Hospital Washington-Arlington-Alexandria, DC-VA-MD-WV

Inova Fairfax Hospital

Inova Fairfax Hospital in Falls Church, VA publishes cash prices for 411 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 Virginia median for 234 of 404 procedures and below it for 128. By typical cash price it ranks #36 of 66 Virginia hospitals and #14 of 19 hospitals in the Washington, DC area, cheapest first. Select a procedure to compare it with other hospitals nearby.

3300 Gallows Road, Falls Church, VA 22042-3307 Collected Sep 23, 2026 Source price file Check a bill from this hospital (703) 698-1110

Acute care hospital Nonprofit hospital Emergency department CMS star rating 5 of 5 CCN 490063 · CMS hospital register NPI 1831220714

Financial assistance

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

Inova Fairfax Hospital 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 Inova Fairfax Hospital in Falls Church, VA:

May 18, 2021 Warning notice
Oct 27, 2021 Corrective action plan requested
Jan 11, 2022 Case closed
Apr 2, 2025 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 Virginia	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABD WWO IV CONT	$1,051.50	$2,103.00	$178.02–$3,033.83	44% below	50%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABD WWO IV CONT	$1,051.50	$2,103.00	$178.02–$3,033.83	—	50%
Abdominal X-ray, 2 views CPT 74019 HC XR ABD 2 VIEWS	$281.50	$563.00	$80.04–$439.14	14% below	50%
Abdominal X-ray, 2 views inpatient CPT 74019 HC XR ABD 2 VIEWS	$281.50	$563.00	$80.04–$439.14	—	50%
Ankle X-ray, complete, 3 or more views CPT 73610 HC XR ANKLE COMP 3+ VIEWS	$339.00	$678.00	$80.04–$528.84	at median	50%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC XR ANKLE COMP 3+ VIEWS	$339.00	$678.00	$80.04–$528.84	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC NONINVS EXT ART STDY LTD BI 1-	$622.50	$1,245.00	$128.90–$1,333.00	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC NONINVS EXT ART STDY LTD BI 1-	$622.50	$1,245.00	$128.90–$1,333.00	—	50%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPEX WO IV CONT	$651.50	$1,303.00	$106.34–$1,764.95	43% below	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPEX WO IV CONT	$651.50	$1,303.00	$106.34–$1,764.95	—	50%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC XR ESOPH SGL CONTRAST STUDY	$503.00	$1,006.00	$80.04–$784.68	4% above	50%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC XR ESOPH SGL CONTRAST STUDY	$503.00	$1,006.00	$80.04–$784.68	—	50%
Bone scan, whole body (nuclear medicine) CPT 78306 HC BONE/JT IMAGING WHOLE BODY	$1,723.50	$3,447.00	$401.83–$2,688.66	24% above	50%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC BONE/JT IMAGING WHOLE BODY	$1,723.50	$3,447.00	$401.83–$2,688.66	—	50%
Breast ultrasound, complete, one breast CPT 76641 HC US BREAST W/IMAGE DOC UNI COMP	$763.00	$1,526.00	$106.34–$1,190.28	36% above	50%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST W/IMAGE DOC UNI COMP	$763.00	$1,526.00	$106.34–$1,190.28	—	50%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST W/IMAGE DOC UNI LTD	$496.00	$992.00	$88.05–$773.76	at median	50%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST W/IMAGE DOC UNI LTD	$496.00	$992.00	$88.05–$773.76	—	50%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CTA ABD-PEL WWO IV CONT W/PROCESS	$1,926.00	$3,852.00	$357.13–$4,441.50	36% below	50%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CTA ABD-PEL WWO IV CONT W/PROCESS	$1,926.00	$3,852.00	$357.13–$4,441.50	—	50%
CT angiography (CTA) of the head CPT 70496 HC CT ANGIO HEAD	$992.00	$1,984.00	$178.02–$2,969.03	45% below	50%
CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIO HEAD	$992.00	$1,984.00	$178.02–$2,969.03	—	50%
CT angiography (CTA) of the neck CPT 70498 HC CT ANGIO NECK	$992.00	$1,984.00	$178.02–$2,964.10	49% below	50%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIO NECK	$992.00	$1,984.00	$178.02–$2,964.10	—	50%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIO CHEST	$1,030.00	$2,060.00	$178.02–$3,003.10	42% below	50%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIO CHEST	$1,030.00	$2,060.00	$178.02–$3,003.10	—	50%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CTA CARDIAC W IV CONT	$794.00	$1,588.00	$357.13–$3,192.75	13% below	50%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CTA CARDIAC W IV CONT	$794.00	$1,588.00	$357.13–$3,192.75	—	50%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT CARDIAC WO IV CONT EVAL CA+	$364.00	$728.00	$88.05–$1,739.00	83% above	50%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT CARDIAC WO IV CONT EVAL CA+	$364.00	$728.00	$88.05–$1,739.00	—	50%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD-PEL WO IV CONT	$747.00	$1,494.00	$241.72–$2,771.67	66% below	50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD-PEL WO IV CONT	$747.00	$1,494.00	$241.72–$2,771.67	—	50%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABD-PEL W IV CONT	$1,064.50	$2,129.00	$357.13–$3,787.26	66% below	50%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABD-PEL W IV CONT	$1,064.50	$2,129.00	$357.13–$3,787.26	—	50%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD-PEL WWO IV CONT	$1,149.00	$2,298.00	$357.13–$4,239.57	67% below	50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABD-PEL WWO IV CONT	$1,149.00	$2,298.00	$357.13–$4,239.57	—	50%
CT scan of the abdomen with contrast CPT 74160 HC CT ABD W IV CONT	$885.50	$1,771.00	$178.02–$2,683.65	46% below	50%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABD W IV CONT	$885.50	$1,771.00	$178.02–$2,683.65	—	50%
CT scan of the abdomen without contrast CPT 74150 HC CT ABD WO IV CONT	$651.50	$1,303.00	$106.34–$1,739.00	54% below	50%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABD WO IV CONT	$651.50	$1,303.00	$106.34–$1,739.00	—	50%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFAC-SINUS WO IV CONT	$628.00	$1,256.00	$106.34–$1,739.00	52% below	50%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFAC-SINUS WO IV CONT	$628.00	$1,256.00	$106.34–$1,739.00	—	50%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD-BRAIN WO IV CONT	$627.50	$1,255.00	$106.34–$1,739.00	53% below	50%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD-BRAIN WO IV CONT	$627.50	$1,255.00	$106.34–$1,739.00	—	50%
CT scan of the head with contrast CPT 70460 HC CT HEAD-BRAIN W IV CONT	$853.00	$1,706.00	$178.02–$1,739.00	44% below	50%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD-BRAIN W IV CONT	$853.00	$1,706.00	$178.02–$1,739.00	—	50%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD-BRAIN WWO IV CONT	$1,013.00	$2,026.00	$178.02–$1,749.58	42% below	50%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD-BRAIN WWO IV CONT	$1,013.00	$2,026.00	$178.02–$1,749.58	—	50%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMB SPINE WO IV CONT	$651.50	$1,303.00	$106.34–$1,739.00	59% below	50%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMB SPINE WO IV CONT	$651.50	$1,303.00	$106.34–$1,739.00	—	50%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERV SPINE WO IV CONT	$660.00	$1,320.00	$106.34–$1,739.00	59% below	50%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT CERV SPINE WO IV CONT	$660.00	$1,320.00	$106.34–$1,739.00	—	50%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W IV CONT	$796.00	$1,592.00	$178.02–$2,698.15	53% below	50%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W IV CONT	$796.00	$1,592.00	$178.02–$2,698.15	—	50%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DOPP EXTRACRAN ARTER COMP BI	$941.50	$1,883.00	$237.75–$1,468.74	—	50%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DOPP EXTRACRAN ARTER COMP BI	$941.50	$1,883.00	$237.75–$1,468.74	—	50%
Chest CT scan without and with contrast CPT 71270 HC CT CHEST DX WWO IV CONT	$1,051.50	$2,103.00	$178.02–$2,114.40	46% below	50%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT CHEST DX WWO IV CONT	$1,051.50	$2,103.00	$178.02–$2,114.40	—	50%
Chest X-ray, 2 views CPT 71046 HC XR CHEST 2 VIEWS	$247.00	$494.00	$80.04–$385.32	12% below	50%
Chest X-ray, 2 views inpatient CPT 71046 HC XR CHEST 2 VIEWS	$247.00	$494.00	$80.04–$385.32	—	50%
Chest X-ray, single view CPT 71045 HC XR CHEST 1 VIEW	$247.00	$494.00	$80.04–$385.32	6% above	50%
Chest X-ray, single view inpatient CPT 71045 HC XR CHEST 1 VIEW	$247.00	$494.00	$80.04–$385.32	—	50%
Collarbone (clavicle) X-ray, complete CPT 73000 HC XR CLAVICLE COMP	$277.00	$554.00	$80.04–$432.12	7% below	50%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC XR CLAVICLE COMP	$277.00	$554.00	$80.04–$432.12	—	50%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEUM COMP	$582.50	$1,165.00	$106.34–$908.70	9% below	50%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEUM COMP	$582.50	$1,165.00	$106.34–$908.70	—	50%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DXA 1+ SITES AXIAL SKELETON	$566.00	$1,132.00	$106.34–$882.96	4% below	50%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DXA 1+ SITES AXIAL SKELETON	$566.00	$1,132.00	$106.34–$882.96	—	50%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC DXA 1+ SITES APPNDCLR SKELETON	$269.00	$538.00	$88.05–$419.64	9% above	50%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC DXA 1+ SITES APPNDCLR SKELETON	$269.00	$538.00	$88.05–$419.64	—	50%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US TRANSABD SGL OR 1ST GEST	$770.00	$1,540.00	$143.89–$1,201.20	16% above	50%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US TRANSABD SGL OR 1ST GEST	$770.00	$1,540.00	$143.89–$1,201.20	—	50%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT CHEST DX WO IV CONT	$651.50	$1,303.00	$106.34–$1,739.00	53% below	50%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT CHEST DX WO IV CONT	$651.50	$1,303.00	$106.34–$1,739.00	—	50%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT CHEST DX W IV CONT	$885.50	$1,771.00	$178.02–$1,739.00	49% below	50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT CHEST DX W IV CONT	$885.50	$1,771.00	$178.02–$1,739.00	—	50%
Diagnostic mammogram, both breasts both sides CPT 77066 HC DIGITAL MAMMO DX W/CAD BI	$364.50	$729.00	$67.44–$568.62	—	50%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DIGITAL MAMMO DX W/CAD BI	$364.50	$729.00	$67.44–$568.62	—	50%
Diagnostic mammogram, one breast CPT 77065 HC DIGITAL MAMMO DX W/CAD UNI	$270.50	$541.00	$67.44–$421.98	21% below	50%
Diagnostic mammogram, one breast inpatient CPT 77065 HC DIGITAL MAMMO DX W/CAD UNI	$270.50	$541.00	$67.44–$421.98	—	50%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DOPP LOEX ARTERY COMP BI	$911.50	$1,823.00	$237.75–$1,421.94	—	50%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DOPP LOEX ARTERY COMP BI	$911.50	$1,823.00	$237.75–$1,421.94	—	50%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUPLEX EXTREMITY VEINS COMP BI	$1,181.50	$2,363.00	$237.75–$1,843.14	—	50%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUPLEX EXTREMITY VEINS COMP BI	$1,181.50	$2,363.00	$237.75–$1,843.14	—	50%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO TTE 2D COMP WO CTRST W/CLR/DPLR	$2,229.50	$4,459.00	$548.30–$3,478.02	29% above	50%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO TTE 2D COMP WO CTRST W/CLR/DPLR	$2,229.50	$4,459.00	$548.30–$3,478.02	—	50%
Elbow X-ray, 2 views CPT 73070 HC XR ELBOW 2 VIEWS	$309.50	$619.00	$80.04–$482.82	15% above	50%
Elbow X-ray, 2 views inpatient CPT 73070 HC XR ELBOW 2 VIEWS	$309.50	$619.00	$80.04–$482.82	—	50%
Elbow X-ray, complete, 3 or more views CPT 73080 HC XR ELBOW COMP 3+VIEWS	$323.00	$646.00	$80.04–$503.88	24% below	50%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC XR ELBOW COMP 3+VIEWS	$323.00	$646.00	$80.04–$503.88	—	50%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORB-SEL-POS FOSSA WO IV CONT	$628.00	$1,256.00	$106.34–$1,739.00	54% below	50%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORB-SEL-POS FOSSA WO IV CONT	$628.00	$1,256.00	$106.34–$1,739.00	—	50%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC XR FACIAL BONES COMP MIN 3 VIE	$296.50	$593.00	$80.04–$462.54	43% below	50%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC XR FACIAL BONES COMP MIN 3 VIE	$296.50	$593.00	$80.04–$462.54	—	50%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC XR FOREARM 2 VIEWS	$329.50	$659.00	$80.04–$514.02	at median	50%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC XR FOREARM 2 VIEWS	$329.50	$659.00	$80.04–$514.02	—	50%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC HEPATOBILIARY SYSTEM IMAGING	$1,135.50	$2,271.00	$401.83–$1,771.38	at median	50%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC HEPATOBILIARY SYSTEM IMAGING	$1,135.50	$2,271.00	$401.83–$1,771.38	—	50%
Hand X-ray, 2 views CPT 73120 HC XR HAND 2 VIEWS	$316.50	$633.00	$80.04–$493.74	26% above	50%
Hand X-ray, 2 views inpatient CPT 73120 HC XR HAND 2 VIEWS	$316.50	$633.00	$80.04–$493.74	—	50%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC XR CALCANEUS 2+ VIEWS	$246.50	$493.00	$80.04–$384.54	12% below	50%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC XR CALCANEUS 2+ VIEWS	$246.50	$493.00	$80.04–$384.54	—	50%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATTN	$234.00	$468.00	$156.46–$3,088.00	49% below	50%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATTN	$234.00	$468.00	$156.46–$3,088.00	—	50%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOM 6YRS+ 4+PRM CPAP/BIPAP REDUCED SVC	$3,175.00	$6,350.00	$1,017.39–$4,953.00	42% above	50%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOM 6YRS+ 4+PRM CPAP/BIPAP	$3,186.00	$6,372.00	$1,017.39–$4,970.16	42% above	50%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOM 6YRS+ 4+PRM CPAP/BIPAP REDUCED SVC	$3,175.00	$6,350.00	$1,017.39–$4,953.00	—	50%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOM 6YRS+ 4+PRM CPAP/BIPAP	$3,186.00	$6,372.00	$1,017.39–$4,970.16	—	50%
Knee X-ray, 3 views CPT 73562 HC XR KNEE 3 VIEWS	$301.00	$602.00	$80.04–$469.56	10% below	50%
Knee X-ray, 3 views inpatient CPT 73562 HC XR KNEE 3 VIEWS	$301.00	$602.00	$80.04–$469.56	—	50%
Knee X-ray, complete, 4 or more views CPT 73564 HC XR KNEE COMP 4+ VIEWS	$320.50	$641.00	$80.04–$499.98	26% below	50%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC XR KNEE COMP 4+ VIEWS	$320.50	$641.00	$80.04–$499.98	—	50%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOEX WO IV CONT	$651.50	$1,303.00	$106.34–$1,739.00	46% below	50%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOEX WO IV CONT	$651.50	$1,303.00	$106.34–$1,739.00	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABD W/IMAGE DOC LTD	$658.00	$1,316.00	$106.34–$1,026.48	at median	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABD W/IMAGE DOC LTD	$658.00	$1,316.00	$106.34–$1,026.48	—	50%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US EX/FOCAL EVAL NON-VAS W/IMG LTD	$455.00	$910.00	$106.34–$709.80	48% above	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US EX/FOCAL EVAL NON-VAS W/IMG LTD	$455.00	$910.00	$106.34–$709.80	—	50%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC LOW DOSE CT LUNG SCRN	$418.50	$837.00	$106.34–$1,739.00	49% above	50%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC LOW DOSE CT LUNG SCRN	$418.50	$837.00	$106.34–$1,739.00	—	50%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC XR TIBIA & FIBULA 2 VIEWS	$328.00	$656.00	$80.04–$511.68	5% above	50%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC XR TIBIA & FIBULA 2 VIEWS	$328.00	$656.00	$80.04–$511.68	—	50%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD WO IV CONT	$833.50	$1,667.00	$241.72–$2,440.35	64% below	50%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA HEAD WO IV CONT	$833.50	$1,667.00	$241.72–$2,440.35	—	50%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST W IV CONT BI	$1,304.50	$2,609.00	$580.28–$3,650.08	—	50%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST WWO IV CONT BI	$1,366.00	$2,732.00	$580.28–$3,650.08	—	50%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 HC MRI BREAST W IV CONT BI	$1,304.50	$2,609.00	$580.28–$3,650.08	—	50%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 HC MRI BREAST WWO IV CONT BI	$1,366.00	$2,732.00	$580.28–$3,650.08	—	50%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOEX JT WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	57% below	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOEX JT WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOEX JT WWO IV CONT	$1,419.00	$2,838.00	$357.13–$4,418.58	59% below	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOEX JT WWO IV CONT	$1,419.00	$2,838.00	$357.13–$4,418.58	—	50%
MRI of the abdomen without contrast CPT 74181 HC MRI ABD WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	49% below	50%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABD WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	—	50%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABD WWO IV CONT	$1,421.00	$2,842.00	$357.13–$4,311.12	50% below	50%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABD WWO IV CONT	$1,421.00	$2,842.00	$357.13–$4,311.12	—	50%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN WO IV CONT	$833.50	$1,667.00	$241.72–$2,629.00	57% below	50%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN WO IV CONT	$833.50	$1,667.00	$241.72–$2,629.00	—	50%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN WWO IV CONT	$1,479.00	$2,958.00	$357.13–$4,376.99	46% below	50%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN WWO IV CONT	$1,479.00	$2,958.00	$357.13–$4,376.99	—	50%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMB SPINE WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	58% below	50%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMB SPINE WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	—	50%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMB SPINE WWO IV CONT	$1,479.00	$2,958.00	$357.13–$4,376.99	55% below	50%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMB SPINE WWO IV CONT	$1,479.00	$2,958.00	$357.13–$4,376.99	—	50%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THOR SPINE WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	58% below	50%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THOR SPINE WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	—	50%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERV SPINE WWO IV CONT	$1,479.00	$2,958.00	$357.13–$4,416.53	55% below	50%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERV SPINE WWO IV CONT	$1,479.00	$2,958.00	$357.13–$4,416.53	—	50%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERV SPINE WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	58% below	50%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERV SPINE WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	—	50%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WWO IV CONT	$1,421.00	$2,842.00	$357.13–$4,311.12	55% below	50%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS WWO IV CONT	$1,421.00	$2,842.00	$357.13–$4,311.12	—	50%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	55% below	50%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPEX JT WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	57% below	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPEX JT WO IV CONT	$835.00	$1,670.00	$241.72–$2,629.00	—	50%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC XR C-SPINE 4 OR 5 VIEWS	$521.00	$1,042.00	$80.04–$812.76	8% above	50%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC XR C-SPINE 4 OR 5 VIEWS	$521.00	$1,042.00	$80.04–$812.76	—	50%
Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TIS NECK W IV CONT	$853.00	$1,706.00	$178.02–$1,837.15	49% below	50%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT SOFT TIS NECK W IV CONT	$853.00	$1,706.00	$178.02–$1,837.15	—	50%
Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TIS NECK WO IV CONT	$628.00	$1,256.00	$106.34–$1,739.00	26% below	50%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SOFT TIS NECK WO IV CONT	$628.00	$1,256.00	$106.34–$1,739.00	—	50%
Neck soft tissue X-ray CPT 70360 HC XR NECK SOFT TISSUE	$250.50	$501.00	$80.04–$390.78	27% below	50%
Neck soft tissue X-ray inpatient CPT 70360 HC XR NECK SOFT TISSUE	$250.50	$501.00	$80.04–$390.78	—	50%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC CARDIAC PERF SPECT MULT/EF/WM RST/STRS	$3,728.50	$7,457.00	$1,305.48–$5,816.46	18% above	50%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC CARDIAC PERF SPECT MULT/EF/WM RST/STRS	$3,728.50	$7,457.00	$1,305.48–$5,816.46	—	50%
OCT scan of the retina (optical coherence tomography) CPT 92134 HC COMPUTERIZED OPHTHALMIC IMAGING RETINA	$119.00	$238.00	$59.40–$867.00	28% above	50%
OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 HC COMPUTERIZED OPHTHALMIC IMAGING RETINA	$119.00	$238.00	$59.40–$867.00	—	50%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET/CT SCAN SKULL-THIGH	$5,133.00	$10,266.00	$1,458.59–$11,887.10	16% above	50%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC PET/CT SCAN SKULL-THIGH	$5,133.00	$10,266.00	$1,458.59–$11,887.10	—	50%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO IV CONT	$587.50	$1,175.00	$106.34–$1,739.00	60% below	50%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS WO IV CONT	$587.50	$1,175.00	$106.34–$1,739.00	—	50%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIC W/IMAGE DOC LTD/F/U	$476.50	$953.00	$106.34–$743.34	11% above	50%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIC W/IMAGE DOC LTD/F/U	$476.50	$953.00	$106.34–$743.34	—	50%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIC W/IMAGE DOC COMP	$682.50	$1,365.00	$106.34–$1,064.70	7% below	50%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIC W/IMAGE DOC COMP	$682.50	$1,365.00	$106.34–$1,064.70	—	50%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB>=14WKS SGL OR 1ST GEST	$708.00	$1,416.00	$106.34–$1,104.48	17% above	50%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB>=14WKS SGL OR 1ST GEST	$708.00	$1,416.00	$106.34–$1,104.48	—	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US OB<14WKS SGL GEST/1ST GEST	$654.00	$1,308.00	$106.34–$1,020.24	36% above	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US OB<14WKS SGL GEST/1ST GEST	$654.00	$1,308.00	$106.34–$1,020.24	—	50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US OB LTD=>1FETUS	$451.00	$902.00	$106.34–$703.56	5% below	50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US OB LTD=>1FETUS	$451.00	$902.00	$106.34–$703.56	—	50%
Rib X-ray, one side, 2 views CPT 71100 HC XR RIBS UNI 2 VIEW	$300.00	$600.00	$80.04–$468.00	9% below	50%
Rib X-ray, one side, 2 views inpatient CPT 71100 HC XR RIBS UNI 2 VIEW	$300.00	$600.00	$80.04–$468.00	—	50%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC XR RIBS UNI W/CHEST 3+VIEWS	$329.00	$658.00	$80.04–$513.24	20% below	50%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC XR RIBS UNI W/CHEST 3+VIEWS	$329.00	$658.00	$80.04–$513.24	—	50%
Screening mammogram, both breasts both sides CPT 77067 HC DIGITAL MAMMO SCREEN W/CAD BI	$345.50	$691.00	$67.44–$538.98	—	50%
Screening mammogram, both breasts inpatient both sides CPT 77067 HC DIGITAL MAMMO SCREEN W/CAD BI	$345.50	$691.00	$67.44–$538.98	—	50%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC XR SHOULDER COMP 2+VIEWS	$298.00	$596.00	$80.04–$464.88	7% below	50%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC XR SHOULDER COMP 2+VIEWS	$298.00	$596.00	$80.04–$464.88	—	50%
Sinus X-ray, complete, 3 or more views CPT 70220 HC XR SINUSES PRNSL COMP MIN 3 VI	$211.00	$422.00	$80.04–$329.16	57% below	50%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC XR SINUSES PRNSL COMP MIN 3 VI	$211.00	$422.00	$80.04–$329.16	—	50%
Skull X-ray, fewer than 4 views CPT 70250 HC XR SKULL <4 VIEWS	$344.50	$689.00	$80.04–$537.42	at median	50%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC XR SKULL <4 VIEWS	$344.50	$689.00	$80.04–$537.42	—	50%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOM 6YRS+ 4+PRM REDUCED SVC	$3,102.00	$6,204.00	$1,017.39–$4,839.12	42% above	50%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOM 6YRS+ 4+PRM	$3,165.00	$6,330.00	$1,017.39–$4,937.40	45% above	50%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOM 6YRS+ 4+PRM REDUCED SVC	$3,102.00	$6,204.00	$1,017.39–$4,839.12	—	50%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOM 6YRS+ 4+PRM	$3,165.00	$6,330.00	$1,017.39–$4,937.40	—	50%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC ECHO TTE 2D STRESS WO CTRST W/CONT EKG	$2,268.00	$4,536.00	$548.30–$3,538.08	32% above	50%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC ECHO TTE 2D STRESS WO CTRST W/CONT EKG	$2,268.00	$4,536.00	$548.30–$3,538.08	—	50%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC XR SWALLOW CINE/VIDEO CONTRAST STUDY	$546.50	$1,093.00	$167.33–$852.54	12% above	50%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC XR SWALLOW CINE/VIDEO CONTRAST STUDY	$546.50	$1,093.00	$167.33–$852.54	—	50%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC XR FEMUR MIN 2 VIEWS	$211.00	$422.00	$80.04–$329.16	31% below	50%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC XR FEMUR MIN 2 VIEWS	$211.00	$422.00	$80.04–$329.16	—	50%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT THOR SPINE WO IV CONT	$651.50	$1,303.00	$106.34–$1,739.00	59% below	50%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT THOR SPINE WO IV CONT	$651.50	$1,303.00	$106.34–$1,739.00	—	50%
Toe X-ray, 2 or more views CPT 73660 HC XR TOE(S) 2+ VIEWS	$264.00	$528.00	$80.04–$411.84	5% above	50%
Toe X-ray, 2 or more views inpatient CPT 73660 HC XR TOE(S) 2+ VIEWS	$264.00	$528.00	$80.04–$411.84	—	50%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL	$575.50	$1,151.00	$106.34–$897.78	1% below	50%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL	$575.50	$1,151.00	$106.34–$897.78	—	50%
Transvaginal ultrasound during pregnancy CPT 76817 HC US OB TRANSVAGINAL	$523.50	$1,047.00	$106.34–$816.66	9% above	50%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US OB TRANSVAGINAL	$523.50	$1,047.00	$106.34–$816.66	—	50%
Ultrasound of the abdomen, complete CPT 76700 HC US ABD W/IMAGE DOC COMP	$867.00	$1,734.00	$106.34–$1,352.52	at median	50%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABD W/IMAGE DOC COMP	$867.00	$1,734.00	$106.34–$1,352.52	—	50%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM & CONTENTS	$714.00	$1,428.00	$106.34–$1,113.84	at median	50%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM & CONTENTS	$714.00	$1,428.00	$106.34–$1,113.84	—	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US HEAD/NECK W/IMAGE DOC	$640.50	$1,281.00	$106.34–$999.18	4% above	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US HEAD/NECK W/IMAGE DOC	$640.50	$1,281.00	$106.34–$999.18	—	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC XR UPPER GI SGL CONTRAST STUDY	$428.00	$856.00	$167.33–$667.68	49% below	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC XR UPPER GI SGL CONTRAST STUDY	$428.00	$856.00	$167.33–$667.68	—	50%
Upper arm X-ray (humerus), 2 views CPT 73060 HC XR HUMERUS 2+ VIEWS	$285.00	$570.00	$80.04–$444.60	15% below	50%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XR HUMERUS 2+ VIEWS	$285.00	$570.00	$80.04–$444.60	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC DUPLEX EX VEIN UNI/LTD STUDY	$786.50	$1,573.00	$106.34–$1,333.00	7% above	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC DUPLEX EX VEIN UNI/LTD STUDY	$786.50	$1,573.00	$106.34–$1,333.00	—	50%
Wrist X-ray, 2 views CPT 73100 HC XR WRIST 2 VIEWS	$335.00	$670.00	$80.04–$522.60	32% above	50%
Wrist X-ray, 2 views inpatient CPT 73100 HC XR WRIST 2 VIEWS	$335.00	$670.00	$80.04–$522.60	—	50%
Wrist X-ray, complete, 3 or more views CPT 73110 HC XR WRIST COMP 3+VIEWS	$339.50	$679.00	$80.04–$529.62	11% above	50%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC XR WRIST COMP 3+VIEWS	$339.50	$679.00	$80.04–$529.62	—	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC XR HIP UNI W/WO PELVIS 2-3 VIEWS	$147.50	$295.00	$80.04–$240.71	41% below	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC XR HIP UNI W/WO PELVIS 2-3 VIEWS	$147.50	$295.00	$80.04–$240.71	—	50%
X-ray of the abdomen, 1 view CPT 74018 HC XR ABD 1 VIEW	$256.00	$512.00	$80.04–$399.36	8% below	50%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABD 1 VIEW	$256.00	$512.00	$80.04–$399.36	—	50%
X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 2 VIEWS	$283.00	$566.00	$80.04–$441.48	5% above	50%
X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 2 VIEWS	$283.00	$566.00	$80.04–$441.48	—	50%
X-ray of the finger(s), 2 or more views CPT 73140 HC XR FINGER(S) 2+VIEWS	$241.50	$483.00	$80.04–$376.74	1% above	50%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XR FINGER(S) 2+VIEWS	$241.50	$483.00	$80.04–$376.74	—	50%
X-ray of the foot, 2 views CPT 73620 HC XR FOOT 2 VIEWS	$339.50	$679.00	$80.04–$529.62	15% above	50%
X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 2 VIEWS	$339.50	$679.00	$80.04–$529.62	—	50%
X-ray of the foot, complete, 3 or more views CPT 73630 HC XR FOOT COMP 3+ VIEWS	$339.50	$679.00	$80.04–$529.62	7% above	50%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC XR FOOT COMP 3+ VIEWS	$339.50	$679.00	$80.04–$529.62	—	50%
X-ray of the hand, 3 or more views CPT 73130 HC XR HAND 3+ VIEWS	$322.00	$644.00	$80.04–$502.32	8% above	50%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC XR HAND 3+ VIEWS	$322.00	$644.00	$80.04–$502.32	—	50%
X-ray of the knee, 1 or 2 views CPT 73560 HC XR KNEE 1/2 VIEWS	$255.50	$511.00	$80.04–$398.58	2% below	50%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC XR KNEE 1/2 VIEWS	$255.50	$511.00	$80.04–$398.58	—	50%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XR L/S-SPINE 2 OR 3 VIEWS	$575.50	$1,151.00	$80.04–$897.78	57% above	50%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC XR L/S-SPINE 2 OR 3 VIEWS	$575.50	$1,151.00	$80.04–$897.78	—	50%
X-ray of the lower back, 4 or more views CPT 72110 HC XR L/S-SPINE 4+ VIEWS	$575.50	$1,151.00	$80.04–$897.78	9% above	50%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC XR L/S-SPINE 4+ VIEWS	$575.50	$1,151.00	$80.04–$897.78	—	50%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC XR T-SPINE 2 VIEWS	$322.50	$645.00	$80.04–$503.10	2% below	50%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC XR T-SPINE 2 VIEWS	$322.50	$645.00	$80.04–$503.10	—	50%
X-ray of the nasal bones, 3 or more views CPT 70160 HC XR NASAL BONES COMP MIN 3 VIEW	$269.00	$538.00	$80.04–$419.64	6% below	50%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC XR NASAL BONES COMP MIN 3 VIEW	$269.00	$538.00	$80.04–$419.64	—	50%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC XR C-SPINE 2 OR 3 VIEWS	$320.00	$640.00	$80.04–$499.20	14% below	50%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC XR C-SPINE 2 OR 3 VIEWS	$320.00	$640.00	$80.04–$499.20	—	50%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC XR PELVIS 1 OR 2 VIEWS	$280.50	$561.00	$80.04–$437.58	14% below	50%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC XR PELVIS 1 OR 2 VIEWS	$280.50	$561.00	$80.04–$437.58	—	50%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XR SACRUM & COCCYX 2 VIEWS	$312.00	$624.00	$80.04–$486.72	26% below	50%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC XR SACRUM & COCCYX 2 VIEWS	$312.00	$624.00	$80.04–$486.72	—	50%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
ACTH blood test CPT 82024 HC ADRENOCORTICOTROPIC HRMN (ACTH)	$387.00	$774.00	$38.62–$603.72	66% above	50%
ACTH blood test inpatient CPT 82024 HC ADRENOCORTICOTROPIC HRMN (ACTH)	$387.00	$774.00	$38.62–$603.72	—	50%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC TRANSFERASE ALANINE AMINO	$53.00	$106.00	$5.30–$82.68	6% above	50%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC TRANSFERASE ALANINE AMINO	$53.00	$106.00	$5.30–$82.68	—	50%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC TRANSFERASE ASPARTATE AMINO	$90.50	$181.00	$5.18–$141.18	82% above	50%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC TRANSFERASE ASPARTATE AMINO	$90.50	$181.00	$5.18–$141.18	—	50%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC PANEL ACUTE HEPATITIS	$449.00	$898.00	$10.76–$700.44	56% above	50%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC PANEL ACUTE HEPATITIS	$449.00	$898.00	$10.76–$700.44	—	50%
Albumin blood test CPT 82040 HC ALBUMIN SERUM PLASMA/WHOLE BLD	$44.50	$89.00	$4.95–$69.42	14% above	50%
Albumin blood test inpatient CPT 82040 HC ALBUMIN SERUM PLASMA/WHOLE BLD	$44.50	$89.00	$4.95–$69.42	—	50%
Aldosterone blood test CPT 82088 HC ALDOSTERONE	$285.00	$570.00	$40.75–$444.60	62% above	50%
Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE	$285.00	$570.00	$40.75–$444.60	—	50%
Alkaline phosphatase (ALP) blood test CPT 84075 HC PHOSPHATASE ALKALINE	$64.50	$129.00	$5.18–$100.62	76% above	50%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC PHOSPHATASE ALKALINE	$64.50	$129.00	$5.18–$100.62	—	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN QUANT/SEMIQUANT CRUDE EXT PIG MEAT	$32.00	$64.00	$5.22–$49.92	30% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN QUANT/SEMIQUANT CRUDE EXT COW MEAT	$32.00	$64.00	$5.22–$49.92	30% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN QUANT/SEMIQUANT CRUDE EXT SHEEP MEAT	$32.00	$64.00	$5.22–$49.92	30% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN CORN	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WHITE ASH	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN COMMON RAGWEED (SHORT)	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN PENICILLIUM NOTATUM	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN CODFISH	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TIMOTHY GRASS	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN COCKROACH	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN PEANUT	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN CLAM	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN CLADOSPORIUM HERBARUM	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN CHICKEN MEAT	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN CAT DANDER	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN QUANT/SEMIQUANT CRUDE EXT BRAZIL NUT	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN CASHEW NUT	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN BLUE MUSSEL	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WILLOW	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN BIRCH	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN PAPER WASP	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN BERMUDA GRASS	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SYCAMORE	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN BEECH	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN OYSTER	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ASPERGILLUS FUMIGATUS	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WHEAT	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ALTERNARIA TENUIS	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ORCHARD GRASS (COCKSFOOT)	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ALTERNARIA ALTERNATA	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE QUANT/SEMIQUANT CRUDE EXT EA	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ALMOND	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN YELLOW JACKET	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WHITE-FACE HORNET	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN QUANT/SEMIQUANT CRUDE EXT MACADAMIA NUT	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN OAK	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SOYBEAN	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN MULBERRY	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN MUCOR RACEMOSUS	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN MOUSE URINE PROTEINS	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN MOUNTAIN CEDAR	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN HAZELNUT TREE	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WALNUT TREE	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN LOBSTER	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SHRIMP	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN JUNE GRASS (KENTUCKY BLUE)	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN MAPLE (BOX ELDER)	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WALNUT	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN HAZELNUT	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SCALLOP	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FIRE ANT	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ENGLISH PLANTAIN	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ELM	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WHITE PINE	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN EGG WHITE	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SALMON	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN DOG DANDER	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TUNA	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN DERMATOPHAGOIDES PTERONYSSINUS	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ROUGH PIGWEED	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN DERMATOPHAGOIDES FARINAE	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN CRAB	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN RED SORREL	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN COW MILK	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TOMATO	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN COTTONWOOD	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN PERENNIAL RYE GRASS	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SESAME SEED	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN HONEY BEE	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN HICKORY/PECAN TREE	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN JOHNSON GRASS	$33.50	$67.00	$5.22–$52.26	36% above	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN QUANT/SEMIQUANT CRUDE EXT SHEEP MEAT	$32.00	$64.00	$5.22–$49.92	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN QUANT/SEMIQUANT CRUDE EXT COW MEAT	$32.00	$64.00	$5.22–$49.92	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN QUANT/SEMIQUANT CRUDE EXT PIG MEAT	$32.00	$64.00	$5.22–$49.92	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN CASHEW NUT	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WHITE-FACE HORNET	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WHITE PINE	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WHITE ASH	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WHEAT	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WALNUT TREE	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WALNUT	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TUNA	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TOMATO	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TIMOTHY GRASS	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SYCAMORE	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE QUANT/SEMIQUANT CRUDE EXT EA	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SOYBEAN	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SHRIMP	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SESAME SEED	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SCALLOP	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SALMON	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ROUGH PIGWEED	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN RED SORREL	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN PERENNIAL RYE GRASS	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN PENICILLIUM NOTATUM	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN PEANUT	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN PAPER WASP	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN OYSTER	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ORCHARD GRASS (COCKSFOOT)	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN OAK	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WILLOW	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN MULBERRY	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN MUCOR RACEMOSUS	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN MOUSE URINE PROTEINS	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN MOUNTAIN CEDAR	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN MAPLE (BOX ELDER)	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN LOBSTER	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN JUNE GRASS (KENTUCKY BLUE)	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN JOHNSON GRASS	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN HONEY BEE	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN HICKORY/PECAN TREE	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN HAZELNUT TREE	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN HAZELNUT	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FIRE ANT	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ENGLISH PLANTAIN	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ELM	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN EGG WHITE	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN DOG DANDER	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN DERMATOPHAGOIDES PTERONYSSINUS	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN DERMATOPHAGOIDES FARINAE	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN CRAB	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN COW MILK	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN COTTONWOOD	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN CORN	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN COMMON RAGWEED (SHORT)	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN CODFISH	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN COCKROACH	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN CLAM	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN CLADOSPORIUM HERBARUM	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN CHICKEN MEAT	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN CAT DANDER	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN BLUE MUSSEL	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN BIRCH	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN BERMUDA GRASS	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN BEECH	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ASPERGILLUS FUMIGATUS	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ALTERNARIA TENUIS	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ALTERNARIA ALTERNATA	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ALMOND	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN YELLOW JACKET	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN QUANT/SEMIQUANT CRUDE EXT MACADAMIA NUT	$33.50	$67.00	$5.22–$52.26	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN QUANT/SEMIQUANT CRUDE EXT BRAZIL NUT	$33.50	$67.00	$5.22–$52.26	—	50%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM	$168.00	$336.00	$14.35–$262.08	51% above	50%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA-FETOPROTEIN SERUM	$168.00	$336.00	$14.35–$262.08	—	50%
Ammonia blood test CPT 82140 HC AMMONIA	$145.50	$291.00	$14.35–$226.98	58% above	50%
Ammonia blood test inpatient CPT 82140 HC AMMONIA	$145.50	$291.00	$14.35–$226.98	—	50%
Amylase blood test CPT 82150 HC AMYLASE	$114.50	$229.00	$6.47–$178.62	104% above	50%
Amylase blood test inpatient CPT 82150 HC AMYLASE	$114.50	$229.00	$6.47–$178.62	—	50%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY	$93.00	$186.00	$12.95–$145.08	27% above	50%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY	$93.00	$186.00	$12.95–$145.08	—	50%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES (ANA)	$145.00	$290.00	$12.09–$226.20	5% above	50%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES (ANA)	$145.00	$290.00	$12.09–$226.20	—	50%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE	$337.50	$675.00	$33.33–$526.50	74% above	50%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE	$337.50	$675.00	$33.33–$526.50	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE BACT OTH AERO W/ISOLATION	$92.50	$185.00	$8.62–$144.30	34% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE BACT OTH AERO W/ISOLATION	$92.50	$185.00	$8.62–$144.30	—	50%
Basic metabolic panel (blood test) CPT 80048 HC PANEL CHEM BASIC W/TOTAL CA	$150.50	$301.00	$8.46–$234.78	101% above	50%
Basic metabolic panel (blood test) inpatient CPT 80048 HC PANEL CHEM BASIC W/TOTAL CA	$150.50	$301.00	$8.46–$234.78	—	50%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL	$44.50	$89.00	$5.02–$69.42	at median	50%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL	$44.50	$89.00	$5.02–$69.42	—	50%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC LEVEL IV - SURG PATH GROSS & MICRO EXAM	$224.00	$448.00	$46.88–$349.44	3% above	50%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC LEVEL IV - SURG PATH GROSS & MICRO EXAM	$224.00	$448.00	$46.88–$349.44	—	50%
Blood culture for bacteria CPT 87040 HC CULTURE BACT BLOOD AEROBIC	$115.00	$230.00	$10.32–$179.40	11% above	50%
Blood culture for bacteria inpatient CPT 87040 HC CULTURE BACT BLOOD AEROBIC	$115.00	$230.00	$10.32–$179.40	—	50%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC VENIPUNCTURE	$10.50	$21.00	$3.00–$34.83	40% below	50%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC VENIPUNCTURE	$10.50	$21.00	$3.00–$34.83	—	50%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANT BLOOD FASTING	$45.00	$90.00	$3.93–$70.20	at median	50%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANT BLOOD	$47.00	$94.00	$3.93–$73.32	4% above	50%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE QUANT BLOOD FASTING	$45.00	$90.00	$3.93–$70.20	—	50%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE QUANT BLOOD	$47.00	$94.00	$3.93–$73.32	—	50%
Blood lead test CPT 83655 HC LEAD	$94.00	$188.00	$12.11–$146.64	49% above	50%
Blood lead test inpatient CPT 83655 HC LEAD	$94.00	$188.00	$12.11–$146.64	—	50%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC (HCG) QUAL	$72.50	$145.00	$6.47–$113.10	31% below	50%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC GONADOTROPIN CHORIONIC (HCG) QUAL	$72.50	$145.00	$6.47–$113.10	—	50%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SRLGC ABO	$92.00	$184.00	$2.99–$352.41	2% above	50%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SRLGC ABO	$92.00	$184.00	$2.99–$352.41	—	50%
Blood urea nitrogen (BUN) test CPT 84520 HC UREA NITROGEN QUANT	$61.50	$123.00	$3.95–$95.94	18% above	50%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC UREA NITROGEN QUANT	$61.50	$123.00	$3.95–$95.94	—	50%
C-peptide blood test CPT 84681 HC C-PEPTIDE	$163.50	$327.00	$14.35–$255.06	50% above	50%
C-peptide blood test inpatient CPT 84681 HC C-PEPTIDE	$163.50	$327.00	$14.35–$255.06	—	50%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN	$78.00	$156.00	$5.18–$121.68	9% below	50%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN	$78.00	$156.00	$5.18–$121.68	—	50%
C. difficile toxin gene test (stool PCR) CPT 87493 HC INFECT AG NA CLOSTRIDIUM DIF TOXIN AMP	$204.00	$408.00	$37.27–$318.24	62% above	50%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC INFECT AG NA CLOSTRIDIUM DIF TOXIN AMP	$204.00	$408.00	$37.27–$318.24	—	50%
CA 19-9 blood test (tumor marker) CPT 86301 HC IA TUMOR ANTIGEN QUANT CA 19-9	$180.50	$361.00	$13.38–$281.58	76% above	50%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC IA TUMOR ANTIGEN QUANT CA 19-9	$180.50	$361.00	$13.38–$281.58	—	50%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC IA TUMOR ANTIGEN QUANT CA 125	$180.50	$361.00	$13.38–$281.58	47% above	50%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC IA TUMOR ANTIGEN QUANT CA 125	$180.50	$361.00	$13.38–$281.58	—	50%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC INFECT AG NA SARS 2/COVID-19 AMP PRB	$100.00	$200.00	$51.31–$258.70	30% above	50%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC INFECT AG NA SARS 2/COVID-19 AMP PRB	$100.00	$200.00	$51.31–$258.70	—	50%
Calcium blood test, total CPT 82310 HC CALCIUM TOTAL	$44.00	$88.00	$5.16–$68.64	8% above	50%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM TOTAL	$44.00	$88.00	$5.16–$68.64	—	50%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CARCINOEMBRYONIC ANTIGEN	$189.50	$379.00	$14.35–$295.62	64% above	50%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CARCINOEMBRYONIC ANTIGEN	$189.50	$379.00	$14.35–$295.62	—	50%
Chickenpox (varicella) immunity blood test CPT 86787 HC ANTIBODY VARICELLA-ZOSTER	$119.50	$239.00	$12.88–$186.42	13% above	50%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC ANTIBODY VARICELLA-ZOSTER	$119.50	$239.00	$12.88–$186.42	—	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC INFECT AG NA CHLAMYDIA TRACHOMATIS AMP	$245.50	$491.00	$35.09–$382.98	85% above	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC INFECT AG NA CHLAMYDIA TRACHOMATIS AMP	$245.50	$491.00	$35.09–$382.98	—	50%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC PANEL LIPID	$145.00	$290.00	$10.76–$226.20	71% above	50%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC PANEL LIPID	$145.00	$290.00	$10.76–$226.20	—	50%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMP AUTO DIFF WBC	$100.50	$201.00	$7.09–$156.78	249% above	50%
Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMP AUTO DIFF WBC	$100.50	$201.00	$7.09–$156.78	—	50%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMP AUTO	$82.50	$165.00	$6.47–$128.70	at median	50%
Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMP AUTO	$82.50	$165.00	$6.47–$128.70	—	50%
Comprehensive metabolic panel (blood test) CPT 80053 HC PANEL COMPREHENSIVE METABOLIC	$194.50	$389.00	$10.56–$303.42	14% above	50%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC PANEL COMPREHENSIVE METABOLIC	$194.50	$389.00	$10.56–$303.42	—	50%
Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL	$163.00	$326.00	$15.74–$254.28	88% above	50%
Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL, LC/MS	$163.00	$326.00	$15.74–$254.28	88% above	50%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL TOTAL	$163.00	$326.00	$15.74–$254.28	—	50%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL TOTAL, LC/MS	$163.00	$326.00	$15.74–$254.28	—	50%
Creatine kinase (CK) blood test, total CPT 82550 HC CREATINE KINASE TOTAL	$85.50	$171.00	$6.47–$133.38	35% above	50%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CREATINE KINASE TOTAL	$85.50	$171.00	$6.47–$133.38	—	50%
Creatinine blood test CPT 82565 HC CREATININE BLOOD	$64.00	$128.00	$5.12–$99.84	at median	50%
Creatinine blood test inpatient CPT 82565 HC CREATININE BLOOD	$64.00	$128.00	$5.12–$99.84	—	50%
Cytomegalovirus (CMV) antibody test CPT 86644 HC ANTIBODY CYTOMEGALOVIRUS (CMV)	$163.00	$326.00	$13.38–$254.28	139% above	50%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC ANTIBODY CYTOMEGALOVIRUS (CMV)	$163.00	$326.00	$13.38–$254.28	—	50%
D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN DEG PROD D-DIMER QUANT	$192.00	$384.00	$5.25–$299.52	23% above	50%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC FIBRIN DEG PROD D-DIMER QUANT	$192.00	$384.00	$5.25–$299.52	—	50%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE-SULF (DHEA-S)	$141.00	$282.00	$15.74–$219.96	17% above	50%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DEHYDROEPIANDROSTERONE-SULF (DHEA-S)	$141.00	$282.00	$15.74–$219.96	—	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRESUMPTIVE ANY INST CHEM ANALYZERS PER DOS	$296.50	$593.00	$62.14–$462.54	93% above	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRESUMPTIVE ANY INST CHEM ANALYZERS PER DOS	$296.50	$593.00	$62.14–$462.54	—	50%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTES WHOLE BLOOD	$112.00	$224.00	$7.01–$174.72	17% above	50%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC PANEL ELECTROLYTE	$112.00	$224.00	$7.01–$174.72	17% above	50%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC PANEL ELECTROLYTE	$112.00	$224.00	$7.01–$174.72	—	50%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTES WHOLE BLOOD	$112.00	$224.00	$7.01–$174.72	—	50%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC ANTIBODY EB VIRUS VIRAL CAPSID	$185.50	$371.00	$13.38–$289.38	101% above	50%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC ANTIBODY EB VIRUS VIRAL CAPSID IGG	$185.50	$371.00	$13.38–$289.38	101% above	50%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC ANTIBODY EB VIRUS VIRAL CAPSID IGM	$185.50	$371.00	$13.38–$289.38	101% above	50%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC ANTIBODY EB VIRUS VIRAL CAPSID IGG	$185.50	$371.00	$13.38–$289.38	—	50%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC ANTIBODY EB VIRUS VIRAL CAPSID IGM	$185.50	$371.00	$13.38–$289.38	—	50%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC ANTIBODY EB VIRUS VIRAL CAPSID	$185.50	$371.00	$13.38–$289.38	—	50%
Estradiol blood test CPT 82670 HC ESTRADIOL TOTAL	$277.00	$554.00	$15.74–$432.12	127% above	50%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL TOTAL	$277.00	$554.00	$15.74–$432.12	—	50%
FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN FOLLICLE STIM HORMONE	$226.50	$453.00	$15.74–$353.34	114% above	50%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC GONADOTROPIN FOLLICLE STIM HORMONE	$226.50	$453.00	$15.74–$353.34	—	50%
Fecal calprotectin (stool inflammation test) CPT 83993 HC CALPROTECTIN FECAL	$214.50	$429.00	$14.35–$334.62	77% above	50%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC CALPROTECTIN FECAL	$214.50	$429.00	$14.35–$334.62	—	50%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN	$135.50	$271.00	$13.63–$211.38	5% above	50%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN	$135.50	$271.00	$13.63–$211.38	—	50%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN ACTIVITY	$110.50	$221.00	$5.25–$172.38	32% above	50%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN ACTIVITY	$110.50	$221.00	$5.25–$172.38	—	50%
Folate (folic acid) blood test CPT 82746 HC FOLIC ACID SERUM	$148.00	$296.00	$14.35–$230.88	37% above	50%
Folate (folic acid) blood test inpatient CPT 82746 HC FOLIC ACID SERUM	$148.00	$296.00	$14.35–$230.88	—	50%
Free T3 thyroid hormone test CPT 84481 HC TRIIODOTHYRONINE T3 FREE	$129.50	$259.00	$15.74–$202.02	26% above	50%
Free T3 thyroid hormone test inpatient CPT 84481 HC TRIIODOTHYRONINE T3 FREE	$129.50	$259.00	$15.74–$202.02	—	50%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC THYROXINE FREE	$97.50	$195.00	$9.02–$152.10	26% above	50%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC THYROXINE FREE	$97.50	$195.00	$9.02–$152.10	—	50%
Free testosterone test CPT 84402 HC TESTOSTERONE FREE	$279.00	$558.00	$15.74–$435.24	53% above	50%
Free testosterone test inpatient CPT 84402 HC TESTOSTERONE FREE	$279.00	$558.00	$15.74–$435.24	—	50%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GLUTAMYLTRANSFERASE GAMMA (GGT)	$126.50	$253.00	$6.47–$197.34	197% above	50%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GLUTAMYLTRANSFERASE GAMMA (GGT)	$126.50	$253.00	$6.47–$197.34	—	50%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE POST GLUCOSE DOSE	$57.00	$114.00	$4.75–$88.92	39% above	50%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE POST GLUCOSE DOSE	$57.00	$114.00	$4.75–$88.92	—	50%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST 3 SPEC	$104.50	$209.00	$12.87–$163.02	27% above	50%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE TEST 3 SPEC	$104.50	$209.00	$12.87–$163.02	—	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC INFECT AG NA NEISSERIA GONREA AMP	$245.50	$491.00	$35.09–$382.98	126% above	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC INFECT AG NA NEISSERIA GONREA AMP	$245.50	$491.00	$35.09–$382.98	—	50%
H. pylori antibody blood test CPT 86677 HC ANTIBODY HELICOBACTER PYLORI	$135.50	$271.00	$13.38–$211.38	83% above	50%
H. pylori antibody blood test inpatient CPT 86677 HC ANTIBODY HELICOBACTER PYLORI	$135.50	$271.00	$13.38–$211.38	—	50%
H. pylori stool antigen test CPT 87338 HC INFECT AG EIA HELICOBACTER PYLORI STOOL	$222.00	$444.00	$11.72–$346.32	106% above	50%
H. pylori stool antigen test inpatient CPT 87338 HC INFECT AG EIA HELICOBACTER PYLORI STOOL	$222.00	$444.00	$11.72–$346.32	—	50%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC INFECT AG NA HIV-1 QUANT	$553.00	$1,106.00	$69.10–$862.68	85% above	50%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC INFECT AG NA HIV-1 QUANT	$553.00	$1,106.00	$69.10–$862.68	—	50%
HIV-1 and HIV-2 antibody test CPT 86703 HC ANTIBODY HIV-1/HIV-2 SGL RESULT	$136.50	$273.00	$13.38–$212.94	14% above	50%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC ANTIBODY HIV-1/HIV-2 SGL RESULT	$136.50	$273.00	$13.38–$212.94	—	50%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC INFECT AG EIA HIV-1 ANT W/HIV-1&2 AB SGL	$207.50	$415.00	$11.72–$323.70	85% above	50%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC INFECT AG EIA HIV-1 ANT W/HIV-1&2 AB SGL	$207.50	$415.00	$11.72–$323.70	—	50%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC INFECT AG NA HPV HIGH-RISK TYPES	$253.00	$506.00	$35.09–$394.68	120% above	50%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC INFECT AG NA HPV HIGH-RISK TYPES	$253.00	$506.00	$35.09–$394.68	—	50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN GLYCOSYLATED (A1C)	$109.00	$218.00	$6.47–$170.04	at median	50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HEMOGLOBIN GLYCOSYLATED (A1C)	$109.00	$218.00	$6.47–$170.04	—	50%
Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN (HGB)	$19.50	$39.00	$2.37–$30.42	8% above	50%
Hemoglobin blood test inpatient CPT 85018 HC BLOOD COUNT HEMOGLOBIN (HGB)	$19.50	$39.00	$2.37–$30.42	—	50%
Hepatitis B core antibody test (total) CPT 86704 HC ANTIBODY HEPATITIS B CORE (HBCAB) TOTAL	$119.00	$238.00	$12.05–$185.64	80% above	50%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC ANTIBODY HEPATITIS B CORE (HBCAB) TOTAL	$119.00	$238.00	$12.05–$185.64	—	50%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC ANTIBODY HEPATITIS B SURFACE (HBSAB)	$112.00	$224.00	$10.74–$174.72	34% above	50%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC ANTIBODY HEPATITIS B SURFACE (HBSAB)	$112.00	$224.00	$10.74–$174.72	—	50%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC INFECT AG EIA HEP B SURFACE ANTIGEN	$104.00	$208.00	$10.33–$162.24	65% above	50%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC INFECT AG EIA HEP B SURFACE ANTIGEN	$104.00	$208.00	$10.33–$162.24	—	50%
Hepatitis C antibody blood test (screening) CPT 86803 HC ANTIBODY HEPATITIS C	$101.50	$203.00	$13.38–$158.34	29% above	50%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC ANTIBODY HEPATITIS C	$101.50	$203.00	$13.38–$158.34	—	50%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C NUCLEIC ACID QUANT	$253.00	$506.00	$42.84–$394.68	at median	50%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C NUCLEIC ACID QUANT	$253.00	$506.00	$42.84–$394.68	—	50%
Herpes blood test, HSV-1 antibody CPT 86695 HC ANTIBODY HERPES SIMPLEX TYPE I	$137.50	$275.00	$13.19–$214.50	64% above	50%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC ANTIBODY HERPES SIMPLEX TYPE I	$137.50	$275.00	$13.19–$214.50	—	50%
Herpes blood test, HSV-2 antibody CPT 86696 HC ANTIBODY HERPES SIMPLEX TYPE 2	$195.00	$390.00	$13.38–$304.20	113% above	50%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC ANTIBODY HERPES SIMPLEX TYPE 2	$195.00	$390.00	$13.38–$304.20	—	50%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY	$143.50	$287.00	$12.95–$223.86	166% above	50%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY	$143.50	$287.00	$12.95–$223.86	—	50%
Homocysteine blood test CPT 83090 HC HOMOCYSTEINE	$251.50	$503.00	$15.74–$392.34	127% above	50%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTEINE	$251.50	$503.00	$15.74–$392.34	—	50%
Insulin blood test CPT 83525 HC INSULIN TOTAL	$163.50	$327.00	$11.43–$255.06	135% above	50%
Insulin blood test inpatient CPT 83525 HC INSULIN TOTAL	$163.50	$327.00	$11.43–$255.06	—	50%
Iron blood test (serum iron) CPT 83540 HC IRON	$81.00	$162.00	$6.47–$126.36	3% above	50%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON	$81.00	$162.00	$6.47–$126.36	—	50%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY	$107.00	$214.00	$6.47–$166.92	60% above	50%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY	$107.00	$214.00	$6.47–$166.92	—	50%
Kidney function blood test panel CPT 80069 HC PANEL RENAL FUNCTION	$188.50	$377.00	$8.68–$294.06	75% above	50%
Kidney function blood test panel inpatient CPT 80069 HC PANEL RENAL FUNCTION	$188.50	$377.00	$8.68–$294.06	—	50%
LH (luteinizing hormone) test CPT 83002 HC GONADOTROPIN LUTEINIZING HRMN	$193.50	$387.00	$15.74–$301.86	44% above	50%
LH (luteinizing hormone) test inpatient CPT 83002 HC GONADOTROPIN LUTEINIZING HRMN	$193.50	$387.00	$15.74–$301.86	—	50%
Lactate (lactic acid) blood test CPT 83605 HC LACTATE (LACTIC ACID)	$107.00	$214.00	$11.57–$166.92	19% above	50%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTATE (LACTIC ACID)	$107.00	$214.00	$11.57–$166.92	—	50%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE DEHYDROGENASE	$64.00	$128.00	$6.04–$99.84	19% above	50%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE DEHYDROGENASE	$64.00	$128.00	$6.04–$99.84	—	50%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE	$109.00	$218.00	$6.47–$170.04	1% above	50%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE	$109.00	$218.00	$6.47–$170.04	—	50%
Liver function blood test panel CPT 80076 HC PANEL HEPATIC FUNCTION	$228.00	$456.00	$8.17–$355.68	174% above	50%
Liver function blood test panel inpatient CPT 80076 HC PANEL HEPATIC FUNCTION	$228.00	$456.00	$8.17–$355.68	—	50%
Lyme disease antibody test CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI TOTAL, CSF	$89.00	$178.00	$13.38–$138.84	2% above	50%
Lyme disease antibody test CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI TOTAL, SERUM	$89.00	$178.00	$13.38–$138.84	2% above	50%
Lyme disease antibody test CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI	$89.00	$178.00	$13.38–$138.84	2% above	50%
Lyme disease antibody test CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI IGG CSF	$89.00	$178.00	$13.38–$138.84	2% above	50%
Lyme disease antibody test CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI IGG SERUM	$89.00	$178.00	$13.38–$138.84	2% above	50%
Lyme disease antibody test inpatient CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI TOTAL, CSF	$89.00	$178.00	$13.38–$138.84	—	50%
Lyme disease antibody test inpatient CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI TOTAL, SERUM	$89.00	$178.00	$13.38–$138.84	—	50%
Lyme disease antibody test inpatient CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI IGG CSF	$89.00	$178.00	$13.38–$138.84	—	50%
Lyme disease antibody test inpatient CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI IGG SERUM	$89.00	$178.00	$13.38–$138.84	—	50%
Lyme disease antibody test inpatient CPT 86618 HC ANTIBODY BORRELIA BURGDORFERI	$89.00	$178.00	$13.38–$138.84	—	50%
Magnesium blood test CPT 83735 HC MAGNESIUM, STOOL	$78.00	$156.00	$6.47–$121.68	42% above	50%
Magnesium blood test CPT 83735 HC MAGNESIUM	$78.00	$156.00	$6.47–$121.68	42% above	50%
Magnesium blood test CPT 83735 HC MAGNESIUM, URINE	$78.00	$156.00	$6.47–$121.68	42% above	50%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM, URINE	$78.00	$156.00	$6.47–$121.68	—	50%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM, STOOL	$78.00	$156.00	$6.47–$121.68	—	50%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM	$78.00	$156.00	$6.47–$121.68	—	50%
Measles (rubeola) antibody test CPT 86765 HC ANTIBODY RUBEOLA	$119.50	$239.00	$12.88–$186.42	60% above	50%
Measles (rubeola) antibody test inpatient CPT 86765 HC ANTIBODY RUBEOLA	$119.50	$239.00	$12.88–$186.42	—	50%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODIES SCREEN	$96.00	$192.00	$5.18–$149.76	7% above	50%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE ANTIBODIES SCREEN	$96.00	$192.00	$5.18–$149.76	—	50%
Mumps immunity blood test CPT 86735 HC ANTIBODY MUMPS	$84.00	$168.00	$13.05–$131.04	21% above	50%
Mumps immunity blood test inpatient CPT 86735 HC ANTIBODY MUMPS	$84.00	$168.00	$13.05–$131.04	—	50%
Obstetric blood test panel CPT 80055 HC OBSTETRICS PANEL	$508.00	$1,016.00	$10.76–$792.48	170% above	50%
Obstetric blood test panel inpatient CPT 80055 HC OBSTETRICS PANEL	$508.00	$1,016.00	$10.76–$792.48	—	50%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN (PSA) FREE	$187.00	$374.00	$14.35–$291.72	73% above	50%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PROSTATE SPECIFIC ANTIGEN (PSA) FREE	$187.00	$374.00	$14.35–$291.72	—	50%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGEN (PSA) TOTAL	$141.00	$282.00	$14.35–$219.96	43% above	50%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATE SPECIFIC ANTIGEN (PSA) TOTAL	$141.00	$282.00	$14.35–$219.96	—	50%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTOPATHOLOGY CERVICAL/VAGINAL AUTO THIN LYR PREP W/SCR MANUAL RESCR PHYS	$98.00	$196.00	$24.23–$186.53	at median	50%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC CYTOPATHOLOGY CERVICAL/VAGINAL AUTO THIN LYR PREP W/SCR MANUAL RESCR PHYS	$98.00	$196.00	$24.23–$186.53	—	50%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CYTOPATH C/V THIN LAYER MANUAL SCREEN	$84.50	$169.00	$20.26–$142.68	25% above	50%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC CYTOPATH C/V THIN LAYER MANUAL SCREEN	$84.50	$169.00	$20.26–$142.68	—	50%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE)	$324.50	$649.00	$41.28–$506.22	41% above	50%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE)	$324.50	$649.00	$41.28–$506.22	—	50%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PRTL (PTT) PLSMA/WHL	$79.00	$158.00	$5.25–$123.24	33% above	50%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PRTL (PTT) PLSMA/WHL	$79.00	$158.00	$5.25–$123.24	—	50%
Phosphorus (phosphate) blood test CPT 84100 HC PHOSPHORUS INORGANIC (PHOSPHATE)	$47.00	$94.00	$4.74–$73.32	2% below	50%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC PHOSPHORUS INORGANIC (PHOSPHATE)	$47.00	$94.00	$4.74–$73.32	—	50%
Potassium blood test CPT 84132 HC POTASSIUM SERUM PLASMA/WHOLE BLOOD	$46.00	$92.00	$4.76–$71.76	18% above	50%
Potassium blood test inpatient CPT 84132 HC POTASSIUM SERUM PLASMA/WHOLE BLOOD	$46.00	$92.00	$4.76–$71.76	—	50%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC FETAL CHROM ANEUPLOIDY GSA PANEL	$2,474.00	$4,948.00	$759.05–$3,859.44	140% above	50%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC FETAL CHROM ANEUPLOIDY GSA PANEL	$2,474.00	$4,948.00	$759.05–$3,859.44	—	50%
Progesterone blood test CPT 84144 HC PROGESTERONE	$229.50	$459.00	$15.74–$358.02	27% above	50%
Progesterone blood test inpatient CPT 84144 HC PROGESTERONE	$229.50	$459.00	$15.74–$358.02	—	50%
Prolactin blood test CPT 84146 HC PROLACTIN	$242.50	$485.00	$15.74–$378.30	106% above	50%
Prolactin blood test inpatient CPT 84146 HC PROLACTIN	$242.50	$485.00	$15.74–$378.30	—	50%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME	$45.00	$90.00	$4.29–$70.20	74% above	50%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME	$45.00	$90.00	$4.29–$70.20	—	50%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG TEST PRESUMPTIVE ANY DIRECT OPTICAL OBS PER DOS	$104.50	$209.00	$12.60–$163.02	145% above	50%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC DRUG TEST PRESUMPTIVE ANY DIRECT OPTICAL OBS PER DOS	$104.50	$209.00	$12.60–$163.02	—	50%
Rapid flu test (influenza antigen) CPT 87804 HC INFECT AG IA OPTC OBS INFLUENZA	$134.50	$269.00	$11.72–$209.82	59% above	50%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFECT AG IA OPTC OBS INFLUENZA	$134.50	$269.00	$11.72–$209.82	—	50%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC INFECT AG IA OPTC OBS STREP GRP A	$123.50	$247.00	$11.72–$192.66	38% above	50%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC INFECT AG IA OPTC OBS STREP GRP A	$123.50	$247.00	$11.72–$192.66	—	50%
Renin blood test CPT 84244 HC RENIN	$170.50	$341.00	$15.74–$265.98	29% above	50%
Renin blood test inpatient CPT 84244 HC RENIN	$170.50	$341.00	$15.74–$265.98	—	50%
Rh blood typing CPT 86901 HC BLOOD TYPING SRLGC RH (D)	$83.00	$166.00	$2.99–$129.48	35% above	50%
Rh blood typing inpatient CPT 86901 HC BLOOD TYPING SRLGC RH (D)	$83.00	$166.00	$2.99–$129.48	—	50%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANT	$48.00	$96.00	$5.67–$74.88	33% above	50%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR QUANT	$48.00	$96.00	$5.67–$74.88	—	50%
Rubella antibody test (immunity check) CPT 86762 HC ANTIBODY RUBELLA	$126.50	$253.00	$13.38–$197.34	30% above	50%
Rubella antibody test (immunity check) inpatient CPT 86762 HC ANTIBODY RUBELLA	$126.50	$253.00	$13.38–$197.34	—	50%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SED RATE ERYTHROCYTE AUTOMATED	$57.50	$115.00	$2.70–$89.70	at median	50%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SED RATE ERYTHROCYTE AUTOMATED	$57.50	$115.00	$2.70–$89.70	—	50%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALY VOL/COUNT/MOT AND DIFF	$152.00	$304.00	$5.86–$237.12	at median	50%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC SEMEN ANALY VOL/COUNT/MOT AND DIFF	$152.00	$304.00	$5.86–$237.12	—	50%
Sodium blood test CPT 84295 HC SODIUM SERUM PLASMA/WHOLE BLOOD	$51.50	$103.00	$4.81–$80.34	2% above	50%
Sodium blood test inpatient CPT 84295 HC SODIUM SERUM PLASMA/WHOLE BLOOD	$51.50	$103.00	$4.81–$80.34	—	50%
Stool ova and parasites exam CPT 87177 HC OVA & PARASITES DIRECT SMEARS CNCNT/IDNT	$79.00	$158.00	$8.90–$123.24	46% above	50%
Stool ova and parasites exam inpatient CPT 87177 HC OVA & PARASITES DIRECT SMEARS CNCNT/IDNT	$79.00	$158.00	$8.90–$123.24	—	50%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC BLOOD OCCULT QUAL FECES MULTI	$30.00	$60.00	$4.38–$46.80	30% above	50%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC BLOOD OCCULT QUAL FECES MULTI	$30.00	$60.00	$4.38–$46.80	—	50%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLOOD OCCULT QUAL FECES FECAL HGB 1-3	$115.00	$230.00	$14.35–$179.40	49% above	50%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC BLOOD OCCULT QUAL FECES FECAL HGB 1-3	$115.00	$230.00	$14.35–$179.40	—	50%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC TREPONEMA PALLIDIUM AB CONFIRM	$75.50	$151.00	$13.24–$117.78	7% above	50%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC TREPONEMA PALLIDIUM AB CONFIRM	$75.50	$151.00	$13.24–$117.78	—	50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST QUAL	$48.00	$96.00	$4.27–$74.88	90% above	50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST QUAL	$48.00	$96.00	$4.27–$74.88	—	50%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB TEST CELL MEDIATED RESPONSE GAMMA	$388.50	$777.00	$48.37–$606.06	76% above	50%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB TEST CELL MEDIATED RESPONSE GAMMA	$388.50	$777.00	$48.37–$606.06	—	50%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$235.50	$471.00	$15.74–$367.38	57% above	50%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL	$235.50	$471.00	$15.74–$367.38	—	50%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC THYROID PEROXIDASE ANTIBODY	$103.00	$206.00	$13.38–$160.68	39% above	50%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC LIVER KIDNEY MICROSOME (LKM-1) ANTIBODY	$103.00	$206.00	$13.38–$160.68	39% above	50%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EA	$103.00	$206.00	$13.38–$160.68	39% above	50%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC LIVER KIDNEY MICROSOME (LKM-1) ANTIBODY	$103.00	$206.00	$13.38–$160.68	—	50%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES EA	$103.00	$206.00	$13.38–$160.68	—	50%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC THYROID PEROXIDASE ANTIBODY	$103.00	$206.00	$13.38–$160.68	—	50%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE (TSH)	$161.50	$323.00	$15.74–$251.94	65% above	50%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE (TSH)	$161.50	$323.00	$15.74–$251.94	—	50%
Total IgE blood test CPT 82785 HC GAMMAGLOBULIN IGE	$134.50	$269.00	$14.35–$209.82	51% above	50%
Total IgE blood test inpatient CPT 82785 HC GAMMAGLOBULIN IGE	$134.50	$269.00	$14.35–$209.82	—	50%
Total cholesterol blood test CPT 82465 HC CHOLESTEROL SERUM/BLOOD TOTAL	$73.50	$147.00	$4.35–$114.66	35% above	50%
Total cholesterol blood test inpatient CPT 82465 HC CHOLESTEROL SERUM/BLOOD TOTAL	$73.50	$147.00	$4.35–$114.66	—	50%
Total thyroxine (T4) blood test CPT 84436 HC THYROXINE TOTAL	$77.50	$155.00	$6.87–$120.90	61% above	50%
Total thyroxine (T4) blood test inpatient CPT 84436 HC THYROXINE TOTAL	$77.50	$155.00	$6.87–$120.90	—	50%
Total triiodothyronine (T3) blood test CPT 84480 HC TRIIODOTHYRONINE T3 TOTAL (TT-3)	$143.50	$287.00	$14.18–$223.86	42% above	50%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC TRIIODOTHYRONINE T3 TOTAL (TT-3)	$143.50	$287.00	$14.18–$223.86	—	50%
Transferrin blood test CPT 84466 HC TRANSFERRIN	$114.00	$228.00	$12.76–$177.84	48% above	50%
Transferrin blood test inpatient CPT 84466 HC TRANSFERRIN	$114.00	$228.00	$12.76–$177.84	—	50%
Trichomonas test (NAAT) CPT 87661 HC IADNA TRICHOMONAS VAGINALIS AMP PROBE TECH	$204.50	$409.00	$35.09–$319.02	85% above	50%
Trichomonas test (NAAT) inpatient CPT 87661 HC IADNA TRICHOMONAS VAGINALIS AMP PROBE TECH	$204.50	$409.00	$35.09–$319.02	—	50%
Triglycerides blood test CPT 84478 HC TRIGLYCERIDES	$70.00	$140.00	$5.74–$109.20	30% above	50%
Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDES	$70.00	$140.00	$5.74–$109.20	—	50%
Troponin test, quantitative CPT 84484 HC HS TROPONIN QUANT	$133.00	$266.00	$12.47–$207.48	31% above	50%
Troponin test, quantitative CPT 84484 HC TROPONIN QUANT	$133.00	$266.00	$12.47–$207.48	31% above	50%
Troponin test, quantitative inpatient CPT 84484 HC HS TROPONIN QUANT	$133.00	$266.00	$12.47–$207.48	—	50%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN QUANT	$133.00	$266.00	$12.47–$207.48	—	50%
Uric acid blood test CPT 84550 HC URIC ACID BLOOD	$72.00	$144.00	$4.52–$112.32	3% above	50%
Uric acid blood test inpatient CPT 84550 HC URIC ACID BLOOD	$72.00	$144.00	$4.52–$112.32	—	50%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTO W/MICRO	$44.50	$89.00	$3.17–$69.42	at median	50%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS AUTO W/MICRO	$44.50	$89.00	$3.17–$69.42	—	50%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O MICRO	$33.00	$66.00	$2.25–$51.48	at median	50%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO W/O MICRO	$33.00	$66.00	$2.25–$51.48	—	50%
Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS W/O MICRO NONAUTO	$25.00	$50.00	$3.48–$39.00	22% above	50%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINALYSIS W/O MICRO NONAUTO	$25.00	$50.00	$3.48–$39.00	—	50%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE BACT QUANT COLONY COUNT URINE	$77.00	$154.00	$8.07–$120.12	1% below	50%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE BACT QUANT COLONY COUNT URINE	$77.00	$154.00	$8.07–$120.12	—	50%
Urine microalbumin (albumin) test CPT 82043 HC ALBUMIN URINE/MICROALBUMIN QUANT	$68.00	$136.00	$3.50–$106.08	14% above	50%
Urine microalbumin (albumin) test inpatient CPT 82043 HC ALBUMIN URINE/MICROALBUMIN QUANT	$68.00	$136.00	$3.50–$106.08	—	50%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY VISUAL COMPARE	$74.50	$149.00	$3.50–$116.22	19% below	50%
Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY VISUAL COMPARE	$74.50	$149.00	$3.50–$116.22	—	50%
Vitamin B12 (cobalamin) blood test CPT 82607 HC CYANOCOBALAMIN (VIT B12)	$151.50	$303.00	$15.08–$236.34	80% above	50%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC CYANOCOBALAMIN (VIT B12)	$151.50	$303.00	$15.08–$236.34	—	50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D 25 HYDROXY	$294.00	$588.00	$29.60–$458.64	109% above	50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D 25 HYDROXY	$294.00	$588.00	$29.60–$458.64	—	50%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC VITAMIN D 1 25 DIHYDROXY	$383.00	$766.00	$33.33–$597.48	76% above	50%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC VITAMIN D 1 25 DIHYDROXY	$383.00	$766.00	$33.33–$597.48	—	50%
Zinc blood test CPT 84630 HC ZINC	$102.00	$204.00	$11.39–$159.12	59% above	50%
Zinc blood test inpatient CPT 84630 HC ZINC	$102.00	$204.00	$11.39–$159.12	—	50%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC (HCG) QUANT	$238.50	$477.00	$15.05–$372.06	77% above	50%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC (HCG) QUANT	$238.50	$477.00	$15.05–$372.06	—	50%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
Botox injections for chronic migraine CPT 64615 HC CHEMODNRV MSCL FACIAL/TRIGEM/CERV MIGRN	$518.00	$1,036.00	$295.19–$2,561.00	6% above	50%
Botox injections for chronic migraine inpatient CPT 64615 HC CHEMODNRV MSCL FACIAL/TRIGEM/CERV MIGRN	$518.00	$1,036.00	$295.19–$2,561.00	—	50%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST PQ W/DEVICE PLC 1ST LESION STEREO GUIDE	$2,579.50	$5,159.00	$1,620.24–$5,689.00	5% below	50%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST PQ W/DEVICE PLC 1ST LESION STEREO GUIDE	$2,579.50	$5,159.00	$1,620.24–$5,689.00	—	50%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC TX CLOSED METATARSAL FX W/O MANIP EA	$380.00	$760.00	$239.88–$2,561.00	31% above	50%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC TX CLOSED METATARSAL FX W/O MANIP EA	$380.00	$760.00	$239.88–$2,561.00	—	50%
Cardiac catheterization with coronary angiogram one side CPT 93458 HC CATH PLC ART ANGIO LT HRT CTH	$9,673.00	$19,346.00	$3,216.41–$15,089.88	at median	50%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 HC CATH PLC ART ANGIO LT HRT CTH	$9,673.00	$19,346.00	$3,216.41–$15,089.88	—	50%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION EXTERNAL	$1,385.50	$2,771.00	$654.38–$15,150.00	15% above	50%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION EXTERNAL	$1,385.50	$2,771.00	$654.38–$15,150.00	—	50%
Catheter ablation for atrial fibrillation CPT 93656 HC TX ATRIAL FIB PULM VEIN ISOL	$24,742.00	$49,484.00	$11,793.00–$67,069.09	15% above	50%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC TX ATRIAL FIB PULM VEIN ISOL	$24,742.00	$49,484.00	$11,793.00–$67,069.09	—	50%
Cervical biopsy CPT 57500 HC BX CERVIX SNGL/MULTI/ EXCISION OF LESION SEPARATE PROC	$1,772.50	$3,545.00	$752.86–$2,765.10	6% above	50%
Cervical biopsy inpatient CPT 57500 HC BX CERVIX SNGL/MULTI/ EXCISION OF LESION SEPARATE PROC	$1,772.50	$3,545.00	$752.86–$2,765.10	—	50%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION	$219.50	$439.00	$342.42–$6,158.37	85% below	50%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC CIRCUMCISION	$219.50	$439.00	$342.42–$6,158.37	—	50%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC TX CLOSED RADIUS FX/EPIPHYSEAL SEP W/O MANIP	$380.00	$760.00	$239.88–$2,561.00	12% above	50%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC TX CLOSED RADIUS FX/EPIPHYSEAL SEP W/O MANIP	$380.00	$760.00	$239.88–$2,561.00	—	50%
Colonoscopy, diagnostic CPT 45378 HC COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD	$1,443.50	$2,887.00	$911.71–$3,645.00	2% above	50%
Colonoscopy, diagnostic inpatient CPT 45378 HC COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD	$1,443.50	$2,887.00	$911.71–$3,645.00	—	50%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC BX OF CERVIX W/SCOPE LEEP	$5,215.50	$10,431.00	$2,149.00–$8,692.54	at median	50%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HC BX OF CERVIX W/SCOPE LEEP	$5,215.50	$10,431.00	$2,149.00–$8,692.54	—	50%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC COLPSCPY CRVX U/A VAG W/BX CRVX & ENDOCRVCL CURTTG	$515.50	$1,031.00	$304.19–$3,645.00	4% below	50%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC COLPSCPY CRVX U/A VAG W/BX CRVX & ENDOCRVCL CURTTG	$515.50	$1,031.00	$304.19–$3,645.00	—	50%
Coronary stent placement, one artery CPT 92928 HC PRQ CARD STENT W/ANGIO 1 LSN W/1+ SGMNT	$18,773.00	$37,546.00	$2,294.17–$31,004.09	80% above	50%
Coronary stent placement, one artery inpatient CPT 92928 HC PRQ CARD STENT W/ANGIO 1 LSN W/1+ SGMNT	$18,773.00	$37,546.00	$2,294.17–$31,004.09	—	50%
Cystoscopy with ureteral stent placement CPT 52332 HC URETERAL STENT RETRO	$3,559.50	$7,119.00	$2,149.00–$9,429.17	17% below	50%
Cystoscopy with ureteral stent placement inpatient CPT 52332 HC URETERAL STENT RETRO	$3,559.50	$7,119.00	$2,149.00–$9,429.17	—	50%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOURETHROSCOPY	$506.50	$1,013.00	$667.47–$2,678.00	42% below	50%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC CYSTOURETHROSCOPY	$506.50	$1,013.00	$667.47–$2,678.00	—	50%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HC D&C DX A/O TX NON-OBS	$6,672.50	$13,345.00	$2,149.00–$10,409.10	185% above	50%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC D&C DX A/O TX NON-OBS	$6,672.50	$13,345.00	$2,149.00–$10,409.10	—	50%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DESTRUCTION PREMAL LSN 1ST LSN	$120.00	$240.00	$109.68–$2,561.00	at median	50%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DESTRUCTION PREMAL LSN 1ST LSN	$120.00	$240.00	$109.68–$2,561.00	—	50%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC REM IMPACT CERUMEN IRR/LAVAGE UNI	$105.50	$211.00	$59.40–$2,561.00	8% above	50%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC REM IMPACT CERUMEN IRR/LAVAGE UNI	$105.50	$211.00	$59.40–$2,561.00	—	50%
Earwax removal with instruments, one ear CPT 69210 HC REM IMPACT CERUMEN (SEP PROC)	$263.50	$527.00	$59.40–$2,561.00	53% above	50%
Earwax removal with instruments, one ear inpatient CPT 69210 HC REM IMPACT CERUMEN (SEP PROC)	$263.50	$527.00	$59.40–$2,561.00	—	50%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC ENDOMETRIAL BX W/W/O ENDOCERVIX BX W/O CERVICAL DILAT SEPARATE PROC	$608.00	$1,216.00	$201.17–$2,561.00	100% above	50%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC ENDOMETRIAL BX W/W/O ENDOCERVIX BX W/O CERVICAL DILAT SEPARATE PROC	$608.00	$1,216.00	$201.17–$2,561.00	—	50%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC INJ EPIDURAL SGL CERV-THOR W/IMG	$1,932.50	$3,865.00	$692.52–$3,014.70	44% above	50%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC INJ EPIDURAL SGL CERV-THOR W/IMG	$1,932.50	$3,865.00	$692.52–$3,014.70	—	50%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ W/CT/FLRO FACET JNT L/S 1S	$1,508.50	$3,017.00	$890.29–$2,678.00	7% above	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ W/CT/FLRO FACET JNT L/S 1S	$1,508.50	$3,017.00	$890.29–$2,678.00	—	50%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD	$1,443.50	$2,887.00	$911.71–$2,561.00	28% above	50%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD	$1,443.50	$2,887.00	$911.71–$2,561.00	—	50%
Hammertoe correction surgery CPT 28285 HC CORRECT HAMMERTOE	$6,228.00	$12,456.00	$3,145.37–$9,715.68	14% above	50%
Hammertoe correction surgery inpatient CPT 28285 HC CORRECT HAMMERTOE	$6,228.00	$12,456.00	$3,145.37–$9,715.68	—	50%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC HEMORRHOIDECTOMY INTRNL LIG RBBR BAND LIGATIONS	$2,540.50	$5,081.00	$911.71–$3,963.18	75% above	50%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC HEMORRHOIDECTOMY INTRNL LIG RBBR BAND LIGATIONS	$2,540.50	$5,081.00	$911.71–$3,963.18	—	50%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC INJ PROC SIS OR HYSTERO	$479.00	$958.00	$437.81–$2,561.00	9% below	50%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC INJ PROC SIS OR HYSTERO	$479.00	$958.00	$437.81–$2,561.00	—	50%
IUD insertion (the device itself billed separately) CPT 58300 HC INSERT INTRAUTERINE DEVICE IUD	$1,004.00	$2,008.00	$314.28–$2,561.00	336% above	50%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC INSERT INTRAUTERINE DEVICE IUD	$1,004.00	$2,008.00	$314.28–$2,561.00	—	50%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D SUPRFL ABSC SMPL	$431.50	$863.00	$198.70–$2,561.00	11% above	50%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D SUPRFL ABSC SMPL	$431.50	$863.00	$198.70–$2,561.00	—	50%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJECT TENDON/LIG/GANG	$410.50	$821.00	$295.19–$2,678.00	12% above	50%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJECT TENDON/LIG/GANG	$410.50	$821.00	$295.19–$2,678.00	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC INJ/ASP MAJOR JNT/BURSA WO US GUID	$478.00	$956.00	$295.19–$2,678.00	23% above	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC INJ/ASP MAJOR JNT/BURSA WO US GUID	$478.00	$956.00	$295.19–$2,678.00	—	50%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERT DRUG DELIVERY IMPLANT	$564.50	$1,129.00	$128.90–$2,561.00	at median	50%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC INSERT DRUG DELIVERY IMPLANT	$564.50	$1,129.00	$128.90–$2,561.00	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC INJ/ASP INTRMDT JNT/BURSA WO US GUID	$478.00	$956.00	$295.19–$2,678.00	13% above	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC INJ/ASP INTRMDT JNT/BURSA WO US GUID	$478.00	$956.00	$295.19–$2,678.00	—	50%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC INJ/ASP SMALL JNT/BURSA WO US GUID	$478.00	$956.00	$295.19–$2,678.00	30% above	50%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC INJ/ASP SMALL JNT/BURSA WO US GUID	$478.00	$956.00	$295.19–$2,678.00	—	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC REPAIR INTMD S/A/T/EXT 2.5CM/<	$363.00	$726.00	$331.78–$2,561.00	30% below	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC REPAIR INTMD S/A/T/EXT 2.5CM/<	$363.00	$726.00	$331.78–$2,561.00	—	50%
Left heart catheterization, diagnostic one side CPT 93452 HC CATH LT HEART W/INJ/S&I	$5,586.50	$11,173.00	$3,216.41–$11,406.22	15% below	50%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC CATH LT HEART W/INJ/S&I	$5,586.50	$11,173.00	$3,216.41–$11,406.22	—	50%
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ EPIDURAL SGL LUMB-SACRAL W/IMG	$1,710.00	$3,420.00	$692.52–$2,678.00	1% above	50%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ EPIDURAL SGL LUMB-SACRAL W/IMG	$1,710.00	$3,420.00	$692.52–$2,678.00	—	50%
Lower-back epidural injection, without imaging guidance CPT 62322 HC INJ EPIDURAL SGL LUMB-SACRAL W/O IMG	$1,415.50	$2,831.00	$890.29–$2,678.00	6% below	50%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC INJ EPIDURAL SGL LUMB-SACRAL W/O IMG	$1,415.50	$2,831.00	$890.29–$2,678.00	—	50%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ W/CT/FLRO TFL L/S SGL LVL	$1,508.50	$3,017.00	$890.29–$2,678.00	at median	50%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ W/CT/FLRO TFL L/S SGL LVL	$1,508.50	$3,017.00	$890.29–$2,678.00	—	50%
Lumpectomy (partial mastectomy) CPT 19301 HC MASTECTOMY PARTIAL	$5,819.50	$11,639.00	$3,508.00–$10,468.91	47% below	50%
Lumpectomy (partial mastectomy) inpatient CPT 19301 HC MASTECTOMY PARTIAL	$5,819.50	$11,639.00	$3,508.00–$10,468.91	—	50%
Miscarriage treatment with D&C, first trimester CPT 59820 HC TX MISSED ABORTION FIRST TRIMESTER SURGICAL	$7,780.00	$15,560.00	$2,584.94–$12,136.80	230% above	50%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC TX MISSED ABORTION FIRST TRIMESTER SURGICAL	$7,780.00	$15,560.00	$2,584.94–$12,136.80	—	50%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC B9 LES +MRGN XCP SK TG 0.5CM/<	$561.50	$1,123.00	$621.13–$2,678.00	at median	50%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXC B9 LES +MRGN XCP SK TG 0.5CM/<	$561.50	$1,123.00	$621.13–$2,678.00	—	50%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<	$1,191.50	$2,383.00	$621.13–$3,645.00	at median	50%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<	$1,191.50	$2,383.00	$621.13–$3,645.00	—	50%
Nail removal (partial or complete), one nail CPT 11730 HC SGL AVUL NAIL PLATE	$379.00	$758.00	$95.61–$2,561.00	78% above	50%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC SGL AVUL NAIL PLATE	$379.00	$758.00	$95.61–$2,561.00	—	50%
Occipital nerve block (injection for headaches) CPT 64405 HC BLOCK GREATER OCCIPITAL NERVE	$447.50	$895.00	$295.19–$2,678.00	19% below	50%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC BLOCK GREATER OCCIPITAL NERVE	$447.50	$895.00	$295.19–$2,678.00	—	50%
Pacemaker implant (dual chamber) CPT 33208 HC INS/RPL PM W/TV LD A&V	$11,016.50	$22,033.00	$8,272.00–$37,720.00	6% below	50%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC INS/RPL PM W/TV LD A&V	$11,016.50	$22,033.00	$8,272.00–$37,720.00	—	50%
Paracentesis with imaging guidance CPT 49083 HC ABDOMINAL PARACENTESIS W/GUIDE	$1,445.50	$2,891.00	$937.56–$3,645.00	24% above	50%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABDOMINAL PARACENTESIS W/GUIDE	$1,445.50	$2,891.00	$937.56–$3,645.00	—	50%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC REMOVE NAIL BED	$1,422.00	$2,844.00	$399.53–$2,678.00	136% above	50%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC REMOVE NAIL BED	$1,422.00	$2,844.00	$399.53–$2,678.00	—	50%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DEST FACET NRV W/GUIDE L/S SGL JNT	$2,201.50	$4,403.00	$1,509.00–$6,696.00	20% below	50%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DEST FACET NRV W/GUIDE L/S SGL JNT	$2,201.50	$4,403.00	$1,509.00–$6,696.00	—	50%
Removal of a foreign object under the skin, simple CPT 10120 HC FB REMOVE SUBQ SIMPLE	$561.50	$1,123.00	$251.22–$2,561.00	at median	50%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC FB REMOVE SUBQ SIMPLE	$561.50	$1,123.00	$251.22–$2,561.00	—	50%
Short arm cast (elbow to hand) CPT 29075 HC APPLY CAST SHORT ARM	$273.00	$546.00	$249.52–$1,290.59	at median	50%
Short arm cast (elbow to hand) inpatient CPT 29075 HC APPLY CAST SHORT ARM	$273.00	$546.00	$249.52–$1,290.59	—	50%
Short arm splint (forearm and hand) CPT 29125 HC APPLY SPLINT SHORT ARM STATIC	$174.00	$348.00	$106.80–$1,290.59	28% below	50%
Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLY SPLINT SHORT ARM STATIC	$174.00	$348.00	$106.80–$1,290.59	—	50%
Short leg cast (below the knee) CPT 29405 HC APPLY CAST SHORT LEG	$318.00	$636.00	$265.58–$1,290.59	at median	50%
Short leg cast (below the knee) inpatient CPT 29405 HC APPLY CAST SHORT LEG	$318.00	$636.00	$265.58–$1,290.59	—	50%
Short leg splint (calf to foot) CPT 29515 HC APPLY SPLINT SHORT LEG	$144.00	$288.00	$106.80–$1,290.59	38% below	50%
Short leg splint (calf to foot) inpatient CPT 29515 HC APPLY SPLINT SHORT LEG	$144.00	$288.00	$106.80–$1,290.59	—	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC REPAIR SIMPLE S/N/A/G/T/EXT 2.5CM/<	$363.00	$726.00	$198.70–$2,561.00	at median	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC REPAIR SIMPLE S/N/A/G/T/EXT 2.5CM/<	$363.00	$726.00	$198.70–$2,561.00	—	50%
Skin biopsy, punch, one lesion CPT 11104 HC BX SKIN PUNCH SGL LES	$436.00	$872.00	$398.50–$2,561.00	40% above	50%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC BX SKIN PUNCH SGL LES	$436.00	$872.00	$398.50–$2,561.00	—	50%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC EXC MAL LES +MRGN T/A/L 0.5CM/<	$1,196.00	$2,392.00	$621.13–$2,678.00	6% above	50%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC EXC MAL LES +MRGN T/A/L 0.5CM/<	$1,196.00	$2,392.00	$621.13–$2,678.00	—	50%
Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL OF SKIN TAGS <= 15 LSN(S)	$316.00	$632.00	$198.70–$2,561.00	26% above	50%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC REMOVAL OF SKIN TAGS <= 15 LSN(S)	$316.00	$632.00	$198.70–$2,561.00	—	50%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PUNC DX LUMBAR SPINE	$838.00	$1,676.00	$692.52–$2,678.00	2% below	50%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC PUNC DX LUMBAR SPINE	$838.00	$1,676.00	$692.52–$2,678.00	—	50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC REPAIR SMPL S/N/A/EXT GNTL/T/E 2.6CM-7.5CM	$422.00	$844.00	$198.70–$1,290.59	at median	50%
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 REPAIR SMPL S/N/A/EXT GNTL/T/E 2.6CM-7.5CM	$422.00	$844.00	$198.70–$1,290.59	—	50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC REPAIR SMPL F/E/E/N/L/M 2.5 CM/<	$377.00	$754.00	$198.70–$1,290.59	at median	50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC REPAIR SMPL F/E/E/N/L/M 2.5 CM/<	$377.00	$754.00	$198.70–$1,290.59	—	50%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC BX SKIN TANGENTIAL SGL LES	$410.50	$821.00	$198.70–$2,561.00	63% above	50%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC BX SKIN TANGENTIAL SGL LES	$410.50	$821.00	$198.70–$2,561.00	—	50%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS ASP PLEURAL SPC W/IMAGE	$1,161.50	$2,323.00	$618.26–$2,678.00	12% below	50%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS ASP PLEURAL SPC W/IMAGE	$1,161.50	$2,323.00	$618.26–$2,678.00	—	50%
Trigger finger release surgery CPT 26055 HC INCISN TENDON SHEATH	$3,179.00	$6,358.00	$1,600.41–$4,959.24	at median	50%
Trigger finger release surgery inpatient CPT 26055 HC INCISN TENDON SHEATH	$3,179.00	$6,358.00	$1,600.41–$4,959.24	—	50%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ TRG PT 1-2 MSC GRPS	$410.50	$821.00	$295.19–$2,678.00	12% above	50%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ TRG PT 1-2 MSC GRPS	$410.50	$821.00	$295.19–$2,678.00	—	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST PQ W/DEVICE PLC 1ST LESION US GUIDE	$1,974.00	$3,948.00	$1,620.24–$5,689.00	2% below	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST PQ W/DEVICE PLC 1ST LESION US GUIDE	$1,974.00	$3,948.00	$1,620.24–$5,689.00	—	50%
Upper endoscopy (EGD) with biopsy CPT 43239 HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE	$1,484.00	$2,968.00	$937.56–$3,645.00	at median	50%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE	$1,484.00	$2,968.00	$937.56–$3,645.00	—	50%
Upper endoscopy (EGD), diagnostic CPT 43235 HC UPPER GI ENDOSCOPY DX W/W/O COLLECTION SPECIMEN	$1,484.00	$2,968.00	$937.56–$2,857.22	at median	50%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC UPPER GI ENDOSCOPY DX W/W/O COLLECTION SPECIMEN	$1,484.00	$2,968.00	$937.56–$2,857.22	—	50%
Vein ablation, radiofrequency, first vein CPT 36475 HC ENDOVENOUS RF ABL 1ST VEIN	$2,169.00	$4,338.00	$3,147.50–$11,070.00	46% below	50%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC ENDOVENOUS RF ABL 1ST VEIN	$2,169.00	$4,338.00	$3,147.50–$11,070.00	—	50%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCTION B9 LSN UP TO 14 LSN	$150.50	$301.00	$137.56–$2,561.00	10% above	50%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCTION B9 LSN UP TO 14 LSN	$150.50	$301.00	$137.56–$2,561.00	—	50%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDE SBQ TISS 1ST 20 SQ CM OR LESS	$810.50	$1,621.00	$399.53–$3,645.00	36% above	50%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDE SBQ TISS 1ST 20 SQ CM OR LESS	$810.50	$1,621.00	$399.53–$3,645.00	—	50%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION	$1,062.50	$2,125.00	$437.18–$2,678.00	24% above	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION	$1,062.50	$2,125.00	$437.18–$2,678.00	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INH TX AIR OBST/SPUT IND	$167.00	$334.00	$49.67–$1,208.00	6% above	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INH TX AIR OBST/SPUT IND	$167.00	$334.00	$49.67–$1,208.00	—	50%
Chemotherapy IV infusion, first hour CPT 96413 HC IV INF CHEMO INI UP TO 1HR	$872.00	$1,744.00	$331.69–$1,718.04	14% above	50%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC IV INF CHEMO INI UP TO 1HR	$872.00	$1,744.00	$331.69–$1,718.04	—	50%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC COMP HEARING TEST + SRT	$274.50	$549.00	$114.85–$1,049.00	at median	50%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC COMP HEARING TEST + SRT	$274.50	$549.00	$114.85–$1,049.00	—	50%
Critical care, first 30 to 74 minutes CPT 99291 HC E&M CC 30-74MIN	$2,535.00	$5,070.00	$842.61–$6,256.22	at median	50%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC E&M CC 30-74MIN	$2,535.00	$5,070.00	$842.61–$6,256.22	—	50%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE AND DROWSY	$564.50	$1,129.00	$311.40–$2,053.00	at median	50%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG AWAKE AND DROWSY	$564.50	$1,129.00	$311.40–$2,053.00	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG TRACE ONLY W/O I&R	$209.00	$418.00	$37.44–$326.04	at median	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC EKG TRACE ONLY W/O I&R	$209.00	$418.00	$37.44–$326.04	—	50%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROSHOCK THERAPY	$1,130.00	$2,260.00	$530.60–$1,762.80	42% above	50%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROSHOCK THERAPY	$1,130.00	$2,260.00	$530.60–$1,762.80	—	50%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC LEVEL 1 E&M ED	$386.00	$772.00	$88.05–$920.00	105% above	50%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC LEVEL 1 E&M ED	$386.00	$772.00	$88.05–$920.00	—	50%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC LEVEL 2 E&M ED	$506.50	$1,013.00	$158.36–$1,026.00	52% above	50%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC LEVEL 2 E&M ED	$506.50	$1,013.00	$158.36–$1,026.00	—	50%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC LEVEL 3 E&M ED	$919.50	$1,839.00	$276.89–$2,678.00	83% above	50%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC LEVEL 3 E&M ED	$919.50	$1,839.00	$276.89–$2,678.00	—	50%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC LEVEL 4 E&M ED	$1,458.50	$2,917.00	$425.82–$4,493.00	60% above	50%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC LEVEL 4 E&M ED	$1,458.50	$2,917.00	$425.82–$4,493.00	—	50%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC LEVEL 5 E&M ED	$1,778.50	$3,557.00	$613.10–$7,672.00	24% above	50%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC LEVEL 5 E&M ED	$1,778.50	$3,557.00	$613.10–$7,672.00	—	50%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CV STRESS TEST TRACING ONLY	$1,105.50	$2,211.00	$245.97–$1,724.58	47% above	50%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CV STRESS TEST TRACING ONLY	$1,105.50	$2,211.00	$245.97–$1,724.58	—	50%
Family therapy with the patient, 50 minutes CPT 90847 HC FAMILY PSYCHOTHERAPY W PT 50 MINS	$350.50	$701.00	$160.67–$546.78	53% above	50%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC FAMILY PSYCHOTHERAPY W PT 50 MINS	$350.50	$701.00	$160.67–$546.78	—	50%
Family therapy without the patient, 50 minutes CPT 90846 HC PSYTX FAMILY W/O PT PRESENT 50 MINS	$462.00	$924.00	$160.67–$720.72	93% above	50%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC PSYTX FAMILY W/O PT PRESENT 50 MINS	$462.00	$924.00	$160.67–$720.72	—	50%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY NON FAMILY	$142.00	$284.00	$92.50–$398.92	at median	50%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY NON FAMILY	$142.00	$284.00	$92.50–$398.92	—	50%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INF HYDRATION INI 31-60 MIN	$390.00	$780.00	$210.69–$1,233.94	16% above	50%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV INF HYDRATION INI 31-60 MIN	$390.00	$780.00	$210.69–$1,233.94	—	50%
IV infusion of a medicine, first hour CPT 96365 HC IV INF THER INITIAL UP TO 1 HR	$476.50	$953.00	$210.69–$1,233.94	31% above	50%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INF THER INITIAL UP TO 1 HR	$476.50	$953.00	$210.69–$1,233.94	—	50%
IV push of a medicine, first drug CPT 96374 HC IV PUSH 1ST SBST/DRUG	$267.00	$534.00	$74.35–$1,233.94	1% below	50%
IV push of a medicine, first drug inpatient CPT 96374 HC IV PUSH 1ST SBST/DRUG	$267.00	$534.00	$74.35–$1,233.94	—	50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJ THER PROPH/DX SUBQ/IM	$109.00	$218.00	$71.17–$224.01	at median	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJ THER PROPH/DX SUBQ/IM	$109.00	$218.00	$71.17–$224.01	—	50%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSYCH DIAG EVAL	$361.00	$722.00	$160.67–$563.16	16% above	50%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PSYCH DIAG EVAL	$361.00	$722.00	$160.67–$563.16	—	50%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NERVE CONDUCTION STUDIES 7-8	$436.00	$872.00	$193.05–$1,144.00	8% below	50%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC NERVE CONDUCTION STUDIES 7-8	$436.00	$872.00	$193.05–$1,144.00	—	50%
Neuromuscular re-education, 15 minutes CPT 97112 HC PT NEURO RE-EDUC EA 15MIN	$154.00	$308.00	$35.98–$570.62	41% above	50%
Neuromuscular re-education, 15 minutes CPT 97112 HC OT NEURO RE-EDUC EA 15MIN	$154.00	$308.00	$35.98–$570.62	41% above	50%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC PT NEURO RE-EDUC EA 15MIN	$154.00	$308.00	$35.98–$570.62	—	50%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC OT NEURO RE-EDUC EA 15MIN	$154.00	$308.00	$35.98–$570.62	—	50%
New patient office visit, about 30 minutes CPT 99203 HC FACT PROG CHRONIC NEW PT	$342.50	$685.00	$305.37–$534.30	80% above	50%
New patient office visit, about 30 minutes inpatient CPT 99203 HC FACT PROG CHRONIC NEW PT	$342.50	$685.00	$305.37–$534.30	—	50%
New patient office visit, about 60 minutes CPT 99205 HC FACT PROG ACUTE NEW PT	$401.50	$803.00	$357.98–$626.34	71% above	50%
New patient office visit, about 60 minutes inpatient CPT 99205 HC FACT PROG ACUTE NEW PT	$401.50	$803.00	$357.98–$626.34	—	50%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC FACT PROG FUP NEW PT	$151.50	$303.00	$135.08–$236.34	43% above	50%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC FACT PROG FUP NEW PT	$151.50	$303.00	$135.08–$236.34	—	50%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MNT 1ST ASS&IVNT IND EA 15 MIN	$39.50	$79.00	$35.08–$326.76	52% above	50%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MNT 1ST ASS&IVNT IND EA 15 MIN	$39.50	$79.00	$35.08–$326.76	—	50%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEXITY	$212.00	$424.00	$113.16–$570.62	1% below	50%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEXITY	$212.00	$424.00	$113.16–$570.62	—	50%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEXITY	$246.00	$492.00	$110.07–$570.62	1% below	50%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEXITY	$246.00	$492.00	$110.07–$570.62	—	50%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEXITY	$212.00	$424.00	$110.07–$570.62	2% below	50%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEXITY	$212.00	$424.00	$110.07–$570.62	—	50%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEXITY	$212.50	$425.00	$110.07–$570.62	8% below	50%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEXITY	$212.50	$425.00	$110.07–$570.62	—	50%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC OT MANUAL THERAPY EA 15MIN	$127.00	$254.00	$30.50–$570.62	44% above	50%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC PT MANUAL THERAPY EA 15MIN	$127.00	$254.00	$30.50–$570.62	44% above	50%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC PT MANUAL THERAPY EA 15MIN	$127.00	$254.00	$30.50–$570.62	—	50%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC OT MANUAL THERAPY EA 15MIN	$127.00	$254.00	$30.50–$570.62	—	50%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT THERAP EX EA 15MIN	$124.00	$248.00	$32.34–$570.62	34% above	50%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PT THERAP EX EA 15MIN	$124.00	$248.00	$32.34–$570.62	34% above	50%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC PT THERAP EX EA 15MIN	$124.00	$248.00	$32.34–$570.62	—	50%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC OT THERAP EX EA 15MIN	$124.00	$248.00	$32.34–$570.62	—	50%
Psychiatric evaluation with medical services CPT 90792 HC PSYCH DIAG EVAL W/MEDICAL SVCS	$250.00	$500.00	$160.67–$482.00	22% below	50%
Psychiatric evaluation with medical services inpatient CPT 90792 HC PSYCH DIAG EVAL W/MEDICAL SVCS	$250.00	$500.00	$160.67–$482.00	—	50%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HC PSYCH TEST EVAL SVC PHYS/QHP 1ST HR	$490.00	$980.00	$88.44–$972.48	60% above	50%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 HC PSYCH TEST EVAL SVC PHYS/QHP 1ST HR	$490.00	$980.00	$88.44–$972.48	—	50%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC PSYTX CRISIS INITIAL 30-74 MIN	$603.50	$1,207.00	$160.67–$941.46	104% above	50%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PSYTX CRISIS INITIAL 30-74 MIN	$603.50	$1,207.00	$160.67–$941.46	—	50%
Psychotherapy session, 30 minutes CPT 90832 HC PSYTX PT 16-37 MINUTES	$283.00	$566.00	$105.68–$606.71	88% above	50%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYTX PT 16-37 MINUTES	$283.00	$566.00	$105.68–$606.71	—	50%
Psychotherapy session, 45 minutes CPT 90834 HC PSYTX PT 38-52 MINUTES	$375.50	$751.00	$160.67–$606.71	81% above	50%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYTX PT 38-52 MINUTES	$375.50	$751.00	$160.67–$606.71	—	50%
Psychotherapy session, 60 minutes CPT 90837 HC PSYTX PT 53+ MINUTES	$396.00	$792.00	$160.67–$617.76	58% above	50%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYTX PT 53+ MINUTES	$396.00	$792.00	$160.67–$617.76	—	50%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC COUNSELING SMOKE CESS INTERM 3>10MINS	$40.50	$81.00	$29.79–$270.00	15% below	50%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC COUNSELING SMOKE CESS INTERM 3>10MINS	$40.50	$81.00	$29.79–$270.00	—	50%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC FACT PROG ACUTE ESTAB PT	$401.50	$803.00	$357.98–$626.34	64% above	50%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC FACT PROG ACUTE ESTAB PT	$401.50	$803.00	$357.98–$626.34	—	50%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC FACT PROG CHRONIC ESTAB PT	$342.50	$685.00	$305.37–$534.30	126% above	50%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC FACT PROG CHRONIC ESTAB PT	$342.50	$685.00	$305.37–$534.30	—	50%
Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND PROD W/COMPREH/EXPRESS	$726.50	$1,453.00	$158.52–$1,133.34	121% above	50%
Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND PROD W/COMPREH/EXPRESS	$726.50	$1,453.00	$158.52–$1,133.34	—	50%
Speech therapy session, individual CPT 92507 HC SLP TREATMENT INDIVID	$235.50	$471.00	$83.75–$570.62	33% above	50%
Speech therapy session, individual inpatient CPT 92507 HC SLP TREATMENT INDIVID	$235.50	$471.00	$83.75–$570.62	—	50%
Spirometry (breathing test) CPT 94010 HC SPIROMETRY	$298.50	$597.00	$83.53–$790.00	15% above	50%
Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY	$298.50	$597.00	$83.53–$790.00	—	50%
Spirometry before and after a bronchodilator CPT 94060 HC SPIRO PRE & POST BRONCHDIL	$330.00	$660.00	$152.37–$851.33	20% below	50%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC SPIRO PRE & POST BRONCHDIL	$330.00	$660.00	$152.37–$851.33	—	50%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC PT THERAP ACTIV EA 15MIN	$128.00	$256.00	$39.33–$570.62	25% above	50%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC OT THERAP ACTIV EA 15MIN	$128.00	$256.00	$39.33–$570.62	25% above	50%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC PT THERAP ACTIV EA 15MIN	$128.00	$256.00	$39.33–$570.62	—	50%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC OT THERAP ACTIV EA 15MIN	$128.00	$256.00	$39.33–$570.62	—	50%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY THERAPEUTIC	$249.00	$498.00	$102.78–$388.44	at median	50%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY THERAPEUTIC	$249.00	$498.00	$102.78–$388.44	—	50%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 mRNA vaccine (12 years and above) 50 mcg/0.5mL Susp 1 each Syringe	$60.38	$120.75	$36.65–$296.70	21% below	50%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 mRNA vaccine (12 years and above) 50 mcg/0.5mL Susp 0.5 mL Syringe	$60.38	$120.75	$36.65–$296.70	21% below	50%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID-19 mRNA vaccine (12 years and above) 50 mcg/0.5mL Susp 1 each Syringe	$60.38	$120.75	$36.65–$296.70	—	50%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID-19 mRNA vaccine (12 years and above) 50 mcg/0.5mL Susp 0.5 mL Syringe	$60.38	$120.75	$36.65–$296.70	—	50%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 varicella virus vaccine (live) 1350 PFU/0.5ML Susr 1 each Vial	$242.15	$484.30	$176.95–$382.65	40% below	50%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 varicella virus vaccine (live) 1350 PFU/0.5ML Susr 1 each Vial	$242.15	$484.30	$176.95–$382.65	—	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 diphth-acell pertussis-tetanus per 0.5 mL	$27.81	$55.61	$29.80–$59.46	66% below	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 diphth-acell pertussis-tetanus per 0.5 mL	$27.81	$55.61	$29.80–$59.46	—	50%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP-hepatitis B recombinant-IPV Susy 0.5 mL Syringe	$50.06	$100.11	$36.65–$203.92	37% below	50%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP-hepatitis B recombinant-IPV Susy 0.5 mL Syringe	$50.06	$100.11	$36.65–$203.92	—	50%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza trivalent 2025-2026 inactivated vaccine 0.5 ML Susy 0.5 mL Syringe	$10.36	$20.72	$11.77–$41.03	70% below	50%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza trivalent 2025-2026 inactivated vaccine 0.5 ML Susy 0.5 mL Syringe	$10.36	$20.72	$11.77–$41.03	—	50%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 hepatitis B vaccine adjuvanted 20 mcg/0.5 mL Sosy 0.5 mL Syringe	$176.53	$353.05	$36.65–$308.91	at median	50%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 hepatitis B vaccine adjuvanted 20 mcg/0.5 mL Sosy 0.5 mL Syringe	$176.53	$353.05	$36.65–$308.91	—	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 hepatitis B virus vaccine (recombinant) 10 MCG/0.5ML Susy 0.5 mL Syringe	$27.53	$55.05	$29.71–$58.13	71% below	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 hepatitis B virus vaccine (recombinant) 10 MCG/0.5ML Susy 0.5 mL Syringe	$27.53	$55.05	$29.71–$58.13	—	50%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 haemophilus B conjugate vaccine Solr 1 each Vial	$24.22	$48.43	$13.30–$40.32	13% below	50%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 haemophilus B conjugate vaccine Solr 1 each Vial	$24.22	$48.43	$13.30–$40.32	—	50%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 influenza trivalent 2025-2026 inactivated high-dose vaccine 0.5 ML Susy 0.5 mL Syringe	$43.40	$86.80	$36.65–$153.25	73% below	50%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 influenza trivalent 2025-2026 inactivated high-dose vaccine 0.5 ML Susy 0.5 mL Syringe	$43.40	$86.80	$36.65–$153.25	—	50%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles, mumps & rubella vac per 0.5 mL	$61.76	$123.52	$36.65–$192.75	82% below	50%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles, mumps & rubella vac per 0.5 mL	$61.76	$123.52	$36.65–$192.75	—	50%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal (A,C,Y, and W-135) oligosaccharide diphtheria CRM Solr 1 each Vial	$60.30	$120.60	$66.33–$329.92	77% below	50%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal (A,C,Y, and W-135) oligosaccharide diphtheria CRM Soln 0.5 mL Vial	$164.74	$329.48	$169.96–$329.92	38% below	50%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 meningococcal (A,C,Y, and W-135) oligosaccharide diphtheria CRM Solr 1 each Vial	$60.30	$120.60	$66.33–$329.92	—	50%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 meningococcal (A,C,Y, and W-135) oligosaccharide diphtheria CRM Soln 0.5 mL Vial	$164.74	$329.48	$169.96–$329.92	—	50%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 meningococcal group B vaccine Susy 0.5 mL Syringe	$231.58	$463.15	$176.95–$469.26	29% below	50%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 meningococcal group B vaccine Susy 0.5 mL Syringe	$231.58	$463.15	$176.95–$469.26	—	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-val conj vaccine 0.5 ML Susy 0.5 mL Syringe	$321.98	$643.95	$176.95–$547.11	2% below	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-val conj vaccine 0.5 ML Susy 0.5 mL Syringe	$321.98	$643.95	$176.95–$547.11	—	50%
Polio vaccine, inactivated (IPV) CPT 90713 poliovirus vaccine (inactivated) Susp 5 mL Vial	$38.55	$77.10	$36.65–$93.34	4% below	50%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 poliovirus vaccine (inactivated) Susp 5 mL Vial	$38.55	$77.10	$36.65–$93.34	—	50%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 nirsevimab-alip 100 MG/ML Sosy 1 mL Syringe	$702.05	$1,404.10	$567.26–$1,514.95	at median	50%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 nirsevimab-alip 100 MG/ML Sosy 1 mL Syringe	$702.05	$1,404.10	$567.26–$1,514.95	—	50%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 nirsevimab-alip 50 MG/0.5ML Sosy 0.5 mL Syringe	$688.81	$1,377.61	$567.26–$1,514.95	42% below	50%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 nirsevimab-alip 50 MG/0.5ML Sosy 0.5 mL Syringe	$688.81	$1,377.61	$567.26–$1,514.95	—	50%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV vaccine 120 MCG/0.5ML Solr 1 each Vial	$343.10	$686.20	$36.65–$617.26	at median	50%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV vaccine 120 MCG/0.5ML Solr 1 each Vial	$343.10	$686.20	$36.65–$617.26	—	50%
Rabies vaccine, one dose CPT 90675 rabies vaccine per 1 mL	$395.45	$790.89	$176.95–$866.07	58% below	50%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine per 1 mL	$395.45	$790.89	$176.95–$866.07	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diptheria toxoids (adult) per 0.5 mL	$32.78	$65.55	$36.65–$83.82	75% below	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus-diptheria toxoids (adult) per 0.5 mL	$32.78	$65.55	$36.65–$83.82	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus-diphth-acell pertussis 5-2.5-18.5 LF-MCG/0.5 Susp 0.5 mL Syringe	$34.43	$68.85	$36.65–$98.38	68% below	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus-diphth-acell pertussis 5-2.5-18.5 LF-MCG/0.5 Susp 0.5 mL Vial	$41.40	$82.80	$36.65–$98.38	62% below	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus-diphth-acell pertussis 5-2.5-18.5 LF-MCG/0.5 Susp 0.5 mL Syringe	$34.43	$68.85	$36.65–$98.38	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus-diphth-acell pertussis 5-2.5-18.5 LF-MCG/0.5 Susp 0.5 mL Vial	$41.40	$82.80	$36.65–$98.38	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN ALL OTHER VACCINES INIT	$65.00	$130.00	$57.38–$194.59	15% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN ALL OTHER VACCINES INIT	$65.00	$130.00	$57.38–$194.59	—	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC ADMIN ALL OTHER VACCINES ADDL	$32.00	$64.00	$28.53–$140.00	22% below	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC ADMIN ALL OTHER VACCINES ADDL	$32.00	$64.00	$28.53–$140.00	—	50%

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.inova.org/sites/default/files/patient_visitor/price_transparency/2026/540620889_inova-fairfax-hospital_standardcharges.csv