Hospital Seaford, DE

Bayhealth Hospital, Sussex Campus

Bayhealth Hospital, Sussex Campus in Milford, DE publishes cash prices for 405 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Delaware median for 188 of 392 procedures and below it for 73. By typical cash price it ranks #3 of 6 Delaware hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

100 Wellness Way, Milford, DE 19963,18383 HUDSON RD, STE A, Milton, DE 19968 Collected Sep 22, 2026 Source price file Check a bill from this hospital (302) 422-3311

Acute care hospital Nonprofit hospital Emergency department CMS star rating 3 of 5 CCN 080009 · CMS hospital register NPI 1023006434

Financial assistance

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

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

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

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

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 4 actions for a hospital named Bayhealth Hospital, Sussex Campus in Milford, DE:

Sep 29, 2021 Warning notice
Jun 29, 2022 Corrective action plan requested
Aug 26, 2022 Case closed
Feb 3, 2026 Met requirements

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems. Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Delaware	Off list
Abdominal CT scan without and with contrast CPT 74170 Hc Ct Abdomen W/Wo Contrast	$4,290.72	$5,108.00	—	22% above	16%
Abdominal CT scan without and with contrast inpatient CPT 74170 Hc Ct Abdomen W/Wo Contrast	$4,290.72	$5,108.00	—	—	16%
Abdominal X-ray, 2 views CPT 74019 Hc X-Ray Exam Abdomen 2 Views	$407.40	$485.00	—	42% above	16%
Abdominal X-ray, 2 views inpatient CPT 74019 Hc X-Ray Exam Abdomen 2 Views	$407.40	$485.00	—	—	16%
Ankle X-ray, complete, 3 or more views CPT 73610 Hc Ankle Complete 3 Views	$344.40	$410.00	—	2% above	16%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 Hc Ankle Complete 3 Views	$344.40	$410.00	—	—	16%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Hc Upr/L Xtremity Art 2 Levels	$580.44	$691.00	—	26% above	16%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Hc Upr/L Xtremity Art 2 Levels	$580.44	$691.00	—	—	16%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 Hc Ct Upper Extremity W/O Cont	$2,797.20	$3,330.00	—	24% above	16%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 Hc Ct Upper Extremity W/O Cont	$2,797.20	$3,330.00	—	—	16%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Hc Ba Swallow/Esophagus	$402.36	$479.00	—	3% below	16%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Hc Ba Swallow/Esophagus	$402.36	$479.00	—	—	16%
Bone scan, whole body (nuclear medicine) CPT 78306 Hc Bone Scan /Whole Body	$2,441.04	$2,906.00	—	18% above	16%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Hc Bone Scan /Whole Body	$2,441.04	$2,906.00	—	—	16%
Breast ultrasound, complete, one breast CPT 76641 Hc Us Breast Complete	$596.40	$710.00	—	at median	16%
Breast ultrasound, complete, one breast inpatient CPT 76641 Hc Us Breast Complete	$596.40	$710.00	—	—	16%
Breast ultrasound, limited (one breast or one area) CPT 76642 Hc Us Breast Limited	$596.40	$710.00	—	10% above	16%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Hc Us Breast Limited	$596.40	$710.00	—	—	16%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 Hc Ct Angiograph Abd/Pelvis W/O & W Cont	$6,941.76	$8,264.00	—	25% above	16%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 Hc Ct Angiograph Abd/Pelvis W/O & W Cont	$6,941.76	$8,264.00	—	—	16%
CT angiography (CTA) of the head CPT 70496 Hc Ct Angiography Head	$2,656.92	$3,163.00	—	at median	16%
CT angiography (CTA) of the head inpatient CPT 70496 Hc Ct Angiography Head	$2,656.92	$3,163.00	—	—	16%
CT angiography (CTA) of the neck CPT 70498 Hc Ct Angiography Neck	$2,652.72	$3,158.00	—	at median	16%
CT angiography (CTA) of the neck inpatient CPT 70498 Hc Ct Angiography Neck	$2,652.72	$3,158.00	—	—	16%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Hc Ct Angiography Chest	$4,716.60	$5,615.00	—	18% above	16%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Hc Ct Angiography Chest	$4,716.60	$5,615.00	—	—	16%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Hc Ct Coronary Arteries W 3D Image	$2,799.72	$3,333.00	—	12% above	16%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 Hc Ct Coronary Arteries W 3D Image	$2,799.72	$3,333.00	—	—	16%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 Hc Ct Heart No Contrast Quant Eval Coronry Calcium	$167.16	$199.00	—	21% below	16%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 Hc Ct Heart No Contrast Quant Eval Coronry Calcium	$167.16	$199.00	—	—	16%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Hc Abd/Pel W/O Contrast	$3,261.72	$3,883.00	—	2% above	16%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Hc Abd/Pel W/O Contrast	$3,261.72	$3,883.00	—	—	16%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 Hc Abd/Pel W Contrast	$5,040.00	$6,000.00	—	22% above	16%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Hc Abd/Pel W Contrast	$5,040.00	$6,000.00	—	—	16%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Hc Abd/Pel W&W/O Contrast	$5,618.76	$6,689.00	—	27% above	16%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Hc Abd/Pel W&W/O Contrast	$5,618.76	$6,689.00	—	—	16%
CT scan of the abdomen with contrast CPT 74160 Hc Ct Abdomen W/Contrast	$3,795.12	$4,518.00	—	17% above	16%
CT scan of the abdomen with contrast inpatient CPT 74160 Hc Ct Abdomen W/Contrast	$3,795.12	$4,518.00	—	—	16%
CT scan of the abdomen without contrast CPT 74150 Hc Ct Abdomen W/O Contrast	$3,193.68	$3,802.00	—	32% above	16%
CT scan of the abdomen without contrast inpatient CPT 74150 Hc Ct Abdomen W/O Contrast	$3,193.68	$3,802.00	—	—	16%
CT scan of the face and sinuses, no contrast dye CPT 70486 Hc Ct Maxillofacial W/O Cont	$3,155.04	$3,756.00	—	61% above	16%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Hc Ct Maxillofacial W/O Cont	$3,155.04	$3,756.00	—	—	16%
CT scan of the head or brain, no contrast dye CPT 70450 Hc Ct Head W/O Contrast	$1,794.24	$2,136.00	—	20% above	16%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 Hc Ct Head W/O Contrast	$1,794.24	$2,136.00	—	—	16%
CT scan of the head with contrast CPT 70460 Hc Ct Head W/Contrast	$2,385.60	$2,840.00	—	8% above	16%
CT scan of the head with contrast inpatient CPT 70460 Hc Ct Head W/Contrast	$2,385.60	$2,840.00	—	—	16%
CT scan of the head without and with contrast CPT 70470 Hc Ct Head W/Wo Contrast	$4,980.36	$5,929.00	—	76% above	16%
CT scan of the head without and with contrast inpatient CPT 70470 Hc Ct Head W/Wo Contrast	$4,980.36	$5,929.00	—	—	16%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Hc Ct Spine Lumbar W/O Contrast	$2,670.36	$3,179.00	—	16% above	16%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 Hc Ct Spine Lumbar W/O Contrast	$2,670.36	$3,179.00	—	—	16%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Hc Ct Spine Cervical W/O Contrast	$2,908.92	$3,463.00	—	1% above	16%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 Hc Ct Spine Cervical W/O Contrast	$2,908.92	$3,463.00	—	—	16%
CT scan of the pelvis, with contrast dye CPT 72193 Hc Ct Pelvis W/Contrast	$2,668.68	$3,177.00	—	11% above	16%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 Hc Ct Pelvis W/Contrast	$2,668.68	$3,177.00	—	—	16%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Hc Extracranial Bilat Study	$984.48	$1,172.00	—	—	16%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Hc Extracranial Bilat Study	$984.48	$1,172.00	—	—	16%
Chest CT scan without and with contrast CPT 71270 Hc Ct Thorax W/Wo Contrast	$4,914.00	$5,850.00	—	82% above	16%
Chest CT scan without and with contrast inpatient CPT 71270 Hc Ct Thorax W/Wo Contrast	$4,914.00	$5,850.00	—	—	16%
Chest X-ray, 2 views CPT 71046 Hc X-Ray Exam Chest 2 Views	$344.40	$410.00	—	15% above	16%
Chest X-ray, 2 views inpatient CPT 71046 Hc X-Ray Exam Chest 2 Views	$344.40	$410.00	—	—	16%
Chest X-ray, single view CPT 71045 Hc X-Ray Exam Chest 1 View	$273.84	$326.00	—	40% above	16%
Chest X-ray, single view inpatient CPT 71045 Hc X-Ray Exam Chest 1 View	$273.84	$326.00	—	—	16%
Collarbone (clavicle) X-ray, complete CPT 73000 Hc Clavicle Complete	$478.80	$570.00	—	12% above	16%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 Hc Clavicle Complete	$478.80	$570.00	—	—	16%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Hc Retroperitoneal Complete	$1,092.84	$1,301.00	—	21% above	16%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Hc Retroperitoneal Complete	$1,092.84	$1,301.00	—	—	16%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Hc Bone Density Axial	$559.44	$666.00	—	12% above	16%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Hc Bone Density Axial	$559.44	$666.00	—	—	16%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Hc Bone Denisity-Periphral	$219.24	$261.00	—	15% below	16%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 Hc Bone Denisity-Periphral	$219.24	$261.00	—	—	16%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Hc Us Preg Uterus W/Detail Fetal Anat 1St Gestation	$556.08	$662.00	—	at median	16%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 Hc Us Preg Uterus W/Detail Fetal Anat 1St Gestation	$556.08	$662.00	—	—	16%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Hc Ct Thorax W/O Contrast	$2,699.76	$3,214.00	—	33% above	16%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Hc Ct Thorax W/O Contrast	$2,699.76	$3,214.00	—	—	16%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Hc Ct Thorax W/Contrast	$4,177.32	$4,973.00	—	42% above	16%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Hc Ct Thorax W/Contrast	$4,177.32	$4,973.00	—	—	16%
Diagnostic mammogram, both breasts both sides CPT 77066 Hc Mammo Diagnostic Bilateral	$811.44	$966.00	—	—	16%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Hc Mammo Diagnostic Bilateral	$811.44	$966.00	—	—	16%
Diagnostic mammogram, one breast one side CPT 77065 Hc Mammo Diagnostic Unilateral	$657.72	$783.00	—	23% above	16%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Hc Mammo Diagnostic Unilateral	$657.72	$783.00	—	—	16%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Hc Lower Extremity Study; Bilateral	$1,680.84	$2,001.00	—	—	16%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 Hc Lower Extremity Study; Bilateral	$1,680.84	$2,001.00	—	—	16%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Hc Extremity Study; Bilateral	$1,774.08	$2,112.00	—	—	16%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Hc Extremity Study; Bilateral	$1,774.08	$2,112.00	—	—	16%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Hc Echo 2D W/ Doppler & Color Flow; Complete	$2,776.20	$3,305.00	—	at median	16%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Hc Echo 2D W/ Doppler & Color Flow; Complete	$2,776.20	$3,305.00	—	—	16%
Elbow X-ray, 2 views CPT 73070 Hc Elbow Ap/Lateral	$344.40	$410.00	—	19% above	16%
Elbow X-ray, 2 views inpatient CPT 73070 Hc Elbow Ap/Lateral	$344.40	$410.00	—	—	16%
Elbow X-ray, complete, 3 or more views CPT 73080 Hc Elbow Complete 3 Views	$344.40	$410.00	—	at median	16%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 Hc Elbow Complete 3 Views	$344.40	$410.00	—	—	16%
Eye socket (orbit) CT scan without contrast CPT 70480 Hc Ct Orbit/Ear/Fossa W/O Contrast	$1,979.04	$2,356.00	—	16% above	16%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Hc Ct Orbit/Ear/Fossa W/O Contrast	$1,979.04	$2,356.00	—	—	16%
Facial bones X-ray, complete, 3 or more views CPT 70150 Hc Facial Bones-Min 3 View	$473.76	$564.00	—	10% above	16%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 Hc Facial Bones-Min 3 View	$473.76	$564.00	—	—	16%
Forearm X-ray (radius and ulna), 2 views CPT 73090 Hc Forearm 2 Views	$344.40	$410.00	—	3% above	16%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 Hc Forearm 2 Views	$344.40	$410.00	—	—	16%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hc Hepatobiliary System Imaging	$1,929.48	$2,297.00	—	22% above	16%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hc Hepatobiliary System Imaging	$1,929.48	$2,297.00	—	—	16%
Hand X-ray, 2 views CPT 73120 Hc Hand Ap/Lateral	$344.40	$410.00	—	4% above	16%
Hand X-ray, 2 views inpatient CPT 73120 Hc Hand Ap/Lateral	$344.40	$410.00	—	—	16%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 Hc Heel 2 Views	$344.40	$410.00	—	14% above	16%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 Hc Heel 2 Views	$344.40	$410.00	—	—	16%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Hc Sleep Std Airflow Hrt Rate&O2 Sat Effort Unatt	$2,387.28	$2,842.00	—	14% above	16%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Hc Sleep Std Airflow Hrt Rate&O2 Sat Effort Unatt	$2,387.28	$2,842.00	—	—	16%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Hc Cpap Follow-Up	$6,673.80	$7,945.00	—	at median	16%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Hc Cpap Follow-Up	$6,673.80	$7,945.00	—	—	16%
Knee X-ray, 3 views CPT 73562 Hc Knee 3 Views	$344.40	$410.00	—	at median	16%
Knee X-ray, 3 views inpatient CPT 73562 Hc Knee 3 Views	$344.40	$410.00	—	—	16%
Knee X-ray, complete, 4 or more views CPT 73564 Hc Knee 4 Views	$344.40	$410.00	—	2% below	16%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 Hc Knee 4 Views	$344.40	$410.00	—	—	16%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 Hc Ct Lower Extremity Wo Cont	$2,540.16	$3,024.00	—	33% above	16%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 Hc Ct Lower Extremity Wo Cont	$2,540.16	$3,024.00	—	—	16%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Hc Echo Exam Of Abdomen Limited	$1,092.84	$1,301.00	—	28% above	16%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Hc Echo Exam Of Abdomen Limited	$1,092.84	$1,301.00	—	—	16%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Hc Us Nonvascular Extremity Limited	$698.88	$832.00	—	23% above	16%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 Hc Us Nonvascular Extremity Limited	$698.88	$832.00	—	—	16%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Hc Computed Tomography Thorax Lw Dose Lng Ca Scr C-	$1,023.12	$1,218.00	—	291% above	16%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Hc Computed Tomography Thorax Lw Dose Lng Ca Scr C-	$1,023.12	$1,218.00	—	—	16%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 Hc Lower Leg 2 Views	$478.80	$570.00	—	20% above	16%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 Hc Lower Leg 2 Views	$478.80	$570.00	—	—	16%
MR angiography (MRA) of the head without contrast CPT 70544 Hc Mr Angiography Head W/O Contrast	$3,174.36	$3,779.00	—	11% above	16%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 Hc Mr Angiography Head W/O Contrast	$3,174.36	$3,779.00	—	—	16%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Hc Mri Joint Of Lower Extremity W/O Cont	$4,452.84	$5,301.00	—	82% above	16%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Hc Mri Joint Of Lower Extremity W/O Cont	$4,452.84	$5,301.00	—	—	16%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Hc Mri Joint Lower Extr W/O&W/Cont	$6,117.72	$7,283.00	—	72% above	16%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Hc Mri Joint Lower Extr W/O&W/Cont	$6,117.72	$7,283.00	—	—	16%
MRI of the abdomen without contrast CPT 74181 Hc Mri Abdomen W/O Contrast	$3,302.04	$3,931.00	—	31% above	16%
MRI of the abdomen without contrast inpatient CPT 74181 Hc Mri Abdomen W/O Contrast	$3,302.04	$3,931.00	—	—	16%
MRI of the abdomen, without and then with contrast dye CPT 74183 Hc Mri Abdomen W/O & W/Contrast	$4,655.28	$5,542.00	—	32% above	16%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Hc Mri Abdomen W/O & W/Contrast	$4,655.28	$5,542.00	—	—	16%
MRI of the brain, no contrast dye CPT 70551 Hc Mri Brain Stem W/O Contrast	$2,942.52	$3,503.00	—	12% above	16%
MRI of the brain, no contrast dye inpatient CPT 70551 Hc Mri Brain Stem W/O Contrast	$2,942.52	$3,503.00	—	—	16%
MRI of the brain, with and without contrast dye CPT 70553 Hc Mri Brain Stem W/O & W Contrast	$5,196.24	$6,186.00	—	13% above	16%
MRI of the brain, with and without contrast dye inpatient CPT 70553 Hc Mri Brain Stem W/O & W Contrast	$5,196.24	$6,186.00	—	—	16%
MRI of the lower back, no contrast dye CPT 72148 Hc Mri Lumbar Spine W/O Contrast	$3,370.92	$4,013.00	—	37% above	16%
MRI of the lower back, no contrast dye inpatient CPT 72148 Hc Mri Lumbar Spine W/O Contrast	$3,370.92	$4,013.00	—	—	16%
MRI of the lower back, without and then with contrast dye CPT 72158 Hc Mri Lumbar Spine Wo/W Contrast	$7,408.80	$8,820.00	—	96% above	16%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 Hc Mri Lumbar Spine Wo/W Contrast	$7,408.80	$8,820.00	—	—	16%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Hc Mri Chest Spine W/O Contrast	$4,377.24	$5,211.00	—	74% above	16%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 Hc Mri Chest Spine W/O Contrast	$4,377.24	$5,211.00	—	—	16%
MRI of the neck (cervical spine) without and with contrast CPT 72156 Hc Mri Neck Spine W/Wo Contrast	$8,962.80	$10,670.00	—	151% above	16%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 Hc Mri Neck Spine W/Wo Contrast	$8,962.80	$10,670.00	—	—	16%
MRI of the neck (cervical spine), no contrast dye CPT 72141 Hc Mri Neck Spine W/O Contrast	$4,078.20	$4,855.00	—	62% above	16%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 Hc Mri Neck Spine W/O Contrast	$4,078.20	$4,855.00	—	—	16%
MRI of the pelvis without and with contrast CPT 72197 Hc Mri Pelvis Wo/W Contrast	$5,047.56	$6,009.00	—	42% above	16%
MRI of the pelvis without and with contrast inpatient CPT 72197 Hc Mri Pelvis Wo/W Contrast	$5,047.56	$6,009.00	—	—	16%
MRI of the pelvis, no contrast dye CPT 72195 Hc Mri Pelvis Wo Contrast	$3,504.48	$4,172.00	—	45% above	16%
MRI of the pelvis, no contrast dye inpatient CPT 72195 Hc Mri Pelvis Wo Contrast	$3,504.48	$4,172.00	—	—	16%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Hc Mri Joint Upr Extrem W/O Cont	$4,498.20	$5,355.00	—	81% above	16%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 Hc Mri Joint Upr Extrem W/O Cont	$4,498.20	$5,355.00	—	—	16%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Hc Spine Cervical 4-5 View	$800.52	$953.00	—	34% above	16%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 Hc Spine Cervical 4-5 View	$800.52	$953.00	—	—	16%
Neck soft tissue CT scan with contrast CPT 70491 Hc Ct Soft Tissue Neck W/Contrast	$4,200.00	$5,000.00	—	44% above	16%
Neck soft tissue CT scan with contrast inpatient CPT 70491 Hc Ct Soft Tissue Neck W/Contrast	$4,200.00	$5,000.00	—	—	16%
Neck soft tissue CT scan without contrast CPT 70490 Hc Ct Soft Tissue Neck W/O Contrast	$1,726.20	$2,055.00	—	22% above	16%
Neck soft tissue CT scan without contrast inpatient CPT 70490 Hc Ct Soft Tissue Neck W/O Contrast	$1,726.20	$2,055.00	—	—	16%
Neck soft tissue X-ray CPT 70360 Hc Neck Soft Tissue	$314.16	$374.00	—	1% above	16%
Neck soft tissue X-ray inpatient CPT 70360 Hc Neck Soft Tissue	$314.16	$374.00	—	—	16%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Hc Ht Muscle Image Spect Mult	$5,480.16	$6,524.00	—	9% above	16%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Hc Ht Muscle Image Spect Mult	$5,480.16	$6,524.00	—	—	16%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 Hc Pet Image W/Ct Skull-Thigh	$11,802.00	$14,050.00	—	82% above	16%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Hc Pet Image W/Ct Skull-Thigh	$11,802.00	$14,050.00	—	—	16%
Pelvic CT scan without contrast CPT 72192 Hc Ct Pelvis W/O Contrast	$2,076.48	$2,472.00	—	10% above	16%
Pelvic CT scan without contrast inpatient CPT 72192 Hc Ct Pelvis W/O Contrast	$2,076.48	$2,472.00	—	—	16%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Hc Us Pelvic Limited	$700.56	$834.00	—	21% above	16%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Hc Us Pelvic Limited	$700.56	$834.00	—	—	16%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Hc Us Pelvic Complete	$1,092.84	$1,301.00	—	14% above	16%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Hc Us Pelvic Complete	$1,092.84	$1,301.00	—	—	16%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Hc Ob Fetal >= 14 Wks Single	$937.44	$1,116.00	—	at median	16%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Hc Ob Fetal >= 14 Wks Single	$937.44	$1,116.00	—	—	16%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Hc Ob Fetal <14 Wks	$607.32	$723.00	—	39% below	16%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Hc Ob Fetal <14 Wks	$607.32	$723.00	—	—	16%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Hc Ob Fetal, Limited	$607.32	$723.00	—	20% above	16%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Hc Ob Fetal, Limited	$607.32	$723.00	—	—	16%
Rib X-ray, one side, 2 views CPT 71100 Hc Ribs Wo/Pa Chest	$344.40	$410.00	—	at median	16%
Rib X-ray, one side, 2 views inpatient CPT 71100 Hc Ribs Wo/Pa Chest	$344.40	$410.00	—	—	16%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 Hc Ribs W/Pa Chest	$390.60	$465.00	—	6% above	16%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 Hc Ribs W/Pa Chest	$390.60	$465.00	—	—	16%
Screening mammogram, both breasts both sides CPT 77067 Hc Mammo Screening Bilateral	$616.56	$734.00	—	—	16%
Screening mammogram, both breasts inpatient both sides CPT 77067 Hc Mammo Screening Bilateral	$616.56	$734.00	—	—	16%
Shoulder X-ray, complete, 2 or more views CPT 73030 Hc Shoulder 2 Views	$344.40	$410.00	—	at median	16%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 Hc Shoulder 2 Views	$344.40	$410.00	—	—	16%
Sinus X-ray, complete, 3 or more views CPT 70220 Hc Sinus Complete	$344.40	$410.00	—	at median	16%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Hc Sinus Complete	$344.40	$410.00	—	—	16%
Skull X-ray, fewer than 4 views CPT 70250 Hc Skull Limited	$344.40	$410.00	—	5% above	16%
Skull X-ray, fewer than 4 views inpatient CPT 70250 Hc Skull Limited	$344.40	$410.00	—	—	16%
Sleep study in a lab (polysomnography) CPT 95810 Hc Sleep Apnea Over Night	$5,859.84	$6,976.00	—	at median	16%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Hc Sleep Apnea Over Night	$5,859.84	$6,976.00	—	—	16%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Hc Stress Tte Complete	$1,521.24	$1,811.00	—	at median	16%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Hc Stress Tte Complete	$1,521.24	$1,811.00	—	—	16%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Hc Video Swallowing Eval	$415.80	$495.00	—	3% below	16%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Hc Video Swallowing Eval	$415.80	$495.00	—	—	16%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 Hc X-Ray Exam Of Femur 2/>	$309.12	$368.00	—	at median	16%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 Hc X-Ray Exam Of Femur 2/>	$309.12	$368.00	—	—	16%
Thoracic spine (mid back) CT scan without contrast CPT 72128 Hc Ct Spine Thoracic W/O Cont	$3,144.96	$3,744.00	—	20% above	16%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 Hc Ct Spine Thoracic W/O Cont	$3,144.96	$3,744.00	—	—	16%
Toe X-ray, 2 or more views CPT 73660 Hc Toe Or Toes 2 Views	$344.40	$410.00	—	10% above	16%
Toe X-ray, 2 or more views inpatient CPT 73660 Hc Toe Or Toes 2 Views	$344.40	$410.00	—	—	16%
Transvaginal pelvic ultrasound CPT 76830 Hc Us Transvaginal	$1,092.84	$1,301.00	—	14% above	16%
Transvaginal pelvic ultrasound inpatient CPT 76830 Hc Us Transvaginal	$1,092.84	$1,301.00	—	—	16%
Transvaginal ultrasound during pregnancy CPT 76817 Hc Ob Fetal Transvaginal	$687.12	$818.00	—	at median	16%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 Hc Ob Fetal Transvaginal	$687.12	$818.00	—	—	16%
Ultrasound of the abdomen, complete CPT 76700 Hc Abdominal Complete	$1,092.84	$1,301.00	—	at median	16%
Ultrasound of the abdomen, complete inpatient CPT 76700 Hc Abdominal Complete	$1,092.84	$1,301.00	—	—	16%
Ultrasound of the scrotum and testicles CPT 76870 Hc Us Scrotum	$1,092.84	$1,301.00	—	13% above	16%
Ultrasound of the scrotum and testicles inpatient CPT 76870 Hc Us Scrotum	$1,092.84	$1,301.00	—	—	16%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Hc Us Head & Neck Soft Tissue	$626.64	$746.00	—	2% below	16%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Hc Us Head & Neck Soft Tissue	$626.64	$746.00	—	—	16%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Hc Upper Gi Single W/O Kub	$597.24	$711.00	—	3% above	16%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Hc Upper Gi Single W/O Kub	$597.24	$711.00	—	—	16%
Upper arm X-ray (humerus), 2 views CPT 73060 Hc Humerus 2 Views	$344.40	$410.00	—	9% above	16%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 Hc Humerus 2 Views	$344.40	$410.00	—	—	16%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Hc Extremity Study; Unilateral	$1,092.00	$1,300.00	—	24% above	16%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Hc Extremity Study; Unilateral	$1,092.00	$1,300.00	—	—	16%
Wrist X-ray, 2 views CPT 73100 Hc Wrist Ap/Lateral	$279.72	$333.00	—	10% above	16%
Wrist X-ray, 2 views inpatient CPT 73100 Hc Wrist Ap/Lateral	$279.72	$333.00	—	—	16%
Wrist X-ray, complete, 3 or more views CPT 73110 Hc Wrist Complete 3 Views	$344.40	$410.00	—	10% above	16%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 Hc Wrist Complete 3 Views	$344.40	$410.00	—	—	16%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 Hc X-Ray Exam Hip Uni 2-3 Views	$349.44	$416.00	—	11% above	16%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 Hc X-Ray Exam Hip Uni 2-3 Views	$349.44	$416.00	—	—	16%
X-ray of the abdomen, 1 view CPT 74018 Hc X-Ray Exam Abdomen 1 View	$318.36	$379.00	—	50% above	16%
X-ray of the abdomen, 1 view inpatient CPT 74018 Hc X-Ray Exam Abdomen 1 View	$318.36	$379.00	—	—	16%
X-ray of the ankle, 2 views CPT 73600 Hc Ankle Ap/Lat	$279.72	$333.00	—	1% above	16%
X-ray of the ankle, 2 views inpatient CPT 73600 Hc Ankle Ap/Lat	$279.72	$333.00	—	—	16%
X-ray of the finger(s), 2 or more views CPT 73140 Hc Finger Or Fingers 2 Views	$478.80	$570.00	—	18% above	16%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 Hc Finger Or Fingers 2 Views	$478.80	$570.00	—	—	16%
X-ray of the foot, 2 views CPT 73620 Hc Foot Ap/Lat	$344.40	$410.00	—	15% above	16%
X-ray of the foot, 2 views inpatient CPT 73620 Hc Foot Ap/Lat	$344.40	$410.00	—	—	16%
X-ray of the foot, complete, 3 or more views CPT 73630 Hc Foot Complete 3 Views	$344.40	$410.00	—	5% above	16%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 Hc Foot Complete 3 Views	$344.40	$410.00	—	—	16%
X-ray of the hand, 3 or more views CPT 73130 Hc Hand Complete 3 Views	$344.40	$410.00	—	5% above	16%
X-ray of the hand, 3 or more views inpatient CPT 73130 Hc Hand Complete 3 Views	$344.40	$410.00	—	—	16%
X-ray of the knee, 1 or 2 views CPT 73560 Hc Knee 1 Or 2 Views	$344.40	$410.00	—	at median	16%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 Hc Knee 1 Or 2 Views	$344.40	$410.00	—	—	16%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Hc Spine Lumbar 2-3 Views	$344.40	$410.00	—	at median	16%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Hc Spine Lumbar 2-3 Views	$344.40	$410.00	—	—	16%
X-ray of the lower back, 4 or more views CPT 72110 Hc Spine Lumbar 4-5 Views	$575.40	$685.00	—	9% above	16%
X-ray of the lower back, 4 or more views inpatient CPT 72110 Hc Spine Lumbar 4-5 Views	$575.40	$685.00	—	—	16%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Hc Spine Thoracic Two View	$478.80	$570.00	—	11% above	16%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Hc Spine Thoracic Two View	$478.80	$570.00	—	—	16%
X-ray of the nasal bones, 3 or more views CPT 70160 Hc Nasal Bones	$344.40	$410.00	—	at median	16%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Hc Nasal Bones	$344.40	$410.00	—	—	16%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Hc Spine Cervical 2-3 View	$478.80	$570.00	—	19% above	16%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Hc Spine Cervical 2-3 View	$478.80	$570.00	—	—	16%
X-ray of the pelvis, 1 or 2 views CPT 72170 Hc Pelvis 1 Or 2 View	$344.40	$410.00	—	17% above	16%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Hc Pelvis 1 Or 2 View	$344.40	$410.00	—	—	16%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Hc Spine Sacrum/Coccyx	$344.40	$410.00	—	2% above	16%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Hc Spine Sacrum/Coccyx	$344.40	$410.00	—	—	16%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Delaware	Off list
ACTH blood test CPT 82024 Hc Adrenocorticotropic Hormone	$404.04	$481.00	—	at median	16%
ACTH blood test inpatient CPT 82024 Hc Adrenocorticotropic Hormone	$404.04	$481.00	—	—	16%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Hc Alanine Amino (Alt) (Sgpt	$84.00	$100.00	—	7% below	16%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Hc Alanine Amino (Alt) (Sgpt	$84.00	$100.00	—	—	16%
AST (aspartate aminotransferase) enzyme test CPT 84450 Hc Transferase Ast	$84.00	$100.00	—	at median	16%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Hc Transferase Ast	$84.00	$100.00	—	—	16%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hc Hepatitis Panel (A,B,C)	$272.16	$324.00	—	at median	16%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hc Hepatitis Panel (A,B,C)	$272.16	$324.00	—	—	16%
Albumin blood test CPT 82040 Hc Assay Of Serum Albumin	$55.44	$66.00	—	at median	16%
Albumin blood test inpatient CPT 82040 Hc Assay Of Serum Albumin	$55.44	$66.00	—	—	16%
Aldosterone blood test CPT 82088 Hc Assay Of Aldosterone	$404.04	$481.00	—	at median	16%
Aldosterone blood test inpatient CPT 82088 Hc Assay Of Aldosterone	$404.04	$481.00	—	—	16%
Alkaline phosphatase (ALP) blood test CPT 84075 Hc Assay Alkaline Phosphatase	$94.08	$112.00	—	8% below	16%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Hc Assay Alkaline Phosphatase	$94.08	$112.00	—	—	16%
Allergy blood test, specific IgE, per allergen CPT 86003 Hc Allergen Specific Ige	$131.04	$156.00	—	27% above	16%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hc Allergen Specific Ige	$131.04	$156.00	—	—	16%
Alpha-fetoprotein (AFP) blood test CPT 82105 Hc Alpha Fetoprotein Serum	$215.04	$256.00	—	5% below	16%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Hc Alpha Fetoprotein Serum	$215.04	$256.00	—	—	16%
Ammonia blood test CPT 82140 Hc Assay Of Ammonia	$93.24	$111.00	—	10% below	16%
Ammonia blood test inpatient CPT 82140 Hc Assay Of Ammonia	$93.24	$111.00	—	—	16%
Amylase blood test CPT 82150 Hc Assay Of Amylase	$171.36	$204.00	—	4% above	16%
Amylase blood test inpatient CPT 82150 Hc Assay Of Amylase	$171.36	$204.00	—	—	16%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Hc Cyclic Citrullinated Peptide	$211.68	$252.00	—	246% above	16%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Hc Cyclic Citrullinated Peptide	$211.68	$252.00	—	—	16%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Hc Antinuclear Antibodies	$161.28	$192.00	—	4% above	16%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Hc Antinuclear Antibodies	$161.28	$192.00	—	—	16%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Hc Assay Of Natriuretic Peptide	$327.60	$390.00	—	28% above	16%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Hc Assay Of Natriuretic Peptide	$327.60	$390.00	—	—	16%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Culture Othr Specimn Aerobic	$246.12	$293.00	—	9% above	16%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Culture Othr Specimn Aerobic	$246.12	$293.00	—	—	16%
Basic metabolic panel (blood test) CPT 80048 Hc Basic Metabolic Panel Total Ca	$74.76	$89.00	—	44% below	16%
Basic metabolic panel (blood test) inpatient CPT 80048 Hc Basic Metabolic Panel Total Ca	$74.76	$89.00	—	—	16%
Bilirubin blood test, total CPT 82247 Hc Bilirubin Total	$112.56	$134.00	—	1% below	16%
Bilirubin blood test, total inpatient CPT 82247 Hc Bilirubin Total	$112.56	$134.00	—	—	16%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Hc Surgical Path Level 4	$474.60	$565.00	—	24% above	16%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Hc Surgical Path Level 4	$474.60	$565.00	—	—	16%
Blood culture for bacteria CPT 87040 Hc Blood Culture For Bacteria	$188.16	$224.00	—	at median	16%
Blood culture for bacteria inpatient CPT 87040 Hc Blood Culture For Bacteria	$188.16	$224.00	—	—	16%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Hc Venipuncture	$20.16	$24.00	—	5% below	16%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Hc Venipuncture, Blood Draw Kit, Sendout	$20.16	$24.00	—	5% below	16%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Hc Venipuncture	$20.16	$24.00	—	—	16%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Hc Venipuncture, Blood Draw Kit, Sendout	$20.16	$24.00	—	—	16%
Blood glucose (sugar) test CPT 82947 Hc Assay Glucose Blood Quant	$37.80	$45.00	—	at median	16%
Blood glucose (sugar) test inpatient CPT 82947 Hc Assay Glucose Blood Quant	$37.80	$45.00	—	—	16%
Blood lead test CPT 83655 Hc Assay Of Lead	$162.96	$194.00	—	16% above	16%
Blood lead test inpatient CPT 83655 Hc Assay Of Lead	$162.96	$194.00	—	—	16%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hc Gonadotropin, Chorionic Hcg Qualitative	$166.32	$198.00	—	3% above	16%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Hc Gonadotropin, Chorionic Hcg Qualitative	$166.32	$198.00	—	—	16%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Hc Blood Typing Serologic Abo	$115.92	$138.00	—	1% below	16%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Hc Blood Typing Serologic Abo	$115.92	$138.00	—	—	16%
Blood urea nitrogen (BUN) test CPT 84520 Hc Urea Nitrogen	$60.48	$72.00	—	8% above	16%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Hc Urea Nitrogen	$60.48	$72.00	—	—	16%
C-peptide blood test CPT 84681 Hc C-Peptide	$268.80	$320.00	—	at median	16%
C-peptide blood test inpatient CPT 84681 Hc C-Peptide	$268.80	$320.00	—	—	16%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Hc C-Reactive Protein	$65.52	$78.00	—	10% below	16%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 Hc C-Reactive Protein	$65.52	$78.00	—	—	16%
C. difficile toxin gene test (stool PCR) CPT 87493 Hc C Diff Amplified Probe	$409.92	$488.00	—	at median	16%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Hc C Diff Amplified Probe	$409.92	$488.00	—	—	16%
CA 19-9 blood test (tumor marker) CPT 86301 Hc Immunoassay Tumor Ca 19-9	$293.16	$349.00	—	at median	16%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Hc Immunoassay Tumor Ca 19-9	$293.16	$349.00	—	—	16%
CA-125 blood test (ovarian cancer marker) CPT 86304 Hc Immunoassay Tumor Ca 125	$121.80	$145.00	—	32% below	16%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Hc Immunoassay Tumor Ca 125	$121.80	$145.00	—	—	16%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Hc Sars-Cov-2 Pcr	$226.80	$270.00	—	at median	16%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Hc Sars-Cov-2 Pcr	$226.80	$270.00	—	—	16%
Calcium blood test, total CPT 82310 Hc Calcium Total	$66.36	$79.00	—	4% above	16%
Calcium blood test, total inpatient CPT 82310 Hc Calcium Total	$66.36	$79.00	—	—	16%
Carcinoembryonic antigen (CEA) test CPT 82378 Hc Carcinoembryonic Antigen	$127.68	$152.00	—	23% below	16%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Hc Carcinoembryonic Antigen	$127.68	$152.00	—	—	16%
Chickenpox (varicella) immunity blood test CPT 86787 Hc Varicella-Zoster Antibody	$242.76	$289.00	—	104% above	16%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Hc Varicella-Zoster Antibody	$242.76	$289.00	—	—	16%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Hc Chylmd Trach Dna Amp Probe	$269.64	$321.00	—	8% above	16%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Hc Chylmd Trach Dna Amp Probe	$269.64	$321.00	—	—	16%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Hc Lipid Panel	$72.24	$86.00	—	56% below	16%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Hc Lipid Panel	$72.24	$86.00	—	—	16%
Complete blood count (CBC) with differential CPT 85025 Hc Complete Cbc With Diff	$134.40	$160.00	—	at median	16%
Complete blood count (CBC) with differential inpatient CPT 85025 Hc Complete Cbc With Diff	$134.40	$160.00	—	—	16%
Complete blood count (CBC), no differential CPT 85027 Hc Complete Cbc Without Diff	$62.16	$74.00	—	8% below	16%
Complete blood count (CBC), no differential inpatient CPT 85027 Hc Complete Cbc Without Diff	$62.16	$74.00	—	—	16%
Comprehensive metabolic panel (blood test) CPT 80053 Hc Comprehensive Metabolic Panel	$84.84	$101.00	—	44% below	16%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Hc Comprehensive Metabolic Panel	$84.84	$101.00	—	—	16%
Cortisol blood test, total CPT 82533 Hc Cortisol Total	$112.56	$134.00	—	40% below	16%
Cortisol blood test, total inpatient CPT 82533 Hc Cortisol Total	$112.56	$134.00	—	—	16%
Creatine kinase (CK) blood test, total CPT 82550 Hc Assay Of Ck (Pk)	$57.96	$69.00	—	2% below	16%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Hc Assay Of Ck (Pk)	$57.96	$69.00	—	—	16%
Creatinine blood test CPT 82565 Hc Assay Of Creatinine	$59.64	$71.00	—	1% below	16%
Creatinine blood test inpatient CPT 82565 Hc Assay Of Creatinine	$59.64	$71.00	—	—	16%
Cytomegalovirus (CMV) antibody test CPT 86644 Hc Cmv Antibody	$231.00	$275.00	—	48% above	16%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Hc Cmv Antibody	$231.00	$275.00	—	—	16%
D-dimer blood test (blood clot marker) CPT 85379 Hc Fibrin Degradation Quant	$260.40	$310.00	—	53% above	16%
D-dimer blood test (blood clot marker) inpatient CPT 85379 Hc Fibrin Degradation Quant	$260.40	$310.00	—	—	16%
DHEA sulfate (DHEA-S) blood test CPT 82627 Hc Dehydroepiandrosterone Sulfate	$287.28	$342.00	—	38% above	16%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Hc Dehydroepiandrosterone Sulfate	$287.28	$342.00	—	—	16%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Drug Test Prsmv Chem Anlyzr	$734.16	$874.00	—	55% above	16%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Drug Test Prsmv Chem Anlyzr	$734.16	$874.00	—	—	16%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Hc Electrolytes	$63.84	$76.00	—	29% below	16%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Hc Electrolytes	$63.84	$76.00	—	—	16%
Epstein-Barr virus (EBV) antibody test CPT 86665 Hc Epstein-Barr Capsid Vca	$92.40	$110.00	—	4% above	16%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Hc Epstein-Barr Capsid Vca	$92.40	$110.00	—	—	16%
Estradiol blood test CPT 82670 Hc Assay Of Estradiol	$161.28	$192.00	—	at median	16%
Estradiol blood test inpatient CPT 82670 Hc Assay Of Estradiol	$161.28	$192.00	—	—	16%
FSH (follicle-stimulating hormone) test CPT 83001 Hc Assay Of Gonadotropin (Fsh)	$166.32	$198.00	—	at median	16%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Hc Assay Of Gonadotropin (Fsh)	$166.32	$198.00	—	—	16%
Fecal calprotectin (stool inflammation test) CPT 83993 Hc Calprotectin Stool	$288.96	$344.00	—	at median	16%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Hc Calprotectin Stool	$288.96	$344.00	—	—	16%
Ferritin blood test (iron stores) CPT 82728 Hc Ferritin	$99.96	$119.00	—	24% below	16%
Ferritin blood test (iron stores) inpatient CPT 82728 Hc Ferritin	$99.96	$119.00	—	—	16%
Fibrinogen blood test CPT 85384 Hc Fibrinogen Activity	$55.44	$66.00	—	24% below	16%
Fibrinogen blood test inpatient CPT 85384 Hc Fibrinogen Activity	$55.44	$66.00	—	—	16%
Folate (folic acid) blood test CPT 82746 Hc Assay Of Folic Acid Serum	$206.64	$246.00	—	5% above	16%
Folate (folic acid) blood test inpatient CPT 82746 Hc Assay Of Folic Acid Serum	$206.64	$246.00	—	—	16%
Free T3 thyroid hormone test CPT 84481 Hc T3, Free	$298.20	$355.00	—	15% above	16%
Free T3 thyroid hormone test inpatient CPT 84481 Hc T3, Free	$298.20	$355.00	—	—	16%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Hc Thyroxine Free	$157.92	$188.00	—	at median	16%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Hc Thyroxine Free	$157.92	$188.00	—	—	16%
Free testosterone test CPT 84402 Hc Testosterone,Free	$199.08	$237.00	—	at median	16%
Free testosterone test inpatient CPT 84402 Hc Testosterone,Free	$199.08	$237.00	—	—	16%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Hc Assay Of Ggt	$91.56	$109.00	—	at median	16%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Hc Assay Of Ggt	$91.56	$109.00	—	—	16%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 Hc General Health Panel	$308.28	$367.00	—	47% below	16%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 Hc General Health Panel	$308.28	$367.00	—	—	16%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Hc Glucose Test	$38.64	$46.00	—	14% below	16%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Hc Glucose Test	$38.64	$46.00	—	—	16%
Glucose tolerance test, 3 samples CPT 82951 Hc Glucose Tolerance Test 3 Spec	$118.44	$141.00	—	22% below	16%
Glucose tolerance test, 3 samples inpatient CPT 82951 Hc Glucose Tolerance Test 3 Spec	$118.44	$141.00	—	—	16%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Hc N.Gonorrhoeae Dna Amp Prob	$217.56	$259.00	—	13% above	16%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Hc N.Gonorrhoeae Dna Amp Prob	$217.56	$259.00	—	—	16%
H. pylori antibody blood test CPT 86677 Hc Helicobacter Pylori Antibody	$99.12	$118.00	—	at median	16%
H. pylori antibody blood test inpatient CPT 86677 Hc Helicobacter Pylori Antibody	$99.12	$118.00	—	—	16%
H. pylori stool antigen test CPT 87338 Hc Helicobacter Pylori Antigen Stool	$345.24	$411.00	—	104% above	16%
H. pylori stool antigen test inpatient CPT 87338 Hc Helicobacter Pylori Antigen Stool	$345.24	$411.00	—	—	16%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hc Hiv-1 Quant&Revrse Trnscrpj	$656.88	$782.00	—	2% above	16%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Hc Hiv-1 Quant&Revrse Trnscrpj	$656.88	$782.00	—	—	16%
HIV-1 and HIV-2 antibody test CPT 86703 Hc Hiv-1/Hiv-2 1 Result Antbdy	$92.40	$110.00	—	at median	16%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Hc Hiv-1/Hiv-2 1 Result Antbdy	$92.40	$110.00	—	—	16%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hc Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$237.72	$283.00	—	39% above	16%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Hc Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$237.72	$283.00	—	—	16%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Hc Hpv High-Risk Types	$353.64	$421.00	—	48% above	16%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Hc Hpv High-Risk Types	$353.64	$421.00	—	—	16%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hc Glycosylated Hemoglobin Test	$154.56	$184.00	—	6% below	16%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hc Glycosylated Hemoglobin Test	$154.56	$184.00	—	—	16%
Hemoglobin blood test CPT 85018 Hc Hemoglobin	$31.92	$38.00	—	11% below	16%
Hemoglobin blood test inpatient CPT 85018 Hc Hemoglobin	$31.92	$38.00	—	—	16%
Hepatitis C antibody blood test (screening) CPT 86803 Hc Hepatitis C Antibody	$129.36	$154.00	—	4% below	16%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hc Hepatitis C Antibody	$129.36	$154.00	—	—	16%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hc Hepatitis C Revrs Trnscrpj	$771.96	$919.00	—	21% above	16%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hc Hepatitis C Revrs Trnscrpj	$771.96	$919.00	—	—	16%
Herpes blood test, HSV-1 antibody CPT 86695 Hc Herpes Simplex Type 1 Test	$193.20	$230.00	—	23% above	16%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Hc Herpes Simplex Type 1 Test	$193.20	$230.00	—	—	16%
Herpes blood test, HSV-2 antibody CPT 86696 Hc Herpes Simplex Type 2 Test	$193.20	$230.00	—	5% above	16%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Hc Herpes Simplex Type 2 Test	$193.20	$230.00	—	—	16%
High-sensitivity CRP (hs-CRP) test CPT 86141 Hc C-Reactive Protein Hs	$96.60	$115.00	—	1% above	16%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 Hc C-Reactive Protein Hs	$96.60	$115.00	—	—	16%
Homocysteine blood test CPT 83090 Hc Assay Of Homocysteine	$298.20	$355.00	—	5% below	16%
Homocysteine blood test inpatient CPT 83090 Hc Assay Of Homocysteine	$298.20	$355.00	—	—	16%
Insulin blood test CPT 83525 Hc Assay Of Insulin Total	$148.68	$177.00	—	1% above	16%
Insulin blood test inpatient CPT 83525 Hc Assay Of Insulin Total	$148.68	$177.00	—	—	16%
Iron blood test (serum iron) CPT 83540 Hc Assay Of Iron	$84.84	$101.00	—	6% below	16%
Iron blood test (serum iron) inpatient CPT 83540 Hc Assay Of Iron	$84.84	$101.00	—	—	16%
Iron-binding capacity (TIBC) test CPT 83550 Hc Iron Binding Test	$189.84	$226.00	—	at median	16%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Hc Iron Binding Test	$189.84	$226.00	—	—	16%
Kidney function blood test panel CPT 80069 Hc Renal Function Panel	$80.64	$96.00	—	9% below	16%
Kidney function blood test panel inpatient CPT 80069 Hc Renal Function Panel	$80.64	$96.00	—	—	16%
LH (luteinizing hormone) test CPT 83002 Hc Assay Of Gonadotropin (Lh)	$224.28	$267.00	—	at median	16%
LH (luteinizing hormone) test inpatient CPT 83002 Hc Assay Of Gonadotropin (Lh)	$224.28	$267.00	—	—	16%
Lactate (lactic acid) blood test CPT 83605 Hc Lactic Acid	$79.80	$95.00	—	5% below	16%
Lactate (lactic acid) blood test inpatient CPT 83605 Hc Lactic Acid	$79.80	$95.00	—	—	16%
Lactate dehydrogenase (LDH) blood test CPT 83615 Hc Lactate (Ld) (Ldh) Enzyme	$47.04	$56.00	—	5% below	16%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Hc Lactate (Ld) (Ldh) Enzyme	$47.04	$56.00	—	—	16%
Lipase blood test (pancreas enzyme) CPT 83690 Hc Lipase	$172.20	$205.00	—	56% above	16%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Hc Lipase	$172.20	$205.00	—	—	16%
Liver function blood test panel CPT 80076 Hc Hepatic Function Panel	$80.64	$96.00	—	60% below	16%
Liver function blood test panel inpatient CPT 80076 Hc Hepatic Function Panel	$80.64	$96.00	—	—	16%
Lyme disease antibody test CPT 86618 Hc Lyme Disease Antibody	$169.68	$202.00	—	at median	16%
Lyme disease antibody test inpatient CPT 86618 Hc Lyme Disease Antibody	$169.68	$202.00	—	—	16%
Magnesium blood test CPT 83735 Hc Magnesium (Sendout Only)	$63.00	$75.00	—	7% below	16%
Magnesium blood test CPT 83735 Hc Magnesium	$63.00	$75.00	—	7% below	16%
Magnesium blood test inpatient CPT 83735 Hc Magnesium	$63.00	$75.00	—	—	16%
Magnesium blood test inpatient CPT 83735 Hc Magnesium (Sendout Only)	$63.00	$75.00	—	—	16%
Measles (rubeola) antibody test CPT 86765 Hc Rubeola Antibody	$237.72	$283.00	—	65% above	16%
Measles (rubeola) antibody test inpatient CPT 86765 Hc Rubeola Antibody	$237.72	$283.00	—	—	16%
Mono test (heterophile antibody, Monospot) CPT 86308 Hc Heterophile Antibody Screen	$139.44	$166.00	—	at median	16%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Hc Heterophile Antibody Screen	$139.44	$166.00	—	—	16%
Mumps immunity blood test CPT 86735 Hc Mumps Antibody	$240.24	$286.00	—	33% above	16%
Mumps immunity blood test inpatient CPT 86735 Hc Mumps Antibody	$240.24	$286.00	—	—	16%
PSA (prostate-specific antigen) blood test, free CPT 84154 Hc Assay Of Psa Free	$105.84	$126.00	—	at median	16%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Hc Assay Of Psa Free	$105.84	$126.00	—	—	16%
PSA (prostate-specific antigen) blood test, total CPT 84153 Hc Assay Of Psa Total	$115.08	$137.00	—	at median	16%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Hc Assay Of Psa Total	$115.08	$137.00	—	—	16%
Pap test (liquid-based, automated screening with review) CPT 88175 Hc Cytp C/V Auto Thin Lyr Prepj Scr Mnl Rescr Phys	$252.84	$301.00	—	19% above	16%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Hc Cytp C/V Auto Thin Lyr Prepj Scr Mnl Rescr Phys	$252.84	$301.00	—	—	16%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Hc Cytopath C/V Thin Layer	$168.84	$201.00	—	36% above	16%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Hc Cytopath C/V Thin Layer	$168.84	$201.00	—	—	16%
Parathyroid hormone (PTH) blood test CPT 83970 Hc Assay Of Parathormone	$195.72	$233.00	—	at median	16%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Hc Assay Of Parathormone	$195.72	$233.00	—	—	16%
Partial thromboplastin time (PTT) clotting test CPT 85730 Hc Thromboplastin Time Partial	$81.48	$97.00	—	5% above	16%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Hc Thromboplastin Time Partial	$81.48	$97.00	—	—	16%
Phosphorus (phosphate) blood test CPT 84100 Hc Phosphorus	$47.04	$56.00	—	6% below	16%
Phosphorus (phosphate) blood test inpatient CPT 84100 Hc Phosphorus	$47.04	$56.00	—	—	16%
Potassium blood test CPT 84132 Hc Potassium	$60.48	$72.00	—	at median	16%
Potassium blood test inpatient CPT 84132 Hc Potassium	$60.48	$72.00	—	—	16%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 Hc Fetal Chromosomal Aneuploidy Genomic Seq Analys	$2,688.00	$3,200.00	—	11% above	16%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 Hc Fetal Chromosomal Aneuploidy Genomic Seq Analys	$2,688.00	$3,200.00	—	—	16%
Progesterone blood test CPT 84144 Hc Progesterone	$206.64	$246.00	—	at median	16%
Progesterone blood test inpatient CPT 84144 Hc Progesterone	$206.64	$246.00	—	—	16%
Prolactin blood test CPT 84146 Hc Prolactin	$341.04	$406.00	—	23% above	16%
Prolactin blood test inpatient CPT 84146 Hc Prolactin	$341.04	$406.00	—	—	16%
Prothrombin time (PT/INR) clotting test CPT 85610 Hc Prothrombin Time	$33.60	$40.00	—	25% below	16%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Hc Prothrombin Time	$33.60	$40.00	—	—	16%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Hc Strep A Assay W/Optic	$120.12	$143.00	—	5% above	16%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Hc Strep A Assay W/Optic	$120.12	$143.00	—	—	16%
Renin blood test CPT 84244 Hc Renin	$248.64	$296.00	—	at median	16%
Renin blood test inpatient CPT 84244 Hc Renin	$248.64	$296.00	—	—	16%
Rh blood typing CPT 86901 Hc Blood Typing Rh (D)	$110.04	$131.00	—	at median	16%
Rh blood typing inpatient CPT 86901 Hc Blood Typing Rh (D)	$110.04	$131.00	—	—	16%
Rheumatoid factor (RF) test CPT 86431 Hc Rheumatoid Factor Test Quant	$36.96	$44.00	—	33% below	16%
Rheumatoid factor (RF) test CPT 86431 Hc Rheumatoid Factor Quant	$36.96	$44.00	—	33% below	16%
Rheumatoid factor (RF) test inpatient CPT 86431 Hc Rheumatoid Factor Test Quant	$36.96	$44.00	—	—	16%
Rheumatoid factor (RF) test inpatient CPT 86431 Hc Rheumatoid Factor Quant	$36.96	$44.00	—	—	16%
Rubella antibody test (immunity check) CPT 86762 Hc Rubella Antibody	$94.08	$112.00	—	at median	16%
Rubella antibody test (immunity check) inpatient CPT 86762 Hc Rubella Antibody	$94.08	$112.00	—	—	16%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Hc Rbc Sed Rate Automated	$35.28	$42.00	—	5% below	16%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Hc Rbc Sed Rate Automated	$35.28	$42.00	—	—	16%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Hc Semen Analysis Volume/Count/Motility	$248.64	$296.00	—	at median	16%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Hc Semen Analysis Volume/Count/Motility	$248.64	$296.00	—	—	16%
Sodium blood test CPT 84295 Hc Sodium	$60.48	$72.00	—	at median	16%
Sodium blood test inpatient CPT 84295 Hc Sodium	$60.48	$72.00	—	—	16%
Stool ova and parasites exam CPT 87177 Hc Ova And Parasites Smears	$87.36	$104.00	—	at median	16%
Stool ova and parasites exam inpatient CPT 87177 Hc Ova And Parasites Smears	$87.36	$104.00	—	—	16%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Hc Occult Blood Feces 1-3	$47.04	$56.00	—	37% above	16%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Hc Occult Blood Feces 1-3	$47.04	$56.00	—	—	16%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Hc Blood Occult Fecal Hgb Deter Ia Qual Feces 1-3	$52.08	$62.00	—	9% below	16%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Hc Blood Occult Fecal Hgb Deter Ia Qual Feces 1-3	$52.08	$62.00	—	—	16%
Syphilis antibody test (Treponema pallidum) CPT 86780 Hc Treponema Pallidum	$86.52	$103.00	—	at median	16%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Hc Treponema Pallidum	$86.52	$103.00	—	—	16%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Hc Syphilis Test Non-Treponemal Antibody Qualitative	$90.72	$108.00	—	at median	16%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Hc Syphilis Test Non-Treponemal Antibody Qualitative	$90.72	$108.00	—	—	16%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Hc Tb Test Cell Immun Measure	$429.24	$511.00	—	73% above	16%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Hc Tb Test Cell Immun Measure	$429.24	$511.00	—	—	16%
Testosterone blood test, total (not free testosterone) CPT 84403 Hc Testosterone Total	$200.76	$239.00	—	12% below	16%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Hc Testosterone Total	$200.76	$239.00	—	—	16%
Thyroid peroxidase (TPO) antibody test CPT 86376 Hc Microsomal Antibody Each	$204.96	$244.00	—	2% above	16%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Hc Microsomal Antibody Each	$204.96	$244.00	—	—	16%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Hc Assay Thyroid Stim Hormone	$191.52	$228.00	—	44% above	16%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Hc Assay Thyroid Stim Hormone	$191.52	$228.00	—	—	16%
Total IgE blood test CPT 82785 Hc Immunoglobulin E	$110.88	$132.00	—	at median	16%
Total IgE blood test inpatient CPT 82785 Hc Immunoglobulin E	$110.88	$132.00	—	—	16%
Total cholesterol blood test CPT 82465 Hc Assay Bld/Serum Cholesterol	$57.96	$69.00	—	3% below	16%
Total cholesterol blood test inpatient CPT 82465 Hc Assay Bld/Serum Cholesterol	$57.96	$69.00	—	—	16%
Total thyroxine (T4) blood test CPT 84436 Hc Thyroxine Total	$59.64	$71.00	—	at median	16%
Total thyroxine (T4) blood test inpatient CPT 84436 Hc Thyroxine Total	$59.64	$71.00	—	—	16%
Total triiodothyronine (T3) blood test CPT 84480 Hc T3, Total	$206.64	$246.00	—	3% above	16%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Hc T3, Total	$206.64	$246.00	—	—	16%
Transferrin blood test CPT 84466 Hc Transferrin	$123.48	$147.00	—	at median	16%
Transferrin blood test inpatient CPT 84466 Hc Transferrin	$123.48	$147.00	—	—	16%
Trichomonas test (NAAT) CPT 87661 Hc Iadna Trichomonas Vaginalis Amplified Probe Tech	$275.52	$328.00	—	7% above	16%
Trichomonas test (NAAT) inpatient CPT 87661 Hc Iadna Trichomonas Vaginalis Amplified Probe Tech	$275.52	$328.00	—	—	16%
Triglycerides blood test CPT 84478 Hc Triglycerides	$57.96	$69.00	—	at median	16%
Triglycerides blood test inpatient CPT 84478 Hc Triglycerides	$57.96	$69.00	—	—	16%
Troponin test, quantitative CPT 84484 Hc Troponin	$140.28	$167.00	—	at median	16%
Troponin test, quantitative inpatient CPT 84484 Hc Troponin	$140.28	$167.00	—	—	16%
Uric acid blood test CPT 84550 Hc Blood/Uric Acid	$62.16	$74.00	—	at median	16%
Uric acid blood test inpatient CPT 84550 Hc Blood/Uric Acid	$62.16	$74.00	—	—	16%
Urinalysis with microscope exam, automated CPT 81001 Hc Urinalysis Auto W/Scope	$79.80	$95.00	—	at median	16%
Urinalysis with microscope exam, automated inpatient CPT 81001 Hc Urinalysis Auto W/Scope	$79.80	$95.00	—	—	16%
Urinalysis without microscope exam, automated CPT 81003 Hc Urinalysis Auto W/O Scope	$59.64	$71.00	—	2% above	16%
Urinalysis without microscope exam, automated inpatient CPT 81003 Hc Urinalysis Auto W/O Scope	$59.64	$71.00	—	—	16%
Urinalysis without microscope exam, manual CPT 81002 Hc Urinalysis Nonauto W/O Scope	$54.60	$65.00	—	25% above	16%
Urinalysis without microscope exam, manual inpatient CPT 81002 Hc Urinalysis Nonauto W/O Scope	$54.60	$65.00	—	—	16%
Urine culture for bacteria, with colony count CPT 87086 Hc Urine Culture/Colony Count	$135.24	$161.00	—	3% below	16%
Urine culture for bacteria, with colony count inpatient CPT 87086 Hc Urine Culture/Colony Count	$135.24	$161.00	—	—	16%
Urine microalbumin (albumin) test CPT 82043 Hc Microalbumin Quantitative	$85.68	$102.00	—	at median	16%
Urine microalbumin (albumin) test inpatient CPT 82043 Hc Microalbumin Quantitative	$85.68	$102.00	—	—	16%
Urine pregnancy test, read by color change CPT 81025 Hc Urine Pregnancy Color Compare	$178.08	$212.00	—	at median	16%
Urine pregnancy test, read by color change inpatient CPT 81025 Hc Urine Pregnancy Color Compare	$178.08	$212.00	—	—	16%
Vitamin B12 (cobalamin) blood test CPT 82607 Hc Vitamin B12	$195.72	$233.00	—	at median	16%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Hc Vitamin B12	$195.72	$233.00	—	—	16%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Hc Vitamin D 25-Hydroxy	$234.36	$279.00	—	12% below	16%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Hc Vitamin D 25-Hydroxy	$234.36	$279.00	—	—	16%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Hc Vitamin D 1,25 Dihydroxy	$382.20	$455.00	—	2% above	16%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Hc Vitamin D 1,25 Dihydroxy	$382.20	$455.00	—	—	16%
Zinc blood test CPT 84630 Hc Zinc	$152.04	$181.00	—	22% above	16%
Zinc blood test inpatient CPT 84630 Hc Zinc	$152.04	$181.00	—	—	16%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hc Gonadotropin, Chorionic Hcg Quant	$277.20	$330.00	—	at median	16%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hc Gonadotropin, Chorionic Hcg Quant	$277.20	$330.00	—	—	16%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Delaware	Off list
Botox injections for chronic migraine CPT 64615 Hc Chemodervate Facial/Trigem/Cerv Musc Migraine	$890.40	$1,060.00	—	—	16%
Botox injections for chronic migraine inpatient CPT 64615 Hc Chemodervate Facial/Trigem/Cerv Musc Migraine	$890.40	$1,060.00	—	—	16%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Hc Bx Breast 1St Lesion Strtctc	$3,733.80	$4,445.00	—	at median	16%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Hc Bx Breast 1St Lesion Strtctc	$3,733.80	$4,445.00	—	—	16%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Hc Closed Tx Prox Tibal Fx Wo Man	$621.60	$740.00	—	at median	16%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Hc Closed Tx Prox Tibal Fx Wo Man	$621.60	$740.00	—	—	16%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Hc Metatarsal Fx W/O Manipulation	$661.08	$787.00	—	at median	16%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Hc Metatarsal Fx W/O Manipulation	$661.08	$787.00	—	—	16%
Cardiac catheterization with coronary angiogram CPT 93458 Hc L Hrt Artery/Ventricle Angio	$10,774.68	$12,827.00	—	at median	16%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 Hc L Hrt Artery/Ventricle Angio	$10,774.68	$12,827.00	—	—	16%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Hc Cardioversion Electrical Ext	$1,871.52	$2,228.00	—	6% above	16%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Hc Cardioversion Electrical Ext	$1,871.52	$2,228.00	—	—	16%
Catheter ablation for atrial fibrillation CPT 93656 Hc Ephys Evl Trnsptl Tx Atrial Fib Isolat Pulm Vein	$35,787.36	$42,604.00	—	6% below	16%
Catheter ablation for atrial fibrillation inpatient CPT 93656 Hc Ephys Evl Trnsptl Tx Atrial Fib Isolat Pulm Vein	$35,787.36	$42,604.00	—	—	16%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Hc Circumcision Using Clamp Or Other W Regional Block	$4,664.52	$5,553.00	—	2% below	16%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Hc Circumcision Using Clamp Or Other W Regional Block	$4,664.52	$5,553.00	—	—	16%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Hc Rad/Ulnar Dis Fx W/O Manipula	$669.48	$797.00	—	at median	16%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Hc Rad/Ulnar Dis Fx W/O Manipula	$669.48	$797.00	—	—	16%
Colonoscopy with endoscopic ultrasound CPT 45391 Hc Colsc Flx W/Ndsc Us Xm Rctm Et Al Lmtd&Adj Strux	$4,026.12	$4,793.00	—	—	16%
Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Hc Colsc Flx W/Ndsc Us Xm Rctm Et Al Lmtd&Adj Strux	$4,026.12	$4,793.00	—	—	16%
Colonoscopy with polyp removal CPT 45385 Hc Colonoscopy W/Lesion Removal By Snare	$2,373.00	$2,825.00	—	30% above	16%
Colonoscopy with polyp removal inpatient CPT 45385 Hc Colonoscopy W/Lesion Removal By Snare	$2,373.00	$2,825.00	—	—	16%
Colonoscopy with tissue sample CPT 45380 Hc Colonoscopy And Biopsy	$2,373.00	$2,825.00	—	4% above	16%
Colonoscopy with tissue sample inpatient CPT 45380 Hc Colonoscopy And Biopsy	$2,373.00	$2,825.00	—	—	16%
Colonoscopy, diagnostic CPT 45378 Hc Diagnostic Colonoscopy	$2,373.00	$2,825.00	—	at median	16%
Colonoscopy, diagnostic inpatient CPT 45378 Hc Diagnostic Colonoscopy	$2,373.00	$2,825.00	—	—	16%
Coronary stent placement, one artery CPT 92928 Hc Prq Card Stent W/Angio 1 Vsl	$19,620.72	$23,358.00	—	13% below	16%
Coronary stent placement, one artery inpatient CPT 92928 Hc Prq Card Stent W/Angio 1 Vsl	$19,620.72	$23,358.00	—	—	16%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Hc Cystourethroscopy	$2,286.48	$2,722.00	—	at median	16%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Hc Cystourethroscopy	$2,286.48	$2,722.00	—	—	16%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Hc Remove Impacted Ear Wax Uni	$247.08	$294.14	—	at median	16%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Hc Removal Impacted Cerumen Irrigation/Lvg Unilat	$246.96	$294.00	—	at median	16%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Hc Remove Impacted Ear Wax Uni	$247.08	$294.14	—	—	16%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 Hc Removal Impacted Cerumen Irrigation/Lvg Unilat	$246.96	$294.00	—	—	16%
Earwax removal with instruments, one ear one side CPT 69210 Hc Remove Impacted Ear Wax Unilateral	$259.56	$309.00	—	at median	16%
Earwax removal with instruments, one ear one side CPT 69210 Hc Removal Impacted Cerumen Instrumentation Unilat	$259.56	$309.00	—	at median	16%
Earwax removal with instruments, one ear inpatient one side CPT 69210 Hc Remove Impacted Ear Wax Unilateral	$259.56	$309.00	—	—	16%
Earwax removal with instruments, one ear inpatient one side CPT 69210 Hc Removal Impacted Cerumen Instrumentation Unilat	$259.56	$309.00	—	—	16%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Hc Endometrial Biopsy	$809.76	$964.00	—	at median	16%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Hc Endometrial Biopsy	$809.76	$964.00	—	—	16%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Hc Inject Spine Cerv/Thoracic	$2,860.20	$3,405.00	—	24% above	16%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Hc Inject Spine Cerv/Thoracic	$2,860.20	$3,405.00	—	—	16%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Hc Inj Paravert F Jnt L/S 1 Lev	$3,859.80	$4,595.00	—	at median	16%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Hc Inj Paravert F Jnt L/S 1 Lev	$3,859.80	$4,595.00	—	—	16%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Hc Diagnostic Sigmoidoscopy	$1,480.08	$1,762.00	—	at median	16%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Hc Diagnostic Sigmoidoscopy	$1,480.08	$1,762.00	—	—	16%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Hc Catheter For Hysterography	$541.80	$645.00	—	at median	16%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Hc Catheter For Hysterography	$541.80	$645.00	—	—	16%
IUD insertion (the device itself billed separately) CPT 58300 Hc Insertion Intrauterine Device Iud	$4,498.20	$5,355.00	—	14% below	16%
IUD insertion (the device itself billed separately) CPT 58300 Hc Insertion Intrauterine Device Iud (Us)	$4,498.20	$5,355.00	—	14% below	16%
IUD insertion (the device itself billed separately) inpatient CPT 58300 Hc Insertion Intrauterine Device Iud	$4,498.20	$5,355.00	—	—	16%
IUD insertion (the device itself billed separately) inpatient CPT 58300 Hc Insertion Intrauterine Device Iud (Us)	$4,498.20	$5,355.00	—	—	16%
Incision and drainage of a simple or single skin abscess CPT 10060 Hc I&D Skin Abcess Simple	$632.52	$753.00	—	14% above	16%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Hc I&D Skin Abcess Simple	$632.52	$753.00	—	—	16%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Hc Inj Tendon Sheath/Ligament	$872.76	$1,039.00	—	at median	16%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Hc Inj Tendon Sheath/Ligament	$872.76	$1,039.00	—	—	16%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Hc Drain/Inj Major Joint/Bursa W/O Us	$1,210.44	$1,441.00	—	26% above	16%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Hc Drain/Inj Major Joint/Bursa W/O Us	$1,210.44	$1,441.00	—	—	16%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Hc Insj Non-Biodegradable Drug Delivery Implant	$522.48	$622.00	—	at median	16%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Hc Insj Non-Biodegradable Drug Delivery Implant	$522.48	$622.00	—	—	16%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Hc Drain/Inj Intermediate Joint/Bursa W/O Us	$1,042.44	$1,241.00	—	19% above	16%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Hc Drain/Inj Intermediate Joint/Bursa W/O Us	$1,042.44	$1,241.00	—	—	16%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Hc Drain/Inj Small Joint/Bursa W/O Us	$1,012.20	$1,205.00	—	at median	16%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Hc Drain/Inj Small Joint/Bursa W/O Us	$1,012.20	$1,205.00	—	—	16%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Hc Intmd Rpr Sclp Trnk Extm<2.6Cm	$717.36	$854.00	—	at median	16%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Hc Intmd Rpr Sclp Trnk Extm<2.6Cm	$717.36	$854.00	—	—	16%
Left heart catheterization, diagnostic one side CPT 93452 Hc Left Heart Catheterization W/Ventrclgrphy	$10,774.68	$12,827.00	—	at median	16%
Left heart catheterization, diagnostic inpatient one side CPT 93452 Hc Left Heart Catheterization W/Ventrclgrphy	$10,774.68	$12,827.00	—	—	16%
Lower-back epidural injection, with imaging guidance CPT 62323 Hc Inject Spine Lumbar/Sacral	$2,960.16	$3,524.00	—	28% above	16%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Hc Inject Spine Lumbar/Sacral	$2,960.16	$3,524.00	—	—	16%
Lower-back epidural injection, without imaging guidance CPT 62322 Hc Njx Interlaminar Lmbr/Sac	$2,220.96	$2,644.00	—	at median	16%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Hc Njx Interlaminar Lmbr/Sac	$2,220.96	$2,644.00	—	—	16%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Hc Inj Foramen Epidural L/S	$3,859.80	$4,595.00	—	at median	16%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Hc N Block Inj Foramen / Lumbar Plexus Epidural L/S	$3,859.80	$4,595.00	—	at median	16%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Hc Inj Foramen Epidural L/S	$3,859.80	$4,595.00	—	—	16%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Hc N Block Inj Foramen / Lumbar Plexus Epidural L/S	$3,859.80	$4,595.00	—	—	16%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Hc Exc Tr-Ext B9+Marg 0.5 Cm<	$1,269.24	$1,511.00	—	59% below	16%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Hc Exc Tr-Ext B9+Marg 0.5 Cm<	$1,269.24	$1,511.00	—	—	16%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Hc Exc Face-Mm B9+Marg 0.5 Cm/<	$1,269.24	$1,511.00	—	at median	16%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Hc Exc Face-Mm B9+Marg 0.5 Cm/<	$1,269.24	$1,511.00	—	—	16%
Nail removal (partial or complete), one nail CPT 11730 Hc Avulsion Of Nail Plate	$299.88	$357.00	—	23% below	16%
Nail removal (partial or complete), one nail inpatient CPT 11730 Hc Avulsion Of Nail Plate	$299.88	$357.00	—	—	16%
Occipital nerve block (injection for headaches) CPT 64405 Hc Injection Aa&/Strd Greater Occipital Nerve	$1,205.40	$1,435.00	—	at median	16%
Occipital nerve block (injection for headaches) CPT 64405 Hc Inj(S), Anes Agent(S) A/O Steroid; Greater Occipital Nerve	$1,205.40	$1,435.00	—	at median	16%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Hc Inj(S), Anes Agent(S) A/O Steroid; Greater Occipital Nerve	$1,205.40	$1,435.00	—	—	16%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Hc Injection Aa&/Strd Greater Occipital Nerve	$1,205.40	$1,435.00	—	—	16%
Pacemaker implant (dual chamber) CPT 33208 Hc Insert/Repl Perm Pacemaker W/Atrial And Ventricular	$33,664.68	$40,077.00	—	14% above	16%
Pacemaker implant (dual chamber) inpatient CPT 33208 Hc Insert/Repl Perm Pacemaker W/Atrial And Ventricular	$33,664.68	$40,077.00	—	—	16%
Paracentesis with imaging guidance CPT 49083 Hc Abdom Paracentesis Dx/Ther W/Imaging Guidance	$1,644.72	$1,958.00	—	at median	16%
Paracentesis with imaging guidance CPT 49083 Hc Abd Paracentesis W/Imaging	$1,644.72	$1,958.00	—	at median	16%
Paracentesis with imaging guidance inpatient CPT 49083 Hc Abd Paracentesis W/Imaging	$1,644.72	$1,958.00	—	—	16%
Paracentesis with imaging guidance inpatient CPT 49083 Hc Abdom Paracentesis Dx/Ther W/Imaging Guidance	$1,644.72	$1,958.00	—	—	16%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Hc Excision Removal Of Nail Bed	$1,622.04	$1,931.00	—	at median	16%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Hc Excision Removal Of Nail Bed	$1,622.04	$1,931.00	—	—	16%
Prostate biopsy CPT 55700 Hc Biopsy Of Prostate	$5,118.12	$6,093.00	—	at median	16%
Prostate biopsy inpatient CPT 55700 Hc Biopsy Of Prostate	$5,118.12	$6,093.00	—	—	16%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Hc Destroy Lumb/Sac Facet Jnt	$2,976.96	$3,544.00	—	at median	16%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Hc Destroy Lumb/Sac Facet Jnt	$2,976.96	$3,544.00	—	—	16%
Removal of a breast lump, open surgery CPT 19120 Hc Removal Of Breast Lesion	$6,876.24	$8,186.00	—	at median	16%
Removal of a breast lump, open surgery inpatient CPT 19120 Hc Removal Of Breast Lesion	$6,876.24	$8,186.00	—	—	16%
Removal of a foreign object under the skin, simple CPT 10120 Hc Incision & Removal Foreign Body Subq Tiss Simple	$624.12	$743.00	—	21% below	16%
Removal of a foreign object under the skin, simple CPT 10120 Hc Incision & Removal Of Fb	$624.12	$743.00	—	21% below	16%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Hc Incision & Removal Of Fb	$624.12	$743.00	—	—	16%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Hc Incision & Removal Foreign Body Subq Tiss Simple	$624.12	$743.00	—	—	16%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Hc Colon Ca Scrn Not Hi Rsk Ind	$2,726.64	$3,246.00	—	at median	16%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 Hc Colon Ca Scrn Not Hi Rsk Ind	$2,726.64	$3,246.00	—	—	16%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Hc Colorectal Scrn; Hi Risk Ind	$3,656.52	$4,353.00	—	at median	16%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 Hc Colorectal Scrn; Hi Risk Ind	$3,656.52	$4,353.00	—	—	16%
Short arm cast (elbow to hand) CPT 29075 Hc Application Cast Elbow Finger Short Arm	$918.96	$1,094.00	—	at median	16%
Short arm cast (elbow to hand) inpatient CPT 29075 Hc Application Cast Elbow Finger Short Arm	$918.96	$1,094.00	—	—	16%
Short arm splint (forearm and hand) CPT 29125 Hc Short Arm Splint	$360.36	$429.00	—	at median	16%
Short arm splint (forearm and hand) inpatient CPT 29125 Hc Short Arm Splint	$360.36	$429.00	—	—	16%
Short leg cast (below the knee) CPT 29405 Hc Apply Short Leg Cast	$484.68	$577.00	—	at median	16%
Short leg cast (below the knee) inpatient CPT 29405 Hc Apply Short Leg Cast	$484.68	$577.00	—	—	16%
Short leg splint (calf to foot) CPT 29515 Hc Splint Short Leg	$268.80	$320.00	—	1% below	16%
Short leg splint (calf to foot) inpatient CPT 29515 Hc Splint Short Leg	$268.80	$320.00	—	—	16%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Hc Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5Cm/<	$669.48	$797.00	—	6% above	16%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Hc Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5Cm/<	$669.48	$797.00	—	—	16%
Skin biopsy, punch, one lesion CPT 11104 Hc Punch Biopsy Skin Single Lesion	$753.48	$897.00	—	at median	16%
Skin biopsy, punch, one lesion inpatient CPT 11104 Hc Punch Biopsy Skin Single Lesion	$753.48	$897.00	—	—	16%
Skin tag removal, up to 15 tags CPT 11200 Hc Removal Skn Tags Mlt Fibrq Tags Any Area Upw/15	$771.96	$919.00	—	at median	16%
Skin tag removal, up to 15 tags inpatient CPT 11200 Hc Removal Skn Tags Mlt Fibrq Tags Any Area Upw/15	$771.96	$919.00	—	—	16%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Hc Spinal Fluid Tap Diagnostic	$1,107.12	$1,318.00	—	4% below	16%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Hc Spinal Fluid Tap Diagnostic	$1,107.12	$1,318.00	—	—	16%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Hc Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5Cm	$909.72	$1,083.00	—	at median	16%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Hc Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5Cm	$909.72	$1,083.00	—	—	16%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Hc Simple Repair F/E/E/N/L/M 2.5Cm/<	$686.28	$817.00	—	at median	16%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Hc Simple Repair F/E/E/N/L/M 2.5Cm/<	$686.28	$817.00	—	—	16%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Hc Tangential Biopsy Skin Single Lesion	$753.48	$897.00	—	22% above	16%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Hc Tangential Biopsy Skin Single Lesion	$753.48	$897.00	—	—	16%
Thoracentesis with imaging guidance CPT 32555 Hc Thoracentesis W/Guidance	$2,073.12	$2,468.00	—	16% above	16%
Thoracentesis with imaging guidance inpatient CPT 32555 Hc Thoracentesis W/Guidance	$2,073.12	$2,468.00	—	—	16%
Trigger point injections, 1 or 2 muscles CPT 20552 Hc Inj Trigger Point 1/2 Muscl	$866.88	$1,032.00	—	at median	16%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Hc Inj Trigger Point 1/2 Muscl	$866.88	$1,032.00	—	—	16%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Hc Breast Bx 1St Lesion	$3,733.80	$4,445.00	—	at median	16%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Hc Breast Bx 1St Lesion	$3,733.80	$4,445.00	—	—	16%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Hc Egd W/Dilation/Balloon <30Mm	$2,236.08	$2,662.00	—	at median	16%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 Hc Egd W/Dilation/Balloon <30Mm	$2,236.08	$2,662.00	—	—	16%
Upper endoscopy (EGD) with biopsy CPT 43239 Hc Egd Biopsy Single/Multiple	$2,236.08	$2,662.00	—	at median	16%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Hc Egd Biopsy Single/Multiple	$2,236.08	$2,662.00	—	—	16%
Upper endoscopy (EGD) with injection into the lining CPT 43236 Hc Esophagogastric Duodenoscopy Submucosal Injection	$3,213.84	$3,826.00	—	at median	16%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 Hc Esophagogastric Duodenoscopy Submucosal Injection	$3,213.84	$3,826.00	—	—	16%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Hc Egd Remove Lesion Snare	$2,236.08	$2,662.00	—	9% above	16%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 Hc Egd Remove Lesion Snare	$2,236.08	$2,662.00	—	—	16%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Hc Egd Guide Wire Insertion	$2,236.08	$2,662.00	—	at median	16%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 Hc Egd Guide Wire Insertion	$2,236.08	$2,662.00	—	—	16%
Upper endoscopy (EGD), diagnostic CPT 43235 Hc Egd Diagnostic Brush Wash	$2,236.08	$2,662.00	—	at median	16%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Hc Egd Diagnostic Brush Wash	$2,236.08	$2,662.00	—	—	16%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 Hc Endoscopic Ultrasound With Pseudocyst Drainage	$9,055.20	$10,780.00	—	—	16%
Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 Hc Endoscopic Ultrasound With Pseudocyst Drainage	$9,055.20	$10,780.00	—	—	16%
Wart removal, up to 14 warts CPT 17110 Hc Destruct B9 Lesion 1-14	$361.20	$430.00	—	40% below	16%
Wart removal, up to 14 warts inpatient CPT 17110 Hc Destruct B9 Lesion 1-14	$361.20	$430.00	—	—	16%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Hc Debridement Subcutaneous Tissue 20 Sq Cm/&Lt;	$1,245.72	$1,483.00	—	13% above	16%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Hc Debridement Subq 1St 20 Sq Cm Or Less	$1,245.72	$1,483.00	—	13% above	16%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Hc Debridement Subcutaneous Tissue 20 Sq Cm/&Lt;	$1,245.72	$1,483.00	—	—	16%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Hc Debridement Subq 1St 20 Sq Cm Or Less	$1,245.72	$1,483.00	—	—	16%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Delaware	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Hc Administration Of Blood	$918.58	$1,093.55	—	6% below	16%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Hc Administration Of Blood	$918.58	$1,093.55	—	—	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Mdi With Spacer Treatment	$285.60	$340.00	—	3% below	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Mdi With Spacer Initial	$285.60	$340.00	—	3% below	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Ultra Sonic Nebulizer Treatment	$285.60	$340.00	—	3% below	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Antibiotic Nebulizer Treatment	$285.60	$340.00	—	3% below	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Er Hand Held Nebulizer	$285.60	$340.00	—	3% below	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Sputum Induction	$285.60	$340.00	—	3% below	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Hand Held Nebulizer	$285.60	$340.00	—	3% below	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Antibiotic Nebulizer Treatment	$285.60	$340.00	—	—	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Mdi With Spacer Treatment	$285.60	$340.00	—	—	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Er Hand Held Nebulizer	$285.60	$340.00	—	—	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Sputum Induction	$285.60	$340.00	—	—	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Ultra Sonic Nebulizer Treatment	$285.60	$340.00	—	—	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Mdi With Spacer Initial	$285.60	$340.00	—	—	16%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Hand Held Nebulizer	$285.60	$340.00	—	—	16%
Chemotherapy IV infusion, first hour CPT 96413 Hc Chemo Iv Infusion 1 Hr	$1,026.48	$1,222.00	—	10% above	16%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Hc Chemo Iv Infusion 1 Hr	$1,026.48	$1,222.00	—	—	16%
Critical care, first 30 to 74 minutes CPT 99291 Hc Critical Care First Hour	$2,590.56	$3,084.00	—	at median	16%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Hc Critical Care First Hour	$2,590.56	$3,084.00	—	—	16%
EEG (brain wave test), awake and drowsy, routine CPT 95816 Hc Eeg Awake And Drowsy	$971.04	$1,156.00	—	at median	16%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Hc Eeg Awake And Drowsy	$971.04	$1,156.00	—	—	16%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Hc Electrocardiogram Tracing	$317.52	$378.00	—	at median	16%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Hc Electrocardiogram Tracing	$317.52	$378.00	—	—	16%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Hc Ed Level 0	$425.88	$507.00	—	4% above	16%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Hc Emergency Dept Visit Level 1	$435.12	$518.00	—	7% above	16%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Hc Ed Level 0	$425.88	$507.00	—	—	16%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Hc Emergency Dept Visit Level 1	$435.12	$518.00	—	—	16%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Hc Emergency Dept Visit Level 2	$747.60	$890.00	—	5% above	16%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Hc Emergency Dept Visit Level 2	$747.60	$890.00	—	—	16%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Hc Emergency Dept Visit Level 3	$957.60	$1,140.00	—	6% above	16%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Hc Emergency Dept Visit Level 3	$957.60	$1,140.00	—	—	16%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Hc Emergency Dept Visit Level 4	$1,430.52	$1,703.00	—	2% above	16%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Hc Emergency Dept Visit Level 4	$1,430.52	$1,703.00	—	—	16%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Hc Emergency Dept Visit Level 5	$2,120.16	$2,524.00	—	2% above	16%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Hc Emergency Dept Visit Level 5	$2,120.16	$2,524.00	—	—	16%
Exercise stress test, tracing only, the hospital charge CPT 93017 Hc Cardiovascular Stress Test W/O Intrp And Report	$1,093.68	$1,302.00	—	11% below	16%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Hc Cardiovascular Stress Test W/O Intrp And Report	$1,093.68	$1,302.00	—	—	16%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hc Iv Infusion Hydra Initial =< 1Hr	$700.56	$834.00	—	15% above	16%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hc Iv Infusion Hydra Initial =< 1Hr	$700.56	$834.00	—	—	16%
IV infusion of a medicine, first hour CPT 96365 Hc Iv Infusion Thera/Proph/Diag Initial	$648.48	$772.00	—	7% above	16%
IV infusion of a medicine, first hour inpatient CPT 96365 Hc Iv Infusion Thera/Proph/Diag Initial	$648.48	$772.00	—	—	16%
IV push of a medicine, first drug CPT 96374 Hc Thera/Diag Inj-Iv Push Sing/Initl	$273.84	$326.00	—	16% below	16%
IV push of a medicine, first drug inpatient CPT 96374 Hc Thera/Diag Inj-Iv Push Sing/Initl	$273.84	$326.00	—	—	16%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Hc Ther/Proph/Diag Inj Sc/Im	$129.36	$154.00	—	8% below	16%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Hc Ther/Proph/Diag Inj Sc/Im	$129.36	$154.00	—	—	16%
Neuromuscular re-education, 15 minutes CPT 97112 Hc Neuromuscular Reeducation	$122.64	$146.00	—	9% above	16%
Neuromuscular re-education, 15 minutes CPT 97112 Hc Telemedicine Ot Ther Px 1/> Areas Each 15 Min Neuromusc Reeduca	$122.64	$146.00	—	9% above	16%
Neuromuscular re-education, 15 minutes CPT 97112 Hc Telemedicine Ther Px 1/> Areas Each 15 Min Neuromusc Reeduca	$122.64	$146.00	—	9% above	16%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Hc Neuromuscular Reeducation	$122.64	$146.00	—	—	16%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Hc Telemedicine Ther Px 1/> Areas Each 15 Min Neuromusc Reeduca	$122.64	$146.00	—	—	16%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Hc Telemedicine Ot Ther Px 1/> Areas Each 15 Min Neuromusc Reeduca	$122.64	$146.00	—	—	16%
New patient office visit, about 30 minutes CPT 99203 Hc Office O/P New Sf 30-44 Min (Telemed)	$231.84	$276.00	—	at median	16%
New patient office visit, about 30 minutes inpatient CPT 99203 Hc Office O/P New Sf 30-44 Min (Telemed)	$231.84	$276.00	—	—	16%
New patient office visit, about 45 minutes CPT 99204 Hc Office O/P New Sf 45-59 Min (Telemed)	$271.32	$323.00	—	at median	16%
New patient office visit, about 45 minutes inpatient CPT 99204 Hc Office O/P New Sf 45-59 Min (Telemed)	$271.32	$323.00	—	—	16%
New patient office visit, about 60 minutes CPT 99205 Hc Office O/P New Sf 60-74 Min (Telemed)	$310.80	$370.00	—	at median	16%
New patient office visit, about 60 minutes inpatient CPT 99205 Hc Office O/P New Sf 60-74 Min (Telemed)	$310.80	$370.00	—	—	16%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Hc Office O/P New Sf 15-29 Min (Telemed)	$194.04	$231.00	—	at median	16%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Hc Office O/P New Sf 15-29 Min (Telemed)	$194.04	$231.00	—	—	16%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Hc Nutrition Therapy Initial Ind 15M	$57.12	$68.00	—	22% below	16%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Hc Telemedicine Medical Nutrition Indiv In	$57.12	$68.00	—	22% below	16%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Hc Nutrition Therapy Initial Ind 15M	$57.12	$68.00	—	—	16%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Hc Telemedicine Medical Nutrition Indiv In	$57.12	$68.00	—	—	16%
Occupational therapy evaluation, low complexity CPT 97165 Hc Telemedicine Ot Eval Low Complex 30 Min	$265.44	$316.00	—	3% above	16%
Occupational therapy evaluation, low complexity CPT 97165 Hc Ot Eval Low Complex 30 Min	$265.44	$316.00	—	3% above	16%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Hc Ot Eval Low Complex 30 Min	$265.44	$316.00	—	—	16%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Hc Telemedicine Ot Eval Low Complex 30 Min	$265.44	$316.00	—	—	16%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Hc Pt Eval High Complex 45 Min	$275.52	$328.00	—	12% below	16%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Hc Telemedicine Pt Eval High Complex 45 Min	$275.52	$328.00	—	12% below	16%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Hc Pt Eval High Complex 45 Min	$275.52	$328.00	—	—	16%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Hc Telemedicine Pt Eval High Complex 45 Min	$275.52	$328.00	—	—	16%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Hc Pt Eval Low Complex 20 Min	$275.52	$328.00	—	6% above	16%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Hc Telemedicine Pt Eval Low Complex 20 Min	$275.52	$328.00	—	6% above	16%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Hc Telemedicine Pt Eval Low Complex 20 Min	$275.52	$328.00	—	—	16%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Hc Pt Eval Low Complex 20 Min	$275.52	$328.00	—	—	16%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Hc Pt Eval Mod Complex 30 Min	$275.52	$328.00	—	at median	16%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Hc Telemedicine Pt Eval Mod Complex 30 Min	$275.52	$328.00	—	at median	16%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Hc Pt Eval Mod Complex 30 Min	$275.52	$328.00	—	—	16%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Hc Telemedicine Pt Eval Mod Complex 30 Min	$275.52	$328.00	—	—	16%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Hc Manual Therapy 1/> Regions	$166.32	$198.00	—	28% above	16%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Hc Manual Therapy 1/> Regions	$166.32	$198.00	—	—	16%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Hc Telemedicine Therapeutic Px 1/> Areas Each 15 Min Exercises	$104.16	$124.00	—	at median	16%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Hc Telemedicine Ot Therapeutic Px 1/> Areas Each 15 Min Exercises	$104.16	$124.00	—	at median	16%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Hc Therapeutic Exercises	$104.16	$124.00	—	at median	16%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Hc Therapeutic Exercises	$104.16	$124.00	—	—	16%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Hc Telemedicine Therapeutic Px 1/> Areas Each 15 Min Exercises	$104.16	$124.00	—	—	16%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Hc Telemedicine Ot Therapeutic Px 1/> Areas Each 15 Min Exercises	$104.16	$124.00	—	—	16%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Hc Tobacco Use Cessation Intermediate 3-10 Minutes	$90.72	$108.00	—	14% above	16%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Hc Tobacco Use Cessation Intermediate 3-10 Minutes	$90.72	$108.00	—	—	16%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Hc Office O/P Est Hi 40-54 Min (Telemed)	$310.80	$370.00	—	at median	16%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Hc Office O/P Est Hi 40-54 Min (Telemed)	$310.80	$370.00	—	—	16%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Hc Office O/P Est Low 20-29 Min (Telemed)	$231.84	$276.00	—	at median	16%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Hc Office O/P Est Low 20-29 Min (Telemed)	$231.84	$276.00	—	—	16%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Hc Office O/P Est Mod 30-39 Min (Telemed)	$271.32	$323.00	—	at median	16%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Hc Office O/P Est Mod 30-39 Min (Telemed)	$271.32	$323.00	—	—	16%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Hc Office O/P Est Sf 10-19 Min (Telemed)	$193.20	$230.00	—	at median	16%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Hc Office O/P Est Sf 10-19 Min (Telemed)	$193.20	$230.00	—	—	16%
Speech and language evaluation CPT 92523 Hc Dds Evaluation	$151.20	$180.00	—	66% below	16%
Speech and language evaluation CPT 92523 Hc Telemedicine Eval Speech Sound Product Language Comprehension	$542.64	$646.00	—	22% above	16%
Speech and language evaluation CPT 92523 Hc Speech Sound Lang Comprehension	$542.64	$646.00	—	22% above	16%
Speech and language evaluation inpatient CPT 92523 Hc Dds Evaluation	$151.20	$180.00	—	—	16%
Speech and language evaluation inpatient CPT 92523 Hc Speech Sound Lang Comprehension	$542.64	$646.00	—	—	16%
Speech and language evaluation inpatient CPT 92523 Hc Telemedicine Eval Speech Sound Product Language Comprehension	$542.64	$646.00	—	—	16%
Speech therapy session, individual CPT 92507 Hc Speech/Lang Therapy Individual	$180.60	$215.00	—	8% below	16%
Speech therapy session, individual CPT 92507 Hc Telemedicine Tx Speech Lang Voice Commj &/Auditory Proc Ind	$180.60	$215.00	—	8% below	16%
Speech therapy session, individual inpatient CPT 92507 Hc Telemedicine Tx Speech Lang Voice Commj &/Auditory Proc Ind	$180.60	$215.00	—	—	16%
Speech therapy session, individual inpatient CPT 92507 Hc Speech/Lang Therapy Individual	$180.60	$215.00	—	—	16%
Spirometry (breathing test) CPT 94010 Hc Spirometry Simple Or Bedside	$383.88	$457.00	—	at median	16%
Spirometry (breathing test) inpatient CPT 94010 Hc Spirometry Simple Or Bedside	$383.88	$457.00	—	—	16%
Spirometry before and after a bronchodilator CPT 94060 Hc Spirometry Pre And Post	$733.32	$873.00	—	at median	16%
Spirometry before and after a bronchodilator inpatient CPT 94060 Hc Spirometry Pre And Post	$733.32	$873.00	—	—	16%
Therapeutic activities (functional training), 15 minutes CPT 97530 Hc Therapeutic Activities Each 15 Min	$111.72	$133.00	—	at median	16%
Therapeutic activities (functional training), 15 minutes CPT 97530 Hc Telemedicine Therapeut Actvity Direct Pt Contact Each 15 Min	$111.72	$133.00	—	at median	16%
Therapeutic activities (functional training), 15 minutes CPT 97530 Hc Telemedicine Ot Therapeut Actvity Direct Pt Contact Each 15 Min	$111.72	$133.00	—	at median	16%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Hc Telemedicine Ot Therapeut Actvity Direct Pt Contact Each 15 Min	$111.72	$133.00	—	—	16%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Hc Therapeutic Activities Each 15 Min	$111.72	$133.00	—	—	16%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Hc Telemedicine Therapeut Actvity Direct Pt Contact Each 15 Min	$111.72	$133.00	—	—	16%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Hc Therapeutic Phlebotomy	$317.52	$378.00	—	2% above	16%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Hc Therapeutic Phlebotomy	$317.52	$378.00	—	—	16%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Delaware	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 FLU VACC 2024-25(65YR UP)-MF59C(PF) 45 MCG(15 MCGX3)/0.5 ML IM SYRINGE [199064]	$303.45	$361.25	—	at median	16%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 FLU VACC 2024-25(65YR UP)-MF59C(PF) 45 MCG(15 MCGX3)/0.5 ML IM SYRINGE [199064]	$303.45	$361.25	—	—	16%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COVID VACC 2024-2025 (12 YRS UP) (PFIZER)(PF) 30 MCG/0.3 ML IM SYRINGE [199546]	$137.97	$164.25	—	—	16%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COVID VACC 2024-2025 (12 YRS UP) (PFIZER)(PF) 30 MCG/0.3 ML IM SYRINGE [199546]	$137.97	$164.25	—	—	16%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [113088]	$658.14	$783.50	—	at median	16%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [113088]	$658.14	$783.50	—	—	16%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH,PERTUS(ACEL),TET PED(PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SYRINGE [19451]	$160.23	$190.75	—	27% above	16%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH,PERTUS(ACEL),TET PEDI (PF) 15 LF UNIT-10 MCG-5 LF/0.5 ML IM SUSP [131264]	$164.64	$196.00	—	30% above	16%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPH,PERTUS(ACEL),TET PED(PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SYRINGE [19451]	$160.23	$190.75	—	—	16%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPH,PERTUS(ACEL),TET PEDI (PF) 15 LF UNIT-10 MCG-5 LF/0.5 ML IM SUSP [131264]	$164.64	$196.00	—	—	16%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]	$426.72	$508.00	—	39% above	16%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]	$426.72	$508.00	—	—	16%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DP(A)T-POLIO-HIB CONJ-TET (PF) 15 LF UNIT-20 MCG-5 LF /0.5 ML IM KIT [92074]	$426.09	$507.25	—	at median	16%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DIP-PERT-TET-POLIO-HIB(PF) 15 LF-20 MCG-5 LF-62 DU-10MCG/0.5 ML IM KIT [184831]	$494.97	$589.25	—	16% above	16%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DP(A)T-POLIO-HIB CONJ-TET (PF) 15 LF UNIT-20 MCG-5 LF /0.5 ML IM KIT [92074]	$426.09	$507.25	—	—	16%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DIP-PERT-TET-POLIO-HIB(PF) 15 LF-20 MCG-5 LF-62 DU-10MCG/0.5 ML IM KIT [184831]	$494.97	$589.25	—	—	16%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE [199068]	$133.56	$159.00	—	62% above	16%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE [199068]	$133.56	$159.00	—	—	16%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT (PF) 0.5 ML IM SUSPENSION [165495]	$822.15	$978.75	—	at median	16%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [165496]	$1,109.64	$1,321.00	—	35% above	16%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT (PF) 0.5 ML IM SUSPENSION [165495]	$822.15	$978.75	—	—	16%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [165496]	$1,109.64	$1,321.00	—	—	16%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [130591]	$356.58	$424.50	—	11% above	16%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [130591]	$356.58	$424.50	—	—	16%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE [91033]	$213.99	$254.75	—	29% above	16%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE [91033]	$213.99	$254.75	—	—	16%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [130502]	$298.83	$355.75	—	18% above	16%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SUSP [130547]	$298.83	$355.75	—	18% above	16%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [130502]	$298.83	$355.75	—	—	16%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SUSP [130547]	$298.83	$355.75	—	—	16%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [179564]	$1,124.13	$1,338.25	—	—	16%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [179564]	$1,124.13	$1,338.25	—	—	16%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [130543]	$159.81	$190.25	—	39% above	16%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [130543]	$159.81	$190.25	—	—	16%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [11931]	$86.52	$103.00	—	73% above	16%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [11931]	$86.52	$103.00	—	—	16%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACCINE TS2024-25(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE [199069]	$303.45	$361.25	—	11% above	16%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VACCINE TS2024-25(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE [199069]	$303.45	$361.25	—	—	16%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOC VAC A,C,Y,W-135 DIP (PF) 4 MCG/0.5 ML INTRAMUSCULAR SOLUTION [40540]	$586.53	$698.25	—	at median	16%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOC VAC A,C,Y,W-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS) [101034]	$649.95	$773.75	—	11% above	16%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOC VAC A,C,Y,W-135 DIP (PF) 4 MCG/0.5 ML INTRAMUSCULAR SOLUTION [40540]	$586.53	$698.25	—	—	16%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOC VAC A,C,Y,W-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS) [101034]	$649.95	$773.75	—	—	16%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION [186397]	$620.34	$738.50	—	at median	16%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION [186397]	$620.34	$738.50	—	—	16%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE [165212]	$855.33	$1,018.25	—	at median	16%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE [165212]	$855.33	$1,018.25	—	—	16%
Meningococcal B vaccine (Trumenba) CPT 90621 N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [166697]	$747.81	$890.25	—	5% above	16%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [166697]	$747.81	$890.25	—	—	16%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [103895]	$816.69	$972.25	—	at median	16%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [103895]	$816.69	$972.25	—	—	16%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [189404]	$990.57	$1,179.25	—	7% above	16%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [189404]	$990.57	$1,179.25	—	—	16%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 PNEUMOCOCCAL 21-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [199117]	$1,038.03	$1,235.75	—	—	16%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 PNEUMOCOCCAL 21-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [199117]	$1,038.03	$1,235.75	—	—	16%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [128310]	$485.10	$577.50	—	60% above	16%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION [11037]	$485.10	$577.50	—	60% above	16%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION [11037]	$485.10	$577.50	—	—	16%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [128310]	$485.10	$577.50	—	—	16%
Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [108127]	$184.38	$219.50	—	at median	16%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [108127]	$184.38	$219.50	—	—	16%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [196405]	$1,704.36	$2,029.00	—	at median	16%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [196405]	$1,704.36	$2,029.00	—	—	16%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [196404]	$1,704.36	$2,029.00	—	at median	16%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [196404]	$1,704.36	$2,029.00	—	—	16%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RESP SYNCYTIAL VIRUS VAC, PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION [195695]	$1,107.33	$1,318.25	—	—	16%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RESP SYNCYTIAL VIRUS VAC, PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION [195695]	$1,107.33	$1,318.25	—	—	16%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [131291]	$1,346.52	$1,603.00	—	2% above	16%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]	$1,489.53	$1,773.25	—	12% above	16%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [131291]	$1,346.52	$1,603.00	—	—	16%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]	$1,489.53	$1,773.25	—	—	16%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT [177281]	$777.84	$926.00	—	—	16%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT [177281]	$777.84	$926.00	—	—	16%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS-TD 2 LF UNIT-2 LF UNIT/0.5 ML IM SUSPENSION [37504]	$153.51	$182.75	—	10% above	16%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE [131266]	$219.66	$261.50	—	58% above	16%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SUSP [131267]	$219.66	$261.50	—	58% above	16%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS-TD 2 LF UNIT-2 LF UNIT/0.5 ML IM SUSPENSION [37504]	$153.51	$182.75	—	—	16%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SUSP [131267]	$219.66	$261.50	—	—	16%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE [131266]	$219.66	$261.50	—	—	16%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH,PERTUSSIS,TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML INJECTION [172682]	$194.88	$232.00	—	11% above	16%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH,PERTUSSIS(ACELL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML IM SUSP [129774]	$194.88	$232.00	—	11% above	16%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH,PERTUSSIS(ACEL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5ML IM SYRINGE [41293]	$209.58	$249.50	—	19% above	16%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTH,PERTUSSIS(ACELL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML IM SUSP [129774]	$194.88	$232.00	—	—	16%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTH,PERTUSSIS,TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML INJECTION [172682]	$194.88	$232.00	—	—	16%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTH,PERTUSSIS(ACEL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5ML IM SYRINGE [41293]	$209.58	$249.50	—	—	16%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Hc Immunization Admin	$113.40	$135.00	—	17% below	16%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Hc Immunization Admin	$113.40	$135.00	—	—	16%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Hc Immunization Admin Each Add	$113.40	$135.00	—	at median	16%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Hc Immunization Admin Each Add	$113.40	$135.00	—	—	16%

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

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

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

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

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

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

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

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

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

Source file: https://www.bayhealth.org/-/media/files/patients-and-visitors/billing-financial-aid/price-transparency/2026/510064318bayhealthhospitalsussexcampusstandardcharges.json