Hospital Los Angeles-Long Beach-Anaheim, CA

UCI Health-Orange

Listed in its price file as “Regents of the University of California at Irvine Hospital”.

UCI Health-Orange in Orange, CA publishes cash prices for 443 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the California median for 71 of 75 procedures and above it for 4. By typical cash price it ranks #1 of 226 California hospitals and #1 of 55 hospitals in the Los Angeles, CA area, cheapest first. Select a procedure to compare it with other hospitals nearby.

101 City Drive South, Orange, CA 92868 Collected Sep 28, 2026 Source price file Check a bill from this hospital (714) 456-7890

Acute care hospital Government-owned hospital Emergency department CMS star rating 4 of 5 CCN 050348 · CMS hospital register NPI 1689608150

Financial assistance

Public hospital: ask for its charity care or sliding-scale discount

UCI Health-Orange is government-owned (CMS register). The federal financial assistance rules for nonprofit hospitals do not always apply to public ones, but many public hospitals run charity care or sliding-scale discounts for uninsured and low-income patients. Ask the billing office for its financial assistance or charity care policy and application before you pay. Letters you can copy.

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 inpatient CPT 74170 HB CT ABDOMEN W/O & W/CONTRAST MATERIAL	$1,109.60	$2,774.00	—	—	60%
Abdominal X-ray, 2 views inpatient CPT 74019 HB RADIOLOGIC EXAM ABDOMEN 2 VIEWS	$315.20	$788.00	—	—	60%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HB RADEX ANKLE COMPLETE MINIMUM 3 VIEWS	$439.20	$1,098.00	—	—	60%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HB NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$50.00	$125.00	—	91% below	60%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HB NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$50.00	$125.00	—	—	60%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HB NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$120.80	$302.00	—	—	60%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HB CT UPPER EXTREMITY W/O CONTRAST MATERIAL	$2,286.00	$5,715.00	—	—	60%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HB RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY	$548.80	$1,372.00	—	—	60%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HB BONE &/JOINT IMAGING WHOLE BODY	$1,655.60	$4,139.00	—	—	60%
Breast ultrasound, complete, one breast inpatient CPT 76641 HB US BREAST UNI REAL TIME WITH IMAGE COMPLETE	$593.60	$1,484.00	—	—	60%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HB US BREAST UNI REAL TIME WITH IMAGE LIMITED	$359.20	$898.00	—	—	60%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HB CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG	$1,597.60	$3,994.00	—	—	60%
CT angiography (CTA) of the head inpatient CPT 70496 HB CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST	$749.60	$1,874.00	—	—	60%
CT angiography (CTA) of the neck inpatient CPT 70498 HB CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST	$701.20	$1,753.00	—	—	60%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HB CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST	$3,648.80	$9,122.00	—	—	60%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HB CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST	$2,755.20	$6,888.00	—	—	60%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HB CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM	$928.00	$2,320.00	—	—	60%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HB CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL	$840.80	$2,102.00	—	—	60%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HB CT ABDOMEN & PELVIS W/CONTRAST MATERIAL	$1,248.00	$3,120.00	—	—	60%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HB CT ABDOMEN & PELVIS WO/W CONTRST 1/> BODY RE	$1,536.00	$3,840.00	—	—	60%
CT scan of the abdomen with contrast inpatient CPT 74160 HB CT ABDOMEN W/CONTRAST MATERIAL	$1,026.80	$2,567.00	—	—	60%
CT scan of the abdomen without contrast inpatient CPT 74150 HB CT ABDOMEN W/O CONTRAST MATERIAL	$989.20	$2,473.00	—	—	60%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HB CT MAXILLOFACIAL W/O CONTRAST MATERIAL	$571.20	$1,428.00	—	—	60%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HB CT HEAD/BRAIN W/O CONTRAST MATERIAL	$821.60	$2,054.00	—	—	60%
CT scan of the head with contrast inpatient CPT 70460 HB CT HEAD/BRAIN W/CONTRAST MATERIAL	$1,101.20	$2,753.00	—	—	60%
CT scan of the head without and with contrast inpatient CPT 70470 HB CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL	$1,337.60	$3,344.00	—	—	60%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HB CT LUMBAR SPINE W/O CONTRAST MATERIAL	$828.80	$2,072.00	—	—	60%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HB CT CERVICAL SPINE W/O CONTRAST MATERIAL	$1,532.00	$3,830.00	—	—	60%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HB CT PELVIS W/CONTRAST MATERIAL	$1,088.80	$2,722.00	—	—	60%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HB DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$1,735.20	$4,338.00	—	—	60%
Chest CT scan without and with contrast inpatient CPT 71270 HB CT THORAX W/O & W/CONTRAST MATERIAL	$2,160.00	$5,400.00	—	—	60%
Chest X-ray, 2 views inpatient CPT 71046 HB RADIOLOGIC EXAM CHEST 2 VIEWS	$321.60	$804.00	—	—	60%
Chest X-ray, single view inpatient CPT 71045 HB RADIOLOGIC EXAM CHEST SINGLE VIEW	$257.20	$643.00	—	—	60%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HB RADEX CLAVICLE COMPLETE	$510.80	$1,277.00	—	—	60%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HB US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE	$373.60	$934.00	—	—	60%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HB DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL	$363.60	$909.00	—	—	60%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HB DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL	$357.20	$893.00	—	—	60%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HB US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION	$1,396.40	$3,491.00	—	—	60%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HB CT THORAX W/O CONTRAST MATERIAL	$989.20	$2,473.00	—	—	60%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HB CT THORAX W/CONTRAST MATERIAL	$1,557.60	$3,894.00	—	—	60%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HB DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	$403.20	$1,008.00	—	—	60%
Diagnostic mammogram, one breast inpatient CPT 77065 HB DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$322.40	$806.00	—	—	60%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HB DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$1,726.00	$4,315.00	—	—	60%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HB DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY	$1,360.40	$3,401.00	—	—	60%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HB ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D	$1,356.00	$3,390.00	—	—	60%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HB ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D W/CONTRAST	$1,356.00	$3,390.00	—	—	60%
Elbow X-ray, 2 views inpatient CPT 73070 HB RADEX ELBOW 2 VIEWS	$223.20	$558.00	—	—	60%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HB RADEX ELBOW COMPLETE MINIMUM 3 VIEWS	$348.00	$870.00	—	—	60%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HB CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL	$581.60	$1,454.00	—	—	60%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HB RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS	$815.20	$2,038.00	—	—	60%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HB RADEX FOREARM 2 VIEWS	$336.40	$841.00	—	—	60%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HB HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER	$3,613.20	$9,033.00	—	—	60%
Hand X-ray, 2 views inpatient CPT 73120 HB RADEX HAND 2 VIEWS	$292.40	$731.00	—	—	60%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HB RADEX CALCANEUS MINIMUM 2 VIEWS	$222.00	$555.00	—	—	60%
Knee X-ray, 3 views inpatient CPT 73562 HB RADIOLOGIC EXAMINATION KNEE 3 VIEWS	$310.40	$776.00	—	—	60%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HB RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS	$929.60	$2,324.00	—	—	60%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HB CT LOWER EXTREMITY W/O CONTRAST MATERIAL	$1,583.20	$3,958.00	—	—	60%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HB ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED	$572.40	$1,431.00	—	—	60%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HB US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG	$970.00	$2,425.00	—	—	60%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HB LOW-DOSE CT FOR LUNG CANCER SCREENING	$130.00	$325.00	—	—	60%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HB RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS	$416.00	$1,040.00	—	—	60%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HB MRA HEAD W/O CONTRST MATERIAL	$1,762.40	$4,406.00	—	—	60%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 HB MRI BREAST BILATERAL W/O & W/CONTRAST	$576.00	$1,440.00	—	—	60%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 HB MRI BREASTS BILATERAL W/W/O CONTRAST MATERIAL	$576.00	$1,440.00	—	—	60%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HB MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL	$1,530.00	$3,825.00	—	—	60%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HB MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL	$2,196.80	$5,492.00	—	—	60%
MRI of the abdomen without contrast inpatient CPT 74181 HB MRI ABDOMEN W/O CONTRAST MATERIAL	$1,464.40	$3,661.00	—	—	60%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HB MRI ABDOMEN W/O & W/CONTRAST MATERIAL	$2,179.60	$5,449.00	—	—	60%
MRI of the brain, no contrast dye inpatient CPT 70551 HB MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL	$1,430.80	$3,577.00	—	—	60%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HB MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL	$1,920.00	$4,800.00	—	—	60%
MRI of the lower back, no contrast dye inpatient CPT 72148 HB MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL	$1,532.00	$3,830.00	—	—	60%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HB MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL	$1,776.00	$4,440.00	—	—	60%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HB MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL	$1,532.00	$3,830.00	—	—	60%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HB MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL	$1,776.00	$4,440.00	—	—	60%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HB MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL	$1,532.00	$3,830.00	—	—	60%
MRI of the pelvis without and with contrast inpatient CPT 72197 HB MRI PELVIS W/O & W/CONTRAST MATERIAL	$2,471.20	$6,178.00	—	—	60%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HB MRI PELVIS W/O CONTRAST MATERIAL	$1,667.60	$4,169.00	—	—	60%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HB MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL	$1,527.20	$3,818.00	—	—	60%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HB RADEX SPINE CERVICAL 4 OR 5 VIEWS	$493.20	$1,233.00	—	—	60%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HB CT SOFT TISSUE NECK W/CONTRAST MATERIAL	$1,370.00	$3,425.00	—	—	60%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HB CT SOFT TISSUE NECK W/O CONTRAST MATERIAL	$804.00	$2,010.00	—	—	60%
Neck soft tissue X-ray inpatient CPT 70360 HB RADIOLOGIC EXAMINATION NECK SOFT TISSUE	$681.20	$1,703.00	—	—	60%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HB MYOCARDIAL SPECT MULTIPLE STUDIES	$2,331.20	$5,828.00	—	—	60%
OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 HB COMPUTERIZED OPICAL COHERENCE TOMOGRAPHY IMAGING RETINA	$49.60	$124.00	—	—	60%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HB PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH	$3,172.40	$7,931.00	—	—	60%
Pelvic CT scan without contrast inpatient CPT 72192 HB CT PELVIS W/O CONTRAST MATERIAL	$927.20	$2,318.00	—	—	60%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HB US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U	$187.60	$469.00	—	65% below	60%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HB US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U	$187.60	$469.00	—	—	60%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HB US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U	$370.40	$926.00	—	—	60%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HB US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE	$543.20	$1,358.00	—	—	60%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HB US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION	$655.20	$1,638.00	—	—	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HB US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT	$497.60	$1,244.00	—	—	60%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HB US PREGNANT UTERUS LIMITED 1/> FETUSES	$899.60	$2,249.00	—	—	60%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HB RADEX RIBS UNILATERAL 2 VIEWS	$592.80	$1,482.00	—	—	60%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HB RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS	$720.40	$1,801.00	—	—	60%
Screening mammogram, both breasts inpatient both sides CPT 77067 HB SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	$201.60	$504.00	—	—	60%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HB RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS	$658.80	$1,647.00	—	—	60%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HB RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS	$202.40	$506.00	—	—	60%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HB RADIOLOGIC EXAMINATION SKULL 4/> VIEWS	$563.20	$1,408.00	—	—	60%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HB RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$532.00	$1,330.00	—	—	60%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HB RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS	$718.40	$1,796.00	—	—	60%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HB CT THORACIC SPINE W/O CONTRAST MATERIAL	$833.20	$2,083.00	—	—	60%
Toe X-ray, 2 or more views inpatient CPT 73660 HB RADEX TOE MINIMUM 2 VIEWS	$465.20	$1,163.00	—	—	60%
Transvaginal pelvic ultrasound inpatient CPT 76830 HB ULTRASOUND TRANSVAGINAL	$416.40	$1,041.00	—	—	60%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HB US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG	$966.80	$2,417.00	—	—	60%
Ultrasound of the abdomen, complete inpatient CPT 76700 HB US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION	$725.60	$1,814.00	—	—	60%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HB ULTRASOUND SCROTUM & CONTENTS	$488.40	$1,221.00	—	—	60%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HB US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM	$60.00	$150.00	—	93% below	60%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HB US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM	$60.00	$150.00	—	—	60%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HB US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM	$320.80	$802.00	—	—	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HB RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY	$388.80	$972.00	—	—	60%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HB RADEX HUMERUS MINIMUM 2 VIEWS	$428.40	$1,071.00	—	—	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HB DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$62.80	$157.00	—	93% below	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HB DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$62.80	$157.00	—	—	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HB DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$762.80	$1,907.00	—	—	60%
Wrist X-ray, 2 views inpatient CPT 73100 HB RADEX WRIST 2 VIEWS	$241.20	$603.00	—	—	60%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HB RADEX WRIST COMPLETE MINIMUM 3 VIEWS	$294.00	$735.00	—	—	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HB RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS	$858.80	$2,147.00	—	—	60%
X-ray of the abdomen, 1 view inpatient CPT 74018 HB RADIOLOGIC EXAM ABDOMEN 1 VIEW	$184.40	$461.00	—	—	60%
X-ray of the ankle, 2 views inpatient CPT 73600 HB RADIOLOGIC EXAMINATION ANKLE 2 VIEWS	$296.80	$742.00	—	—	60%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HB RADEX FINGR MINIMUM 2 VIEWS	$216.00	$540.00	—	—	60%
X-ray of the foot, 2 views inpatient CPT 73620 HB RADIOLOGIC EXAMINATION FOOT 2 VIEWS	$296.80	$742.00	—	—	60%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HB RADEX FOOT COMPLETE MINIMUM 3 VIEWS	$306.00	$765.00	—	—	60%
X-ray of the hand, 3 or more views inpatient CPT 73130 HB RADEX HAND MINIMUM 3 VIEWS	$307.20	$768.00	—	—	60%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HB RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS	$215.20	$538.00	—	—	60%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HB RADEX SPINE LUMBOSACRAL 2/3 VIEWS	$344.40	$861.00	—	—	60%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HB RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS	$472.00	$1,180.00	—	—	60%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HB RADEX SPINE THORACIC 2 VIEWS	$260.00	$650.00	—	—	60%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HB RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS	$360.80	$902.00	—	—	60%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HB RADEX SPINE CERVICAL 2 OR 3 VIEWS	$366.40	$916.00	—	—	60%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HB RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS	$396.00	$990.00	—	—	60%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HB RADEX SACRUM & COCCYX MINIMUM 2 VIEWS	$677.20	$1,693.00	—	—	60%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs California	Off list
ACTH blood test inpatient CPT 82024 HB LAB LABCORP ZEACTH ASSAY OF ACTH (UCI ONLY)	$25.88	$64.70	—	—	60%
ACTH blood test inpatient CPT 82024 HB LAB ACTH	$34.40	$86.00	—	—	60%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HB TRANSFERASE ALANINE AMINO ALT SGPT	$14.80	$37.00	—	—	60%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HB TRANSFERASE ASPARTATE AMINO AST SGOT	$45.20	$113.00	—	—	60%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HB ACUTE HEPATITIS PANEL	$98.00	$245.00	—	—	60%
Albumin blood test inpatient CPT 82040 HB LAB ARUP OLIGOCLONAL BAND PROFILE ADD	$6.17	$15.42	—	—	60%
Albumin blood test inpatient CPT 82040 HB ALBUMIN SERUM PLASMA/WHOLE BLOOD	$15.20	$38.00	—	—	60%
Aldosterone blood test inpatient CPT 82088 HB LAB LABCORP ZEALDO ASSAY OF ALDOSTERONE (UCI ONLY)	$27.60	$69.00	—	—	60%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HB ASSAY OF PHOSPHATASE ALKALINE	$8.80	$22.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB UCI ONLY ARUP ALLRG CHESTNUT IGE	$1.70	$4.25	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ARUP ALLERGEN SINGLE	$1.70	$4.25	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ARUP RAST INDIV ALLERGEN59	$1.70	$4.25	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ARUP XSQID ALLG SPEC IGE CRUDE XTRC EA (UCI ONLY)	$1.70	$4.25	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB UCI ONLY ARUP ALLRG CRAYFISH IGE	$1.70	$4.25	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ARUP ALLRG MACADAMIA IGE	$1.70	$4.25	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB RESPIRATORY ALLERGY PROFILE REGION XIII (UCI ONLY)	$2.51	$6.27	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ARUP ALLERGEN FOOD ANNATTO SEED IGE (UCI ONLY)	$8.61	$21.53	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB UCI ONLY ARUP ANNATTO SEED IGE	$8.61	$21.53	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN ALDER TREE IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG SOYBEAN IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG WHEAT IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB NUTPNL ALMOND IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB OLIVE TREE IGE ALLERGEN	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB SHELL CLAM IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLINH A. TENUIS	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLINH BERMUDA GRASS	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLINH BIRCH TREE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLINH D. FARINAE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLINH DOG EPI	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLINH ENG PLANTAIN	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLINH JAPA CEDAR	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLINH P. NOTATUM	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLINH TIMOTHY GRASS	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG ALMONG IGE NUTPNL	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG BRAZIL NUT NUTPNL	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG CASHEW IGE NUTPNL	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG FOOD COD IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG FOOD EGG WHT IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG FOOD MILK IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG FOOD PEANUT IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG FOOD SOYBEAN IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG FOOD WHEAT IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG HAZELNUT IGE NUTPNL	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG LATEX IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG PISTACHIO NUTPNL	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG SHRIMP SHELL	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG WALNUT IGE NUTPNL	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLINH COMM RAGWEED	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG MILK IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG CORN IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG COD IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLINH CAT EPI	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN WHITE OAK IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN WHITE MULBERY IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN WALNUT TREE IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN TIMOTHY GRASS IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN RUSSIANTHISTLEIGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN MUGWORT IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN JOHNSON GRASS IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN ELM TREEWHITE IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN DOG DANDER IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN COTTONWOOD IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN COCKROACH IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN CLADOSPORIUM IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN CAT DANDER IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN BERMUDA GRASS IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLERGEN ALTERNARIA IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB NUTPNL BRAILNUT IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB NUTPNL CASHEW IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB NUTPNL HAZELNUT IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB NUTPNL PEANUT IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB NUTPNL PECAN IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB NUTPNL PISTACHIO IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB NUTPNL WALNUT IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB SHELL CRAB IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB SHELL LOBSTER IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB SHELL OYSTER IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB SHELL SCALLOP IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB SHELL SHRIMP IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB SINGLE ALLERGEN TEST*59	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG DUST GREER IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG DUST STIER IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG SESAME SEED IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG PECAN IGE NUTPNL	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG SCALLOP SHELL	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG CRAB IGE SHELL	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG LOBSTER SHELL	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB UCI ONLY ALLRG CLAM IGE	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB UCI ONLY ALLRG OYSTER SHELL	$14.80	$37.00	—	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HB LAB ALLRG PEANUT IGE NUTPNL	$14.80	$37.00	—	—	60%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HB ALPHA-FETOPROTEIN SERUM	$18.80	$47.00	—	—	60%
Ammonia blood test inpatient CPT 82140 HB ASSAY OF AMMONIA	$19.20	$48.00	—	—	60%
Amylase blood test inpatient CPT 82150 HB ASSAY OF AMYLASE	$15.20	$38.00	—	—	60%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HB LAB CCP ANTIBODY (UCI ONLY)	$5.94	$14.86	—	—	60%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HB CYCLIC CITRULLINATED PEPTIDE ANTIBODY	$7.92	$19.80	—	—	60%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HB LAB ANTINUCLEAR ANTIBODIES (UCI ONLY)	$5.55	$13.87	—	—	60%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HB ANTINUCLEAR ANTIBODIES ANA	$38.40	$96.00	—	—	60%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HB LAB MAYO PBNP1 NT-PRO BNP, S	$28.23	$70.57	—	—	60%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HB NATRIURETIC PEPTIDE	$34.40	$86.00	—	—	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HB LAB ARUP NOCARDIA CULTURE AND GRAM STAIN UCI ONLY)	$13.64	$34.11	—	—	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HB LAB CULTURE SPINAL FLUID	$129.20	$323.00	—	—	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HB CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL	$129.20	$323.00	—	—	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HB LAB CULTURE SPUTUM	$129.20	$323.00	—	—	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HB LAB CULTURE BORDETELLA	$129.20	$323.00	—	—	60%
Basic metabolic panel (blood test) inpatient CPT 80048 HB BASIC METABOLIC PANEL CALCIUM TOTAL	$44.80	$112.00	—	—	60%
Bilirubin blood test, total inpatient CPT 82247 HB LAB ARUP OXYHEMOGLOBIN CSF	$11.63	$29.08	—	—	60%
Bilirubin blood test, total inpatient CPT 82247 HB BILIRUBIN TOTAL	$12.80	$32.00	—	—	60%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HB LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM	$86.00	$215.00	—	34% below	60%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HB LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM	$86.00	$215.00	—	—	60%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HB LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM	$157.60	$394.00	—	—	60%
Blood culture for bacteria inpatient CPT 87040 HB CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES	$188.00	$470.00	—	—	60%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HB LAB VENIPUNCTURE	$15.60	$39.00	—	—	60%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HB COLLECTION VENOUS BLOOD VENIPUNCTURE	$15.60	$39.00	—	—	60%
Blood glucose (sugar) test inpatient CPT 82947 HB GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP	$45.20	$113.00	—	—	60%
Blood lead test inpatient CPT 83655 HB LAB ARUP ASSAY OF LEAD	$4.40	$11.01	—	—	60%
Blood lead test inpatient CPT 83655 HB LAB QUEST ZHVYMB ASSAY OF LEAD (UCI ONLY)	$9.62	$24.06	—	—	60%
Blood lead test inpatient CPT 83655 HB LAB MAYO LEAD HAIR (UCI ONLY)	$15.28	$38.19	—	—	60%
Blood lead test inpatient CPT 83655 HB ASSAY OF LEAD	$15.28	$38.19	—	—	60%
Blood lead test inpatient CPT 83655 HB LAB LEAD BY ATOMIC ABSORPTION*	$21.60	$54.00	—	—	60%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HB BLOOD TYPING SEROLOGIC ABO	$64.00	$160.00	—	—	60%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HB UREA NITROGEN VENOUS (UCI ONLY)	$12.80	$32.00	—	—	60%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HB LAB POCT ISTAT BUN	$12.80	$32.00	—	—	60%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HB UREA NITROGEN (UCI ONLY)	$12.80	$32.00	—	—	60%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HB ASSAY OF UREA NITROGEN QUANTITATIVE	$12.80	$32.00	—	—	60%
C-peptide blood test inpatient CPT 84681 HB ASSAY OF C-PEPTIDE	$19.20	$48.00	—	—	60%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HB LAB C-REACTIVE PROTEIN (UCI ONLY)	$5.60	$14.00	—	—	60%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HB PROMETHEUS 1800 ZIBD C-REACTIVE PROTEIN	$8.12	$20.30	—	—	60%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HB C-REACTIVE PROTEIN	$38.80	$97.00	—	—	60%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HB INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE	$115.20	$288.00	—	—	60%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HB IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9	$60.40	$151.00	—	—	60%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HB IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125	$60.40	$151.00	—	—	60%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HB LAB UCI ARUP 2019 NOVEL CORONAVIRUS SARS-COV-2 BY PCR	$38.00	$95.00	—	—	60%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC SARS-COV-2 COVID-19 AMP PRB, POCT	$160.40	$401.00	—	—	60%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HB LAB CORONAVIRUS DISEASE 2019 (COVID-19), ANAHEIM DUCKS ATHLETES (UCI ONLY)	$160.40	$401.00	—	—	60%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HB LAB CORONAVIRUS DISEASE 2019 (COVID-19), ANAHEIM DUCKS STAFF (UCI)	$160.40	$401.00	—	—	60%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HB LAB GENX COVID TEST (UCI ONLY)	$160.40	$401.00	—	—	60%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HB LAB IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ (UCI ONLY)	$160.40	$401.00	—	—	60%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HB LAB UCI COVID-19 ROUTINE RNA / DNA	$160.40	$401.00	—	—	60%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HB LAB UCI COVID-19 RNA/DNA	$160.40	$401.00	—	—	60%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient one side CPT 87635 HB LAB UCI QUEST SARS-COV-2 RNA QUALITATIVE REAL-TIME RT-PCR	$160.40	$401.00	—	—	60%
Calcium blood test, total inpatient CPT 82310 HB CALCIUM TOTAL	$9.20	$23.00	—	—	60%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HB CARCINOEMBRYONIC ANTIGEN CEA	$23.60	$59.00	—	—	60%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HB ANTIBODY VARICELLA-ZOSTER	$57.20	$143.00	—	—	60%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HB LAB AB VARICELLA ZOSTER IGM	$57.20	$143.00	—	—	60%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HB LAB QUEST ZCTNGU CHLMYD TRACH DNA AMP PROBE (UCI ONLY)	$12.00	$30.00	—	—	60%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HB LAB IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ (UCI ONLY)	$30.80	$77.01	—	—	60%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HB IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ	$213.20	$533.00	—	—	60%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HB LAB LIPIC PANEL CHOL/HDL REFER	$7.20	$18.00	—	—	60%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HB LIPID PANEL	$7.20	$18.00	—	—	60%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HB LAB QUEST ADV LIPID PANEL W/INFLAM CARDIO IQ (UCI ONLY)	$10.91	$27.28	—	—	60%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HB LAB QUEST ZIQADL LIPID PANEL (UCI ONLY)	$18.24	$45.59	—	—	60%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HB LAB QUEST ZAPLIN LIPID PANEL (UCI ONLY)	$19.05	$47.62	—	—	60%
Complete blood count (CBC) with differential inpatient CPT 85025 HB LAB BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC (BMT CHOC)	$32.00	$80.00	—	—	60%
Complete blood count (CBC) with differential inpatient CPT 85025 HB LAB CBC W/DIFF PLACENTVEN BL	$32.00	$80.00	—	—	60%
Complete blood count (CBC) with differential inpatient CPT 85025 HB BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$32.00	$80.00	—	—	60%
Complete blood count (CBC), no differential inpatient CPT 85027 HB BLOOD COUNT COMPLETE AUTOMATED	$26.80	$67.00	—	—	60%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HB COMPREHENSIVE METABOLIC PANEL	$50.00	$125.00	—	—	60%
Cortisol blood test, total inpatient CPT 82533 HB LAB LABCORP ZECORT TOTAL CORTISOL (UCI ONLY)	$13.20	$33.00	—	—	60%
Cortisol blood test, total inpatient CPT 82533 HB CORTISOL TOTAL	$19.20	$48.00	—	—	60%
Cortisol blood test, total inpatient CPT 82533 HB LAB MAYO SALCT CORTISOL, SALIVA	$21.03	$52.58	—	—	60%
Cortisol blood test, total inpatient CPT 82533 HB LAB LABCORP ZECAH1 TOTAL CORTISOL (UCI ONLY)	$22.16	$55.40	—	—	60%
Cortisol blood test, total inpatient CPT 82533 HB LAB LABCORP ZECAH6 TOTAL CORTISOL (UCI ONLY)	$25.11	$62.77	—	—	60%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HB CREATINE KINASE TOTAL	$19.60	$49.00	—	—	60%
Creatinine blood test inpatient CPT 82565 HB LAB POCT ISTAT CREATININE	$9.20	$23.00	—	—	60%
Creatinine blood test inpatient CPT 82565 HB CREATININE BLOOD	$9.20	$23.00	—	—	60%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HB LAB UCI BMT DONOR PANEL CUSTOM PANEL-VIROMED (UCI ONLY)	$6.00	$15.00	—	—	60%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HB LAB HB EAP ZBMTD REFLEX--CYTOMEGALOVIRUS (CMV) AB IGG/M (UCI ONLY)	$6.00	$15.00	—	—	60%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HB ANTIBODY CYTOMEGALOVIRUS CMV	$70.40	$176.00	—	—	60%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HB LAB QUANTITATIVE D-DIMER/DIC	$77.20	$193.00	—	—	60%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HB FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE	$77.20	$193.00	—	—	60%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HB LAB DHEA SULFATE	$24.80	$62.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB MAYO ETGS ETHYL GLUCURONIDE SCREEN, U	$23.52	$58.79	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB ARUP DRUG DETECTION PAN UMBILICAL CORD QUAL (UCI ONLY)	$36.20	$90.51	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB METHADONE SCREEN	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB DRUG SCREEN PANEL 14 URINE ( UCI ONLY)	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB DRUG SCREEN RAPID 12 URINE W/REFLEX TO CONFIRM (UCI ONLY)	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB DRUG SCREEN RAPID PANEL 12 URINE NO CONFIRM (UCI ONLY)	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB DRUG SCREEN PAIN WITH REFLEX TO CONFIRMATION (UCI ONLY)	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB DRUG TEST PRESUMPTIVE SCREEN	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB DRUG SCREEN QUANTITATIVE ALCOHOLS	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB UCI ONLY DARVON UR SCR (REF)	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB RDSE DRUG CLASS A	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB RDSD DRUG CLASS A	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB RDSC DRUG CLASS A	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB AMPHETAMINES SC UR	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB MDMA SCREEN (REF)	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB RDSO DRUG CLASS A	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB 6-MAM UR SCR (REF)	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB RDS DRUG CLASS A	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB COCAINE SCREEN	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB BARBITURATES URINE	$65.60	$164.00	—	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HB LAB-BENZODIAZEPINE SCREEN	$65.60	$164.00	—	—	60%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HB LAB NEO/PED ELECTROLYTE PANEL	$60.80	$152.00	—	—	60%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HB ELECTROLYTE PANEL	$60.80	$152.00	—	—	60%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HB ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA	$78.80	$197.00	—	—	60%
Estradiol blood test inpatient CPT 82670 HB LAB QUEST ZESDUS ASSAY OF TOTAL ESTRADIOL (UCI ONLY)	$15.20	$38.00	—	—	60%
Estradiol blood test inpatient CPT 82670 HB ASSAY OF ESTRADIOL	$24.80	$62.00	—	—	60%
Estradiol blood test inpatient CPT 82670 HB LAB LABCORP ZEESTR ASSAY OF TOTAL ESTRADIOL (UCI ONLY)	$30.00	$75.00	—	—	60%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HB LAB LABCORP ZEFSH ASSAY OF GONADOTROPIN (FSH) (UCI ONLY)	$18.00	$45.00	—	—	60%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HB GONADOTROPIN FOLLICLE STIMULATING HORMONE	$21.20	$53.00	—	—	60%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HB ASSAY OF CALPROTECTIN FECAL	$24.00	$60.00	—	—	60%
Ferritin blood test (iron stores) inpatient CPT 82728 HB ASSAY OF FERRITIN	$20.80	$52.00	—	—	60%
Fibrinogen blood test inpatient CPT 85384 HB FIBRINOGEN ACTIVITY	$39.20	$98.00	—	—	60%
Fibrinogen blood test inpatient CPT 85384 HB LAB UCI ONLY FIBTEM MCF/A20 FIBRINOGEN	$39.20	$98.00	—	—	60%
Folate (folic acid) blood test inpatient CPT 82746 HB ASSAY OF FOLIC ACID SERUM	$19.60	$49.00	—	—	60%
Free T3 thyroid hormone test inpatient CPT 84481 HB LAB T3 FREE	$14.40	$36.00	—	—	60%
Free T3 thyroid hormone test inpatient CPT 84481 HB LAB LABCORP ZRT3FR FREE ASSAY (FT-3) (UCI ONLY)	$44.10	$110.25	—	—	60%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HB ASSAY OF FREE THYROXINE	$17.20	$43.00	—	—	60%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HB LAB LABCORP ZET4F ASSAY OF FREE THYROXINE (UCI ONLY)	$22.00	$55.00	—	—	60%
Free testosterone test inpatient CPT 84402 HB LAB TESTOSTERONE FREE, ADULT MALE	$17.60	$44.00	—	—	60%
Free testosterone test inpatient CPT 84402 HB LAB LABCORP ZESTRA ASSAY OF GONADOTROPIN (LH) (UCI ONLY)	$19.60	$49.00	—	—	60%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HB ASSAY OF GLUTAMYLTRASE GAMMA	$12.00	$30.00	—	—	60%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HB LAB GLUCOSE TOLERANCE 1 HO	$19.60	$49.00	—	—	60%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HB GLUCOSE POST GLUCOSE DOSE	$19.60	$49.00	—	—	60%
Glucose tolerance test, 3 samples inpatient CPT 82951 HB GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS	$32.80	$82.00	—	—	60%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HB LAB QUEST ZCTNGU N.GONORRHOEAE DNA AMP PROB (UCI ONLY)	$12.00	$30.00	—	—	60%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HB LAB IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ (UCI ONLY)	$30.80	$77.01	—	—	60%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HB IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ	$213.20	$533.00	—	—	60%
H. pylori antibody blood test inpatient CPT 86677 HB LABCORP HELICOBACTER PYLORI ANTIBODIES, IGG (UCI ONLY)	$6.74	$16.85	—	—	60%
H. pylori antibody blood test inpatient CPT 86677 HB ANTIBODY HELICOBACTER PYLORI	$76.00	$190.00	—	—	60%
H. pylori stool antigen test inpatient CPT 87338 HB IAAD IA HPYLORI STOOL	$264.80	$662.00	—	—	60%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HB QUEST40085 ZHIVRTQ HIV-1 QUANT&REVRSE TRNSCRPJ	$30.00	$75.00	—	—	60%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HB LAB MBL GENOSURE VIRAL LOAD	$37.63	$94.07	—	—	60%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HB LABCORP 550420 ZHIVRTL HIV-1 QUANT&REVRSE TRNSCRPJ	$39.20	$98.00	—	—	60%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HB LAB HIV-1 RNA BY PCR, VIRAL LOAD (UCI ONLY)	$59.60	$149.00	—	—	60%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HB LAB HIV VIRAL LOAD RNA PCR (UCI ONLY)	$59.60	$149.00	—	—	60%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HB IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION	$59.60	$149.00	—	—	60%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HB LAB EUROFINS DPT ZBWP HIV-1/HIV-2 1 RESULT ANTBDY (UCI ONLY)	$8.68	$21.70	—	—	60%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HB ANTIBODY HIV-1&HIV-2 SINGLE RESULT	$13.20	$33.00	—	—	60%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HB UCI BMT DONOR PANEL CUSTOM PANEL-VIROMED ADDL (UCI ONLY)	$10.00	$25.00	—	—	60%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HB IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE	$95.60	$239.00	—	—	60%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HB IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES PULLED RESULTS	$146.00	$365.00	—	—	60%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HB LAB QUEST ZIQHGB HEMOGLOBIN GLYCOSYLATED A1C (UCI ONLY)	$6.29	$15.73	—	—	60%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HB HEMOGLOBIN GLYCOSYLATED A1C	$16.80	$42.00	—	—	60%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HB LAB MAYO HBA1C HEMOGLOBIN A1C, B	$58.76	$146.90	—	—	60%
Hemoglobin blood test inpatient CPT 85018 HB BLOOD COUNT HEMOGLOBIN	$12.00	$30.00	—	—	60%
Hepatitis B core antibody test (total) inpatient CPT 86704 HB HEPATITIS B CORE ANTIBODY HBCAB TOTAL	$50.00	$125.00	—	—	60%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HB HEPATITIS B SURF ANTIBODY HBSAB	$45.60	$114.00	—	—	60%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HB UCI BMT DONOR PANEL CUSTOM PANEL-VIROMED ADDL (UCI ONLY)	$5.60	$14.00	—	—	60%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HB LAB EUROFINS DPT ZBWP HEPATITIS B SURFACE AG IA (UCI ONLY)	$8.68	$21.70	—	—	60%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HB LAB HEP SCREEN TO REFLEX	$65.60	$164.00	—	—	60%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HB IAAD IA HEPATITIS B SURFACE ANTIGEN	$65.60	$164.00	—	—	60%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HB LAB UCI BMT DONOR PANEL CUSTOM PANEL-VIROMED ADDL (UCI ONLY)	$8.00	$20.00	—	—	60%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HB LAB EUROFINS DPT ZBWP HEPATITIS C AB TEST (UCI ONLY)	$8.68	$21.70	—	—	60%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HB HEPATITIS C ANTIBODY	$57.20	$143.00	—	—	60%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HB LAB HEPATITIS C VIRAL LOAD (UCI ONLY)	$300.40	$751.00	—	—	60%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HB LAB HEPATITIS C VIRAL LOAD RNA PCR (UCI ONLY)	$300.40	$751.00	—	—	60%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HB IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION	$300.40	$751.00	—	—	60%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HB ANTIBODY HERPES SMPLX TYPE 1	$84.00	$210.00	—	—	60%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HB LAB AB HERPES 1 IGM ONLY	$84.00	$210.00	—	—	60%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HB ANTIBODY HERPES SMPLX TYPE 2	$85.60	$214.00	—	—	60%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HB LAB AB HERPES 2 IGM ONLY	$85.60	$214.00	—	—	60%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HB LAB QUEST ADV LIPID PANEL W INFLAM CARDIO IQ (UCI ONLY)	$10.91	$27.28	—	—	60%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HB LAB QUEST ZIQHS C-REACTIVE PROTEIN HS (UCI ONLY)	$18.00	$45.00	—	—	60%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HB LAB QUEST ZAPLIN C-REACTIVE PROTEIN HS (UCI ONLY)	$19.05	$47.62	—	—	60%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HB LAB PROMETHEUS MONITR CROHN'S DISEASE (UCI ONLY)	$19.50	$48.75	—	—	60%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HB C-REACTIVE PROTEIN HIGH SENSITIVITY	$66.80	$167.00	—	—	60%
Homocysteine blood test inpatient CPT 83090 HB ASSAY OF HOMOCYSTEINE	$18.80	$47.00	—	—	60%
Homocysteine blood test inpatient CPT 83090 HB LAB QUEST ZIQHM ASSAY OF HOMOCYSTEINE (UCI ONLY)	$28.00	$70.00	—	—	60%
Insulin blood test inpatient CPT 83525 HB LAB INSULIN 30 MINUTES	$12.80	$32.00	—	—	60%
Insulin blood test inpatient CPT 83525 HB ASSAY OF INSULIN TOTAL	$12.80	$32.00	—	—	60%
Insulin blood test inpatient CPT 83525 HB LAB INSULIN 60 MINUTES	$12.80	$32.00	—	—	60%
Iron blood test (serum iron) inpatient CPT 83540 HB ASSAY OF IRON	$16.00	$40.00	—	—	60%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HB LAB BNP CARTRIDGE (UCI ONLY)	$14.80	$37.00	—	—	60%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HB IRON BINDING CAPACITY	$14.80	$37.00	—	—	60%
Kidney function blood test panel inpatient CPT 80069 HB LAB UCI ONLY RENAL FUNCTION PANEL	$68.00	$170.00	—	—	60%
LH (luteinizing hormone) test inpatient CPT 83002 HB LAB LABCORP ZELHP ASSAY OF GONADOTROPIN (LH) (UCI ONLY)	$10.40	$26.00	—	—	60%
LH (luteinizing hormone) test inpatient CPT 83002 HB GONADOTROPIN LUTEINIZING HORMONE	$21.60	$54.00	—	—	60%
Lactate (lactic acid) blood test inpatient CPT 83605 HB LAB ARUP LACTATE	$7.26	$18.16	—	—	60%
Lactate (lactic acid) blood test inpatient CPT 83605 HB LAB NEO/PED LACTATE	$19.60	$49.00	—	—	60%
Lactate (lactic acid) blood test inpatient CPT 83605 HB LAB LACTATE (UCI ONLY)	$19.60	$49.00	—	—	60%
Lactate (lactic acid) blood test inpatient CPT 83605 HB LAB UCI ONLY LACMIC LACTIC ACID MICRODX	$19.60	$49.00	—	—	60%
Lactate (lactic acid) blood test inpatient CPT 83605 HB ASSAY OF LACTATE	$19.60	$49.00	—	—	60%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HB LAB ARUP LDH TOTAL	$3.55	$8.88	—	—	60%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HB LACTATE DEHYDROGENASE LDH	$16.40	$41.00	—	—	60%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HB ASSAY OF LIPASE	$19.60	$49.00	—	—	60%
Liver function blood test panel inpatient CPT 80076 HB HEPATIC FUNCTION PANEL	$26.80	$67.00	—	—	60%
Lyme disease antibody test inpatient CPT 86618 HB ARUP XBORAB LYME DISEASE ANTIBODY (UCI ONLY)	$18.74	$46.86	—	—	60%
Lyme disease antibody test inpatient CPT 86618 HB LAB LYME TOTAL ANTIBODY	$89.60	$224.00	—	—	60%
Lyme disease antibody test inpatient CPT 86618 HB LAB LYME IGM ANTIBODY	$89.60	$224.00	—	—	60%
Magnesium blood test inpatient CPT 83735 HB LAB ARUP RBC MAGNESIUM	$12.54	$31.35	—	—	60%
Magnesium blood test inpatient CPT 83735 HB ASSAY OF MAGNESIUM	$21.20	$53.00	—	—	60%
Measles (rubeola) antibody test inpatient CPT 86765 HB ANTIBODY RUBEOLA	$114.80	$287.00	—	—	60%
Measles (rubeola) antibody test inpatient CPT 86765 HB LAB AB MEASLES IGM	$114.80	$287.00	—	—	60%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HB HETEROPHILE ANTIBODIES SCREEN INFECT MONONUCLEOSIS	$184.40	$461.00	—	—	60%
Mumps immunity blood test inpatient CPT 86735 HB LAB AB MUMPS IGM	$51.20	$128.00	—	—	60%
Mumps immunity blood test inpatient CPT 86735 HB ANTIBODY MUMPS	$51.20	$128.00	—	—	60%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HB ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE	$21.20	$53.00	—	—	60%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HB ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL	$21.20	$53.00	—	—	60%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HB CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN	$188.80	$472.00	—	—	60%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HB LAB MAYO PTHFN PTH, FNAB, NEEDLE WASH	$29.48	$73.71	—	—	60%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HB ASSAY OF PARATHORMONE	$35.60	$89.00	—	—	60%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HB LAB QUEST PTT-LA WITH REFLEX TO HEXAGONAL PHASE CONFIRM (UCI ONLY)	$6.45	$16.12	—	—	60%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HB THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD	$37.60	$94.00	—	—	60%
Phosphorus (phosphate) blood test inpatient CPT 84100 HB ASSAY OF PHOSPHORUS INORGANIC	$10.40	$26.00	—	—	60%
Potassium blood test inpatient CPT 84132 HB POTASSIUM SERUM PLASMA/WHOLE BLOOD	$12.00	$30.00	—	—	60%
Potassium blood test inpatient CPT 84132 HB LAB NEO/PED POTASSIUM-SINGLE	$12.00	$30.00	—	—	60%
Progesterone blood test inpatient CPT 84144 HB ASSAY OF PROGESTERONE	$23.60	$59.00	—	—	60%
Progesterone blood test inpatient CPT 84144 HB LAB LABCORP ZECAH6 ASSAY OF PROGESTERONE (UCI ONLY)	$25.11	$62.77	—	—	60%
Prolactin blood test inpatient CPT 84146 HB LAB AURP MACROPROLACTIN (UCI ONLY)	$15.37	$38.43	—	—	60%
Prolactin blood test inpatient CPT 84146 HB LAB XMCROP ASSAY OF PROLACTIN (UCI ONLY)	$15.38	$38.44	—	—	60%
Prolactin blood test inpatient CPT 84146 HB ASSAY OF PROLACTIN	$23.60	$59.00	—	—	60%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HB LAB PROTHROM CLOT TIME DRVVT3	$29.20	$73.00	—	—	60%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HB PROTHROMBIN TIME	$29.20	$73.00	—	—	60%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HB LAB PROTHROM CLOT TIME DRVVT2	$29.20	$73.00	—	—	60%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HB IAADIADOO STREPTOCOCCUS GROUP A	$13.20	$33.00	—	88% below	60%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HB IAADIADOO STREPTOCOCCUS GROUP A	$13.20	$33.00	—	—	60%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HB LAB DIRECT AG GROUP A STREP	$16.00	$40.00	—	—	60%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HB IAADIADOO STREPTOCOCCUS GROUP A	$16.00	$40.00	—	—	60%
Rh blood typing inpatient CPT 86901 HB BLOOD TYPING SEROLOGIC RH (D)	$38.00	$95.00	—	—	60%
Rheumatoid factor (RF) test inpatient CPT 86431 HB LAB ARUP RHEUMATOID FACTOR (UCI ONLY)	$3.62	$9.04	—	—	60%
Rheumatoid factor (RF) test inpatient CPT 86431 HB RHEUMATOID FACTOR QUANTITATIVE	$68.00	$170.00	—	—	60%
Rubella antibody test (immunity check) inpatient CPT 86762 HB ANTIBODY RUBELLA	$104.80	$262.00	—	—	60%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HB SEDIMENTATION RATE RBC AUTOMATED	$19.60	$49.00	—	—	60%
Sodium blood test inpatient CPT 84295 HB SODIUM SERUM PLASMA OR WHOLE BLOOD	$14.80	$37.00	—	—	60%
Stool ova and parasites exam inpatient CPT 87177 HB OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID	$78.40	$196.00	—	—	60%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HB BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3	$17.60	$44.00	—	—	60%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HB LAB UCI BMT DONOR PANEL CUSTOM PANEL-VIROMED ADDL(UCI ONLY)	$4.80	$12.00	—	—	60%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HB LAB SYPHILIS TP PA	$53.60	$134.00	—	—	60%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HB ANTIBODY TREPONEMA PALLIDUM	$53.60	$134.00	—	—	60%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HB SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL	$76.00	$190.00	—	—	60%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HB LAB RPR QUAL ANTIBODY	$76.00	$190.00	—	—	60%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HB LAB RAPID PLASMA REAGIN (RPR), RESPONSE TO THERAPY (UCI ONLY)	$76.00	$190.00	—	—	60%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HB ARUP XQTF1 TB TEST CELL IMMUN MEASURE (UCI ONLY)	$14.00	$35.00	—	—	60%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HB TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$14.00	$35.00	—	—	60%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HB QUANTIFERON GOLD TB PLUS, 4 TUBE (UCI ONLY)	$39.20	$98.00	—	—	60%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HB LAB TESTOSTERONE *	$11.60	$29.00	—	—	60%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HB LAB TESTOSTERONE TOTAL, ADULT MALE	$11.60	$29.00	—	—	60%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HB LAB LABCORP ZETEST ASSAY OF TOTAL TESTOSTERONE (UCI ONLY)	$16.40	$41.00	—	—	60%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HB LAB LABCORP ZESTRA ASSAY OF TOTAL TESTOSTERONE (UCI ONLY)	$20.00	$50.00	—	—	60%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HB LAB LABCORP ZECAH1 ASSAY OF TOTAL TESTOSTERONE (UCI ONLY)	$22.16	$55.40	—	—	60%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HB LAB LABCORP ZECAH6 ASSAY OF TOTAL TESTOSTERONE (UCI ONLY)	$25.14	$62.84	—	—	60%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HB LAB LABCORP ZECAH7 ASSAY OF TOTAL TESTOSTERONE (UCI ONLY)	$57.73	$144.33	—	—	60%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HB LAB MICROSOMAL ANTIBODY EACH (UCI ONLY)	$6.68	$16.70	—	—	60%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HB LAB THYROID PEROXIDASE AB	$41.60	$104.00	—	—	60%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HB LAB ARUP TSH(NBS)	$9.20	$23.00	—	—	60%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HB LAB LABCORP ZETSH ASSAY THYROID STIM HORMONE (UCI ONLY)	$14.00	$35.00	—	—	60%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HB LAB QUEST ZTHAMA ASSAY THYROID STIM HORMONE (UCI ONLY)	$18.34	$45.85	—	—	60%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HB ASSAY OF THYROID STIMULATING HORMONE TSH	$23.60	$59.00	—	—	60%
Total IgE blood test inpatient CPT 82785 HB ASSAY OF GAMMAGLOBULIN IGE	$15.20	$38.00	—	—	60%
Total IgE blood test inpatient CPT 82785 HB LAB ARUP XRRXIII ASSAY OF IGE (UCI ONLY)	$23.43	$58.57	—	—	60%
Total IgE blood test inpatient CPT 82785 HB LAB ARUP ALLERGEN, REGION13 RESPIRATORY PANEL IGE (UCI ONLY)	$23.53	$58.83	—	—	60%
Total IgE blood test inpatient CPT 82785 HB LAB RESPIRATORY ALLERGY PROFILE REGION XIII (UCI ONLY)	$34.20	$85.50	—	—	60%
Total cholesterol blood test inpatient CPT 82465 HB LAB ARUP LDL SUBCLASS ADD	$8.52	$21.30	—	—	60%
Total cholesterol blood test inpatient CPT 82465 HB CHOLESTEROL SERUM/WHOLE BLOOD TOTAL	$11.60	$29.00	—	—	60%
Total thyroxine (T4) blood test inpatient CPT 84436 HB LAB LABCORP ZET4 ASSAY OF TOTAL THYROXINE (UCI ONLY)	$5.60	$14.00	—	—	60%
Total thyroxine (T4) blood test inpatient CPT 84436 HB ASSAY OF THYROXINE TOTAL	$11.60	$29.00	—	—	60%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HB ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3	$20.00	$50.00	—	—	60%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HB LAB LABCORP ZRT3FR ASSAY TRIIODOTHYRONINE (T3) (UCI ONLY)	$44.10	$110.25	—	—	60%
Transferrin blood test inpatient CPT 84466 HB ASSAY OF L7383TRANSFERRIN	$17.60	$44.00	—	—	60%
Trichomonas test (NAAT) inpatient CPT 87661 HB LAB LABCORP ZTRICH TRICHOMONAS VAGINALIS AMPLIF (UCI ONLY)	$14.00	$35.00	—	—	60%
Trichomonas test (NAAT) inpatient CPT 87661 HB LAB LABCORP VAGINITIS NUSWAB (UCI ONLY)	$16.80	$41.99	—	—	60%
Trichomonas test (NAAT) inpatient CPT 87661 HB LAB UCI ONLY MAYO VAGINITIS ADD	$18.43	$46.08	—	—	60%
Trichomonas test (NAAT) inpatient CPT 87661 HB LAB IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH (UCI ONLY)	$30.80	$77.01	—	—	60%
Triglycerides blood test inpatient CPT 84478 HB LAB QUEST ADVANCED LIPID PANEL, CARDIO IQ (UCI ONLY)	$3.47	$8.68	—	—	60%
Triglycerides blood test inpatient CPT 84478 HB ASSAY OF TRIGLYCERIDES	$12.00	$30.00	—	—	60%
Troponin test, quantitative inpatient CPT 84484 HB LAB ARUP TROPONIN T	$11.72	$29.31	—	—	60%
Troponin test, quantitative inpatient CPT 84484 HB LAB TROPONIN I (UCI ONLY)	$43.20	$108.00	—	—	60%
Troponin test, quantitative inpatient CPT 84484 HB LAB UCI ONLY TROPONIN I HIGH SENSITIVITY	$43.20	$108.00	—	—	60%
Troponin test, quantitative inpatient CPT 84484 HB ASSAY OF TROPONIN QUANTITATIVE	$43.20	$108.00	—	—	60%
Uric acid blood test inpatient CPT 84550 HB ASSAY OF BLOOD/URIC ACID	$9.20	$23.00	—	—	60%
Urinalysis with microscope exam, automated inpatient CPT 81001 HB URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY	$68.80	$172.00	—	—	60%
Urinalysis with microscope exam, manual inpatient CPT 81000 HB URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY	$26.80	$67.00	—	—	60%
Urinalysis with microscope exam, manual inpatient CPT 81000 HB LAB SPECIFIC GRAVITIY	$26.80	$67.00	—	—	60%
Urinalysis without microscope exam, automated inpatient CPT 81003 HB URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY	$18.80	$47.00	—	—	60%
Urinalysis without microscope exam, manual inpatient CPT 81002 HB URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$15.20	$38.00	—	—	60%
Urine culture for bacteria, with colony count inpatient CPT 87086 HB CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE	$118.00	$295.00	—	—	60%
Urine microalbumin (albumin) test inpatient CPT 82043 HB ALBUMIN URINE MICROALBUMIN QUANTIATIVE	$19.20	$48.00	—	—	60%
Urine pregnancy test, read by color change CPT 81025 HB URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS	$12.80	$32.00	—	85% below	60%
Urine pregnancy test, read by color change inpatient CPT 81025 HB URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS	$12.80	$32.00	—	—	60%
Urine pregnancy test, read by color change inpatient CPT 81025 HB URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS	$30.40	$76.00	—	—	60%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HB CYANOCOBALAMIN VITAMIN B-12	$19.60	$49.00	—	—	60%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HB 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED	$28.40	$71.00	—	—	60%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HB LAB QUEST ZIQV25 VITAMIN D 25 HYDROXY (UCI ONLY)	$31.86	$79.66	—	—	60%
Zinc blood test inpatient CPT 84630 HB LAB ARUP ASSAY OF ZINC	$4.40	$11.01	—	—	60%
Zinc blood test inpatient CPT 84630 HB ASSAY OF ZINC	$17.20	$43.00	—	—	60%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HB GONADOTROPIN CHORIONIC QUANTITATIVE	$19.60	$49.00	—	—	60%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HB LAB ISTAT BHCG	$19.60	$49.00	—	—	60%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Botox injections for chronic migraine inpatient CPT 64615 HB CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$235.60	$589.00	—	—	60%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HB BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE	$883.20	$2,208.00	—	—	60%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HB CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ	$235.60	$589.00	—	—	60%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HB CLOSED TX METATARSAL FRACTURE W/O MANIPULATION	$186.40	$466.00	—	—	60%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HB CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$795.20	$1,988.00	—	—	60%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HB PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM	$795.20	$1,988.00	—	—	60%
Carpal tunnel release, open surgery inpatient CPT 64721 HB NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE	$1,310.40	$3,276.00	—	—	60%
Cervical biopsy inpatient CPT 57500 HB BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX	$572.00	$1,430.00	—	—	60%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 HB CIRCUMCISION AGE >28 DAYS	$1,647.20	$4,118.00	—	—	60%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HB CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK	$1,812.80	$4,532.00	—	—	60%
Circumcision, surgical, older than a newborn inpatient CPT 54160 HB CIRCUMCISION NEONATE	$1,812.80	$4,532.00	—	—	60%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HB CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ	$312.40	$781.00	—	—	60%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HB COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX	$2,891.20	$7,228.00	—	—	60%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HB COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE	$82.40	$206.00	—	91% below	60%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HB COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE	$82.40	$206.00	—	—	60%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HB COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE	$315.20	$788.00	—	—	60%
Cystoscopy with ureteral stent placement inpatient CPT 52332 HB CYSTO W/INSERT URETERAL STENT	$3,299.20	$8,248.00	—	—	60%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HB CYSTOURETHROSCOPY	$122.80	$307.00	—	92% below	60%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HB CYSTOURETHROSCOPY	$122.80	$307.00	—	—	60%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HB CYSTOURETHROSCOPY	$643.60	$1,609.00	—	—	60%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HB DILATION & CURETTAGE DX&/THER NONOBSTETRIC	$1,357.60	$3,394.00	—	68% below	60%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HB DILATION & CURETTAGE DX&/THER NONOBSTETRIC	$1,357.60	$3,394.00	—	—	60%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HB DILATION & CURETTAGE DX&/THER NONOBSTETRIC	$2,630.40	$6,576.00	—	—	60%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HB DESTRUCTION PREMALIGNANT LESION 1ST	$42.40	$106.00	—	87% below	60%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HB DESTRUCTION PREMALIGNANT LESION 1ST	$42.40	$106.00	—	—	60%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HB DESTRUCTION PREMALIGNANT LESION 1ST	$162.40	$406.00	—	—	60%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 HB TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA	$665.20	$1,663.00	—	—	60%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 HB REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$131.60	$329.00	—	—	60%
Earwax removal with instruments, one ear one side CPT 69210 HB REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILATERAL	$26.40	$66.00	—	86% below	60%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HB REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILATERAL	$26.40	$66.00	—	—	60%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HB REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILATERAL	$52.00	$130.00	—	—	60%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HB ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX	$54.00	$135.00	—	90% below	60%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HB ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX	$54.00	$135.00	—	—	60%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HB ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX	$204.80	$512.00	—	—	60%
Endoscopic sinus surgery: full ethmoid sinus opening inpatient CPT 31255 HB NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY TOTAL	$5,724.40	$14,311.00	—	—	60%
Endoscopic sinus surgery: opening the frontal sinus inpatient CPT 31276 HB NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS	$6,121.20	$15,303.00	—	—	60%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 HB NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY	$4,139.60	$10,349.00	—	—	60%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 HB NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS	$5,684.40	$14,211.00	—	—	60%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HB NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN	$1,795.60	$4,489.00	—	—	60%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HB INTRAVITREAL NJX PHARMACOLOGIC AGT SPX	$299.20	$748.00	—	—	60%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HB NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL	$1,335.60	$3,339.00	—	—	60%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HB SIGMOIDOSCOPY FLX DX W/WO COLLJ SPECIMENS	$741.60	$1,854.00	—	—	60%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HB HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS	$717.20	$1,793.00	—	—	60%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HB CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI	$128.40	$321.00	—	80% below	60%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HB CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI	$128.40	$321.00	—	—	60%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HB CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI	$314.40	$786.00	—	—	60%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HB HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C	$702.00	$1,755.00	—	90% below	60%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HB HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C	$702.00	$1,755.00	—	—	60%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HB HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C	$1,092.80	$2,732.00	—	—	60%
IUD insertion (the device itself billed separately) CPT 58300 HB INSERTION INTRAUTERINE DEVICE IUD	$95.60	$239.00	—	84% below	60%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HB INSERTION INTRAUTERINE DEVICE IUD	$95.60	$239.00	—	—	60%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HB INSERTION INTRAUTERINE DEVICE IUD	$213.20	$533.00	—	—	60%
Incision and drainage of a simple or single skin abscess CPT 10060 HB INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$63.20	$158.00	—	86% below	60%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HB INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$63.20	$158.00	—	—	60%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HB INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$162.40	$406.00	—	—	60%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HB INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$236.80	$592.00	—	—	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HB ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$420.80	$1,052.00	—	—	60%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HB INSJ DRUG DELIVERY IMPLANT	$118.80	$297.00	—	58% below	60%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HB INSJ DRUG DELIVERY IMPLANT	$118.80	$297.00	—	—	60%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HB INSJ DRUG DELIVERY IMPLANT	$527.60	$1,319.00	—	—	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HB ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	$245.20	$613.00	—	—	60%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HB ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	$237.20	$593.00	—	—	60%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 HB POST-CATARACT LASER SURGERY	$408.40	$1,021.00	—	—	60%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HB REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<	$134.00	$335.00	—	85% below	60%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HB REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<	$134.00	$335.00	—	—	60%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HB REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<	$312.40	$781.00	—	—	60%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HB NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	$882.80	$2,207.00	—	—	60%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HB NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	$723.20	$1,808.00	—	—	60%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HB NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL	$2,711.60	$6,779.00	—	—	60%
Lumpectomy (partial mastectomy) inpatient CPT 19301 HB MASTECTOMY PARTIAL	$2,655.20	$6,638.00	—	—	60%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HB TX MISSED ABORTION FIRST TRIMESTER SURGICAL	$360.40	$901.00	—	—	60%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 HB MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS	$414.80	$1,037.00	—	—	60%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HB EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<	$65.20	$163.00	—	95% below	60%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HB EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<	$65.20	$163.00	—	—	60%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HB EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<	$396.80	$992.00	—	—	60%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HB EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<	$73.20	$183.00	—	95% below	60%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HB EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<	$73.20	$183.00	—	—	60%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HB EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<	$396.80	$992.00	—	—	60%
Nail removal (partial or complete), one nail CPT 11730 HB AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1	$58.00	$145.00	—	88% below	60%
Nail removal (partial or complete), one nail inpatient CPT 11730 HB AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1	$58.00	$145.00	—	—	60%
Nail removal (partial or complete), one nail inpatient CPT 11730 HB AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1	$162.40	$406.00	—	—	60%
Occipital nerve block (injection for headaches) CPT 64405 HB INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$52.00	$130.00	—	94% below	60%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HB INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$52.00	$130.00	—	—	60%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HB INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$1,108.40	$2,771.00	—	—	60%
Paracentesis with imaging guidance inpatient CPT 49083 HB ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE	$1,073.60	$2,684.00	—	—	60%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HB EXCISION NAIL MATRIX PERMANENT REMOVAL	$113.20	$283.00	—	91% below	60%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HB EXCISION NAIL MATRIX PERMANENT REMOVAL	$113.20	$283.00	—	—	60%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HB EXCISION NAIL MATRIX PERMANENT REMOVAL	$312.40	$781.00	—	—	60%
Prostate biopsy inpatient CPT 55700 HB PROSTATE NEEDLE BIOPSY ANY APPROACH	$1,751.20	$4,378.00	—	—	60%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HB DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	$2,419.20	$6,048.00	—	—	60%
Removal of a breast lump, open surgery CPT 19120 HB EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION	$253.60	$634.00	—	95% below	60%
Removal of a breast lump, open surgery inpatient CPT 19120 HB EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION	$253.60	$634.00	—	—	60%
Removal of a breast lump, open surgery inpatient CPT 19120 HB EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION	$2,994.80	$7,487.00	—	—	60%
Removal of a foreign object under the skin, simple CPT 10120 HB INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$90.00	$225.00	—	91% below	60%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HB INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$90.00	$225.00	—	—	60%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HB INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$312.40	$781.00	—	—	60%
Short arm cast (elbow to hand) CPT 29075 HB APPLICATION CAST ELBOW FINGER SHORT ARM	$47.20	$118.00	—	91% below	60%
Short arm cast (elbow to hand) inpatient CPT 29075 HB APPLICATION CAST ELBOW FINGER SHORT ARM	$47.20	$118.00	—	—	60%
Short arm cast (elbow to hand) inpatient CPT 29075 HB APPLICATION CAST ELBOW FINGER SHORT ARM	$218.00	$545.00	—	—	60%
Short arm splint (forearm and hand) CPT 29125 HB APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC	$34.40	$86.00	—	92% below	60%
Short arm splint (forearm and hand) inpatient CPT 29125 HB APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC	$34.40	$86.00	—	—	60%
Short arm splint (forearm and hand) inpatient CPT 29125 HB APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC	$101.20	$253.00	—	—	60%
Short leg cast (below the knee) CPT 29405 HB APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$48.40	$121.00	—	90% below	60%
Short leg cast (below the knee) inpatient CPT 29405 HB APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$48.40	$121.00	—	—	60%
Short leg cast (below the knee) inpatient CPT 29405 HB APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$218.00	$545.00	—	—	60%
Short leg splint (calf to foot) CPT 29515 HB APPLICATION SHORT LEG SPLINT CALF FOOT	$37.20	$93.00	—	92% below	60%
Short leg splint (calf to foot) inpatient CPT 29515 HB APPLICATION SHORT LEG SPLINT CALF FOOT	$37.20	$93.00	—	—	60%
Short leg splint (calf to foot) inpatient CPT 29515 HB APPLICATION SHORT LEG SPLINT CALF FOOT	$216.80	$542.00	—	—	60%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HB SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<	$47.20	$118.00	—	91% below	60%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HB SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<	$47.20	$118.00	—	—	60%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HB SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<	$221.20	$553.00	—	—	60%
Skin biopsy, punch, one lesion CPT 11104 HB PUNCH BIOPSY SKIN SINGLE LESION	$64.40	$161.00	—	91% below	60%
Skin biopsy, punch, one lesion inpatient CPT 11104 HB PUNCH BIOPSY SKIN SINGLE LESION	$64.40	$161.00	—	—	60%
Skin biopsy, punch, one lesion inpatient CPT 11104 HB PUNCH BIOPSY SKIN SINGLE LESION	$312.40	$781.00	—	—	60%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HB EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<	$396.80	$992.00	—	—	60%
Skin tag removal, up to 15 tags CPT 11200 HB REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15	$46.00	$115.00	—	88% below	60%
Skin tag removal, up to 15 tags inpatient CPT 11200 HB REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15	$46.00	$115.00	—	—	60%
Skin tag removal, up to 15 tags inpatient CPT 11200 HB REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15	$162.40	$406.00	—	—	60%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HB SPINAL PUNCTURE LUMBAR DIAGNOSTIC	$573.20	$1,433.00	—	—	60%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HB SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM	$56.40	$141.00	—	92% below	60%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HB SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM	$56.40	$141.00	—	—	60%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HB SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM	$268.00	$670.00	—	—	60%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HB SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<	$56.40	$141.00	—	91% below	60%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HB SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<	$56.40	$141.00	—	—	60%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HB SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<	$185.60	$464.00	—	—	60%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HB TANGENTIAL BIOPSY SKIN SINGLE LESION	$52.00	$130.00	—	91% below	60%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HB TANGENTIAL BIOPSY SKIN SINGLE LESION	$52.00	$130.00	—	—	60%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HB TANGENTIAL BIOPSY SKIN SINGLE LESION	$162.40	$406.00	—	—	60%
Thoracentesis with imaging guidance inpatient CPT 32555 HB THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$1,240.40	$3,101.00	—	—	60%
Trigger finger release surgery inpatient CPT 26055 HB TENDON SHEATH INCISION(TRIGGER FINGER)	$1,073.60	$2,684.00	—	—	60%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HB INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$718.00	$1,795.00	—	—	60%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 HB LAPAROSCOPY FULGURATION OVIDUCTS	$4,592.00	$11,480.00	—	—	60%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HB BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE	$904.80	$2,262.00	—	—	60%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 HB VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS	$195.60	$489.00	—	—	60%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 HB VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS	$195.60	$489.00	—	—	60%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 HB VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS	$1,380.40	$3,451.00	—	—	60%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HB ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN	$5,054.00	$12,635.00	—	—	60%
Wart removal, up to 14 warts CPT 17110 HB DESTRUCTION BENIGN LESIONS UP TO 14	$58.80	$147.00	—	84% below	60%
Wart removal, up to 14 warts inpatient CPT 17110 HB DESTRUCTION BENIGN LESIONS UP TO 14	$58.80	$147.00	—	—	60%
Wart removal, up to 14 warts inpatient CPT 17110 HB DESTRUCTION BENIGN LESIONS UP TO 14	$162.40	$406.00	—	—	60%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HB DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<	$65.20	$163.00	—	90% below	60%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HB DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<	$65.20	$163.00	—	—	60%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HB DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<	$312.40	$781.00	—	—	60%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HB TRANSFUSION BLOOD/BLOOD COMPONENTS	$537.20	$1,343.00	—	—	60%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HB CELL SAVER SERVICE	$537.20	$1,343.00	—	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HB INCENTIVE SPIROMETER	$170.00	$425.00	—	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HB MED NEB TREATMENT INITIAL DAY	$170.00	$425.00	—	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HB MDI TREATMENT INITIAL DAY	$170.00	$425.00	—	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HB PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$170.00	$425.00	—	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HB NITRIC OXIDE THERAPY SUBSEQ DAY	$170.00	$425.00	—	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HB NITRIC OXIDE THERAPY INITIAL DAY	$170.00	$425.00	—	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HB COUGH ASSIST TREATMENT	$170.00	$425.00	—	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HB MDI TREATMENT SUBSEQ DAY	$170.00	$425.00	—	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HB MED NEB TREATMENT SUBSEQ DAY	$170.00	$425.00	—	—	60%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HB CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG	$379.60	$949.00	—	—	60%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HB COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ	$122.00	$305.00	—	—	60%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HB CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN	$2,381.60	$5,954.00	—	—	60%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HB ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY	$957.20	$2,393.00	—	—	60%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HB ECG ROUTINE ECG W/LEAST 12 LDS W/I&R	$16.40	$41.00	—	82% below	60%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 HB ECG ROUTINE ECG W/LEAST 12 LDS W/I&R	$16.40	$41.00	—	—	60%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HB ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R	$108.00	$270.00	—	—	60%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HB ELECTROCONVULSIVE THERAPY	$447.20	$1,118.00	—	—	60%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HB EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP	$227.20	$568.00	—	—	60%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HB EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM	$446.00	$1,115.00	—	—	60%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HB EMERGENCY DEPARTMENT VISIT LOW MDM	$669.20	$1,673.00	—	—	60%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HB EMERGENCY DEPARTMENT VISIT MODERATE MDM	$1,260.40	$3,151.00	—	—	60%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HB EMERGENCY DEPARTMENT VISIT HIGH MDM	$1,831.20	$4,578.00	—	—	60%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HB CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY	$636.40	$1,591.00	—	—	60%
Family therapy with the patient, 50 minutes CPT 90847 HB FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$50.00	$125.00	—	85% below	60%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HB FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$50.00	$125.00	—	—	60%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HB FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$139.60	$349.00	—	—	60%
Family therapy without the patient, 50 minutes CPT 90846 HB FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$49.20	$123.00	—	86% below	60%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HB FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$49.20	$123.00	—	—	60%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HB FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$134.80	$337.00	—	—	60%
Group psychotherapy session inpatient CPT 90853 HB GROUP PSYCHOTHERAPY	$72.00	$180.00	—	—	60%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HB IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$34.00	$85.00	—	93% below	60%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HB IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$34.00	$85.00	—	—	60%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HB IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$295.60	$739.00	—	—	60%
IV infusion of a medicine, first hour inpatient CPT 96365 HB IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR	$268.80	$672.00	—	—	60%
IV push of a medicine, first drug CPT 96374 HB THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG	$79.60	$199.00	—	77% below	60%
IV push of a medicine, first drug inpatient CPT 96374 HB THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG	$79.60	$199.00	—	—	60%
IV push of a medicine, first drug inpatient CPT 96374 HB THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG	$190.40	$476.00	—	—	60%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HB THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$40.00	$100.00	—	78% below	60%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HB THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$40.00	$100.00	—	—	60%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HB THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$80.00	$200.00	—	—	60%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HB PSYCHIATRIC DIAGNOSTIC EVALUATION	$82.40	$206.00	—	79% below	60%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HB PSYCHIATRIC DIAGNOSTIC EVALUATION	$82.40	$206.00	—	—	60%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HB PSYCHIATRIC DIAGNOSTIC EVALUATION	$88.80	$222.00	—	—	60%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HB MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB	$280.00	$700.00	—	—	60%
Neuromuscular re-education, 15 minutes CPT 97112 HB THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA	$42.80	$107.00	—	66% below	60%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HB THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA	$42.80	$107.00	—	—	60%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HB THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA	$93.20	$233.00	—	—	60%
New patient office visit, about 30 minutes CPT 99203 HB OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES	$154.80	$387.00	—	28% below	60%
New patient office visit, about 30 minutes inpatient CPT 99203 HB OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES	$72.00	$180.00	—	—	60%
New patient office visit, about 30 minutes inpatient CPT 99203 HB OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES	$154.80	$387.00	—	—	60%
New patient office visit, about 45 minutes CPT 99204 HB OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES	$186.00	$465.00	—	24% below	60%
New patient office visit, about 45 minutes inpatient CPT 99204 HB OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES	$72.00	$180.00	—	—	60%
New patient office visit, about 45 minutes inpatient CPT 99204 HB OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES	$186.00	$465.00	—	—	60%
New patient office visit, about 60 minutes CPT 99205 HB OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES	$223.20	$558.00	—	35% below	60%
New patient office visit, about 60 minutes inpatient CPT 99205 HB OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES	$72.00	$180.00	—	—	60%
New patient office visit, about 60 minutes inpatient CPT 99205 HB OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES	$223.20	$558.00	—	—	60%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HB OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES	$128.80	$322.00	—	8% below	60%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HB OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES	$72.00	$180.00	—	—	60%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HB OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES	$128.80	$322.00	—	—	60%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HB MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI	$18.00	$45.00	—	82% below	60%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HB MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI	$18.00	$45.00	—	—	60%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HB MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI	$88.80	$222.00	—	—	60%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HB OCCUPATIONAL THERAPY EVAL LOW COMPLEXITY	$146.80	$367.00	—	—	60%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HB PHYSICAL THERAPY EVALUATION HIGH COMPLEXITY	$293.60	$734.00	—	—	60%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HB PHYSICAL THERAPY EVALUATION LOW COMPLEXITY	$146.80	$367.00	—	—	60%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HB PHYSICAL THERAPY EVALUATION MODERATE COMPLEXITY	$220.00	$550.00	—	—	60%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HB MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES	$53.60	$134.00	—	—	60%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HB THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES	$102.40	$256.00	—	—	60%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HB PULMONARY REHAB NON-COPD DX TX PROCEDURES INDIVIDUAL EACH 15 MIN	$102.40	$256.00	—	—	60%
Preventive checkup, new patient aged 18–39 CPT 99385 HB INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS	$223.20	$558.00	—	48% above	60%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HB INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS	$73.60	$184.00	—	—	60%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HB INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS	$223.20	$558.00	—	—	60%
Preventive checkup, new patient aged 40–64 CPT 99386 HB INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS	$178.80	$447.00	—	7% above	60%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HB INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS	$73.60	$184.00	—	—	60%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HB INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS	$178.80	$447.00	—	—	60%
Preventive checkup, new patient aged 65 or older CPT 99387 HB INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>	$143.20	$358.00	—	9% below	60%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HB INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>	$73.60	$184.00	—	—	60%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HB INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>	$143.20	$358.00	—	—	60%
Preventive checkup, returning patient aged 18–39 CPT 99395 HB PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS	$157.60	$394.00	—	2% above	60%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HB PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS	$73.60	$184.00	—	—	60%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HB PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS	$157.60	$394.00	—	—	60%
Preventive checkup, returning patient aged 40–64 CPT 99396 HB PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$142.00	$355.00	—	8% below	60%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HB PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$73.60	$184.00	—	—	60%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HB PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$142.00	$355.00	—	—	60%
Preventive checkup, returning patient aged 65 or older CPT 99397 HB PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$128.00	$320.00	—	16% below	60%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HB PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$73.60	$184.00	—	—	60%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HB PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$128.00	$320.00	—	—	60%
Psychiatric evaluation with medical services CPT 90792 HB PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	$92.40	$231.00	—	71% below	60%
Psychiatric evaluation with medical services inpatient CPT 90792 HB PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	$92.40	$231.00	—	—	60%
Psychiatric evaluation with medical services inpatient CPT 90792 HB PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	$100.00	$250.00	—	—	60%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 HB PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR	$232.40	$581.00	—	—	60%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HB PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES	$107.20	$268.00	—	—	60%
Psychotherapy session, 30 minutes CPT 90832 HB PSYCHOTHERAPY W/PATIENT 30 MINUTES	$36.40	$91.00	—	89% below	60%
Psychotherapy session, 30 minutes inpatient CPT 90832 HB PSYCHOTHERAPY W/PATIENT 30 MINUTES	$36.40	$91.00	—	—	60%
Psychotherapy session, 30 minutes inpatient CPT 90832 HB PSYCHOTHERAPY W/PATIENT 30 MINUTES	$88.80	$222.00	—	—	60%
Psychotherapy session, 45 minutes CPT 90834 HB PSYCHOTHERAPY W/PATIENT 45 MINUTES	$48.00	$120.00	—	85% below	60%
Psychotherapy session, 45 minutes inpatient CPT 90834 HB PSYCHOTHERAPY W/PATIENT 45 MINUTES	$48.00	$120.00	—	—	60%
Psychotherapy session, 45 minutes inpatient CPT 90834 HB PSYCHOTHERAPY W/PATIENT 45 MINUTES	$88.80	$222.00	—	—	60%
Psychotherapy session, 60 minutes CPT 90837 HB PSYCHOTHERAPY W/PATIENT 60 MINUTES	$70.40	$176.00	—	81% below	60%
Psychotherapy session, 60 minutes inpatient CPT 90837 HB PSYCHOTHERAPY W/PATIENT 60 MINUTES	$70.40	$176.00	—	—	60%
Psychotherapy session, 60 minutes inpatient CPT 90837 HB PSYCHOTHERAPY W/PATIENT 60 MINUTES	$107.20	$268.00	—	—	60%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HB TOBACCO USE CESSATION ASYMPTOMATIC PATIENT 3-10 MINUTES	$14.00	$35.00	—	81% below	60%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HB TOBACCO USE CESSATION ASYMPTOMATIC PATIENT 3-10 MINUTES	$14.00	$35.00	—	—	60%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HB TOBACCO USE CESSATION ASYMPTOMATIC PATIENT 3-10 MINUTES	$19.20	$48.00	—	—	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HB FQHC PREG VISIT II & III 40 MINUTES	$157.60	$394.00	—	37% below	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HB FQHC PREG INITIAL VISIT 40 MINUTES	$157.60	$394.00	—	37% below	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HB FQHC PREG EARLY ENTRY VISIT 40 MINUTES	$157.60	$394.00	—	37% below	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HB OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN	$157.60	$394.00	—	37% below	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HB ANTEPARTUM VISIT 1,2 & 3 LEVEL 5 (NON-OB PRV/UCI ONLY)	$157.60	$394.00	—	37% below	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HB OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN	$72.00	$180.00	—	—	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HB FQHC PREG INITIAL VISIT 40 MINUTES	$157.60	$394.00	—	—	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HB ANTEPARTUM VISIT 1,2 & 3 LEVEL 5 (NON-OB PRV/UCI ONLY)	$157.60	$394.00	—	—	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HB FQHC PREG VISIT II & III 40 MINUTES	$157.60	$394.00	—	—	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HB FQHC PREG EARLY ENTRY VISIT 40 MINUTES	$157.60	$394.00	—	—	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HB OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN	$157.60	$394.00	—	—	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HB ANTEPARTUM VISIT 1,2 & 3 LEVEL 3 (NON-OB PRV/UCI ONLY)	$130.00	$325.00	—	9% below	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HB FQHC PREG EARLY ENTRY VISIT 15 MINUTES	$130.00	$325.00	—	9% below	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HB FQHC PREG INITIAL VISIT 15 MINUTES	$130.00	$325.00	—	9% below	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HB FQHC PREG VISIT II & III 15 MINUTES	$130.00	$325.00	—	9% below	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HB OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$130.00	$325.00	—	9% below	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HB OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$72.00	$180.00	—	—	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HB FQHC PREG INITIAL VISIT 15 MINUTES	$130.00	$325.00	—	—	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HB OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$130.00	$325.00	—	—	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HB FQHC PREG VISIT II & III 15 MINUTES	$130.00	$325.00	—	—	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HB FQHC PREG EARLY ENTRY VISIT 15 MINUTES	$130.00	$325.00	—	—	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HB ANTEPARTUM VISIT 1,2 & 3 LEVEL 3 (NON-OB PRV/UCI ONLY)	$130.00	$325.00	—	—	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HB FQHC PREG VISIT II & III 25 MINUTES	$143.20	$358.00	—	29% below	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HB OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$143.20	$358.00	—	29% below	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HB ANTEPARTUM VISIT 1,2 & 3 LEVEL 4 (NON-OB PRV/UCI ONLY)	$143.20	$358.00	—	29% below	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HB FQHC PREG EARLY ENTRY VISIT 25 MINUTES	$143.20	$358.00	—	29% below	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HB FQHC PREG INITIAL VISIT 25 MINUTES	$143.20	$358.00	—	29% below	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HB OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$72.00	$180.00	—	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HB ANTEPARTUM VISIT 1,2 & 3 LEVEL 4 (NON-OB PRV/UCI ONLY)	$143.20	$358.00	—	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HB FQHC PREG VISIT II & III 25 MINUTES	$143.20	$358.00	—	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HB FQHC PREG INITIAL VISIT 25 MINUTES	$143.20	$358.00	—	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HB FQHC PREG EARLY ENTRY VISIT 25 MINUTES	$143.20	$358.00	—	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HB OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$143.20	$358.00	—	—	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HB OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN	$118.00	$295.00	—	3% above	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HB FQHC PREG VISIT II & III 10 MINUTES	$118.00	$295.00	—	3% above	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HB FQHC PREG INITIAL VISIT 10 MINUTES	$118.00	$295.00	—	3% above	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HB FQHC PREG EARLY ENTRY VISIT 10 MINUTES	$118.00	$295.00	—	3% above	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HB ANTEPARTUM VISIT 1,2 & 3 LEVEL 2 (NON-OB PRV/UCI ONLY)	$118.00	$295.00	—	3% above	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HB OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN	$72.00	$180.00	—	—	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HB FQHC PREG EARLY ENTRY VISIT 10 MINUTES	$118.00	$295.00	—	—	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HB FQHC PREG VISIT II & III 10 MINUTES	$118.00	$295.00	—	—	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HB OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN	$118.00	$295.00	—	—	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HB ANTEPARTUM VISIT 1,2 & 3 LEVEL 2 (NON-OB PRV/UCI ONLY)	$118.00	$295.00	—	—	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HB FQHC PREG INITIAL VISIT 10 MINUTES	$118.00	$295.00	—	—	60%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HB ANTEPARTUM VISIT 7 THROUGH 14 LEVEL 3 (NON-OB PROV/UCI ONLY)	$154.80	$387.00	—	11% below	60%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HB OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES	$154.80	$387.00	—	11% below	60%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HB ANTEPARTUM VISIT 1,2 & 3 LEVEL 3 (NON-OB PROV/UCI ONLY)	$154.80	$387.00	—	11% below	60%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HB ANTEPARTUM VISIT 4,5 & 6 LEVEL 3 (NON-OB PROV/UCI ONLY)	$154.80	$387.00	—	11% below	60%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HB OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES	$72.00	$180.00	—	—	60%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HB ANTEPARTUM VISIT 4,5 & 6 LEVEL 3 (NON-OB PROV/UCI ONLY)	$154.80	$387.00	—	—	60%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HB OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES	$154.80	$387.00	—	—	60%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HB ANTEPARTUM VISIT 1,2 & 3 LEVEL 3 (NON-OB PROV/UCI ONLY)	$154.80	$387.00	—	—	60%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HB ANTEPARTUM VISIT 7 THROUGH 14 LEVEL 3 (NON-OB PROV/UCI ONLY)	$154.80	$387.00	—	—	60%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HB OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$186.00	$465.00	—	8% below	60%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HB ANTEPARTUM VISIT 1,2, & 3 LEVEL 4 (NON-OB PROV/UCI ONLY)	$186.00	$465.00	—	8% below	60%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HB ANTEPARTUM VISIT 4,5 & 6 LEVEL 4 (NON-OB PROV/UCI ONLY)	$186.00	$465.00	—	8% below	60%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HB ANTEPARTUM 7 THROUGH 14 LEVEL 4 (NON-OB PROV/UCI ONLY)	$186.00	$465.00	—	8% below	60%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HB OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$72.00	$180.00	—	—	60%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HB ANTEPARTUM VISIT 1,2, & 3 LEVEL 4 (NON-OB PROV/UCI ONLY)	$186.00	$465.00	—	—	60%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HB ANTEPARTUM VISIT 4,5 & 6 LEVEL 4 (NON-OB PROV/UCI ONLY)	$186.00	$465.00	—	—	60%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HB OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$186.00	$465.00	—	—	60%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HB ANTEPARTUM 7 THROUGH 14 LEVEL 4 (NON-OB PROV/UCI ONLY)	$186.00	$465.00	—	—	60%
Speech and language evaluation inpatient CPT 92523 HB EVALUATION SPEECH SOUND PRODUCTION LANGUAGE COMPREHENSION	$227.60	$569.00	—	—	60%
Speech and language evaluation inpatient CPT 92523 HB LANGUAGE EVAL ONLY	$227.60	$569.00	—	—	60%
Speech and language evaluation inpatient CPT 92523 HB EVALUATION SPEECH LANGUAGE COMPREHENSION ONLY	$227.60	$569.00	—	—	60%
Speech therapy session, individual inpatient CPT 92507 HB TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND	$131.60	$329.00	—	—	60%
Speech therapy session, individual inpatient CPT 92507 HB TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND 30 MINUTES	$131.60	$329.00	—	—	60%
Spirometry (breathing test) inpatient CPT 94010 HB SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$194.40	$486.00	—	—	60%
Spirometry before and after a bronchodilator inpatient CPT 94060 HB BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN	$232.40	$581.00	—	—	60%
Therapeutic activities (functional training), 15 minutes CPT 97530 HB THERAPEUTIC ACTVITY DIRECT PT CONTACT EACH 15 MIN	$19.60	$49.00	—	86% below	60%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HB THERAPEUTIC ACTVITY DIRECT PT CONTACT EACH 15 MIN	$19.60	$49.00	—	—	60%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HB PULMONARY REHAB NON-COPD DX TX ACTIVITIES INDIVIDUAL EACH 15 MIN	$42.80	$107.00	—	—	60%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HB THERAPEUTIC ACTVITY DIRECT PT CONTACT EACH 15 MIN	$42.80	$107.00	—	—	60%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HB PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE	$266.00	$665.00	—	—	60%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HB LAB THERAPEUTIC PHLEBOTOMY/DON	$266.00	$665.00	—	—	60%
Visual field test, extended inpatient both sides CPT 92083 HB VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM	$88.40	$221.00	—	—	60%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs California	Off list
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 HB VACCINE SARSCOV2 VAC 50 MCG/0.5ML IM (MODERNA 12 YRS AND OLDER)	$133.20	$333.00	—	—	60%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 HB VACCINE SARSCV2 VAC 30MCG TRS-SUC IM (PFIZER 12YRS AND OLDER)	$138.00	$345.00	—	—	60%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 HB VACCINE VARICELLA (CHICKEN POX) LIVE SUBCUTANEOUS	$100.80	$252.00	—	—	60%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 HB VACCINE DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE	$42.80	$107.00	—	—	60%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 HB VACCINE DIPHTHERIA TETANUS ACELLULAR PERTUSSIS PATIENT LESS 7 YEARS	$21.60	$54.00	—	—	60%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HB VACCINE DIPTHERIA TETANUS TOXOIDS ACELLULAR PERTUSS HEPATITIS B POLIOVIRUS	$56.40	$141.00	—	—	60%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 HB VACCINE DIPHTHERIA TETANUS TOXOIDS ACCELLULAR PERTUSSIS HIB IPV	$100.80	$252.00	—	—	60%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 HB VACCINE DTAP-POLIO-HIB-HEPATITIS B	$139.60	$349.00	—	—	60%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 HB VACCINE INFLUENZA TRIVALENT RIV3 PRESERVATIVE/ANTIBIOTIC FREE	$16.00	$40.00	—	—	60%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 HB VACCINE INFLUENZA TRIVALENT SPLIT VIRUS PRESERVATIVE FREE 0.50 ML IM	$9.20	$23.00	—	—	60%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HB VACCINE HUMAN PAPILLOMA VIRUS NONAVALENT (2 OR 3 DOSE SCHEDULE)	$183.60	$459.00	—	—	60%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HB VACCINE HEPATITIS A AND HEPATITIS B ADULT DOSAGE	$58.40	$146.00	—	—	60%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HB VACCINE HEPATITIS A ADULT DOSAGE	$34.80	$87.00	—	—	60%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HB VACCINE HEPATITIS A (2 DOSE SCHEDULE) PEDIATRIC/ADOLESCENT DOSAGE	$18.00	$45.00	—	—	60%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HB VACCINE HEPATITIS B (3 DOSE SCHEDULE) ADULT DOSAGE	$30.80	$77.00	—	—	60%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HB VACCINE HEPATITIS B (2 DOSE SCHEDULE) ADULT DOSAGE	$131.60	$329.00	—	—	60%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HB VACCINE HEPATITIS B (3 DOSE SCHEDULE) PEDIATRIC/ADOLESCENT DOSAGE	$13.20	$33.00	—	—	60%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HB VACCINE HEMOPHILUS INFLUENZA B PRP-OMP CONJUGATE (3 DOSE SCHEDULE)	$24.80	$62.00	—	—	60%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HB VACCINE HEMOPHILUS INFLUENZA B PRP-T CONJUGATE (4 DOSE SCHEDULE)	$30.00	$75.00	—	—	60%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 HB VACCINE INFLUENZA SPLIT VIRUS PF ENHANCED IMMUNOGENICITY	$33.60	$84.00	—	—	60%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule inpatient CPT 90738 HB VACCINE JAPENESE ENCEPHALITIS INACTIVATED INTRAMUSCULAR	$272.00	$680.00	—	—	60%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 HB VACCINE MEASLES MUMPS RUBELLA	$60.00	$150.00	—	—	60%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 HB VACCINE MEASLES MUMPS RUBELLA VARICELLA LIVE SUBCUTANEOUS	$167.20	$418.00	—	—	60%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 HB VACCINE MENINGOCOCCAL CONJUGATE SEROGROUPS A C Y W-135 QUADRAVALENT	$124.80	$312.00	—	—	60%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 HB MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE	$146.00	$365.00	—	—	60%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 HB VACCINE MENINGOCOCCAL B RECOMBINANT PROT W/OUT MEMBRANE	$172.00	$430.00	—	—	60%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 HB VACCINE MENINGOCOCCAL B RECOMBINANT LIPOPROTEIN	$151.20	$378.00	—	—	60%
Nasal spray flu vaccine, live (FluMist) CPT 90660 HB VACCINE INFLUENZA VIRUS TRIVALENT LIVE INTRANASAL	$11.60	$29.00	—	77% below	60%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 HB VACCINE INFLUENZA VIRUS TRIVALENT LIVE INTRANASAL	$11.60	$29.00	—	—	60%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 HB VACCINE INFLUENZA VIRUS TRIVALENT LIVE INTRANASAL	$11.60	$29.00	—	—	60%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 HB VACCINE PNEUMOCOCCAL CONJUGATE13 VALENT	$145.60	$364.00	—	—	60%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 HB VACCINE PNEUMOCOCCAL CONJUGATE 20 VALENT (PCV20) FOR IM USE	$264.00	$660.00	—	—	60%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HB VACCINE PNEUMOCOCCAL POLYSACCHARIDE 23-VALENT PATIENT 2+ YEARS	$71.20	$178.00	—	—	60%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 HB VACCINE POLIO INACTIVATED	$30.80	$77.00	—	—	60%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 HB RSV MONOCLONAL ANTB SEASONAL DOSE IM PER 1 ML (BEYFORTUS)	$534.80	$1,337.00	—	43% below	60%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 HB RSV MONOCLONAL ANTB SEASONAL DOSE IM PER 1 ML (BEYFORTUS)	$534.80	$1,337.00	—	—	60%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 HB RSV MONOCLONAL ANTB SEASONAL DOSE IM PER 1 ML (BEYFORTUS)	$534.80	$1,337.00	—	—	60%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 HB RSV MONOCLONAL ANTB SEASONAL DOSE IM PER 0.5 ML (BEYFORTUS)	$524.40	$1,311.00	—	46% below	60%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 HB RSV MONOCLONAL ANTB SEASONAL DOSE IM PER 0.5 ML (BEYFORTUS)	$524.40	$1,311.00	—	—	60%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 HB RSV MONOCLONAL ANTB SEASONAL DOSE IM PER 0.5 ML (BEYFORTUS)	$524.40	$1,311.00	—	—	60%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 HB VACCINE RSV PREF SUBUNIT BIVALENT FOR IM USE (ABRYSVO)	$316.40	$791.00	—	—	60%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 HB VACCINE RSV PREF RECOMBINANT ADJUVANTED FOR IM USE ( AREXVY)	$148.40	$371.00	—	—	60%
Rabies vaccine, one dose inpatient CPT 90675 HB VACCINE RABIES	$317.20	$793.00	—	—	60%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 HB VACCINE ROTOVIRUS ATTENUATED (2 DOSE SCHEDULE) LIVE ORAL	$108.80	$272.00	—	—	60%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 HB VACCINE ROTOVIRUS PENTAVALENT (3 DOSE) SCHEDULE LIVE ORAL	$80.40	$201.00	—	—	60%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HB VACCINE ZOSTER HZV RECOMBINANT ADJUVANTED IM	$151.20	$378.00	—	—	60%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 HB VACCINE TETANUS DIPHTHERIA TOXOIDS ADSORBED PF PATIENT 7+ YEARS	$21.60	$54.00	—	—	60%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 HB VACCINE TETANUS DIPHTHERIA TOXOIDS ACELLULAR PERTUSSIS PATIENT 7+ YEARS	$34.80	$87.00	—	—	60%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 HB VACCINE TYPHOID VI CAPSULAR POLYSACCHARIDE VICPS	$68.00	$170.00	—	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HB ADMINISTRATION OF INFLUENZA VIRUS VACCINE	$13.60	$34.00	—	87% below	60%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HB ADMINISTRATION OF PNEUMOCOCCAL VACCINE	$13.60	$34.00	—	87% below	60%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HB ADMINISTRATION OF HEPATITIS B VACCINE	$13.60	$34.00	—	87% below	60%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HB IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE	$13.60	$34.00	—	87% below	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HB IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE	$13.60	$34.00	—	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HB ADMINISTRATION OF INFLUENZA VIRUS VACCINE	$13.60	$34.00	—	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HB ADMINISTRATION OF PNEUMOCOCCAL VACCINE	$13.60	$34.00	—	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HB ADMINISTRATION OF HEPATITIS B VACCINE	$13.60	$34.00	—	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HB ADMINISTRATION OF INFLUENZA VIRUS VACCINE	$30.00	$75.00	—	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HB IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE	$30.00	$75.00	—	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HB ADMINISTRATION OF HEPATITIS B VACCINE	$30.00	$75.00	—	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HB ADMINISTRATION OF PNEUMOCOCCAL VACCINE	$30.00	$75.00	—	—	60%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HB IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE	$7.20	$18.00	—	91% below	60%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HB IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE	$7.20	$18.00	—	—	60%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HB IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE	$13.60	$34.00	—	—	60%

Dental

Procedure	Cash price	List price	Insurers pay	vs California	Off list
Routine teeth cleaning (prophylaxis), adult or teen CDT D1110 HB PROPHYLAXIS ADULT	$44.00	$110.00	—	55% below	60%
Routine teeth cleaning (prophylaxis), adult or teen inpatient CDT D1110 HB PROPHYLAXIS ADULT	$44.00	$110.00	—	—	60%

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://ucihealth.org/pricetransparency/952226406_regents-of-the-university-of-california-at-irvine-hospital_standardcharges.json