpd Pnl W/Rflx To Direct Ldl	$79.00	$79.00	—	22% below	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$42.00	$42.00	—	—	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lpd Pnl W/Rflx To Direct Ldl	$79.00	$79.00	—	—	—
Complete blood count (CBC) with differential CPT 85025 Cbc With Auto Diff	$314.00	$314.00	—	183% above	—
Complete blood count (CBC) with differential inpatient CPT 85025 Cbc With Auto Diff	$314.00	$314.00	—	—	—
Complete blood count (CBC), no differential CPT 85027 Hemogram Automated	$308.00	$308.00	—	250% above	—
Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram Automated	$308.00	$308.00	—	—	—
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$504.00	$504.00	—	97% above	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$504.00	$504.00	—	—	—
Creatine kinase (CK) blood test, total CPT 82550 Cpk	$268.00	$268.00	—	207% above	—
Creatine kinase (CK) blood test, total inpatient CPT 82550 Cpk	$268.00	$268.00	—	—	—
Creatinine blood test CPT 82565 Creatinine Blood	$99.00	$99.00	—	114% above	—
Creatinine blood test inpatient CPT 82565 Creatinine Blood	$99.00	$99.00	—	—	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Monitor Pnl 5 W/Conf Urin	$82.00	$82.00	—	32% above	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 Fentanyl Level, Ur	$263.00	$263.00	—	324% above	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 Urine Drugs Of Abuse Screen Nb	$1,074.00	$1,074.00	—	1632% above	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 Asa Qual	$1,100.00	$1,100.00	—	1674% above	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 Acetaminophen Level	$1,217.00	$1,217.00	—	1863% above	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Monitor Pnl 5 W/Conf Urin	$82.00	$82.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Fentanyl Level, Ur	$263.00	$263.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Urine Drugs Of Abuse Screen Nb	$1,074.00	$1,074.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Asa Qual	$1,100.00	$1,100.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Acetaminophen Level	$1,217.00	$1,217.00	—	—	—
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte Panel	$330.00	$330.00	—	292% above	—
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte Panel	$330.00	$330.00	—	—	—
Ferritin blood test (iron stores) CPT 82728 Ferritin	$298.00	$298.00	—	179% above	—
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$298.00	$298.00	—	—	—
Fibrinogen blood test CPT 85384 Ck Angle (Degrees)	$28.00	$28.00	—	79% below	—
Fibrinogen blood test CPT 85384 Ck K (Min)	$28.00	$28.00	—	79% below	—
Fibrinogen blood test CPT 85384 Fibrinogen-Quant	$219.00	$219.00	—	64% above	—
Fibrinogen blood test inpatient CPT 85384 Ck Angle (Degrees)	$28.00	$28.00	—	—	—
Fibrinogen blood test inpatient CPT 85384 Ck K (Min)	$28.00	$28.00	—	—	—
Fibrinogen blood test inpatient CPT 85384 Fibrinogen-Quant	$219.00	$219.00	—	—	—
Free T3 thyroid hormone test CPT 84481 Ft3 (Free T3)	$284.00	$284.00	—	251% above	—
Free T3 thyroid hormone test inpatient CPT 84481 Ft3 (Free T3)	$284.00	$284.00	—	—	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Free	$230.00	$230.00	—	238% above	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 Free	$230.00	$230.00	—	—	—
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Ggt	$199.00	$199.00	—	337% above	—
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Ggt	$199.00	$199.00	—	—	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Post Load	$278.00	$278.00	—	435% above	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose Post Load	$278.00	$278.00	—	—	—
Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerance-Fbs 1Hr,2Hr	$400.00	$400.00	—	192% above	—
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose Tolerance-Fbs 1Hr,2Hr	$400.00	$400.00	—	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.Gonorrhoeae Dna Amp Prob	$33.00	$33.00	—	45% below	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae Rna, Tma	$58.00	$58.00	—	3% below	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrheae By Pcr	$270.00	$270.00	—	352% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.Gonorrhoeae Dna Amp Prob	$33.00	$33.00	—	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Gonorrhoeae Rna, Tma	$58.00	$58.00	—	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Gonorrheae By Pcr	$270.00	$270.00	—	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Glycohemoglobin	$37.00	$37.00	—	43% below	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Glycohemoglobin	$37.00	$37.00	—	—	—
Hemoglobin blood test CPT 85018 Poc Hemoglobin	$50.00	$50.00	—	24% above	—
Hemoglobin blood test CPT 85018 Rt Hemoglobin	$81.00	$81.00	—	101% above	—
Hemoglobin blood test CPT 85018 Hgb	$81.00	$81.00	—	101% above	—
Hemoglobin blood test inpatient CPT 85018 Poc Hemoglobin	$50.00	$50.00	—	—	—
Hemoglobin blood test inpatient CPT 85018 Rt Hemoglobin	$81.00	$81.00	—	—	—
Hemoglobin blood test inpatient CPT 85018 Hgb	$81.00	$81.00	—	—	—
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Ab Total	$81.00	$81.00	—	131% above	—
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Ab Total	$81.00	$81.00	—	—	—
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein Hs	$44.00	$44.00	—	26% below	—
High-sensitivity CRP (hs-CRP) test CPT 86141 Hs-Crp	$286.00	$286.00	—	384% above	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein Hs	$44.00	$44.00	—	—	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 Hs-Crp	$286.00	$286.00	—	—	—
Iron blood test (serum iron) CPT 83540 Iron	$220.00	$220.00	—	278% above	—
Iron blood test (serum iron) inpatient CPT 83540 Iron	$220.00	$220.00	—	—	—
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity	$125.00	$125.00	—	71% above	—
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity	$125.00	$125.00	—	—	—
Kidney function blood test panel CPT 80069 Renal Function Panel	$307.00	$307.00	—	116% above	—
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$307.00	$307.00	—	—	—
Lactate (lactic acid) blood test CPT 83605 Poct Lactate Venous	$55.00	$55.00	—	59% below	—
Lactate (lactic acid) blood test CPT 83605 Lactate Lvl Poct-Lab	$300.00	$300.00	—	125% above	—
Lactate (lactic acid) blood test CPT 83605 Lactic Acid	$329.00	$329.00	—	146% above	—
Lactate (lactic acid) blood test CPT 83605 Rt Lactic Acid	$329.00	$329.00	—	146% above	—
Lactate (lactic acid) blood test inpatient CPT 83605 Poct Lactate Venous	$55.00	$55.00	—	—	—
Lactate (lactic acid) blood test inpatient CPT 83605 Lactate Lvl Poct-Lab	$300.00	$300.00	—	—	—
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid	$329.00	$329.00	—	—	—
Lactate (lactic acid) blood test inpatient CPT 83605 Rt Lactic Acid	$329.00	$329.00	—	—	—
Lactate dehydrogenase (LDH) blood test CPT 83615 Ldh	$148.00	$148.00	—	320% above	—
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Ldh	$148.00	$148.00	—	—	—
Lipase blood test (pancreas enzyme) CPT 83690 Lipase	$385.00	$385.00	—	299% above	—
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Body Fluid	$385.00	$385.00	—	299% above	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase	$385.00	$385.00	—	—	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Body Fluid	$385.00	$385.00	—	—	—
Liver function blood test panel CPT 80076 Liver Panel	$528.00	$528.00	—	249% above	—
Liver function blood test panel inpatient CPT 80076 Liver Panel	$528.00	$528.00	—	—	—
Magnesium blood test CPT 83735 Magnesium	$292.00	$292.00	—	367% above	—
Magnesium blood test CPT 83735 Magnesium Level 24 Hour Urine	$292.00	$292.00	—	367% above	—
Magnesium blood test CPT 83735 Magnesium Level Urine	$292.00	$292.00	—	367% above	—
Magnesium blood test inpatient CPT 83735 Magnesium Level 24 Hour Urine	$292.00	$292.00	—	—	—
Magnesium blood test inpatient CPT 83735 Magnesium	$292.00	$292.00	—	—	—
Magnesium blood test inpatient CPT 83735 Magnesium Level Urine	$292.00	$292.00	—	—	—
Mono test (heterophile antibody, Monospot) CPT 86308 Heterophile	$476.00	$476.00	—	363% above	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Heterophile	$476.00	$476.00	—	—	—
Parathyroid hormone (PTH) blood test CPT 83970 Intact Parathyroid Hormone	$410.00	$410.00	—	273% above	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Intact Parathyroid Hormone	$410.00	$410.00	—	—	—
Partial thromboplastin time (PTT) clotting test CPT 85730 Ptt-La W/Rflx To Hex Phs Conf	$15.00	$15.00	—	76% below	—
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$360.00	$360.00	—	476% above	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Ptt-La W/Rflx To Hex Phs Conf	$15.00	$15.00	—	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time	$360.00	$360.00	—	—	—
Phosphorus (phosphate) blood test CPT 84100 Phosphorus	$215.00	$215.00	—	184% above	—
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus	$215.00	$215.00	—	—	—
Potassium blood test CPT 84132 Poc Potassium	$50.00	$50.00	—	32% below	—
Potassium blood test CPT 84132 Assay Of Serum Potassium	$78.00	$78.00	—	7% above	—
Potassium blood test CPT 84132 Potassium Blood	$99.00	$99.00	—	35% above	—
Potassium blood test inpatient CPT 84132 Poc Potassium	$50.00	$50.00	—	—	—
Potassium blood test inpatient CPT 84132 Assay Of Serum Potassium	$78.00	$78.00	—	—	—
Potassium blood test inpatient CPT 84132 Potassium Blood	$99.00	$99.00	—	—	—
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time	$230.00	$230.00	—	319% above	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time	$230.00	$230.00	—	—	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Group A Streptococcal Antigen	$358.00	$358.00	—	232% above	—
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Group A Streptococcal Antigen	$358.00	$358.00	—	—	—
Rh blood typing CPT 86901 Rh (D)	$188.00	$188.00	—	238% above	—
Rh blood typing inpatient CPT 86901 Rh (D)	$188.00	$188.00	—	—	—
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Quantitative	$101.00	$101.00	—	665% above	—
Rheumatoid factor (RF) test CPT 86431 Rf Titer	$153.00	$153.00	—	1059% above	—
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor Quantitative	$101.00	$101.00	—	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 Rf Titer	$153.00	$153.00	—	—	—
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sed Rate (Esr)	$321.00	$321.00	—	473% above	—
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sed Rate (Esr)	$321.00	$321.00	—	—	—
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Ana Complete	$5,832.00	$5,832.00	—	4099% above	—
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen Ana Complete	$5,832.00	$5,832.00	—	—	—
Sodium blood test CPT 84295 Poc Sodium	$50.00	$50.00	—	24% below	—
Sodium blood test CPT 84295 Assay Of Serum Sodium	$78.00	$78.00	—	19% above	—
Sodium blood test CPT 84295 Sodium Blood	$99.00	$99.00	—	51% above	—
Sodium blood test inpatient CPT 84295 Poc Sodium	$50.00	$50.00	—	—	—
Sodium blood test inpatient CPT 84295 Assay Of Serum Sodium	$78.00	$78.00	—	—	—
Sodium blood test inpatient CPT 84295 Sodium Blood	$99.00	$99.00	—	—	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood	$8.00	$8.00	—	79% below	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Feces Single Det	$10.00	$10.00	—	74% below	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood	$8.00	$8.00	—	—	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Feces Single Det	$10.00	$10.00	—	—	—
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Assay Test For Blood Fecal	$49.00	$49.00	—	at median	—
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Assay Test For Blood Fecal	$49.00	$49.00	—	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rpr	$266.00	$266.00	—	1882% above	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rpr	$266.00	$266.00	—	—	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon Tb Gold Plus 1 Tub	$37.00	$37.00	—	56% below	—
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon Tb Gold Plus 1 Tub	$37.00	$37.00	—	—	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal Ab Ea	$45.00	$45.00	—	97% above	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Microsomal Ab Ea	$45.00	$45.00	—	—	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$54.00	$54.00	—	42% below	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh, Third Generation	$257.00	$257.00	—	178% above	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyr/Stim/Hormone	$284.00	$284.00	—	207% above	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$54.00	$54.00	—	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Tsh, Third Generation	$257.00	$257.00	—	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyr/Stim/Hormone	$284.00	$284.00	—	—	—
Total cholesterol blood test CPT 82465 Cholesterol Body Fluid	$85.00	$85.00	—	102% above	—
Total cholesterol blood test CPT 82465 Cholesterol Total	$85.00	$85.00	—	102% above	—
Total cholesterol blood test inpatient CPT 82465 Cholesterol Body Fluid	$85.00	$85.00	—	—	—
Total cholesterol blood test inpatient CPT 82465 Cholesterol Total	$85.00	$85.00	—	—	—
Triglycerides blood test CPT 84478 Triglycerides	$193.00	$193.00	—	370% above	—
Triglycerides blood test inpatient CPT 84478 Triglycerides	$193.00	$193.00	—	—	—
Troponin test, quantitative CPT 84484 Troponin	$1,353.00	$1,353.00	—	655% above	—
Troponin test, quantitative inpatient CPT 84484 Troponin	$1,353.00	$1,353.00	—	—	—
Uric acid blood test CPT 84550 Uric Acid, Serum	$111.00	$111.00	—	68% above	—
Uric acid blood test inpatient CPT 84550 Uric Acid, Serum	$111.00	$111.00	—	—	—
Urinalysis with microscope exam, automated one side CPT 81001 Urinalysis Rt, Auto W/ Micro	$426.00	$426.00	—	414% above	—
Urinalysis with microscope exam, automated inpatient one side CPT 81001 Urinalysis Rt, Auto W/ Micro	$426.00	$426.00	—	—	—
Urinalysis with microscope exam, manual CPT 81000 Ua W/ Micro	$9.00	$9.00	—	72% below	—
Urinalysis with microscope exam, manual CPT 81000 Urinalysis Nonauto W/Scope	$11.00	$11.00	—	65% below	—
Urinalysis with microscope exam, manual inpatient CPT 81000 Ua W/ Micro	$9.00	$9.00	—	—	—
Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis Nonauto W/Scope	$11.00	$11.00	—	—	—
Urinalysis without microscope exam, automated one side CPT 81003 Urinalysis Rt, Auto W/O Micro	$236.00	$236.00	—	321% above	—
Urinalysis without microscope exam, automated inpatient one side CPT 81003 Urinalysis Rt, Auto W/O Micro	$236.00	$236.00	—	—	—
Urinalysis without microscope exam, manual CPT 81002 Ua W/O Micro	$8.00	$8.00	—	77% below	—
Urinalysis without microscope exam, manual CPT 81002 Ua Wo Micro	$10.00	$10.00	—	71% below	—
Urinalysis without microscope exam, manual CPT 81002 Acetone Urine Ql	$298.00	$298.00	—	771% above	—
Urinalysis without microscope exam, manual CPT 81002 Specific Gravity,Urine	$298.00	$298.00	—	771% above	—
Urinalysis without microscope exam, manual one side CPT 81002 Urinalysis Rt, Non-Auto W/O Mi	$271.00	$271.00	—	692% above	—
Urinalysis without microscope exam, manual inpatient CPT 81002 Ua W/O Micro	$8.00	$8.00	—	—	—
Urinalysis without microscope exam, manual inpatient CPT 81002 Ua Wo Micro	$10.00	$10.00	—	—	—
Urinalysis without microscope exam, manual inpatient CPT 81002 Acetone Urine Ql	$298.00	$298.00	—	—	—
Urinalysis without microscope exam, manual inpatient CPT 81002 Specific Gravity,Urine	$298.00	$298.00	—	—	—
Urinalysis without microscope exam, manual inpatient one side CPT 81002 Urinalysis Rt, Non-Auto W/O Mi	$271.00	$271.00	—	—	—
Urine culture for bacteria, with colony count CPT 87086 Bacterial Culture Urine	$454.00	$454.00	—	226% above	—
Urine culture for bacteria, with colony count inpatient CPT 87086 Bacterial Culture Urine	$454.00	$454.00	—	—	—
Urine microalbumin (albumin) test CPT 82043 Microalbumin 24 Hour Urine	$104.00	$104.00	—	183% above	—
Urine microalbumin (albumin) test CPT 82043 Microalbumin Urine	$104.00	$104.00	—	183% above	—
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Urine	$104.00	$104.00	—	—	—
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin 24 Hour Urine	$104.00	$104.00	—	—	—
Urine pregnancy test, read by color change CPT 81025 Pregnancy Test	$20.00	$20.00	—	77% below	—
Urine pregnancy test, read by color change CPT 81025 Hcg, Urine	$331.00	$331.00	—	276% above	—
Urine pregnancy test, read by color change inpatient CPT 81025 Pregnancy Test	$20.00	$20.00	—	—	—
Urine pregnancy test, read by color change inpatient CPT 81025 Hcg, Urine	$331.00	$331.00	—	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitmain D 25 Total	$207.00	$207.00	—	224% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D	$210.00	$210.00	—	228% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitd 25 Hydroxy Tot Immunoassa	$230.00	$230.00	—	260% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitmain D 25 Total	$207.00	$207.00	—	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D	$210.00	$210.00	—	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitd 25 Hydroxy Tot Immunoassa	$230.00	$230.00	—	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Quantitative Hcg	$396.00	$396.00	—	121% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Quantitative Hcg	$396.00	$396.00	—	—	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Appendectomy, open surgery CPT 44950 Appendectomy	$1,797.66	$1,797.66	—	81% below	—
Appendectomy, open surgery inpatient CPT 44950 Appendectomy	$1,797.66	$1,797.66	—	—	—
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Arthrosc Ant Cruciate Lig Rep	$20,575.00	$20,575.00	—	122% above	—
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 Arthrosc Ant Cruciate Lig Rep	$20,575.00	$20,575.00	—	—	—
Arthroscopic rotator cuff repair of the shoulder CPT 29827 Arthrosc Shldr W/Rotr Cuff Rpr	$15,198.00	$15,198.00	—	101% above	—
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 Arthrosc Shldr W/Rotr Cuff Rpr	$15,198.00	$15,198.00	—	—	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Xr Breast Perc Needle Core	$2,109.00	$2,109.00	—	51% below	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Breast Vac Assist(Stereotactic	$6,260.00	$6,260.00	—	44% above	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Xr Breast Perc Needle Core	$2,109.00	$2,109.00	—	—	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Breast Vac Assist(Stereotactic	$6,260.00	$6,260.00	—	—	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Fracture Care - Metatarsal Eac	$1,796.00	$1,796.00	—	234% above	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Clsd Tx Mttrsl Fx W/O Mnpltn	$4,742.00	$4,742.00	—	782% above	—
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Fracture Care - Metatarsal Eac	$1,796.00	$1,796.00	—	—	—
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Clsd Tx Mttrsl Fx W/O Mnpltn	$4,742.00	$4,742.00	—	—	—
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Corrct Hallux Vlgs W/Ses W/Dis	$9,046.00	$9,046.00	—	116% above	—
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 Corrct Hallux Vlgs W/Ses W/Dis	$9,046.00	$9,046.00	—	—	—
Bunion correction with removal of part of the big toe joint CPT 28292 Keller/Mcbride/Mayo Bunion	$8,789.00	$8,789.00	—	76% above	—
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 Keller/Mcbride/Mayo Bunion	$8,789.00	$8,789.00	—	—	—
Cardiac catheterization with coronary angiogram CPT 93458 L Hrt Artery/Ventricle Angio	$3,434.17	$3,434.17	—	73% below	—
Cardiac catheterization with coronary angiogram inpatient CPT 93458 L Hrt Artery/Ventricle Angio	$3,434.17	$3,434.17	—	—	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion	$2,254.00	$2,254.00	—	18% above	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Elective Externa	$5,366.00	$5,366.00	—	180% above	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 Elective Cardioversion	$6,729.00	$6,729.00	—	252% above	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion	$2,254.00	$2,254.00	—	—	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Elective Externa	$5,366.00	$5,366.00	—	—	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Elective Cardioversion	$6,729.00	$6,729.00	—	—	—
Carpal tunnel release, open surgery CPT 64721 Carpal Tunnel Surgery	$8,342.00	$8,342.00	—	131% above	—
Carpal tunnel release, open surgery inpatient CPT 64721 Carpal Tunnel Surgery	$8,342.00	$8,342.00	—	—	—
Cataract surgery with lens implant CPT 66984 Cataract Surg W/Iol 1 Stage	$4,025.00	$4,025.00	—	20% below	—
Cataract surgery with lens implant inpatient CPT 66984 Cataract Surg W/Iol 1 Stage	$4,025.00	$4,025.00	—	—	—
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Circum 28 Days Or Older	$5,642.00	$5,642.00	—	21% above	—
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 Circum 28 Days Or Older	$5,642.00	$5,642.00	—	—	—
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision W/Regionl Block	$4,081.00	$4,081.00	—	144% above	—
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision W/Regionl Block	$4,081.00	$4,081.00	—	—	—
Circumcision, surgical, older than a newborn CPT 54160 Circumcision Other Than Clamp	$542.48	$542.48	—	at median	—
Circumcision, surgical, older than a newborn inpatient CPT 54160 Circumcision Other Than Clamp	$542.48	$542.48	—	—	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Fx Care -Distal Radius - Witho	$1,796.00	$1,796.00	—	222% above	—
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Fx Care -Distal Radius - Witho	$1,796.00	$1,796.00	—	—	—
Colonoscopy with polyp removal CPT 45385 Colonoscopy W/Lesion Removal	$1,379.91	$1,379.91	—	40% below	—
Colonoscopy with polyp removal inpatient CPT 45385 Colonoscopy W/Lesion Removal	$1,379.91	$1,379.91	—	—	—
Colonoscopy with tissue sample CPT 45380 Colonoscopy And Biopsy	$1,344.25	$1,344.25	—	42% below	—
Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy And Biopsy	$1,344.25	$1,344.25	—	—	—
Colonoscopy, diagnostic CPT 45378 Diagnostic Colonoscopy	$1,027.04	$1,027.04	—	51% below	—
Colonoscopy, diagnostic inpatient CPT 45378 Diagnostic Colonoscopy	$1,027.04	$1,027.04	—	—	—
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 Colposcopy W/ Loope Electrode	$957.26	$957.26	—	79% below	—
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 Colposcopy W/ Loope Electrode	$957.26	$957.26	—	—	—
Complex cataract surgery with lens implant CPT 66982 Cataract Surgery Complex	$4,523.00	$4,523.00	—	13% above	—
Complex cataract surgery with lens implant inpatient CPT 66982 Cataract Surgery Complex	$4,523.00	$4,523.00	—	—	—
Cystoscopy with ureteral stent placement CPT 52332 Cysto W/Insrt Urtrl Stnt	$6,293.00	$6,293.00	—	16% below	—
Cystoscopy with ureteral stent placement inpatient CPT 52332 Cysto W/Insrt Urtrl Stnt	$6,293.00	$6,293.00	—	—	—
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystoscopy	$6,421.00	$6,421.00	—	297% above	—
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Cystoscopy	$6,421.00	$6,421.00	—	—	—
D&C (dilation and curettage), not related to pregnancy CPT 58120 Dilation And Curettage	$5,370.00	$5,370.00	—	27% above	—
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 Dilation And Curettage	$5,370.00	$5,370.00	—	—	—
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 Create Eardrum Opening	$5,800.00	$5,800.00	—	at median	—
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 Create Eardrum Opening	$5,800.00	$5,800.00	—	—	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 Remove Impacted Wax Irrig	$1,753.00	$1,753.00	—	887% above	—
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Remove Impacted Wax Irrig	$1,753.00	$1,753.00	—	—	—
Earwax removal with instruments, one ear CPT 69210 Remove Impacted Wax Requi	$1,753.00	$1,753.00	—	828% above	—
Earwax removal with instruments, one ear inpatient CPT 69210 Remove Impacted Wax Requi	$1,753.00	$1,753.00	—	—	—
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 Exploration Maxillary Sinus	$7,060.00	$7,060.00	—	6% above	—
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 Exploration Maxillary Sinus	$7,060.00	$7,060.00	—	—	—
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Njx Intrlamnr Crv/Thrc W/Img	$4,808.00	$4,808.00	—	97% above	—
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Njx Intrlamnr Crv/Thrc W/Img	$4,808.00	$4,808.00	—	—	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj Paravert F Jnt L/S 1 Lev	$3,810.00	$3,810.00	—	85% above	—
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Inj Paravert F Jnt L/S 1 Lev	$3,810.00	$3,810.00	—	—	—
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Diagnostic Sigmoidoscopy	$568.90	$568.90	—	69% below	—
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Diagnostic Sigmoidoscopy	$568.90	$568.90	—	—	—
Gallbladder removal, laparoscopic CPT 47562 Laparoscopic Cholecystectomy	$17,689.00	$17,689.00	—	34% above	—
Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopic Cholecystectomy	$17,689.00	$17,689.00	—	—	—
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Lap Cholecystctmy W Colangio	$10,836.00	$10,836.00	—	16% above	—
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 Lap Cholecystctmy W Colangio	$10,836.00	$10,836.00	—	—	—
Hammertoe correction surgery CPT 28285 Repair Of Hammertoe	$7,736.00	$7,736.00	—	85% above	—
Hammertoe correction surgery inpatient CPT 28285 Repair Of Hammertoe	$7,736.00	$7,736.00	—	—	—
Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoid Ligation	$1,960.00	$1,960.00	—	5% above	—
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 Hemorrhoid Ligation	$1,960.00	$1,960.00	—	—	—
Hemorrhoidectomy (internal and external), one area CPT 46255 Remove Int/Ext Hem 1 Group	$1,577.53	$1,577.53	—	65% below	—
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 Remove Int/Ext Hem 1 Group	$1,577.53	$1,577.53	—	—	—
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Hsg	$901.00	$901.00	—	44% above	—
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Hsg	$901.00	$901.00	—	—	—
Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy Ablation	$14,465.00	$14,465.00	—	126% above	—
Hysteroscopy with endometrial ablation inpatient CPT 58563 Hysteroscopy Ablation	$14,465.00	$14,465.00	—	—	—
Incision and drainage of a simple or single skin abscess CPT 10060 Fac Fee I And D Abscess Simple	$442.00	$442.00	—	6% below	—
Incision and drainage of a simple or single skin abscess CPT 10060 I D Skin Abscess Simple/S	$4,148.00	$4,148.00	—	786% above	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Fac Fee I And D Abscess Simple	$442.00	$442.00	—	—	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I D Skin Abscess Simple/S	$4,148.00	$4,148.00	—	—	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection For Pain - Tendon Or	$1,796.00	$1,796.00	—	172% above	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Tendon Sheath/Ligament	$2,822.00	$2,822.00	—	327% above	—
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Injection For Pain - Tendon Or	$1,796.00	$1,796.00	—	—	—
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj Tendon Sheath/Ligament	$2,822.00	$2,822.00	—	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain/Inj Major Joint W/O Us	$186.17	$186.17	—	80% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Asp/Inj Major Joint	$1,516.00	$1,516.00	—	59% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Major Joint	$1,565.00	$1,565.00	—	64% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Mjr Wo Usg	$2,066.00	$2,066.00	—	117% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Drain/Inj Major Joint W/O Us	$186.17	$186.17	—	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Asp/Inj Major Joint	$1,516.00	$1,516.00	—	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis Major Joint	$1,565.00	$1,565.00	—	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis Mjr Wo Usg	$2,066.00	$2,066.00	—	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis Intermed Joint	$1,317.00	$1,317.00	—	116% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis Intermedia	$2,066.00	$2,066.00	—	240% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis Interm Jt/ Burs	$3,464.00	$3,464.00	—	469% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis Intermed Joint	$1,317.00	$1,317.00	—	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis Intermedia	$2,066.00	$2,066.00	—	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis Interm Jt/ Burs	$3,464.00	$3,464.00	—	—	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis Small Joint	$151.67	$151.67	—	79% below	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis Small Join	$1,796.00	$1,796.00	—	147% above	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Drain/Inj Joint/Bursa W/O Us	$2,813.00	$2,813.00	—	286% above	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis Small Joint	$151.67	$151.67	—	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis Small Join	$1,796.00	$1,796.00	—	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Drain/Inj Joint/Bursa W/O Us	$2,813.00	$2,813.00	—	—	—
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Arthro Knee W Men Rep Med/Lat	$10,454.00	$10,454.00	—	150% above	—
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 Arthro Knee W Men Rep Med/Lat	$10,454.00	$10,454.00	—	—	—
Knee arthroscopy with meniscus trim one side CPT 29881 Arthro Knee W Mnsc Md/Lt W/Shv	$10,383.00	$10,383.00	—	102% above	—
Knee arthroscopy with meniscus trim inpatient one side CPT 29881 Arthro Knee W Mnsc Md/Lt W/Shv	$10,383.00	$10,383.00	—	—	—
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Arthro Knee W Mnsc Md&Lt W/Shv	$10,910.00	$10,910.00	—	161% above	—
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 Arthro Knee W Mnsc Md&Lt W/Shv	$10,910.00	$10,910.00	—	—	—
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Knee Arthro Debrid/Shvg	$9,465.00	$9,465.00	—	at median	—
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 Knee Arthro Debrid/Shvg	$9,465.00	$9,465.00	—	—	—
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 Lap Ing Hernia Repair Init	$13,202.00	$13,202.00	—	17% below	—
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 Lap Ing Hernia Repair Init	$13,202.00	$13,202.00	—	—	—
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Lap Ing Hernia Repair Recur	$13,700.00	$13,700.00	—	at median	—
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 Lap Ing Hernia Repair Recur	$13,700.00	$13,700.00	—	—	—
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy Remove Adnexa	$13,431.00	$13,431.00	—	at median	—
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 Laparoscopy Remove Adnexa	$13,431.00	$13,431.00	—	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Lacrep Intr Scalp <2.6	$2,254.00	$2,254.00	—	160% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Lacrep Intr Scalp <2.6	$2,254.00	$2,254.00	—	—	—
Left heart catheterization, diagnostic CPT 93452 Lft Hrt Cath W/Ventrclgrphy	$12,819.00	$12,819.00	—	29% above	—
Left heart catheterization, diagnostic inpatient CPT 93452 Lft Hrt Cath W/Ventrclgrphy	$12,819.00	$12,819.00	—	—	—
Lower-back epidural injection, with imaging guidance CPT 62323 Njx Intrlamnr Lmbr/Sac W/Img	$4,563.00	$4,563.00	—	106% above	—
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Njx Intrlamnr Lmbr/Sac W/Img	$4,563.00	$4,563.00	—	—	—
Lower-back epidural injection, without imaging guidance CPT 62322 Njx Intrlamnr Lmbr/Sac W/O Img	$7,946.00	$7,946.00	—	344% above	—
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Njx Intrlamnr Lmbr/Sac W/O Img	$7,946.00	$7,946.00	—	—	—
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa/Strd Tfrm Epil L/S 1	$4,990.00	$4,990.00	—	144% above	—
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Njx Aa/Strd Tfrm Epil L/S 1	$4,990.00	$4,990.00	—	—	—
Miscarriage treatment with D&C, first trimester CPT 59820 Surg Tx Missed Abort 1St Tri	$4,469.00	$4,469.00	—	12% below	—
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 Surg Tx Missed Abort 1St Tri	$4,469.00	$4,469.00	—	—	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc Tr-Ext B9+Marg 0.5 Cm<	$2,692.00	$2,692.00	—	103% above	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Exc Tr-Ext B9+Marg 0.5 Cm<	$2,692.00	$2,692.00	—	—	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Exc Face-Mm B9+Marg 0.5Cm/<	$1,874.00	$1,874.00	—	27% above	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Exc Face-Mm B9+Marg 0.5Cm/<	$1,874.00	$1,874.00	—	—	—
Nail removal (partial or complete), one nail CPT 11730 Remove Nail Plate	$2,066.00	$2,066.00	—	310% above	—
Nail removal (partial or complete), one nail CPT 11730 Removal Of Nail Plate	$2,508.00	$2,508.00	—	398% above	—
Nail removal (partial or complete), one nail inpatient CPT 11730 Remove Nail Plate	$2,066.00	$2,066.00	—	—	—
Nail removal (partial or complete), one nail inpatient CPT 11730 Removal Of Nail Plate	$2,508.00	$2,508.00	—	—	—
Occipital nerve block (injection for headaches) CPT 64405 Nerve Block Occipital	$2,066.00	$2,066.00	—	135% above	—
Occipital nerve block (injection for headaches) CPT 64405 N Block Inj Occipital	$2,842.00	$2,842.00	—	223% above	—
Occipital nerve block (injection for headaches) inpatient CPT 64405 Nerve Block Occipital	$2,066.00	$2,066.00	—	—	—
Occipital nerve block (injection for headaches) inpatient CPT 64405 N Block Inj Occipital	$2,842.00	$2,842.00	—	—	—
Paracentesis with imaging guidance CPT 49083 Paracentesis W Image Guid	$2,254.00	$2,254.00	—	23% above	—
Paracentesis with imaging guidance CPT 49083 Paracentesis Abdominal	$3,824.00	$3,824.00	—	108% above	—
Paracentesis with imaging guidance CPT 49083 Abd Paracentesis W/Fluoro	$5,126.00	$5,126.00	—	179% above	—
Paracentesis with imaging guidance inpatient CPT 49083 Paracentesis W Image Guid	$2,254.00	$2,254.00	—	—	—
Paracentesis with imaging guidance inpatient CPT 49083 Paracentesis Abdominal	$3,824.00	$3,824.00	—	—	—
Paracentesis with imaging guidance inpatient CPT 49083 Abd Paracentesis W/Fluoro	$5,126.00	$5,126.00	—	—	—
Partial knee replacement (one compartment) CPT 27446 Arthro Knee C P Medial Lat	$28,205.00	$28,205.00	—	40% above	—
Partial knee replacement (one compartment) inpatient CPT 27446 Arthro Knee C P Medial Lat	$28,205.00	$28,205.00	—	—	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Remove Nail Bed	$2,254.00	$2,254.00	—	74% above	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Removal Of Nail Bed	$4,155.00	$4,155.00	—	221% above	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Remove Nail Bed	$2,254.00	$2,254.00	—	—	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Removal Of Nail Bed	$4,155.00	$4,155.00	—	—	—
Prostate biopsy CPT 55700 Biopsy Prostate	$7,379.00	$7,379.00	—	22% above	—
Prostate biopsy inpatient CPT 55700 Biopsy Prostate	$7,379.00	$7,379.00	—	—	—
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Destroy Lumb/Sac Facet Jnt	$6,465.00	$6,465.00	—	36% above	—
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Destroy Lumb/Sac Facet Jnt	$6,465.00	$6,465.00	—	—	—
Removal of a foreign object under the skin, simple CPT 10120 Remove Foreign Body Simple	$383.78	$383.78	—	61% below	—
Removal of a foreign object under the skin, simple CPT 10120 Foreign Body Removal By I	$2,254.00	$2,254.00	—	129% above	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 Remove Foreign Body Simple	$383.78	$383.78	—	—	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 Foreign Body Removal By I	$2,254.00	$2,254.00	—	—	—
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colorectal Scrn Non High Risk	$2,366.00	$2,366.00	—	at median	—
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 Colorectal Scrn Non High Risk	$2,366.00	$2,366.00	—	—	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal Screening High Risk	$2,150.00	$2,150.00	—	11% below	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 Colorectal Screening High Risk	$2,150.00	$2,150.00	—	—	—
Septoplasty to straighten the nasal septum CPT 30520 Repair Of Nasal Septum	$7,308.00	$7,308.00	—	48% above	—
Septoplasty to straighten the nasal septum inpatient CPT 30520 Repair Of Nasal Septum	$7,308.00	$7,308.00	—	—	—
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 Fragmenting Of Kidney Stone	$13,586.00	$13,586.00	—	73% above	—
Shock-wave lithotripsy to break up kidney stones (from outside the body) one side CPT 50590 Eswl Unilateral	$40,564.00	$40,564.00	—	416% above	—
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 Fragmenting Of Kidney Stone	$13,586.00	$13,586.00	—	—	—
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient one side CPT 50590 Eswl Unilateral	$40,564.00	$40,564.00	—	—	—
Short arm cast (elbow to hand) CPT 29075 Cast - Short Arm	$1,796.00	$1,796.00	—	260% above	—
Short arm cast (elbow to hand) inpatient CPT 29075 Cast - Short Arm	$1,796.00	$1,796.00	—	—	—
Short arm splint (forearm and hand) CPT 29125 Splint Short Arm Static	$1,753.00	$1,753.00	—	318% above	—
Short arm splint (forearm and hand) inpatient CPT 29125 Splint Short Arm Static	$1,753.00	$1,753.00	—	—	—
Short leg cast (below the knee) CPT 29405 Cast - Short Leg	$1,796.00	$1,796.00	—	260% above	—
Short leg cast (below the knee) inpatient CPT 29405 Cast - Short Leg	$1,796.00	$1,796.00	—	—	—
Short leg splint (calf to foot) CPT 29515 Splint Short Leg	$173.43	$173.43	—	65% below	—
Short leg splint (calf to foot) inpatient CPT 29515 Splint Short Leg	$173.43	$173.43	—	—	—
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Arthrosco Shldr Dstl Claviculc	$10,316.00	$10,316.00	—	146% above	—
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 Arthrosco Shldr Dstl Claviculc	$10,316.00	$10,316.00	—	—	—
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Arthr Sho W/Prt Acro W/Rls	$10,813.00	$10,813.00	—	106% above	—
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Arthr Sho W/Prt Acro W/Rls	$10,813.00	$10,813.00	—	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Repair Superficial Wound	$298.00	$298.00	—	46% below	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Lacrep Sim Scalp <2.6	$2,066.00	$2,066.00	—	275% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Repair Superficial Wound	$298.00	$298.00	—	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Lacrep Sim Scalp <2.6	$2,066.00	$2,066.00	—	—	—
Skin biopsy, punch, one lesion CPT 11104 Punch Bx Skin Single Lesion	$321.88	$321.88	—	55% below	—
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Bx Skin Single Lesion	$321.88	$321.88	—	—	—
Skin tag removal, up to 15 tags CPT 11200 Remove Skin Tag 1-15	$1,796.00	$1,796.00	—	354% above	—
Skin tag removal, up to 15 tags inpatient CPT 11200 Remove Skin Tag 1-15	$1,796.00	$1,796.00	—	—	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 Fac Fee Lumbar Puncture	$2,333.00	$2,333.00	—	77% above	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Puncture Lumbar Diagnos	$3,357.00	$3,357.00	—	154% above	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar Puncture	$3,861.00	$3,861.00	—	192% above	—
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Fac Fee Lumbar Puncture	$2,333.00	$2,333.00	—	—	—
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal Puncture Lumbar Diagnos	$3,357.00	$3,357.00	—	—	—
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Lumbar Puncture	$3,861.00	$3,861.00	—	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Lacrep Sim Scalp 2.6-7.5	$2,066.00	$2,066.00	—	176% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Lacrep Sim Scalp 2.6-7.5	$2,066.00	$2,066.00	—	—	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Lacrep Sim Face <2.6	$2,066.00	$2,066.00	—	213% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Lacrep Sim Face <2.6	$2,066.00	$2,066.00	—	—	—
Thoracentesis with imaging guidance CPT 32555 Thrcntss Ndl/Cth Plr W/Imgng	$870.00	$870.00	—	57% below	—
Thoracentesis with imaging guidance CPT 32555 Thoracentesis W Imaging G	$2,254.00	$2,254.00	—	11% above	—
Thoracentesis with imaging guidance CPT 32555 Thoracentesis	$3,352.00	$3,352.00	—	65% above	—
Thoracentesis with imaging guidance one side CPT 32555 Ct Guided Thoracentesis Left	$2,914.00	$2,914.00	—	43% above	—
Thoracentesis with imaging guidance one side CPT 32555 Ct Guided Thoracentesis Right	$3,352.00	$3,352.00	—	65% above	—
Thoracentesis with imaging guidance one side CPT 32555 Us Guided Thoracentesis Left	$6,494.00	$6,494.00	—	219% above	—
Thoracentesis with imaging guidance one side CPT 32555 Us Guided Thoracentesis Right	$6,494.00	$6,494.00	—	219% above	—
Thoracentesis with imaging guidance inpatient CPT 32555 Thrcntss Ndl/Cth Plr W/Imgng	$870.00	$870.00	—	—	—
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis W Imaging G	$2,254.00	$2,254.00	—	—	—
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis	$3,352.00	$3,352.00	—	—	—
Thoracentesis with imaging guidance inpatient one side CPT 32555 Ct Guided Thoracentesis Left	$2,914.00	$2,914.00	—	—	—
Thoracentesis with imaging guidance inpatient one side CPT 32555 Ct Guided Thoracentesis Right	$3,352.00	$3,352.00	—	—	—
Thoracentesis with imaging guidance inpatient one side CPT 32555 Us Guided Thoracentesis Left	$6,494.00	$6,494.00	—	—	—
Thoracentesis with imaging guidance inpatient one side CPT 32555 Us Guided Thoracentesis Right	$6,494.00	$6,494.00	—	—	—
Tonsil and adenoid removal, age 12 or older CPT 42821 Rem Tonsils Adenoids 12/>Yrs	$3,933.00	$3,933.00	—	7% below	—
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 Rem Tonsils Adenoids 12/>Yrs	$3,933.00	$3,933.00	—	—	—
Tonsil and adenoid removal, child under 12 CPT 42820 Rem Tonsils Adenoids <12 Yrs	$11,074.00	$11,074.00	—	4% above	—
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 Rem Tonsils Adenoids <12 Yrs	$11,074.00	$11,074.00	—	—	—
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Removal Of Tonsils	$7,959.00	$7,959.00	—	41% above	—
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 Removal Of Tonsils	$7,959.00	$7,959.00	—	—	—
Total knee replacement CPT 27447 Total Knee Arthroplasty	$48,061.00	$48,061.00	—	87% above	—
Total knee replacement inpatient CPT 27447 Total Knee Arthroplasty	$48,061.00	$48,061.00	—	—	—
Trigger finger release surgery CPT 26055 Incise Finger Tendon Sheath	$6,708.00	$6,708.00	—	118% above	—
Trigger finger release surgery inpatient CPT 26055 Incise Finger Tendon Sheath	$6,708.00	$6,708.00	—	—	—
Trigger point injections, 1 or 2 muscles CPT 20552 Trigger Point Injection 1	$2,066.00	$2,066.00	—	224% above	—
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Point 1/2 Muscl	$3,602.00	$3,602.00	—	465% above	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Trigger Point Injection 1	$2,066.00	$2,066.00	—	—	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Trigger Point 1/2 Muscl	$3,602.00	$3,602.00	—	—	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Us Biopsy Breast	$6,175.00	$6,175.00	—	92% above	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Us Biopsy Breast	$6,175.00	$6,175.00	—	—	—
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Esoph Egd Dilation <30 Mm	$3,627.25	$3,627.25	—	48% above	—
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 Esoph Egd Dilation <30 Mm	$3,627.25	$3,627.25	—	—	—
Upper endoscopy (EGD) with biopsy CPT 43239 Egd Biopsy Single/Multiple	$1,198.80	$1,198.80	—	32% below	—
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Egd Biopsy Single/Multiple	$1,198.80	$1,198.80	—	—	—
Upper endoscopy (EGD) with injection into the lining CPT 43236 Uppr Gi Scope W/Submuc Inj	$1,201.91	$1,201.91	—	36% below	—
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 Uppr Gi Scope W/Submuc Inj	$1,201.91	$1,201.91	—	—	—
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Egd Remove Lesion Snare	$2,542.00	$2,542.00	—	22% below	—
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 Egd Remove Lesion Snare	$2,542.00	$2,542.00	—	—	—
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Egd Guide Wire Insertion	$1,964.00	$1,964.00	—	5% above	—
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 Egd Guide Wire Insertion	$1,964.00	$1,964.00	—	—	—
Upper endoscopy (EGD), diagnostic CPT 43235 Egd Diagnostic Brush Wash	$890.23	$890.23	—	52% below	—
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Egd Diagnostic Brush Wash	$890.23	$890.23	—	—	—
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 Cystouretero W/Lithotripsy	$10,068.00	$10,068.00	—	26% above	—
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 Cystouretero W/Lithotripsy	$10,068.00	$10,068.00	—	—	—
Ureteroscopy with laser stone breaking and stent placement CPT 52356 Cysto/Uretero W/Lithotripsy	$1,199.44	$1,199.44	—	90% below	—
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 Cysto/Uretero W/Lithotripsy	$1,199.44	$1,199.44	—	—	—
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Removal Of Sperm Duct(S)	$8,344.00	$8,344.00	—	200% above	—
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 Removal Of Sperm Duct(S)	$8,344.00	$8,344.00	—	—	—
Vein ablation, radiofrequency, first vein CPT 36475 Ablation Vein, Endovasc, Init	$11,830.00	$11,830.00	—	38% above	—
Vein ablation, radiofrequency, first vein inpatient CPT 36475 Ablation Vein, Endovasc, Init	$11,830.00	$11,830.00	—	—	—
Wart removal, up to 14 warts CPT 17110 Destruction Benign Lesion 1-14	$646.00	$646.00	—	80% above	—
Wart removal, up to 14 warts inpatient CPT 17110 Destruction Benign Lesion 1-14	$646.00	$646.00	—	—	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Deb Subq Tissue 20 Sq Cm/<	$317.16	$317.16	—	53% below	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debrid Sq Tissue <20Cm Area	$859.00	$859.00	—	26% above	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debridement - Skin And Sc Tis	$1,960.00	$1,960.00	—	188% above	—
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Deb Subq Tissue 20 Sq Cm/<	$317.16	$317.16	—	—	—
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debrid Sq Tissue <20Cm Area	$859.00	$859.00	—	—	—
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debridement - Skin And Sc Tis	$1,960.00	$1,960.00	—	—	—
Wrist fracture surgery (plate and screws), distal radius CPT 25607 Treat Fx Rad Extra-Articul	$18,648.00	$18,648.00	—	206% above	—
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 Treat Fx Rad Extra-Articul	$18,648.00	$18,648.00	—	—	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion Admin	$667.00	$667.00	—	24% below	—
Blood transfusion (giving blood or blood components) CPT 36430 Trans Blood Or Blood Component	$1,960.00	$1,960.00	—	124% above	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion Admin	$667.00	$667.00	—	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Trans Blood Or Blood Component	$1,960.00	$1,960.00	—	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Metaneb Init Airway Inhale Trt	$330.00	$330.00	—	2% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mdi Treatment	$330.00	$330.00	—	2% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mdi Instruction	$330.00	$330.00	—	2% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hand Held Nebulizer Treatment	$330.00	$330.00	—	2% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Ipv Tx	$535.00	$535.00	—	66% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment	$615.00	$615.00	—	90% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer(S)	$1,796.00	$1,796.00	—	456% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hand Held Nebulizer Treatment	$330.00	$330.00	—	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mdi Instruction	$330.00	$330.00	—	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mdi Treatment	$330.00	$330.00	—	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Metaneb Init Airway Inhale Trt	$330.00	$330.00	—	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Ipv Tx	$535.00	$535.00	—	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment	$615.00	$615.00	—	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Nebulizer(S)	$1,796.00	$1,796.00	—	—	—
Chemotherapy IV infusion, first hour CPT 96413 Chemo Iv 1 Hr	$1,466.00	$1,466.00	—	68% above	—
Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemo Iv 1 Hr	$1,466.00	$1,466.00	—	—	—
Critical care, first 30 to 74 minutes CPT 99291 Er Critical Care	$18,546.00	$18,546.00	—	238% above	—
Critical care, first 30 to 74 minutes inpatient CPT 99291 Er Critical Care	$18,546.00	$18,546.00	—	—	—
EEG (brain wave test), awake and drowsy, routine CPT 95816 Eeg Awake/Drowsy (20-40 Min)	$2,652.00	$2,652.00	—	158% above	—
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Eeg Awake/Drowsy (20-40 Min)	$2,652.00	$2,652.00	—	—	—
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Pediatric 12-Lead Ekg W/Interp	$908.00	$908.00	—	913% above	—
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Pediatric 12-Lead Ekg W/Interp	$908.00	$908.00	—	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg-Technical Fee	$25.00	$25.00	—	93% below	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg - Technical Fee	$25.00	$25.00	—	93% below	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Pediatric- Ekg Procedure	$724.00	$724.00	—	114% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg Tracing Only	$796.00	$796.00	—	136% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Repeat Electrocardiogram	$1,694.00	$1,694.00	—	401% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram, Tracing Onl	$1,694.00	$1,694.00	—	401% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Ekg-Technical Fee	$25.00	$25.00	—	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Ekg - Technical Fee	$25.00	$25.00	—	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Pediatric- Ekg Procedure	$724.00	$724.00	—	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Ekg Tracing Only	$796.00	$796.00	—	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram, Tracing Onl	$1,694.00	$1,694.00	—	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Repeat Electrocardiogram	$1,694.00	$1,694.00	—	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Er Level I	$739.00	$739.00	—	76% above	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Er Level I	$739.00	$739.00	—	—	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Er Level Ii	$1,966.00	$1,966.00	—	125% above	—
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Er Level Ii	$1,966.00	$1,966.00	—	—	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Er Level Iii	$4,914.00	$4,914.00	—	228% above	—
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Er Level Iii	$4,914.00	$4,914.00	—	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Er Level Iv	$8,776.00	$8,776.00	—	224% above	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Er Level Iv	$8,776.00	$8,776.00	—	—	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Er Level V	$11,307.00	$11,307.00	—	218% above	—
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Er Level V	$11,307.00	$11,307.00	—	—	—
Exercise stress test, tracing only, the hospital charge CPT 93017 Regular Treadmill	$4,895.00	$4,895.00	—	247% above	—
Exercise stress test, tracing only, the hospital charge CPT 93017 Persantine Stress	$5,384.00	$5,384.00	—	282% above	—
Exercise stress test, tracing only, the hospital charge CPT 93017 Dobutamine Stress	$5,384.00	$5,384.00	—	282% above	—
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiac Treadmill Stress	$5,384.00	$5,384.00	—	282% above	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Regular Treadmill	$4,895.00	$4,895.00	—	—	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiac Treadmill Stress	$5,384.00	$5,384.00	—	—	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Persantine Stress	$5,384.00	$5,384.00	—	—	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Dobutamine Stress	$5,384.00	$5,384.00	—	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hydration Iv Infusion Init	$87.67	$87.67	—	82% below	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Fac Fee Hydra Iv Infusion Init	$1,530.00	$1,530.00	—	207% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hydration Iv Infusion Init	$87.67	$87.67	—	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Fac Fee Hydra Iv Infusion Init	$1,530.00	$1,530.00	—	—	—
IV infusion of a medicine, first hour CPT 96365 Ther/Proph/Diag Iv Inf Init	$1,009.00	$1,009.00	—	72% above	—
IV infusion of a medicine, first hour CPT 96365 Ther/Proph/Diag/Iv Inf Init	$1,009.00	$1,009.00	—	72% above	—
IV infusion of a medicine, first hour CPT 96365 Fac Fee Ther/Proph/Diag Iv Inf	$2,472.00	$2,472.00	—	321% above	—
IV infusion of a medicine, first hour inpatient CPT 96365 Ther/Proph/Diag Iv Inf Init	$1,009.00	$1,009.00	—	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 Ther/Proph/Diag/Iv Inf Init	$1,009.00	$1,009.00	—	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 Fac Fee Ther/Proph/Diag Iv Inf	$2,472.00	$2,472.00	—	—	—
IV push of a medicine, first drug CPT 96374 Ther/Proph/Diag Inj Iv Push	$127.29	$127.29	—	64% below	—
IV push of a medicine, first drug inpatient CPT 96374 Ther/Proph/Diag Inj Iv Push	$127.29	$127.29	—	—	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Ther/Proph/Diag Inj Sc/Im	$43.52	$43.52	—	76% below	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inj Sc/Im Ther/Proph/Diag	$192.00	$192.00	—	7% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Fac Fee Tx/Proph/Dx Inj Sc/Im	$425.00	$425.00	—	137% above	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Ther/Proph/Diag Inj Sc/Im	$43.52	$43.52	—	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Inj Sc/Im Ther/Proph/Diag	$192.00	$192.00	—	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Fac Fee Tx/Proph/Dx Inj Sc/Im	$425.00	$425.00	—	—	—
Neuromuscular re-education, 15 minutes CPT 97112 Hosp Ot-Neurosmusc Re Ed Init	$101.00	$101.00	—	21% below	—
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Hosp Ot-Neurosmusc Re Ed Init	$101.00	$101.00	—	—	—
New patient office visit, about 30 minutes CPT 99203 Fac Fee Off Visit Level Iii	$223.00	$223.00	—	4% above	—
New patient office visit, about 30 minutes CPT 99203 Visit New Level Iii	$256.00	$256.00	—	20% above	—
New patient office visit, about 30 minutes CPT 99203 Fac Fee Visit New Level Iii	$363.00	$363.00	—	69% above	—
New patient office visit, about 30 minutes inpatient CPT 99203 Fac Fee Off Visit Level Iii	$223.00	$223.00	—	—	—
New patient office visit, about 30 minutes inpatient CPT 99203 Visit New Level Iii	$256.00	$256.00	—	—	—
New patient office visit, about 30 minutes inpatient CPT 99203 Fac Fee Visit New Level Iii	$363.00	$363.00	—	—	—
New patient office visit, about 45 minutes CPT 99204 Visit New Lvel Iv	$245.00	$245.00	—	at median	—
New patient office visit, about 45 minutes CPT 99204 Fac Fee Off Visit Level Iv	$288.00	$288.00	—	18% above	—
New patient office visit, about 45 minutes CPT 99204 Visit New Level Iv	$323.00	$323.00	—	32% above	—
New patient office visit, about 45 minutes CPT 99204 Fac Fee Visit New Level Iv	$381.00	$381.00	—	56% above	—
New patient office visit, about 45 minutes inpatient CPT 99204 Visit New Lvel Iv	$245.00	$245.00	—	—	—
New patient office visit, about 45 minutes inpatient CPT 99204 Fac Fee Off Visit Level Iv	$288.00	$288.00	—	—	—
New patient office visit, about 45 minutes inpatient CPT 99204 Visit New Level Iv	$323.00	$323.00	—	—	—
New patient office visit, about 45 minutes inpatient CPT 99204 Fac Fee Visit New Level Iv	$381.00	$381.00	—	—	—
New patient office visit, about 60 minutes CPT 99205 Visit New Level V	$275.00	$275.00	—	20% below	—
New patient office visit, about 60 minutes CPT 99205 Fac Fee Off Visit New Level V	$378.00	$378.00	—	10% above	—
New patient office visit, about 60 minutes CPT 99205 Fac Fee Visit New Level V	$429.00	$429.00	—	25% above	—
New patient office visit, about 60 minutes inpatient CPT 99205 Visit New Level V	$275.00	$275.00	—	—	—
New patient office visit, about 60 minutes inpatient CPT 99205 Fac Fee Off Visit New Level V	$378.00	$378.00	—	—	—
New patient office visit, about 60 minutes inpatient CPT 99205 Fac Fee Visit New Level V	$429.00	$429.00	—	—	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Fac Fee Off Visit Level Ii	$168.00	$168.00	—	20% above	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Visit New Level Ii	$228.00	$228.00	—	63% above	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Fac Fee Visit New Level Ii	$355.00	$355.00	—	154% above	—
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Fac Fee Off Visit Level Ii	$168.00	$168.00	—	—	—
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Visit New Level Ii	$228.00	$228.00	—	—	—
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Fac Fee Visit New Level Ii	$355.00	$355.00	—	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Init Nutrician Therapy Ea 15Mi	$91.32	$91.32	—	8% below	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Init Nutrician Therapy Ea 15Mi	$91.32	$91.32	—	—	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ot Ped-Ther Exer Ea 15M	$157.00	$157.00	—	21% above	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Ot Ped-Ther Exer Ea 15M	$157.00	$157.00	—	—	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Visit Estab Level V	$275.00	$275.00	—	9% above	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Fac Fee Off Visit Est Level V	$288.00	$288.00	—	14% above	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Nb Lac Video Visit Est Pt Leve	$331.00	$331.00	—	31% above	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Fac Fee Visit Estab Level V	$429.00	$429.00	—	70% above	—
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Visit Estab Level V	$275.00	$275.00	—	—	—
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Fac Fee Off Visit Est Level V	$288.00	$288.00	—	—	—
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Nb Lac Video Visit Est Pt Leve	$331.00	$331.00	—	—	—
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Fac Fee Visit Estab Level V	$429.00	$429.00	—	—	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Fac Fee Off Visit Est Lev Iii	$168.00	$168.00	—	17% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Visit Estab Level Iii	$256.00	$256.00	—	79% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Nb Lac Video Visit Est Pt Leve	$280.00	$280.00	—	96% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Fac Fee Visit Estab Level Iii	$363.00	$363.00	—	154% above	—
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Fac Fee Off Visit Est Lev Iii	$168.00	$168.00	—	—	—
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Visit Estab Level Iii	$256.00	$256.00	—	—	—
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Nb Lac Video Visit Est Pt Leve	$280.00	$280.00	—	—	—
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Fac Fee Visit Estab Level Iii	$363.00	$363.00	—	—	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Fac Fee Off Visit Est Lev Iv	$223.00	$223.00	—	11% above	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Visit Estab Level Iv	$270.00	$270.00	—	34% above	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Nb Lac Video Visit Est Pt Leve	$294.00	$294.00	—	46% above	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Fac Fee Visit Estab Level Iv	$381.00	$381.00	—	90% above	—
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Fac Fee Off Visit Est Lev Iv	$223.00	$223.00	—	—	—
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Visit Estab Level Iv	$270.00	$270.00	—	—	—
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Nb Lac Video Visit Est Pt Leve	$294.00	$294.00	—	—	—
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Fac Fee Visit Estab Level Iv	$381.00	$381.00	—	—	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Fac Fee Off Visit Est Level Ii	$168.00	$168.00	—	46% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Visit Estab Level Ii	$228.00	$228.00	—	98% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Nb Lac Video Visit Est Pt Leve	$274.00	$274.00	—	138% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Fac Fee Visit Estab Level Ii	$355.00	$355.00	—	209% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Same Day Ctr Facility Fee	$379.00	$379.00	—	230% above	—
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Fac Fee Off Visit Est Level Ii	$168.00	$168.00	—	—	—
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Visit Estab Level Ii	$228.00	$228.00	—	—	—
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Nb Lac Video Visit Est Pt Leve	$274.00	$274.00	—	—	—
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Fac Fee Visit Estab Level Ii	$355.00	$355.00	—	—	—
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Same Day Ctr Facility Fee	$379.00	$379.00	—	—	—
Specialist consultation, low complexity or 30+ minutes CPT 99243 Office Consult Level Iii	$322.91	$322.91	—	87% above	—
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office Consult Level Iii	$322.91	$322.91	—	—	—
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office Consult Level Iv	$219.00	$219.00	—	8% above	—
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Consult Level Iv	$219.00	$219.00	—	—	—
Speech and language evaluation CPT 92523 Speech Sound Lang Comprehen	$361.00	$361.00	—	21% below	—
Speech and language evaluation inpatient CPT 92523 Speech Sound Lang Comprehen	$361.00	$361.00	—	—	—
Spirometry (breathing test) CPT 94010 Spirometry	$82.00	$82.00	—	78% below	—
Spirometry (breathing test) inpatient CPT 94010 Spirometry	$82.00	$82.00	—	—	—
Spirometry before and after a bronchodilator CPT 94060 Spirometry Pre And Post	$138.00	$138.00	—	83% below	—
Spirometry before and after a bronchodilator inpatient CPT 94060 Spirometry Pre And Post	$138.00	$138.00	—	—	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Pt Ped-Ther Act 15 Min	$127.00	$127.00	—	7% below	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Ot Ped-Ther Act 15 Min	$127.00	$127.00	—	7% below	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Pt Ped-Ther Act 15 Min	$127.00	$127.00	—	—	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Ot Ped-Ther Act 15 Min	$127.00	$127.00	—	—	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Fac Fee Phlebotomy	$130.00	$130.00	—	60% below	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Fac Fee Phlebotomy	$130.00	$130.00	—	—	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs California	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 *Covid Mod 12Y+ 0.5Ml(2023-24)	$232.09	$232.09	—	4% below	—
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 *Covid Mod 12Y+ 0.5Ml	$246.73	$246.73	—	2% above	—
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Sarscov2 Vac 50 Mcg/0.5Ml Im	$2,480.06	$2,480.06	—	925% above	—
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 *Covid Mod 12Y+ 0.5Ml(2023-24)	$232.09	$232.09	—	—	—
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 *Covid Mod 12Y+ 0.5Ml	$246.73	$246.73	—	—	—
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Sarscov2 Vac 50 Mcg/0.5Ml Im	$2,480.06	$2,480.06	—	—	—
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 *Varicella Vir Vac 0.5Ml Froze	$167.78	$167.78	—	46% below	—
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)	$1,218.70	$1,218.70	—	289% above	—
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 *Varicella Vir Vac 0.5Ml Froze	$167.78	$167.78	—	—	—
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)	$1,218.70	$1,218.70	—	—	—
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 *Kinrix Dttap Vac	$88.07	$88.07	—	47% below	—
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 NDC Description Not Available	$1,003.35	$1,003.35	—	503% above	—
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 *Kinrix Dttap Vac	$88.07	$88.07	—	—	—
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 NDC Description Not Available	$1,003.35	$1,003.35	—	—	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 *Infanrix Dttap 0.5Ml Vial	$38.14	$38.14	—	47% below	—
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)	$513.00	$513.00	—	615% above	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 TRIPEDIA: 10 VIAL in 1 PACKAGE (49281-298-10) / .5 mL in 1 VIAL	$537.40	$537.40	—	649% above	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Daptacel: 10 Vial In 1 Package (49281-286-10) / .5 Ml In 1 Vial (49281-286-58)	$552.50	$552.50	—	670% above	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 *Infanrix Dttap 0.5Ml Vial	$38.14	$38.14	—	—	—
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)	$513.00	$513.00	—	—	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 TRIPEDIA: 10 VIAL in 1 PACKAGE (49281-298-10) / .5 mL in 1 VIAL	$537.40	$537.40	—	—	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Daptacel: 10 Vial In 1 Package (49281-286-10) / .5 Ml In 1 Vial (49281-286-58)	$552.50	$552.50	—	—	—
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 *Pediarix (Hep-B/Dpat/Polio)	$129.97	$129.97	—	21% below	—
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)	$1,332.80	$1,332.80	—	710% above	—
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 *Pediarix (Hep-B/Dpat/Polio)	$129.97	$129.97	—	—	—
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)	$1,332.80	$1,332.80	—	—	—
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 *Pentacel Dtapph Tet Vac	$153.66	$153.66	—	26% below	—
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 PENTACEL: 1 KIT in 1 PACKAGE (49281-510-05) * .5 mL in 1 VIAL, SINGLE-DOSE (49281-560-05) * .5 mL in 1 VIAL, SINGLE-DOSE (49281-548-58)	$1,372.85	$1,372.85	—	559% above	—
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 *Pentacel Dtapph Tet Vac	$153.66	$153.66	—	—	—
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 PENTACEL: 1 KIT in 1 PACKAGE (49281-510-05) * .5 mL in 1 VIAL, SINGLE-DOSE (49281-560-05) * .5 mL in 1 VIAL, SINGLE-DOSE (49281-548-58)	$1,372.85	$1,372.85	—	—	—
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 Vaxelis: 10 Vial, Single-Dose In 1 Package (63361-243-10) / .5 Ml In 1 Vial, Single-Dose (63361-243-58)	$1,904.80	$1,904.80	—	990% above	—
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 Vaxelis: 10 Vial, Single-Dose In 1 Package (63361-243-10) / .5 Ml In 1 Vial, Single-Dose (63361-243-58)	$1,904.80	$1,904.80	—	—	—
Flu shot, recombinant, egg-free (Flublok) CPT 90673 *Flu Vax(Egg Allergy)0.5Ml	$63.85	$63.85	—	31% below	—
Flu shot, recombinant, egg-free (Flublok) CPT 90673 *Flublock 0.5Ml Trivalent	$127.44	$127.44	—	38% above	—
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 *Flu Vax(Egg Allergy)0.5Ml	$63.85	$63.85	—	—	—
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 *Flublock 0.5Ml Trivalent	$127.44	$127.44	—	—	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 *Fluarix 0.5Ml Trivalent	$34.10	$34.10	—	20% below	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 *Fluzone 0.5Ml Trivalent	$35.77	$35.77	—	16% below	—
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 *Fluarix 0.5Ml Trivalent	$34.10	$34.10	—	—	—
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 *Fluzone 0.5Ml Trivalent	$35.77	$35.77	—	—	—
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 *Gardasil 9 (Human Pap Virus)	$292.07	$292.07	—	25% below	—
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)	$3,228.05	$3,228.05	—	733% above	—
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 *Gardasil 9 (Human Pap Virus)	$292.07	$292.07	—	—	—
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)	$3,228.05	$3,228.05	—	—	—
Hepatitis A vaccine, adult dose CPT 90632 *Hepatitis A Adult Vaccine	$117.90	$117.90	—	15% below	—
Hepatitis A vaccine, adult dose CPT 90632 Havrix: 10 Syringe In 1 Carton (58160-826-52) / 1 Ml In 1 Syringe (58160-826-43)	$1,202.30	$1,202.30	—	762% above	—
Hepatitis A vaccine, adult dose inpatient CPT 90632 *Hepatitis A Adult Vaccine	$117.90	$117.90	—	—	—
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)	$1,202.30	$1,202.30	—	—	—
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 *Hep-A Vac 720 El.U/0.5Ml Pedi	$53.06	$53.06	—	28% below	—
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 *Hep-A Vac 720 El.U/0.5Ml Pedi	$53.06	$53.06	—	—	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 *Hepatitis B Vacc 20Mcg/1Ml	$97.11	$97.11	—	21% below	—
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)	$1,090.90	$1,090.90	—	789% above	—
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 *Hepatitis B Vacc 20Mcg/1Ml	$97.11	$97.11	—	—	—
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)	$1,090.90	$1,090.90	—	—	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 *Hep B Ped Vaccine 10Mcg/0.5Ml	$39.40	$39.40	—	32% below	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hep B Ped Vaccine 10Mcg/0.5Ml	$531.10	$531.10	—	821% above	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 *Hep B Ped Vaccine 10Mcg/0.5Ml	$39.40	$39.40	—	—	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hep B Ped Vaccine 10Mcg/0.5Ml	$531.10	$531.10	—	—	—
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 *Pedvaxhib 0.5Ml Vial	$41.98	$41.98	—	38% below	—
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)	$505.70	$505.70	—	646% above	—
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 *Pedvaxhib 0.5Ml Vial	$41.98	$41.98	—	—	—
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)	$505.70	$505.70	—	—	—
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 *Haemophilus B Conj Hibrix W/D	$42.11	$42.11	—	1% above	—
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 *Haemophilus B Conj Act-Hib	$50.73	$50.73	—	21% above	—
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)	$663.00	$663.00	—	1484% above	—
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 *Haemophilus B Conj Hibrix W/D	$42.11	$42.11	—	—	—
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 *Haemophilus B Conj Act-Hib	$50.73	$50.73	—	—	—
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)	$663.00	$663.00	—	—	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 *Fluzone High Dose 0.5Ml Triva	$127.44	$127.44	—	2% above	—
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)	$1,228.35	$1,228.35	—	879% above	—
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 (49281-122-65) / .7 mL in 1 SYRINGE, GLASS (49281-122-88)	$1,237.10	$1,237.10	—	886% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Iiv No Prsv Increased Ag Im	$1,390.30	$1,390.30	—	1008% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 *Fluzone High Dose 0.5Ml Triva	$127.44	$127.44	—	—	—
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)	$1,228.35	$1,228.35	—	—	—
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 (49281-122-65) / .7 mL in 1 SYRINGE, GLASS (49281-122-88)	$1,237.10	$1,237.10	—	—	—
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Iiv No Prsv Increased Ag Im	$1,390.30	$1,390.30	—	—	—
MMR vaccine (measles, mumps and rubella), live CPT 90707 *Mmr Ii Sgl Dose Vac W/Dil	$110.37	$110.37	—	21% below	—
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)	$711.00	$711.00	—	408% above	—
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 *Mmr Ii Sgl Dose Vac W/Dil	$110.37	$110.37	—	—	—
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)	$711.00	$711.00	—	—	—
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 *Proquad Vac (Measles/Mumps/Re	$327.03	$327.03	—	19% below	—
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)	$2,962.20	$2,962.20	—	636% above	—
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 *Proquad Vac (Measles/Mumps/Re	$327.03	$327.03	—	—	—
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)	$2,962.20	$2,962.20	—	—	—
Meningococcal ACWY (MenACWY) vaccine CPT 90734 *Menveo 0.5Ml Vaccine	$144.54	$144.54	—	45% below	—
Meningococcal ACWY (MenACWY) vaccine CPT 90734 *Menactra	$188.23	$188.23	—	28% below	—
Meningococcal ACWY (MenACWY) vaccine CPT 90734 *Menveo 0.5Ml(1Vl Presentatn)	$265.88	$265.88	—	2% above	—
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)	$2,187.90	$2,187.90	—	737% above	—
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 *Menveo 0.5Ml Vaccine	$144.54	$144.54	—	—	—
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 *Menactra	$188.23	$188.23	—	—	—
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 *Menveo 0.5Ml(1Vl Presentatn)	$265.88	$265.88	—	—	—
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)	$2,187.90	$2,187.90	—	—	—
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 *Meningococcal B 4-Comp Vacc	$287.87	$287.87	—	35% below	—
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)	$2,650.85	$2,650.85	—	500% above	—
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 *Meningococcal B 4-Comp Vacc	$287.87	$287.87	—	—	—
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)	$2,650.85	$2,650.85	—	—	—
Nasal spray flu vaccine, live (FluMist) CPT 90660 *Flumist Nasal Trivalent	$42.98	$42.98	—	16% below	—
Nasal spray flu vaccine, live (FluMist) CPT 90660 FluMist Quadrivalent: 10 APPLICATOR in 1 PACKAGE (66019-309-10) / .2 mL in 1 APPLICATOR (66019-309-01)	$540.25	$540.25	—	960% above	—
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 *Flumist Nasal Trivalent	$42.98	$42.98	—	—	—
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 FluMist Quadrivalent: 10 APPLICATOR in 1 PACKAGE (66019-309-10) / .2 mL in 1 APPLICATOR (66019-309-01)	$540.25	$540.25	—	—	—
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 *Prevnar 13 Vac .5Ml Prefill	$253.35	$253.35	—	19% below	—
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Prevnar 13: 10 Syringe In 1 Carton (0005-1971-02) / .5 Ml In 1 Syringe (0005-1971-01)	$1,296.30	$1,296.30	—	315% above	—
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 *Prevnar 13 Vac .5Ml Prefill	$253.35	$253.35	—	—	—
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Prevnar 13: 10 Syringe In 1 Carton (0005-1971-02) / .5 Ml In 1 Syringe (0005-1971-01)	$1,296.30	$1,296.30	—	—	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococal Vacc 20 Val	$446.03	$446.03	—	14% below	—
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)	$4,150.70	$4,150.70	—	699% above	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumococal Vacc 20 Val	$446.03	$446.03	—	—	—
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)	$4,150.70	$4,150.70	—	—	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 *Pneumococcal Vacc 23 Valent	$134.20	$134.20	—	17% below	—
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)	$1,246.05	$1,246.05	—	670% above	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 *Pneumococcal Vacc 23 Valent	$134.20	$134.20	—	—	—
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)	$1,246.05	$1,246.05	—	—	—
Polio vaccine, inactivated (IPV) CPT 90713 *Polio Vac Inact 0.5Ml	$62.79	$62.79	—	31% below	—
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)	$531.65	$531.65	—	486% above	—
Polio vaccine, inactivated (IPV) inpatient CPT 90713 *Polio Vac Inact 0.5Ml	$62.79	$62.79	—	—	—
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)	$531.65	$531.65	—	—	—
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 *Beyfortus 100Mg/1Ml	$887.14	$887.14	—	6% below	—
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 *Beyfortus 200Mg/2Ml	$1,774.28	$1,774.28	—	88% above	—
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Nirsevmab Alp Rsv Mnclnl 1Ml	$8,502.65	$8,502.65	—	799% above	—
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 *Beyfortus 100Mg/1Ml	$887.14	$887.14	—	—	—
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 *Beyfortus 200Mg/2Ml	$1,774.28	$1,774.28	—	—	—
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Nirsevmab Alp Rsv Mnclnl 1Ml	$8,502.65	$8,502.65	—	—	—
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 *Beyfortus 50Mg/0.5Ml	$887.14	$887.14	—	8% below	—
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 *Beyfortus 50Mg/0.5Ml	$887.14	$887.14	—	—	—
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 *Abrysvo 0.5Ml	$528.70	$528.70	—	71% above	—
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 Rsv Prf Aprf B Rcmbnt Pr 60Mcg	$5,087.45	$5,087.45	—	1546% above	—
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 *Abrysvo 0.5Ml	$528.70	$528.70	—	—	—
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 Rsv Prf Aprf B Rcmbnt Pr 60Mcg	$5,087.45	$5,087.45	—	—	—
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 *Arexvy 0.5Ml	$501.82	$501.82	—	33% above	—
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 *Arexvy 0.5Ml	$501.82	$501.82	—	—	—
Rabies vaccine, one dose CPT 90675 *Rabies Vac (Movax) W/Dil Syr	$564.08	$564.08	—	20% below	—
Rabies vaccine, one dose CPT 90675 IMOVAX RABIES: 1 KIT in 1 PACKAGE (49281-250-51) * 1 mL in 1 VIAL, SINGLE-USE (49281-248-58) * 1 mL in 1 SYRINGE (49281-249-01)	$3,379.85	$3,379.85	—	378% above	—
Rabies vaccine, one dose CPT 90675 IMOVAX RABIES: 1 KIT in 1 PACKAGE (49281-250-51) * 1 mL in 1 VIAL, SINGLE-USE (49281-248-58) * 1 mL in 1 SYRINGE (49281-249-01)	$3,379.85	$3,379.85	—	378% above	—
Rabies vaccine, one dose CPT 90675 RabAvert: 1 KIT in 1 CARTON (58160-964-12) * 1 mL in 1 VIAL, GLASS (58160-966-01) * 1 mL in 1 SYRINGE (58160-967-02)	$5,804.65	$5,804.65	—	722% above	—
Rabies vaccine, one dose CPT 90675 RabAvert: 1 KIT in 1 CARTON (58160-964-12) * 1 mL in 1 VIAL, GLASS (58160-966-01) * 1 mL in 1 SYRINGE (58160-967-02)	$5,804.65	$5,804.65	—	722% above	—
Rabies vaccine, one dose inpatient CPT 90675 *Rabies Vac (Movax) W/Dil Syr	$564.08	$564.08	—	—	—
Rabies vaccine, one dose inpatient CPT 90675 IMOVAX RABIES: 1 KIT in 1 PACKAGE (49281-250-51) * 1 mL in 1 VIAL, SINGLE-USE (49281-248-58) * 1 mL in 1 SYRINGE (49281-249-01)	$3,379.85	$3,379.85	—	—	—
Rabies vaccine, one dose inpatient CPT 90675 IMOVAX RABIES: 1 KIT in 1 PACKAGE (49281-250-51) * 1 mL in 1 VIAL, SINGLE-USE (49281-248-58) * 1 mL in 1 SYRINGE (49281-249-01)	$3,379.85	$3,379.85	—	—	—
Rabies vaccine, one dose inpatient CPT 90675 RabAvert: 1 KIT in 1 CARTON (58160-964-12) * 1 mL in 1 VIAL, GLASS (58160-966-01) * 1 mL in 1 SYRINGE (58160-967-02)	$5,804.65	$5,804.65	—	—	—
Rabies vaccine, one dose inpatient CPT 90675 RabAvert: 1 KIT in 1 CARTON (58160-964-12) * 1 mL in 1 VIAL, GLASS (58160-966-01) * 1 mL in 1 SYRINGE (58160-967-02)	$5,804.65	$5,804.65	—	—	—
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 *Rotavirus Vac Live Oral	$240.11	$240.11	—	63% above	—
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 *Rotavirus Vac Live Oral 1.5Ml	$240.11	$240.11	—	63% above	—
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 Rotarix: 1 Kit In 1 Carton (58160-854-52) * 10 Vial In 1 Carton (58160-851-10) / 1 Ml In 1 Vial (58160-851-01) * 1 Ml In 1 Applicator (58160-853-02)	$1,797.60	$1,797.60	—	1121% above	—
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 *Rotavirus Vac Live Oral 1.5Ml	$240.11	$240.11	—	—	—
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 *Rotavirus Vac Live Oral	$240.11	$240.11	—	—	—
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 Rotarix: 1 Kit In 1 Carton (58160-854-52) * 10 Vial In 1 Carton (58160-851-10) / 1 Ml In 1 Vial (58160-851-01) * 1 Ml In 1 Applicator (58160-853-02)	$1,797.60	$1,797.60	—	—	—
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)	$1,252.95	$1,252.95	—	599% above	—
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)	$1,252.95	$1,252.95	—	—	—
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Shingrix 0.5Ml Vaccine	$296.07	$296.07	—	36% above	—
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)	$2,479.30	$2,479.30	—	1041% above	—
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Shingrix 0.5Ml Vaccine	$296.07	$296.07	—	—	—
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)	$2,479.30	$2,479.30	—	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 *Td Vacc No Presv 7 Yrs+ Im	$48.23	$48.23	—	41% below	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 *Dip/Tet/Pf Vac >7 Yrs Im	$80.33	$80.33	—	1% below	—
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)	$509.00	$509.00	—	525% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 *Td Vacc No Presv 7 Yrs+ Im	$48.23	$48.23	—	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 *Dip/Tet/Pf Vac >7 Yrs Im	$80.33	$80.33	—	—	—
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)	$509.00	$509.00	—	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 *Tdap Pediatric Vac 0.5Ml	$45.01	$45.01	—	61% below	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 *Tdap Adult 2 Units-15.5Mcg-5	$81.34	$81.34	—	30% below	—
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)	$767.80	$767.80	—	563% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Adacel Tdap: 10 Vial In 1 Package (49281-400-10) / .5 Ml In 1 Vial (49281-400-58)	$793.85	$793.85	—	586% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 *Tdap Pediatric Vac 0.5Ml	$45.01	$45.01	—	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 *Tdap Adult 2 Units-15.5Mcg-5	$81.34	$81.34	—	—	—
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)	$767.80	$767.80	—	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Adacel Tdap: 10 Vial In 1 Package (49281-400-10) / .5 Ml In 1 Vial (49281-400-58)	$793.85	$793.85	—	—	—
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 *Typhoid Vac 25Mcg/0.5Ml Syr	$150.27	$150.27	—	14% below	—
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)	$993.70	$993.70	—	469% above	—
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 *Typhoid Vac 25Mcg/0.5Ml Syr	$150.27	$150.27	—	—	—
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)	$993.70	$993.70	—	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Adm Single/Comb	$192.00	$192.00	—	84% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Fac Fee Immun Adm Single/Comb	$192.00	$192.00	—	84% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Adm Single/Comb	$192.00	$192.00	—	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Fac Fee Immun Adm Single/Comb	$192.00	$192.00	—	—	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Fac Fee Immun Admin Ea Addl S/	$191.00	$191.00	—	139% above	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin Ea Addl S/C	$191.00	$191.00	—	139% above	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Admin Ea Addl S/C	$191.00	$191.00	—	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Fac Fee Immun Admin Ea Addl S/	$191.00	$191.00	—	—	—

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.northbay.org/upload/941458282_northbay-vacavalley-hospital_standardcharges.csv