Hospital

Parkview Montpelier Hospital

Parkview Montpelier Hospital in Montpelier, OH publishes cash prices for 339 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Ohio median for 223 of 337 procedures and above it for 104. By typical cash price it ranks #47 of 139 Ohio hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

909 East Snyder Avenue, Montpelier, OH 43543 Collected Oct 25, 2026 Source price file Check a bill from this hospital (419) 636-1131

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 361327 · CMS hospital register NPI 1275575227

Financial assistance

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

Parkview Montpelier 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.

State law

This state limits hospital bills for lower-income patients

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Abdominal CT scan without and with contrast CPT 74170 Hc Ct Abdomen W/Wo Contrast	$1,065.50	$2,131.00	—	20% below	50%
Abdominal CT scan without and with contrast inpatient CPT 74170 Hc Ct Abdomen W/Wo Contrast	$1,065.50	$2,131.00	—	—	50%
Abdominal X-ray, 2 views CPT 74019 Hc X-Ray Exam Abdomen 2 Views	$260.00	$520.00	—	23% below	50%
Abdominal X-ray, 2 views inpatient CPT 74019 Hc X-Ray Exam Abdomen 2 Views	$260.00	$520.00	—	—	50%
Ankle X-ray, complete, 3 or more views one side CPT 73610 Hc X-Ray-Ankle Min 3 Views Rt	$166.50	$333.00	—	48% below	50%
Ankle X-ray, complete, 3 or more views one side CPT 73610 Hc X-Ray-Ankle Min 3 Views Lt	$166.50	$333.00	—	48% below	50%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Hc X-Ray-Ankle Min 3 Views Rt	$166.50	$333.00	—	—	50%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Hc X-Ray-Ankle Min 3 Views Lt	$166.50	$333.00	—	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Hc U/S Ankle/Brachial Index	$290.00	$580.00	—	40% below	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Hc U/S Ankle/Brachial Index	$290.00	$580.00	—	—	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Hc Ct Upper Ext W/O Contrast Rt	$780.00	$1,560.00	—	17% below	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Hc Ct Upper Ext W/O Contrast Lt	$780.00	$1,560.00	—	17% below	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Hc Ct Upper Ext W/O Contrast Lt	$780.00	$1,560.00	—	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Hc Ct Upper Ext W/O Contrast Rt	$780.00	$1,560.00	—	—	50%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Hc X-Ray Exam Esophagus Single Cont Inc Scout Films Study	$430.00	$860.00	—	3% below	50%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Hc X-Ray Exam Esophagus Single Cont Inc Scout Films Study	$430.00	$860.00	—	—	50%
Bone scan, whole body (nuclear medicine) CPT 78306 Hc Bone Scan - Whole Body	$967.00	$1,934.00	—	37% below	50%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Hc Bone Scan - Whole Body	$967.00	$1,934.00	—	—	50%
Breast ultrasound, complete, one breast one side CPT 76641 Hc Ultrasound Breast Complete Rt	$613.00	$1,226.00	—	28% above	50%
Breast ultrasound, complete, one breast one side CPT 76641 Hc Ultrasound Breast Complete Lt	$613.00	$1,226.00	—	28% above	50%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 Hc Ultrasound Breast Complete Rt	$613.00	$1,226.00	—	—	50%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 Hc Ultrasound Breast Complete Lt	$613.00	$1,226.00	—	—	50%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Hc Ultrasound Breast Limited Lt	$450.00	$900.00	—	10% above	50%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Hc Ultrasound Breast Limited Rt	$450.00	$900.00	—	10% above	50%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Hc Ultrasound Breast Limited Lt	$450.00	$900.00	—	—	50%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Hc Ultrasound Breast Limited Rt	$450.00	$900.00	—	—	50%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 Hc Cta Abdomen & Pelvis	$2,142.00	$4,284.00	—	at median	50%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 Hc Cta Abdomen & Pelvis	$2,142.00	$4,284.00	—	—	50%
CT angiography (CTA) of the head CPT 70496 Hc Cta-Head	$888.50	$1,777.00	—	34% below	50%
CT angiography (CTA) of the head inpatient CPT 70496 Hc Cta-Head	$888.50	$1,777.00	—	—	50%
CT angiography (CTA) of the neck CPT 70498 Hc Cta-Neck	$888.50	$1,777.00	—	32% below	50%
CT angiography (CTA) of the neck inpatient CPT 70498 Hc Cta-Neck	$888.50	$1,777.00	—	—	50%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Hc Cta-Chest	$1,098.50	$2,197.00	—	22% below	50%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Hc Cta-Chest	$1,098.50	$2,197.00	—	—	50%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Hc Ct Abd & Pelvis W/O Contrast	$1,417.50	$2,835.00	—	11% below	50%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Hc Ct Abd & Pelv/Stone W/O Contr	$1,417.50	$2,835.00	—	11% below	50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Hc Ct Abd & Pelvis W/O Contrast	$1,417.50	$2,835.00	—	—	50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Hc Ct Abd & Pelv/Stone W/O Contr	$1,417.50	$2,835.00	—	—	50%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 Hc Ct Abd & Pelvis W/Contrast	$2,285.00	$4,570.00	—	15% above	50%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Hc Ct Abd & Pelvis W/Contrast	$2,285.00	$4,570.00	—	—	50%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Hc Ct Abd & Pelvis W/Wo Contrast	$2,328.50	$4,657.00	—	at median	50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Hc Ct Abd & Pelvis W/Wo Contrast	$2,328.50	$4,657.00	—	—	50%
CT scan of the abdomen with contrast CPT 74160 Hc Ct Abdomen W Contrast	$1,043.00	$2,086.00	—	11% below	50%
CT scan of the abdomen with contrast inpatient CPT 74160 Hc Ct Abdomen W Contrast	$1,043.00	$2,086.00	—	—	50%
CT scan of the abdomen without contrast CPT 74150 Hc Ct Abdomen W/O Contrast	$658.50	$1,317.00	—	37% below	50%
CT scan of the abdomen without contrast inpatient CPT 74150 Hc Ct Abdomen W/O Contrast	$658.50	$1,317.00	—	—	50%
CT scan of the face and sinuses, no contrast dye CPT 70486 Hc Ct Face W/O Contrast	$539.00	$1,078.00	—	38% below	50%
CT scan of the face and sinuses, no contrast dye CPT 70486 Hc Ct Sinus Coronally Wo Contrast	$539.00	$1,078.00	—	38% below	50%
CT scan of the face and sinuses, no contrast dye CPT 70486 Hc Ct Sinus Axially W/O Contrast	$539.00	$1,078.00	—	38% below	50%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Hc Ct Face W/O Contrast	$539.00	$1,078.00	—	—	50%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Hc Ct Sinus Coronally Wo Contrast	$539.00	$1,078.00	—	—	50%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Hc Ct Sinus Axially W/O Contrast	$539.00	$1,078.00	—	—	50%
CT scan of the head or brain, no contrast dye CPT 70450 Hc Ct Head Scan W/O Contrast	$636.50	$1,273.00	—	24% below	50%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 Hc Ct Head Scan W/O Contrast	$636.50	$1,273.00	—	—	50%
CT scan of the head with contrast CPT 70460 Hc Ct Head Scan W/Contrast	$1,005.50	$2,011.00	—	at median	50%
CT scan of the head with contrast inpatient CPT 70460 Hc Ct Head Scan W/Contrast	$1,005.50	$2,011.00	—	—	50%
CT scan of the head without and with contrast CPT 70470 Hc Ct Head Scan W/Wo Contrast	$1,023.50	$2,047.00	—	14% below	50%
CT scan of the head without and with contrast inpatient CPT 70470 Hc Ct Head Scan W/Wo Contrast	$1,023.50	$2,047.00	—	—	50%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Hc Ct Lumbar Spine-Strght W/O Con	$670.00	$1,340.00	—	39% below	50%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 Hc Ct Lumbar Spine-Strght W/O Con	$670.00	$1,340.00	—	—	50%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Hc Ct Cervical Spine W/O Contrast	$539.00	$1,078.00	—	50% below	50%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 Hc Ct Cervical Spine W/O Contrast	$539.00	$1,078.00	—	—	50%
CT scan of the pelvis, with contrast dye CPT 72193 Hc Ct Pelvis W/Contrast	$1,043.00	$2,086.00	—	15% below	50%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 Hc Ct Pelvis W/Contrast	$1,043.00	$2,086.00	—	—	50%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Hc U/S Carotid Doppler Bilateral	$606.50	$1,213.00	—	—	50%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Hc U/S Carotid Doppler Bilateral	$606.50	$1,213.00	—	—	50%
Chest CT scan without and with contrast CPT 71270 Hc Ct Chest W/Wo Contrast	$1,043.00	$2,086.00	—	31% below	50%
Chest CT scan without and with contrast inpatient CPT 71270 Hc Ct Chest W/Wo Contrast	$1,043.00	$2,086.00	—	—	50%
Chest X-ray, 2 views CPT 71046 Hc X-Ray Exam Chest 2 Views	$171.00	$342.00	—	35% below	50%
Chest X-ray, 2 views inpatient CPT 71046 Hc X-Ray Exam Chest 2 Views	$171.00	$342.00	—	—	50%
Chest X-ray, single view CPT 71045 Hc X-Ray Exam Chest 1 View	$171.00	$342.00	—	23% below	50%
Chest X-ray, single view inpatient CPT 71045 Hc X-Ray Exam Chest 1 View	$171.00	$342.00	—	—	50%
Collarbone (clavicle) X-ray, complete one side CPT 73000 Hc X-Ray-Clavicle Rt	$261.00	$522.00	—	4% below	50%
Collarbone (clavicle) X-ray, complete one side CPT 73000 Hc X-Ray-Clavicle Lt	$261.00	$522.00	—	4% below	50%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Hc X-Ray-Clavicle Lt	$261.00	$522.00	—	—	50%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Hc X-Ray-Clavicle Rt	$261.00	$522.00	—	—	50%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Hc U/S Retroperitoneal Complete	$504.00	$1,008.00	—	29% below	50%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Hc U/S Retroperitoneal Complete	$504.00	$1,008.00	—	—	50%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Hc Dexa-Bone Mineral Analysis	$288.50	$577.00	—	36% below	50%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Hc Dexa-Bone Mineral Analysis	$288.50	$577.00	—	—	50%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Hc Ct Chest W/O Contrast	$658.50	$1,317.00	—	30% below	50%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Hc Ct Chest-High Resolution	$658.50	$1,317.00	—	30% below	50%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Hc Ct Chest-High Resolution	$658.50	$1,317.00	—	—	50%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Hc Ct Chest W/O Contrast	$658.50	$1,317.00	—	—	50%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Hc Ct Chest W/Contrast	$1,022.00	$2,044.00	—	16% below	50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Hc Ct Chest W/Contrast	$1,022.00	$2,044.00	—	—	50%
Duplex ultrasound of the leg arteries, both legs CPT 93925 Hc U/S Color Flow Art Low Ext Bil	$928.50	$1,857.00	—	4% above	50%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 Hc U/S Color Flow Art Low Ext Bil	$928.50	$1,857.00	—	—	50%
Duplex ultrasound of the leg veins, both legs CPT 93970 Hc U/S Venous Imaging Up Ext Bil	$928.50	$1,857.00	—	4% above	50%
Duplex ultrasound of the leg veins, both legs CPT 93970 Hc U/S Venous Imaging Lwr Ext Bil	$928.50	$1,857.00	—	4% above	50%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Hc U/S Venous Imaging Up Ext Bil	$928.50	$1,857.00	—	—	50%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Hc U/S Venous Imaging Lwr Ext Bil	$928.50	$1,857.00	—	—	50%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Hc 2D&M-Mode W/Spctrl & Cf Dplr	$1,225.00	$2,450.00	—	28% below	50%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Hc 2D&M-Mode W/Spctrl & Cf Dplr	$1,225.00	$2,450.00	—	—	50%
Elbow X-ray, 2 views one side CPT 73070 Hc X-Ray-Elbow 2 Views Rt	$249.50	$499.00	—	4% below	50%
Elbow X-ray, 2 views one side CPT 73070 Hc X-Ray-Elbow 2 Views Lt	$249.50	$499.00	—	4% below	50%
Elbow X-ray, 2 views inpatient one side CPT 73070 Hc X-Ray-Elbow 2 Views Rt	$249.50	$499.00	—	—	50%
Elbow X-ray, 2 views inpatient one side CPT 73070 Hc X-Ray-Elbow 2 Views Lt	$249.50	$499.00	—	—	50%
Elbow X-ray, complete, 3 or more views one side CPT 73080 Hc X-Ray-Elbow Min 3 Views Rt	$210.50	$421.00	—	33% below	50%
Elbow X-ray, complete, 3 or more views one side CPT 73080 Hc X-Ray-Elbow Min 3 Views Lt	$210.50	$421.00	—	33% below	50%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Hc X-Ray-Elbow Min 3 Views Rt	$210.50	$421.00	—	—	50%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Hc X-Ray-Elbow Min 3 Views Lt	$210.50	$421.00	—	—	50%
Eye socket (orbit) CT scan without contrast CPT 70480 Hc Ct Iac W/O Contrast	$548.00	$1,096.00	—	36% below	50%
Eye socket (orbit) CT scan without contrast CPT 70480 Hc Ct Orbit W/O Contrast	$548.00	$1,096.00	—	36% below	50%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Hc Ct Orbit W/O Contrast	$548.00	$1,096.00	—	—	50%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Hc Ct Iac W/O Contrast	$548.00	$1,096.00	—	—	50%
Facial bones X-ray, complete, 3 or more views CPT 70150 Hc X-Ray-Facial Bones 3+ Views	$288.50	$577.00	—	23% below	50%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 Hc X-Ray-Facial Bones 3+ Views	$288.50	$577.00	—	—	50%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Hc X-Ray-Forearm 2 Views Lt	$205.50	$411.00	—	25% below	50%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Hc X-Ray-Forearm 2 Views Rt	$205.50	$411.00	—	25% below	50%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Hc X-Ray-Forearm 2 Views Rt	$205.50	$411.00	—	—	50%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Hc X-Ray-Forearm 2 Views Lt	$205.50	$411.00	—	—	50%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hc Hepatobiliary System Imaging	$972.00	$1,944.00	—	39% below	50%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hc Hepatobiliary System Imaging	$972.00	$1,944.00	—	—	50%
Hand X-ray, 2 views both sides CPT 73120 Hc X-Ray-Hand 1 View Bi	$349.50	$699.00	—	—	50%
Hand X-ray, 2 views one side CPT 73120 Hc X-Ray-Hand 2 Views Lt	$283.00	$566.00	—	6% above	50%
Hand X-ray, 2 views one side CPT 73120 Hc X-Ray-Hand 2 Views Rt	$283.00	$566.00	—	6% above	50%
Hand X-ray, 2 views inpatient both sides CPT 73120 Hc X-Ray-Hand 1 View Bi	$349.50	$699.00	—	—	50%
Hand X-ray, 2 views inpatient one side CPT 73120 Hc X-Ray-Hand 2 Views Rt	$283.00	$566.00	—	—	50%
Hand X-ray, 2 views inpatient one side CPT 73120 Hc X-Ray-Hand 2 Views Lt	$283.00	$566.00	—	—	50%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Hc X-Ray-Oscalcis (Heel) 2+ Views Rt	$205.50	$411.00	—	24% below	50%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Hc X-Ray-Oscalcis (Heel) 2+ Views Lt	$205.50	$411.00	—	24% below	50%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Hc X-Ray-Oscalcis (Heel) 2+ Views Lt	$205.50	$411.00	—	—	50%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Hc X-Ray-Oscalcis (Heel) 2+ Views Rt	$205.50	$411.00	—	—	50%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Hc Slp Study 6/>Yrs Cpap 4/> Parm 6+ Hrs Recording	$3,412.50	$6,825.00	—	17% below	50%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Hc Slp Study 6/>Yrs Cpap 4/> Parm 6+ Hrs Recording	$3,412.50	$6,825.00	—	—	50%
Knee X-ray, 3 views one side CPT 73562 Hc X-Ray-Knee Three Views Rt	$210.50	$421.00	—	40% below	50%
Knee X-ray, 3 views one side CPT 73562 Hc X-Ray-Knee Three Views Lt	$210.50	$421.00	—	40% below	50%
Knee X-ray, 3 views inpatient one side CPT 73562 Hc X-Ray-Knee Three Views Rt	$210.50	$421.00	—	—	50%
Knee X-ray, 3 views inpatient one side CPT 73562 Hc X-Ray-Knee Three Views Lt	$210.50	$421.00	—	—	50%
Knee X-ray, complete, 4 or more views one side CPT 73564 Hc X-Ray-Knee - 4 Vws Or More Lt	$266.50	$533.00	—	32% below	50%
Knee X-ray, complete, 4 or more views one side CPT 73564 Hc X-Ray-Knee - 4 Vws Or More Rt	$266.50	$533.00	—	32% below	50%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Hc X-Ray-Knee - 4 Vws Or More Lt	$266.50	$533.00	—	—	50%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Hc X-Ray-Knee - 4 Vws Or More Rt	$266.50	$533.00	—	—	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Hc Ct Lower Ext W/O Contrast Rt	$658.50	$1,317.00	—	30% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Hc Ct Lower Ext W/O Contrast Lt	$658.50	$1,317.00	—	30% below	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Hc Ct Lower Ext W/O Contrast Rt	$658.50	$1,317.00	—	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Hc Ct Lower Ext W/O Contrast Lt	$658.50	$1,317.00	—	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Hc U/S Abdomen Limited	$495.50	$991.00	—	10% below	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Hc U/S Soft Tissue Abdomen	$495.50	$991.00	—	10% below	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Hc U/S Abdomen Limited	$495.50	$991.00	—	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Hc U/S Soft Tissue Abdomen	$495.50	$991.00	—	—	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Hc U/S Extr Non-Vasc Lmtd Rt	$594.00	$1,188.00	—	25% above	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Hc U/S Extr Non-Vasc Lmtd Lt	$594.00	$1,188.00	—	25% above	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Hc U/S Extr Non-Vasc Lmtd Lt	$594.00	$1,188.00	—	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Hc U/S Extr Non-Vasc Lmtd Rt	$594.00	$1,188.00	—	—	50%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Hc Smart Lung Ct Scan	$78.00	$156.00	—	74% below	50%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Hc Smart Lung Ct Scan	$78.00	$156.00	—	—	50%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Hc X-Ray-Tibia-Fibula 2 Views Rt	$205.50	$411.00	—	25% below	50%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Hc X-Ray-Tibia-Fibula 2 Views Lt	$205.50	$411.00	—	25% below	50%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Hc X-Ray-Tibia-Fibula 2 Views Rt	$205.50	$411.00	—	—	50%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Hc X-Ray-Tibia-Fibula 2 Views Lt	$205.50	$411.00	—	—	50%
MR angiography (MRA) of the head without contrast CPT 70544 Hc Mra-Head W/O Contrast	$1,432.50	$2,865.00	—	1% below	50%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 Hc Mra-Head W/O Contrast	$1,432.50	$2,865.00	—	—	50%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 Hc Mri Breast Bilateral W/Wo Con	$2,882.00	$5,764.00	—	—	50%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 Hc Mri Breast Bilateral W/Wo Con	$2,882.00	$5,764.00	—	—	50%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Hc Mri Hip W/O Contrast	$1,511.50	$3,023.00	—	14% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Hc Mri-Lower Ext Joint W/O Con Rt	$1,511.50	$3,023.00	—	14% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Hc Mri-Custom Joint W/O Con Rt	$1,511.50	$3,023.00	—	14% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Hc Mri-Knee W/O Contrast Rt	$1,511.50	$3,023.00	—	14% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Hc Mri-Lower Ext Joint W/O Con Lt	$1,511.50	$3,023.00	—	14% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Hc Mri-Custom Joint W/O Con Lt	$1,511.50	$3,023.00	—	14% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Hc Mri-Knee W/O Contrast Lt	$1,511.50	$3,023.00	—	14% below	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Hc Mri Hip W/O Contrast	$1,511.50	$3,023.00	—	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Hc Mri-Knee W/O Contrast Lt	$1,511.50	$3,023.00	—	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Hc Mri-Custom Joint W/O Con Lt	$1,511.50	$3,023.00	—	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Hc Mri-Lower Ext Joint W/O Con Rt	$1,511.50	$3,023.00	—	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Hc Mri-Lower Ext Joint W/O Con Lt	$1,511.50	$3,023.00	—	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Hc Mri-Custom Joint W/O Con Rt	$1,511.50	$3,023.00	—	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Hc Mri-Knee W/O Contrast Rt	$1,511.50	$3,023.00	—	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Hc Mri-Lower Ext Joint W/Wo Con R	$2,497.00	$4,994.00	—	4% above	50%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Hc Mri-Lower Ext Joint W/Wo Con L	$2,497.00	$4,994.00	—	4% above	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Hc Mri-Lower Ext Joint W/Wo Con R	$2,497.00	$4,994.00	—	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Hc Mri-Lower Ext Joint W/Wo Con L	$2,497.00	$4,994.00	—	—	50%
MRI of the abdomen without contrast CPT 74181 Hc Mri-Mrcp	$1,497.50	$2,995.00	—	19% below	50%
MRI of the abdomen without contrast CPT 74181 Hc Mri-Abdomen W/O Contrast	$1,497.50	$2,995.00	—	19% below	50%
MRI of the abdomen without contrast CPT 74181 Hc Mri-Abdomen-Mrcp W/O Contrast	$1,497.50	$2,995.00	—	19% below	50%
MRI of the abdomen without contrast inpatient CPT 74181 Hc Mri-Mrcp	$1,497.50	$2,995.00	—	—	50%
MRI of the abdomen without contrast inpatient CPT 74181 Hc Mri-Abdomen-Mrcp W/O Contrast	$1,497.50	$2,995.00	—	—	50%
MRI of the abdomen without contrast inpatient CPT 74181 Hc Mri-Abdomen W/O Contrast	$1,497.50	$2,995.00	—	—	50%
MRI of the abdomen, without and then with contrast dye CPT 74183 Hc Mri-Abdomen W/Wo Contrast	$2,458.50	$4,917.00	—	7% above	50%
MRI of the abdomen, without and then with contrast dye CPT 74183 Hc Mri-Abdomen-Mrcp W/Wo Contrast	$2,458.50	$4,917.00	—	7% above	50%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Hc Mri-Abdomen-Mrcp W/Wo Contrast	$2,458.50	$4,917.00	—	—	50%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Hc Mri-Abdomen W/Wo Contrast	$2,458.50	$4,917.00	—	—	50%
MRI of the brain, no contrast dye CPT 70551 Hc Mri-Iac W/O Con	$1,419.00	$2,838.00	—	12% below	50%
MRI of the brain, no contrast dye CPT 70551 Hc Mri-Brain Attn Iac Wo Con	$1,419.00	$2,838.00	—	12% below	50%
MRI of the brain, no contrast dye CPT 70551 Hc Mri-Brain W/O Contrast	$1,419.00	$2,838.00	—	12% below	50%
MRI of the brain, no contrast dye inpatient CPT 70551 Hc Mri-Iac W/O Con	$1,419.00	$2,838.00	—	—	50%
MRI of the brain, no contrast dye inpatient CPT 70551 Hc Mri-Brain W/O Contrast	$1,419.00	$2,838.00	—	—	50%
MRI of the brain, no contrast dye inpatient CPT 70551 Hc Mri-Brain Attn Iac Wo Con	$1,419.00	$2,838.00	—	—	50%
MRI of the brain, with and without contrast dye CPT 70553 Hc Mri- Iac W/Wo Con	$2,317.50	$4,635.00	—	6% above	50%
MRI of the brain, with and without contrast dye CPT 70553 Hc Mri-Brain Atn Pitutry W/Wo Con	$2,317.50	$4,635.00	—	6% above	50%
MRI of the brain, with and without contrast dye CPT 70553 Hc Mri-Brain Attn Orbits W/Wo Con	$2,317.50	$4,635.00	—	6% above	50%
MRI of the brain, with and without contrast dye CPT 70553 Hc Mri-Brain W/Wo Contrast	$2,317.50	$4,635.00	—	6% above	50%
MRI of the brain, with and without contrast dye CPT 70553 Hc Mri-Brain Attn Iac W/Wo Con	$2,317.50	$4,635.00	—	6% above	50%
MRI of the brain, with and without contrast dye inpatient CPT 70553 Hc Mri-Brain W/Wo Contrast	$2,317.50	$4,635.00	—	—	50%
MRI of the brain, with and without contrast dye inpatient CPT 70553 Hc Mri-Brain Attn Iac W/Wo Con	$2,317.50	$4,635.00	—	—	50%
MRI of the brain, with and without contrast dye inpatient CPT 70553 Hc Mri- Iac W/Wo Con	$2,317.50	$4,635.00	—	—	50%
MRI of the brain, with and without contrast dye inpatient CPT 70553 Hc Mri-Brain Attn Orbits W/Wo Con	$2,317.50	$4,635.00	—	—	50%
MRI of the brain, with and without contrast dye inpatient CPT 70553 Hc Mri-Brain Atn Pitutry W/Wo Con	$2,317.50	$4,635.00	—	—	50%
MRI of the lower back, no contrast dye CPT 72148 Hc Mri-Lumbar Spine W/O Contrast	$1,497.50	$2,995.00	—	10% below	50%
MRI of the lower back, no contrast dye inpatient CPT 72148 Hc Mri-Lumbar Spine W/O Contrast	$1,497.50	$2,995.00	—	—	50%
MRI of the lower back, without and then with contrast dye CPT 72158 Hc Mri-Lumbar Spine W/Wo Contrast	$2,445.50	$4,891.00	—	5% above	50%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 Hc Mri-Lumbar Spine W/Wo Contrast	$2,445.50	$4,891.00	—	—	50%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Hc Mri-Thoracic Spine W/O Con	$1,497.50	$2,995.00	—	11% below	50%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 Hc Mri-Thoracic Spine W/O Con	$1,497.50	$2,995.00	—	—	50%
MRI of the neck (cervical spine) without and with contrast CPT 72156 Hc Mri-Cervical Spine W/Wo Con	$2,317.50	$4,635.00	—	2% above	50%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 Hc Mri-Cervical Spine W/Wo Con	$2,317.50	$4,635.00	—	—	50%
MRI of the neck (cervical spine), no contrast dye CPT 72141 Hc Mri-Cervical Spine W/O Con	$1,419.00	$2,838.00	—	14% below	50%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 Hc Mri-Cervical Spine W/O Con	$1,419.00	$2,838.00	—	—	50%
MRI of the pelvis without and with contrast CPT 72197 Hc Mri-Pelvis W/Wo Contrast	$2,458.50	$4,917.00	—	26% above	50%
MRI of the pelvis without and with contrast inpatient CPT 72197 Hc Mri-Pelvis W/Wo Contrast	$2,458.50	$4,917.00	—	—	50%
MRI of the pelvis, no contrast dye CPT 72195 Hc Mri-Pelvis W/O Contrast	$1,524.00	$3,048.00	—	at median	50%
MRI of the pelvis, no contrast dye inpatient CPT 72195 Hc Mri-Pelvis W/O Contrast	$1,524.00	$3,048.00	—	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Hc Mri-Shoulder W/O Contrast Rt	$1,511.50	$3,023.00	—	at median	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Hc Mri-Upper Ext Joint W/O Con Lt	$1,511.50	$3,023.00	—	at median	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Hc Mri-Shoulder W/O Contrast Lt	$1,511.50	$3,023.00	—	at median	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Hc Mri-Upper Ext Joint W/O Con Rt	$1,511.50	$3,023.00	—	at median	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Hc Mri-Upper Ext Joint W/O Con Lt	$1,511.50	$3,023.00	—	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Hc Mri-Upper Ext Joint W/O Con Rt	$1,511.50	$3,023.00	—	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Hc Mri-Shoulder W/O Contrast Rt	$1,511.50	$3,023.00	—	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Hc Mri-Shoulder W/O Contrast Lt	$1,511.50	$3,023.00	—	—	50%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Hc X-Ray-Cervical Spine Min 4-5 Views	$294.00	$588.00	—	35% below	50%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 Hc X-Ray-Cervical Spine Min 4-5 Views	$294.00	$588.00	—	—	50%
Neck soft tissue CT scan with contrast CPT 70491 Hc Ct Neck W/Contrast	$843.50	$1,687.00	—	29% below	50%
Neck soft tissue CT scan with contrast inpatient CPT 70491 Hc Ct Neck W/Contrast	$843.50	$1,687.00	—	—	50%
Neck soft tissue CT scan without contrast CPT 70490 Hc Ct Neck W/O Contrast	$548.00	$1,096.00	—	41% below	50%
Neck soft tissue CT scan without contrast inpatient CPT 70490 Hc Ct Neck W/O Contrast	$548.00	$1,096.00	—	—	50%
Neck soft tissue X-ray CPT 70360 Hc X-Ray-Neck (Soft Tissue)	$145.00	$290.00	—	44% below	50%
Neck soft tissue X-ray inpatient CPT 70360 Hc X-Ray-Neck (Soft Tissue)	$145.00	$290.00	—	—	50%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Hc Heart Scan Spect Multiple	$2,983.00	$5,966.00	—	26% below	50%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Hc Heart Scan Spect Multiple	$2,983.00	$5,966.00	—	—	50%
Pelvic CT scan without contrast CPT 72192 Hc Ct Pelvis W/O Contrast	$658.50	$1,317.00	—	34% below	50%
Pelvic CT scan without contrast inpatient CPT 72192 Hc Ct Pelvis W/O Contrast	$658.50	$1,317.00	—	—	50%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Hc U/S Soft Tissue Pelvis	$478.00	$956.00	—	10% above	50%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Hc U/S Pelvic Limited	$478.00	$956.00	—	10% above	50%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Hc U/S Soft Tissue Pelvis	$478.00	$956.00	—	—	50%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Hc U/S Pelvic Limited	$478.00	$956.00	—	—	50%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Hc U/S Pelvic	$504.00	$1,008.00	—	at median	50%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Hc U/S Pelvic	$504.00	$1,008.00	—	—	50%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Hc U/S Maternity > 14 Weeks Initial Gestation	$523.00	$1,046.00	—	13% below	50%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Hc U/S Maternity > 14 Weeks Initial Gestation	$523.00	$1,046.00	—	—	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Hc U/S Maternity < 14 Weeks Initial Gestation	$513.00	$1,026.00	—	7% below	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Hc U/S Maternity < 14 Weeks Initial Gestation	$513.00	$1,026.00	—	—	50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Hc U/S Maternity Limited 1 Or More Fetus(S)	$495.50	$991.00	—	4% above	50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Hc U/S Maternity Limited 1 Or More Fetus(S)	$495.50	$991.00	—	—	50%
Rib X-ray, one side, 2 views one side CPT 71100 Hc X-Ray-Ribs 2 Views Unilateral Lt	$166.50	$333.00	—	45% below	50%
Rib X-ray, one side, 2 views one side CPT 71100 Hc X-Ray-Ribs 2 Views Unilateral Rt	$166.50	$333.00	—	45% below	50%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Hc X-Ray-Ribs 2 Views Unilateral Lt	$166.50	$333.00	—	—	50%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Hc X-Ray-Ribs 2 Views Unilateral Rt	$166.50	$333.00	—	—	50%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Hc X-Ray-Ribs Unilat W/Pa Chest R 3+ Views	$288.50	$577.00	—	25% below	50%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Hc X-Ray-Ribs Unilat W/Pa Chest L 3+ Views	$288.50	$577.00	—	25% below	50%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Hc X-Ray-Ribs Unilat W/Pa Chest L 3+ Views	$288.50	$577.00	—	—	50%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Hc X-Ray-Ribs Unilat W/Pa Chest R 3+ Views	$288.50	$577.00	—	—	50%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Hc X-Ray-Shoulder Min 2 Views Lt	$210.50	$421.00	—	38% below	50%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Hc X-Ray-Shoulder Min 2 Views Rt	$210.50	$421.00	—	38% below	50%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Hc X-Ray-Shoulder Min 2 Views Lt	$210.50	$421.00	—	—	50%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Hc X-Ray-Shoulder Min 2 Views Rt	$210.50	$421.00	—	—	50%
Sinus X-ray, complete, 3 or more views CPT 70220 Hc X-Ray-Paranasal Sinuses Min 3 Views	$166.50	$333.00	—	54% below	50%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Hc X-Ray-Paranasal Sinuses Min 3 Views	$166.50	$333.00	—	—	50%
Skull X-ray, fewer than 4 views CPT 70250 Hc X-Ray-Skull 3 Or Less Views	$288.50	$577.00	—	at median	50%
Skull X-ray, fewer than 4 views inpatient CPT 70250 Hc X-Ray-Skull 3 Or Less Views	$288.50	$577.00	—	—	50%
Sleep study in a lab (polysomnography) CPT 95810 Hc Sleep Study 6/> Yrs 4/> Param 6+ Hrs Recording	$3,412.50	$6,825.00	—	5% below	50%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Hc Sleep Study 6/> Yrs 4/> Param 6+ Hrs Recording	$3,412.50	$6,825.00	—	—	50%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Hc Stress 2D&M-Mode W/Ekg	$777.50	$1,555.00	—	62% below	50%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Hc Stress 2D&M-Mode W/Ekg	$777.50	$1,555.00	—	—	50%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Hc X-Ray-Rehab Esophogram	$435.00	$870.00	—	14% below	50%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Hc X-Ray-Rehab Esophogram	$435.00	$870.00	—	—	50%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Hc X-Ray-Femur 2 Views Lt	$210.50	$421.00	—	22% below	50%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Hc X-Ray-Femur 2 Views Rt	$210.50	$421.00	—	22% below	50%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Hc X-Ray-Femur 2 Views Rt	$210.50	$421.00	—	—	50%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Hc X-Ray-Femur 2 Views Lt	$210.50	$421.00	—	—	50%
Thoracic spine (mid back) CT scan without contrast CPT 72128 Hc Ct Thoracic Spine W/O Contrast	$658.50	$1,317.00	—	27% below	50%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 Hc Ct Thoracic Spine W/O Contrast	$658.50	$1,317.00	—	—	50%
Toe X-ray, 2 or more views one side CPT 73660 Hc X-Ray-Toe 2+ Views Lt	$249.50	$499.00	—	at median	50%
Toe X-ray, 2 or more views one side CPT 73660 Hc X-Ray-Toe 2+ Views Rt	$249.50	$499.00	—	at median	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 Hc X-Ray-Toe 2+ Views Rt	$249.50	$499.00	—	—	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 Hc X-Ray-Toe 2+ Views Lt	$249.50	$499.00	—	—	50%
Transvaginal pelvic ultrasound CPT 76830 Hc U/S Transvaginal Non-Maternity	$513.00	$1,026.00	—	9% below	50%
Transvaginal pelvic ultrasound inpatient CPT 76830 Hc U/S Transvaginal Non-Maternity	$513.00	$1,026.00	—	—	50%
Transvaginal ultrasound during pregnancy CPT 76817 Hc U/S Transvaginal Maternity	$504.00	$1,008.00	—	at median	50%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 Hc U/S Transvaginal Maternity	$504.00	$1,008.00	—	—	50%
Ultrasound of the abdomen, complete CPT 76700 Hc U/S Abdomen Complete	$513.00	$1,026.00	—	18% below	50%
Ultrasound of the abdomen, complete inpatient CPT 76700 Hc U/S Abdomen Complete	$513.00	$1,026.00	—	—	50%
Ultrasound of the scrotum and testicles CPT 76870 Hc U/S Testicular	$504.00	$1,008.00	—	6% below	50%
Ultrasound of the scrotum and testicles inpatient CPT 76870 Hc U/S Testicular	$504.00	$1,008.00	—	—	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Hc U/S Thyroid	$513.00	$1,026.00	—	11% below	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Hc U/S Neck Or Head - Soft Tissue	$513.00	$1,026.00	—	11% below	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Hc U/S Neck Or Head - Soft Tissue	$513.00	$1,026.00	—	—	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Hc U/S Thyroid	$513.00	$1,026.00	—	—	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Hc X-Ray Upper Gi Single Contrast W/O Kub	$440.00	$880.00	—	26% below	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Hc X-Ray Upper Gi Single Contrast W/O Kub	$440.00	$880.00	—	—	50%
Upper arm X-ray (humerus), 2 views one side CPT 73060 Hc X-Ray-Humerus Min 2 Views Lt	$210.50	$421.00	—	23% below	50%
Upper arm X-ray (humerus), 2 views one side CPT 73060 Hc X-Ray-Humerus Min 2 Views Rt	$210.50	$421.00	—	23% below	50%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Hc X-Ray-Humerus Min 2 Views Lt	$210.50	$421.00	—	—	50%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Hc X-Ray-Humerus Min 2 Views Rt	$210.50	$421.00	—	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Hc U/S Venous Imaging Low Ext Uni	$513.00	$1,026.00	—	30% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Hc U/S Venous Imaging Up Ext Uni	$513.00	$1,026.00	—	30% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Hc U/S Venous Imaging Up Ext Uni	$513.00	$1,026.00	—	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Hc U/S Venous Imaging Low Ext Uni	$513.00	$1,026.00	—	—	50%
Wrist X-ray, 2 views one side CPT 73100 Hc X-Ray-Wrist 2 Views Rt	$261.00	$522.00	—	at median	50%
Wrist X-ray, 2 views one side CPT 73100 Hc X-Ray-Wrist 2 Views Lt	$261.00	$522.00	—	at median	50%
Wrist X-ray, 2 views inpatient one side CPT 73100 Hc X-Ray-Wrist 2 Views Lt	$261.00	$522.00	—	—	50%
Wrist X-ray, 2 views inpatient one side CPT 73100 Hc X-Ray-Wrist 2 Views Rt	$261.00	$522.00	—	—	50%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Hc X-Ray-Wrist W/Carpal Series Lt	$190.00	$380.00	—	43% below	50%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Hc X-Ray-Wrist W/Carpal Series Rt	$210.50	$421.00	—	37% below	50%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Hc X-Ray-Wrist 3 Views Lt	$210.50	$421.00	—	37% below	50%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Hc X-Ray-Wrist 3 Views Rt	$210.50	$421.00	—	37% below	50%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Hc X-Ray-Wrist W/Carpal Series Lt	$190.00	$380.00	—	—	50%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Hc X-Ray-Wrist W/Carpal Series Rt	$210.50	$421.00	—	—	50%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Hc X-Ray-Wrist 3 Views Rt	$210.50	$421.00	—	—	50%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Hc X-Ray-Wrist 3 Views Lt	$210.50	$421.00	—	—	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hc X-Ray Exam Hip Uni 2-3 Views Lt	$210.50	$421.00	—	32% below	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hc X-Ray Exam Hip Uni 2-3 Views Rt	$210.50	$421.00	—	32% below	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Hc X-Ray Exam Hip Uni 2-3 Views Rt	$210.50	$421.00	—	—	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Hc X-Ray Exam Hip Uni 2-3 Views Lt	$210.50	$421.00	—	—	50%
X-ray of the abdomen, 1 view CPT 74018 Hc X-Ray Exam Abdomen 1 View	$180.00	$360.00	—	30% below	50%
X-ray of the abdomen, 1 view inpatient CPT 74018 Hc X-Ray Exam Abdomen 1 View	$180.00	$360.00	—	—	50%
X-ray of the ankle, 2 views both sides CPT 73600 Hc X-Ray-Ankle 1 View Bi	$230.00	$460.00	—	—	50%
X-ray of the ankle, 2 views one side CPT 73600 Hc X-Ray-Ankle 2 Views Rt	$205.50	$411.00	—	17% below	50%
X-ray of the ankle, 2 views one side CPT 73600 Hc X-Ray-Ankle 2 Views Lt	$205.50	$411.00	—	17% below	50%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 Hc X-Ray-Ankle 1 View Bi	$230.00	$460.00	—	—	50%
X-ray of the ankle, 2 views inpatient one side CPT 73600 Hc X-Ray-Ankle 2 Views Rt	$205.50	$411.00	—	—	50%
X-ray of the ankle, 2 views inpatient one side CPT 73600 Hc X-Ray-Ankle 2 Views Lt	$205.50	$411.00	—	—	50%
X-ray of the finger(s), 2 or more views one side CPT 73140 Hc X-Ray-Finger 2+ Views Lt	$261.00	$522.00	—	1% above	50%
X-ray of the finger(s), 2 or more views one side CPT 73140 Hc X-Ray-Finger 2+ Views Rt	$261.00	$522.00	—	1% above	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Hc X-Ray-Finger 2+ Views Lt	$261.00	$522.00	—	—	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Hc X-Ray-Finger 2+ Views Rt	$261.00	$522.00	—	—	50%
X-ray of the foot, 2 views one side CPT 73620 Hc X-Ray-Foot 2 Views Lt	$205.50	$411.00	—	11% below	50%
X-ray of the foot, 2 views one side CPT 73620 Hc X-Ray-Foot 2 Views Rt	$205.50	$411.00	—	11% below	50%
X-ray of the foot, 2 views inpatient one side CPT 73620 Hc X-Ray-Foot 2 Views Rt	$205.50	$411.00	—	—	50%
X-ray of the foot, 2 views inpatient one side CPT 73620 Hc X-Ray-Foot 2 Views Lt	$205.50	$411.00	—	—	50%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Hc X-Ray-Foot 3 Or More Views Lt	$210.50	$421.00	—	31% below	50%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Hc X-Ray-Foot 3 Or More Views Rt	$210.50	$421.00	—	31% below	50%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Hc X-Ray-Foot 3 Or More Views Rt	$210.50	$421.00	—	—	50%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Hc X-Ray-Foot 3 Or More Views Lt	$210.50	$421.00	—	—	50%
X-ray of the hand, 3 or more views one side CPT 73130 Hc X-Ray-Hand Min 3 Views Lt	$210.50	$421.00	—	36% below	50%
X-ray of the hand, 3 or more views one side CPT 73130 Hc X-Ray-Hand Min 3 Views Rt	$210.50	$421.00	—	36% below	50%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 Hc X-Ray-Hand Min 3 Views Rt	$210.50	$421.00	—	—	50%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 Hc X-Ray-Hand Min 3 Views Lt	$210.50	$421.00	—	—	50%
X-ray of the knee, 1 or 2 views one side CPT 73560 Hc X-Ray-Knee Two Views Lt	$210.50	$421.00	—	23% below	50%
X-ray of the knee, 1 or 2 views one side CPT 73560 Hc X-Ray-Knee Two Views Rt	$210.50	$421.00	—	23% below	50%
X-ray of the knee, 1 or 2 views one side CPT 73560 Hc X-Ray-Knee Single View Lt	$210.50	$421.00	—	23% below	50%
X-ray of the knee, 1 or 2 views one side CPT 73560 Hc X-Ray-Knee Single View Rt	$210.50	$421.00	—	23% below	50%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Hc X-Ray-Knee Single View Rt	$210.50	$421.00	—	—	50%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Hc X-Ray-Knee Two Views Lt	$210.50	$421.00	—	—	50%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Hc X-Ray-Knee Single View Lt	$210.50	$421.00	—	—	50%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Hc X-Ray-Knee Two Views Rt	$210.50	$421.00	—	—	50%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Hc X-Ray-Ls Spine Flex & Ext Only	$288.50	$577.00	—	11% below	50%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Hc X-Ray-Ls Spine 2 Or 3 Views	$288.50	$577.00	—	11% below	50%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Hc X-Ray-Ls Spine 2 Or 3 Views	$288.50	$577.00	—	—	50%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Hc X-Ray-Ls Spine Flex & Ext Only	$288.50	$577.00	—	—	50%
X-ray of the lower back, 4 or more views CPT 72110 Hc X-Ray-Ls Spine Min 4 Views	$288.50	$577.00	—	39% below	50%
X-ray of the lower back, 4 or more views inpatient CPT 72110 Hc X-Ray-Ls Spine Min 4 Views	$288.50	$577.00	—	—	50%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Hc X-Ray-Thoracic Spine 2 Views	$288.50	$577.00	—	5% below	50%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Hc X-Ray-Thoracic Spine 2 Views	$288.50	$577.00	—	—	50%
X-ray of the nasal bones, 3 or more views CPT 70160 Hc X-Ray-Nasal Bones 3+ Views	$166.50	$333.00	—	43% below	50%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Hc X-Ray-Nasal Bones 3+ Views	$166.50	$333.00	—	—	50%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Hc X-Ray-Cerv Spine 2 Or 3 Views	$166.50	$333.00	—	50% below	50%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Hc X-Ray-Cerv Spine-Flex & Ext 2-3 Views	$166.50	$333.00	—	50% below	50%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Hc X-Ray-Cerv Spine-Flex & Ext 2-3 Views	$166.50	$333.00	—	—	50%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Hc X-Ray-Cerv Spine 2 Or 3 Views	$166.50	$333.00	—	—	50%
X-ray of the pelvis, 1 or 2 views CPT 72170 Hc X-Ray-Pelvis 1 Or 2 Views	$283.00	$566.00	—	12% above	50%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Hc X-Ray-Pelvis 1 Or 2 Views	$283.00	$566.00	—	—	50%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Hc X-Ray-Sacrum / Coccyx 2+ Views	$210.50	$421.00	—	29% below	50%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Hc X-Ray-Sacrum / Coccyx 2+ Views	$210.50	$421.00	—	—	50%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
ACTH blood test CPT 82024 Hc Acth	$154.00	$308.00	—	17% above	50%
ACTH blood test inpatient CPT 82024 Hc Acth	$154.00	$308.00	—	—	50%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Hc Transferase Ala (Alt)	$34.00	$68.00	—	22% above	50%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Hc Transferase Ala (Alt)	$34.00	$68.00	—	—	50%
AST (aspartate aminotransferase) enzyme test CPT 84450 Hc Transferase Asp (Ast)	$34.00	$68.00	—	35% above	50%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Hc Transferase Asp (Ast)	$34.00	$68.00	—	—	50%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hc Hepatitis Acute A/B/C	$257.50	$515.00	—	18% above	50%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hc Hepatitis Acute A/B/C	$257.50	$515.00	—	—	50%
Albumin blood test CPT 82040 Hc Albumin Serum	$25.00	$50.00	—	13% above	50%
Albumin blood test inpatient CPT 82040 Hc Albumin Serum	$25.00	$50.00	—	—	50%
Aldosterone blood test CPT 82088 Hc Aldosterone	$162.00	$324.00	—	16% above	50%
Aldosterone blood test inpatient CPT 82088 Hc Aldosterone	$162.00	$324.00	—	—	50%
Alkaline phosphatase (ALP) blood test CPT 84075 Hc Alk Phos Total	$34.00	$68.00	—	42% above	50%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Hc Alk Phos Total	$34.00	$68.00	—	—	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Hc Allergen Specific Ige Quant Ea	$38.00	$76.00	—	62% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Hc Allg Spec Ige Crude Xtrc Ea	$133.00	$266.00	—	468% above	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hc Allergen Specific Ige Quant Ea	$38.00	$76.00	—	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hc Allg Spec Ige Crude Xtrc Ea	$133.00	$266.00	—	—	50%
Alpha-fetoprotein (AFP) blood test CPT 82105 Hc Afp Serum	$68.00	$136.00	—	12% above	50%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Hc Afp Serum	$68.00	$136.00	—	—	50%
Ammonia blood test CPT 82140 Hc Ammonia	$59.50	$119.00	—	9% above	50%
Ammonia blood test inpatient CPT 82140 Hc Ammonia	$59.50	$119.00	—	—	50%
Amylase blood test CPT 82150 Hc Amylase	$34.00	$68.00	—	29% below	50%
Amylase blood test inpatient CPT 82150 Hc Amylase	$34.00	$68.00	—	—	50%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Hc Cyclic Cit Peptide Ab	$66.00	$132.00	—	14% above	50%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Hc Cyclic Cit Peptide Ab	$66.00	$132.00	—	—	50%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Hc Ana	$56.50	$113.00	—	2% above	50%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Hc Ana	$56.50	$113.00	—	—	50%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Hc Bnp Natriuretic Peptide	$154.00	$308.00	—	3% above	50%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Hc Bnp Natriuretic Peptide	$154.00	$308.00	—	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Cult Aerobic W/Iso & Pres Id	$68.50	$137.00	—	4% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Hc Culture Misc.	$115.50	$231.00	—	75% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Cult Aerobic W/Iso & Pres Id	$68.50	$137.00	—	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Hc Culture Misc.	$115.50	$231.00	—	—	50%
Basic metabolic panel (blood test) CPT 80048 Hc Basic Met Prof	$59.50	$119.00	—	9% below	50%
Basic metabolic panel (blood test) inpatient CPT 80048 Hc Basic Met Prof	$59.50	$119.00	—	—	50%
Bilirubin blood test, total CPT 82247 Hc Bilirubin Total	$34.00	$68.00	—	42% above	50%
Bilirubin blood test, total inpatient CPT 82247 Hc Bilirubin Total	$34.00	$68.00	—	—	50%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Hc Surg Path L Iv, Each Tc Lc Bm	$73.00	$146.00	—	64% below	50%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Hc 88305 Level Iv Tissue	$129.00	$258.00	—	37% below	50%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Hc G&M Surg Path-Level Iv	$301.50	$603.00	—	48% above	50%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Hc Surg Path L Iv, Each Tc Lc Bm	$73.00	$146.00	—	—	50%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Hc 88305 Level Iv Tissue	$129.00	$258.00	—	—	50%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Hc G&M Surg Path-Level Iv	$301.50	$603.00	—	—	50%
Blood culture for bacteria CPT 87040 Hc Cult Bld Aer W/Iso & Pres Id	$82.50	$165.00	—	12% below	50%
Blood culture for bacteria CPT 87040 Hc Cult Bld Aer W/Iso & Pres Id (Add)	$82.50	$165.00	—	12% below	50%
Blood culture for bacteria inpatient CPT 87040 Hc Cult Bld Aer W/Iso & Pres Id (Add)	$82.50	$165.00	—	—	50%
Blood culture for bacteria inpatient CPT 87040 Hc Cult Bld Aer W/Iso & Pres Id	$82.50	$165.00	—	—	50%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Hc Venidraw-Kit Sent Out	$14.00	$28.00	—	12% below	50%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Hc Venipuncture	$14.00	$28.00	—	12% below	50%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Hc Venous Blood Draw	$14.00	$28.00	—	12% below	50%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Hc Venipuncture	$14.00	$28.00	—	—	50%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Hc Venous Blood Draw	$14.00	$28.00	—	—	50%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Hc Venidraw-Kit Sent Out	$14.00	$28.00	—	—	50%
Blood glucose (sugar) test CPT 82947 Hc Glucose Quant Blood	$25.00	$50.00	—	6% above	50%
Blood glucose (sugar) test inpatient CPT 82947 Hc Glucose Quant Blood	$25.00	$50.00	—	—	50%
Blood lead test CPT 83655 Hc Lead	$51.50	$103.00	—	6% above	50%
Blood lead test inpatient CPT 83655 Hc Lead	$51.50	$103.00	—	—	50%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hc Hcg Poc	$43.50	$87.00	—	20% below	50%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hc Hcg Qual	$43.50	$87.00	—	20% below	50%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Hc Hcg Poc	$43.50	$87.00	—	—	50%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Hc Hcg Qual	$43.50	$87.00	—	—	50%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Hc Blood Type Abo	$17.50	$35.00	—	71% below	50%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Hc Blood Type Abo (Arc)	$41.00	$82.00	—	31% below	50%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Hc Blood Type Abo	$17.50	$35.00	—	—	50%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Hc Blood Type Abo (Arc)	$41.00	$82.00	—	—	50%
Blood urea nitrogen (BUN) test CPT 84520 Hc Urea Nitrogen (Bun)	$25.00	$50.00	—	7% above	50%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Hc Urea Nitrogen (Bun)	$25.00	$50.00	—	—	50%
C-peptide blood test CPT 84681 Hc C-Peptide	$85.50	$171.00	—	8% above	50%
C-peptide blood test inpatient CPT 84681 Hc C-Peptide	$85.50	$171.00	—	—	50%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Hc C-Reactive Protein	$38.00	$76.00	—	24% below	50%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 Hc C-Reactive Protein	$38.00	$76.00	—	—	50%
C. difficile toxin gene test (stool PCR) CPT 87493 Hc C Diff Amp Probe	$234.50	$469.00	—	80% above	50%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Hc C Diff Amp Probe	$234.50	$469.00	—	—	50%
CA 19-9 blood test (tumor marker) CPT 86301 Hc Ca 19-9	$95.00	$190.00	—	30% above	50%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Hc Ca 19-9	$95.00	$190.00	—	—	50%
CA-125 blood test (ovarian cancer marker) CPT 86304 Hc Ca 125	$95.00	$190.00	—	1% above	50%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Hc Ca 125	$95.00	$190.00	—	—	50%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Hc Sars-Cov-2 Amp Prb	$257.50	$515.00	—	83% above	50%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Hc Sars-Cov-2 Amp Prb	$257.50	$515.00	—	—	50%
Calcium blood test, total CPT 82310 Hc Calcium Total	$34.00	$68.00	—	8% above	50%
Calcium blood test, total inpatient CPT 82310 Hc Calcium Total	$34.00	$68.00	—	—	50%
Carcinoembryonic antigen (CEA) test CPT 82378 Hc Cea	$77.50	$155.00	—	11% below	50%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Hc Cea	$77.50	$155.00	—	—	50%
Chickenpox (varicella) immunity blood test CPT 86787 Hc Varicella Zoster Ab	$66.00	$132.00	—	14% above	50%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Hc Varicella Zoster Ab	$66.00	$132.00	—	—	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Hc Chlam Trach Dna/Rna Amp Probe	$234.50	$469.00	—	154% above	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Hc Chlam Trach Dna/Rna Amp Probe	$234.50	$469.00	—	—	50%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Hc Lipid Profile	$81.50	$163.00	—	54% above	50%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Hc Lipid Profile	$81.50	$163.00	—	—	50%
Complete blood count (CBC) with differential CPT 85025 Hc Cbc W/Auto Diff	$51.50	$103.00	—	41% above	50%
Complete blood count (CBC) with differential inpatient CPT 85025 Hc Cbc W/Auto Diff	$51.50	$103.00	—	—	50%
Complete blood count (CBC), no differential CPT 85027 Hc Cbc No Diff	$40.00	$80.00	—	18% above	50%
Complete blood count (CBC), no differential inpatient CPT 85027 Hc Cbc No Diff	$40.00	$80.00	—	—	50%
Comprehensive metabolic panel (blood test) CPT 80053 Hc Comprehensive Met Prof	$70.50	$141.00	—	11% above	50%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Hc Comprehensive Met Prof	$70.50	$141.00	—	—	50%
Cortisol blood test, total CPT 82533 Hc Cortisol Total	$68.00	$136.00	—	6% below	50%
Cortisol blood test, total inpatient CPT 82533 Hc Cortisol Total	$68.00	$136.00	—	—	50%
Creatine kinase (CK) blood test, total CPT 82550 Hc Cpk Total	$34.00	$68.00	—	4% below	50%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Hc Cpk Total	$34.00	$68.00	—	—	50%
Creatinine blood test CPT 82565 Hc Creatinine Blood	$34.00	$68.00	—	38% above	50%
Creatinine blood test inpatient CPT 82565 Hc Creatinine Blood	$34.00	$68.00	—	—	50%
Cytomegalovirus (CMV) antibody test CPT 86644 Hc Cmv Ab	$66.00	$132.00	—	4% below	50%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Hc Cmv Ab	$66.00	$132.00	—	—	50%
D-dimer blood test (blood clot marker) CPT 85379 Hc D-Dimer Quant	$61.00	$122.00	—	12% below	50%
D-dimer blood test (blood clot marker) inpatient CPT 85379 Hc D-Dimer Quant	$61.00	$122.00	—	—	50%
DHEA sulfate (DHEA-S) blood test CPT 82627 Hc Dhea Sulfate	$85.50	$171.00	—	14% below	50%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Hc Dhea Sulfate	$85.50	$171.00	—	—	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Pc Drug Scn, Pres, Anal, Per Dos	$63.50	$127.00	—	34% below	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Drug Scn, Pres, Anal, Pc	$93.50	$187.00	—	2% below	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Drug Test Pres, Per Dos	$315.00	$630.00	—	230% above	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Hc Drug Scn, Pres, Anal, Dr, Mec, Bld	$481.50	$963.00	—	404% above	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Pc Drug Scn, Pres, Anal, Per Dos	$63.50	$127.00	—	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Drug Scn, Pres, Anal, Pc	$93.50	$187.00	—	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Drug Test Pres, Per Dos	$315.00	$630.00	—	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Hc Drug Scn, Pres, Anal, Dr, Mec, Bld	$481.50	$963.00	—	—	50%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Hc Electrolyte Profile	$46.50	$93.00	—	3% below	50%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Hc Electrolyte Profile	$46.50	$93.00	—	—	50%
Epstein-Barr virus (EBV) antibody test CPT 86665 Hc Ebv Capsid Ab	$85.50	$171.00	—	32% above	50%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Hc Ebv Capsid Ab	$85.50	$171.00	—	—	50%
Estradiol blood test CPT 82670 Hc Estradiol	$112.00	$224.00	—	at median	50%
Estradiol blood test inpatient CPT 82670 Hc Estradiol	$112.00	$224.00	—	—	50%
FSH (follicle-stimulating hormone) test CPT 83001 Hc Fsh	$77.50	$155.00	—	10% below	50%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Hc Fsh	$77.50	$155.00	—	—	50%
Fecal calprotectin (stool inflammation test) CPT 83993 Hc Calprotectin Fecal	$146.00	$292.00	—	2% below	50%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Hc Calprotectin Fecal	$146.00	$292.00	—	—	50%
Ferritin blood test (iron stores) CPT 82728 Hc Ferritin	$59.50	$119.00	—	22% below	50%
Ferritin blood test (iron stores) inpatient CPT 82728 Hc Ferritin	$59.50	$119.00	—	—	50%
Fibrinogen blood test CPT 85384 Hc Fibrinogen Activity	$51.50	$103.00	—	14% above	50%
Fibrinogen blood test inpatient CPT 85384 Hc Fibrinogen Activity	$51.50	$103.00	—	—	50%
Folate (folic acid) blood test CPT 82746 Hc Folic Acid	$59.50	$119.00	—	12% below	50%
Folate (folic acid) blood test inpatient CPT 82746 Hc Folic Acid	$59.50	$119.00	—	—	50%
Free T3 thyroid hormone test CPT 84481 Hc T3 Free	$68.00	$136.00	—	11% below	50%
Free T3 thyroid hormone test inpatient CPT 84481 Hc T3 Free	$68.00	$136.00	—	—	50%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Hc Thyroxin T4 Free	$43.50	$87.00	—	2% above	50%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Hc Thyroxin T4 Free	$43.50	$87.00	—	—	50%
Free testosterone test CPT 84402 Hc Testosterone Free	$102.50	$205.00	—	5% above	50%
Free testosterone test inpatient CPT 84402 Hc Testosterone Free	$102.50	$205.00	—	—	50%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Hc Ggt	$34.00	$68.00	—	20% below	50%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Hc Ggt	$34.00	$68.00	—	—	50%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 Hc General Health Panel	$221.50	$443.00	—	at median	50%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 Hc General Health Panel	$221.50	$443.00	—	—	50%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Hc Glucose Post Glu Dose	$25.00	$50.00	—	35% below	50%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Hc Glucose Post Glu Dose	$25.00	$50.00	—	—	50%
Glucose tolerance test, 3 samples CPT 82951 Hc Gluc Tolerance 3 Spec & Gluc	$59.50	$119.00	—	11% below	50%
Glucose tolerance test, 3 samples inpatient CPT 82951 Hc Gluc Tolerance 3 Spec & Gluc	$59.50	$119.00	—	—	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Hc Neis Gon Dna/Rna Amp Probe	$234.50	$469.00	—	152% above	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Hc Neis Gon Dna/Rna Amp Probe	$234.50	$469.00	—	—	50%
H. pylori antibody blood test CPT 86677 Hc H Pylori Ab	$76.50	$153.00	—	1% above	50%
H. pylori antibody blood test inpatient CPT 86677 Hc H Pylori Ab	$76.50	$153.00	—	—	50%
H. pylori stool antigen test CPT 87338 Hc H Pylori Ag Eia Qual Stool	$96.50	$193.00	—	38% above	50%
H. pylori stool antigen test inpatient CPT 87338 Hc H Pylori Ag Eia Qual Stool	$96.50	$193.00	—	—	50%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hc Hiv-1 Dna/Rna Quant	$525.00	$1,050.00	—	47% above	50%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Hc Hiv-1 Dna/Rna Quant	$525.00	$1,050.00	—	—	50%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hc Hiv 1 Ag W/Hiv 1-2 Abs Eia	$152.00	$304.00	—	105% above	50%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Hc Hiv 1 Ag W/Hiv 1-2 Abs Eia	$152.00	$304.00	—	—	50%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Hc Hpv High Risk Types	$234.50	$469.00	—	97% above	50%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Hc Hpv High Risk Types	$234.50	$469.00	—	—	50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hc Hemoglobin A1C	$43.50	$87.00	—	5% below	50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hc Hemoglobin A1C	$43.50	$87.00	—	—	50%
Hemoglobin blood test CPT 85018 Hc Hgb	$20.50	$41.00	—	27% above	50%
Hemoglobin blood test inpatient CPT 85018 Hc Hgb	$20.50	$41.00	—	—	50%
Hepatitis B core antibody test (total) CPT 86704 Hc Hep B Core Ab Total	$56.50	$113.00	—	5% above	50%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hc Hep B Core Ab Total	$56.50	$113.00	—	—	50%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hc Hep B Surf Ab	$56.50	$113.00	—	17% above	50%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hc Hep B Surf Ab	$56.50	$113.00	—	—	50%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hc Hep B Surf Ag Eia Qual	$82.50	$165.00	—	74% above	50%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hc Hep B Surf Ag Eia Qual	$82.50	$165.00	—	—	50%
Hepatitis C antibody blood test (screening) CPT 86803 Hc Hep C Ab	$66.00	$132.00	—	3% above	50%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hc Hep C Ab	$66.00	$132.00	—	—	50%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hc Hep C Dna/Rna Quant	$276.50	$553.00	—	44% above	50%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hc Hep C Dna/Rna Quant	$276.50	$553.00	—	—	50%
Herpes blood test, HSV-1 antibody CPT 86695 Hc Hsv Type 1 Ab	$66.00	$132.00	—	12% above	50%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Hc Hsv Type 1 Ab	$66.00	$132.00	—	—	50%
Herpes blood test, HSV-2 antibody CPT 86696 Hc Hsv Type 2 Ab	$85.50	$171.00	—	29% above	50%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Hc Hsv Type 2 Ab	$85.50	$171.00	—	—	50%
High-sensitivity CRP (hs-CRP) test CPT 86141 Hc Crp High Sens	$66.00	$132.00	—	2% below	50%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 Hc Crp High Sens	$66.00	$132.00	—	—	50%
Homocysteine blood test CPT 83090 Hc Homocysteine	$77.50	$155.00	—	4% below	50%
Homocysteine blood test inpatient CPT 83090 Hc Homocysteine	$77.50	$155.00	—	—	50%
Insulin blood test CPT 83525 Hc Insulin Total	$51.50	$103.00	—	at median	50%
Insulin blood test inpatient CPT 83525 Hc Insulin Total	$51.50	$103.00	—	—	50%
Iron blood test (serum iron) CPT 83540 Hc Iron	$34.00	$68.00	—	11% below	50%
Iron blood test (serum iron) inpatient CPT 83540 Hc Iron	$34.00	$68.00	—	—	50%
Iron-binding capacity (TIBC) test CPT 83550 Hc Iron Binding Capacity	$43.50	$87.00	—	12% above	50%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Hc Iron Binding Capacity	$43.50	$87.00	—	—	50%
Kidney function blood test panel CPT 80069 Hc Renal Function Panel	$59.50	$119.00	—	17% below	50%
Kidney function blood test panel inpatient CPT 80069 Hc Renal Function Panel	$59.50	$119.00	—	—	50%
LH (luteinizing hormone) test CPT 83002 Hc Luteinizing Hormone	$77.50	$155.00	—	19% below	50%
LH (luteinizing hormone) test inpatient CPT 83002 Hc Luteinizing Hormone	$77.50	$155.00	—	—	50%
Lactate (lactic acid) blood test CPT 83605 Hc Lactic Acid	$51.50	$103.00	—	1% below	50%
Lactate (lactic acid) blood test CPT 83605 Hc Lactic Acid I-Stat	$171.50	$343.00	—	230% above	50%
Lactate (lactic acid) blood test inpatient CPT 83605 Hc Lactic Acid	$51.50	$103.00	—	—	50%
Lactate (lactic acid) blood test inpatient CPT 83605 Hc Lactic Acid I-Stat	$171.50	$343.00	—	—	50%
Lactate dehydrogenase (LDH) blood test CPT 83615 Hc Ldh	$34.00	$68.00	—	25% above	50%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Hc Ldh	$34.00	$68.00	—	—	50%
Lipase blood test (pancreas enzyme) CPT 83690 Hc Lipase	$34.00	$68.00	—	42% below	50%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Hc Lipase	$34.00	$68.00	—	—	50%
Liver function blood test panel CPT 80076 Hc Hepatic Function Profile	$59.50	$119.00	—	2% below	50%
Liver function blood test panel inpatient CPT 80076 Hc Hepatic Function Profile	$59.50	$119.00	—	—	50%
Lyme disease antibody test CPT 86618 Hc Borrelia Burgdorf Ab (Lyme Dis)	$76.50	$153.00	—	at median	50%
Lyme disease antibody test inpatient CPT 86618 Hc Borrelia Burgdorf Ab (Lyme Dis)	$76.50	$153.00	—	—	50%
Magnesium blood test CPT 83735 Hc Magnesium	$34.00	$68.00	—	1% above	50%
Magnesium blood test inpatient CPT 83735 Hc Magnesium	$34.00	$68.00	—	—	50%
Measles (rubeola) antibody test CPT 86765 Hc Rubeola Ab	$66.00	$132.00	—	16% above	50%
Measles (rubeola) antibody test inpatient CPT 86765 Hc Rubeola Ab	$66.00	$132.00	—	—	50%
Mono test (heterophile antibody, Monospot) CPT 86308 Hc Heterophile Screen	$38.00	$76.00	—	29% below	50%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Hc Heterophile Screen	$38.00	$76.00	—	—	50%
Mumps immunity blood test CPT 86735 Hc Mumps Ab	$66.00	$132.00	—	13% above	50%
Mumps immunity blood test inpatient CPT 86735 Hc Mumps Ab	$66.00	$132.00	—	—	50%
PSA (prostate-specific antigen) blood test, free CPT 84154 Hc Psa Free	$77.50	$155.00	—	6% below	50%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Hc Psa Free	$77.50	$155.00	—	—	50%
PSA (prostate-specific antigen) blood test, total CPT 84153 Hc Psa Total	$77.50	$155.00	—	2% below	50%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Hc Psa Total	$77.50	$155.00	—	—	50%
Pap test (liquid-based, automated screening with review) CPT 88175 Hc Cytopath Gyn Auto W/Man Rev	$67.00	$134.00	—	31% below	50%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Hc Cytopath Gyn Auto W/Man Rev	$67.00	$134.00	—	—	50%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Hc Pap-Gyn Surepath	$56.00	$112.00	—	38% below	50%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Hc Pap-Gyn Surepath	$56.00	$112.00	—	—	50%
Parathyroid hormone (PTH) blood test CPT 83970 Hc Parathormone	$162.00	$324.00	—	14% above	50%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Hc Parathormone	$162.00	$324.00	—	—	50%
Partial thromboplastin time (PTT) clotting test CPT 85730 Hc Ptt	$40.00	$80.00	—	7% above	50%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Hc Ptt	$40.00	$80.00	—	—	50%
Phosphorus (phosphate) blood test CPT 84100 Hc Phosphorus Blood	$25.00	$50.00	—	30% below	50%
Phosphorus (phosphate) blood test inpatient CPT 84100 Hc Phosphorus Blood	$25.00	$50.00	—	—	50%
Potassium blood test CPT 84132 Hc Potassium Blood	$25.00	$50.00	—	7% above	50%
Potassium blood test CPT 84132 Hc Potassium I-Stat	$43.50	$87.00	—	86% above	50%
Potassium blood test inpatient CPT 84132 Hc Potassium Blood	$25.00	$50.00	—	—	50%
Potassium blood test inpatient CPT 84132 Hc Potassium I-Stat	$43.50	$87.00	—	—	50%
Progesterone blood test CPT 84144 Hc Progesterone	$85.50	$171.00	—	6% above	50%
Progesterone blood test inpatient CPT 84144 Hc Progesterone	$85.50	$171.00	—	—	50%
Prolactin blood test CPT 84146 Hc Prolactin	$77.50	$155.00	—	11% below	50%
Prolactin blood test inpatient CPT 84146 Hc Prolactin	$77.50	$155.00	—	—	50%
Prothrombin time (PT/INR) clotting test CPT 85610 Hc Protime	$30.00	$60.00	—	25% above	50%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Hc Protime	$30.00	$60.00	—	—	50%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Hc Strep Gp A Ag Immunoassay	$111.00	$222.00	—	94% above	50%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Hc Strep Scn Poc	$111.00	$222.00	—	94% above	50%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Hc Strep Gp A Ag Immunoassay	$111.00	$222.00	—	—	50%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Hc Strep Scn Poc	$111.00	$222.00	—	—	50%
Renin blood test CPT 84244 Hc Renin	$85.50	$171.00	—	at median	50%
Renin blood test inpatient CPT 84244 Hc Renin	$85.50	$171.00	—	—	50%
Rh blood typing CPT 86901 Hc Blood Type Rh	$17.50	$35.00	—	53% below	50%
Rh blood typing CPT 86901 Hc Blood Type Rh (Arc)	$29.00	$58.00	—	22% below	50%
Rh blood typing inpatient CPT 86901 Hc Blood Type Rh	$17.50	$35.00	—	—	50%
Rh blood typing inpatient CPT 86901 Hc Blood Type Rh (Arc)	$29.00	$58.00	—	—	50%
Rheumatoid factor (RF) test CPT 86431 Hc Ra Quant	$38.00	$76.00	—	15% above	50%
Rheumatoid factor (RF) test inpatient CPT 86431 Hc Ra Quant	$38.00	$76.00	—	—	50%
Rubella antibody test (immunity check) CPT 86762 Hc Rubella Ab	$66.00	$132.00	—	34% above	50%
Rubella antibody test (immunity check) inpatient CPT 86762 Hc Rubella Ab	$66.00	$132.00	—	—	50%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Hc Rbc Sed Rate Automated	$30.00	$60.00	—	21% below	50%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Hc Rbc Sed Rate Automated	$30.00	$60.00	—	—	50%
Sodium blood test CPT 84295 Hc Sodium Blood	$25.00	$50.00	—	8% below	50%
Sodium blood test CPT 84295 Hc Sodium I-Stat	$72.50	$145.00	—	167% above	50%
Sodium blood test inpatient CPT 84295 Hc Sodium Blood	$25.00	$50.00	—	—	50%
Sodium blood test inpatient CPT 84295 Hc Sodium I-Stat	$72.50	$145.00	—	—	50%
Stool ova and parasites exam CPT 87177 Hc O&P Dir Sm Conc & Id	$68.50	$137.00	—	73% above	50%
Stool ova and parasites exam inpatient CPT 87177 Hc O&P Dir Sm Conc & Id	$68.50	$137.00	—	—	50%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Hc Fecal Ob Immunoassay	$81.50	$163.00	—	52% above	50%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Hc Fecal Ob Immunoassay	$81.50	$163.00	—	—	50%
Syphilis antibody test (Treponema pallidum) CPT 86780 Hc Treponema Ab	$66.00	$132.00	—	14% above	50%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Hc Treponema Ab	$66.00	$132.00	—	—	50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Hc Syphilis Test Qual	$28.50	$57.00	—	19% above	50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Hc Syphilis Test Qual	$28.50	$57.00	—	—	50%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Hc Tb Test Interferon	$255.50	$511.00	—	118% above	50%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Hc Tb Test Interferon	$255.50	$511.00	—	—	50%
Testosterone blood test, total (not free testosterone) CPT 84403 Hc Testosterone Total	$102.50	$205.00	—	11% above	50%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Hc Testosterone Total	$102.50	$205.00	—	—	50%
Thyroid peroxidase (TPO) antibody test CPT 86376 Hc Microsomal Ab	$66.00	$132.00	—	2% above	50%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Hc Microsomal Ab	$66.00	$132.00	—	—	50%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Hc Tsh	$68.00	$136.00	—	10% below	50%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Hc Tsh	$68.00	$136.00	—	—	50%
Total IgE blood test CPT 82785 Hc Ige	$68.00	$136.00	—	10% above	50%
Total IgE blood test inpatient CPT 82785 Hc Ige	$68.00	$136.00	—	—	50%
Total cholesterol blood test CPT 82465 Hc Cholesterol Total	$25.00	$50.00	—	32% below	50%
Total cholesterol blood test inpatient CPT 82465 Hc Cholesterol Total	$25.00	$50.00	—	—	50%
Total thyroxine (T4) blood test CPT 84436 Hc Thyroxin T4 Total	$36.00	$72.00	—	14% below	50%
Total thyroxine (T4) blood test inpatient CPT 84436 Hc Thyroxin T4 Total	$36.00	$72.00	—	—	50%
Total triiodothyronine (T3) blood test CPT 84480 Hc T3 Total	$59.50	$119.00	—	1% below	50%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Hc T3 Total	$59.50	$119.00	—	—	50%
Transferrin blood test CPT 84466 Hc Transferrin	$59.50	$119.00	—	20% below	50%
Transferrin blood test inpatient CPT 84466 Hc Transferrin	$59.50	$119.00	—	—	50%
Trichomonas test (NAAT) CPT 87661 Hc Trich Vag Dna/Rna Amp Probe	$234.50	$469.00	—	171% above	50%
Trichomonas test (NAAT) inpatient CPT 87661 Hc Trich Vag Dna/Rna Amp Probe	$234.50	$469.00	—	—	50%
Triglycerides blood test CPT 84478 Hc Triglycerides	$34.00	$68.00	—	1% below	50%
Triglycerides blood test inpatient CPT 84478 Hc Triglycerides	$34.00	$68.00	—	—	50%
Troponin test, quantitative CPT 84484 Hc Troponin Quant	$51.50	$103.00	—	39% below	50%
Troponin test, quantitative inpatient CPT 84484 Hc Troponin Quant	$51.50	$103.00	—	—	50%
Uric acid blood test CPT 84550 Hc Uric Acid Blood	$25.00	$50.00	—	29% below	50%
Uric acid blood test inpatient CPT 84550 Hc Uric Acid Blood	$25.00	$50.00	—	—	50%
Urinalysis with microscope exam, automated CPT 81001 Hc Urinalysis W/Microscop Auto	$29.50	$59.00	—	9% above	50%
Urinalysis with microscope exam, automated inpatient CPT 81001 Hc Urinalysis W/Microscop Auto	$29.50	$59.00	—	—	50%
Urinalysis with microscope exam, manual CPT 81000 Hc Urinalysis W/Microscop Non-Auto	$51.00	$102.00	—	180% above	50%
Urinalysis with microscope exam, manual inpatient CPT 81000 Hc Urinalysis W/Microscop Non-Auto	$51.00	$102.00	—	—	50%
Urinalysis without microscope exam, automated CPT 81003 Hc Urinalysis W/O Microscop Auto	$20.00	$40.00	—	15% below	50%
Urinalysis without microscope exam, automated inpatient CPT 81003 Hc Urinalysis W/O Microscop Auto	$20.00	$40.00	—	—	50%
Urinalysis without microscope exam, manual CPT 81002 Hc Urinalysis Poc	$29.50	$59.00	—	82% above	50%
Urinalysis without microscope exam, manual CPT 81002 Hc Urinalysis W/O Microscop Non-Auto	$29.50	$59.00	—	82% above	50%
Urinalysis without microscope exam, manual inpatient CPT 81002 Hc Urinalysis W/O Microscop Non-Auto	$29.50	$59.00	—	—	50%
Urinalysis without microscope exam, manual inpatient CPT 81002 Hc Urinalysis Poc	$29.50	$59.00	—	—	50%
Urine culture for bacteria, with colony count CPT 87086 Hc Cult Urine W/ Qnt Col Cnt	$68.50	$137.00	—	20% above	50%
Urine culture for bacteria, with colony count inpatient CPT 87086 Hc Cult Urine W/ Qnt Col Cnt	$68.50	$137.00	—	—	50%
Urine microalbumin (albumin) test CPT 82043 Hc Microalbum,24Hr Ua Quant	$34.00	$68.00	—	33% below	50%
Urine microalbumin (albumin) test inpatient CPT 82043 Hc Microalbum,24Hr Ua Quant	$34.00	$68.00	—	—	50%
Vitamin B12 (cobalamin) blood test CPT 82607 Hc Vitamin B12	$68.00	$136.00	—	9% below	50%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Hc Vitamin B12	$68.00	$136.00	—	—	50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Hc Vit D 25-Hydroxy	$112.00	$224.00	—	19% above	50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Hc Vit D 25-Hydroxy	$112.00	$224.00	—	—	50%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Hc Vit D 1 25 Dihydroxy	$154.00	$308.00	—	at median	50%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Hc Vit D 1 25 Dihydroxy	$154.00	$308.00	—	—	50%
Zinc blood test CPT 84630 Hc Zinc	$51.50	$103.00	—	at median	50%
Zinc blood test inpatient CPT 84630 Hc Zinc	$51.50	$103.00	—	—	50%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hc Hcg Quant	$68.00	$136.00	—	1% above	50%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hc Hcg Quant	$68.00	$136.00	—	—	50%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Botox injections for chronic migraine CPT 64615 Hc Dest Nerve Face, Trig, C Spine, Bil Migr	$409.00	$818.00	—	26% below	50%
Botox injections for chronic migraine inpatient CPT 64615 Hc Dest Nerve Face, Trig, C Spine, Bil Migr	$409.00	$818.00	—	—	50%
Cardiac catheterization with coronary angiogram CPT 93458 Hc Cath Lc W/ Coronary Angio	$4,682.00	$9,364.00	—	61% below	50%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 Hc Cath Lc W/ Coronary Angio	$4,682.00	$9,364.00	—	—	50%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Hc Cardioversion Electrical	$1,078.00	$2,156.00	—	48% below	50%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Hc Cardioversion Electrical	$1,078.00	$2,156.00	—	—	50%
Circumcision, surgical, older than a newborn CPT 54160 Hc Circumcision Routine	$341.50	$683.00	—	83% below	50%
Circumcision, surgical, older than a newborn inpatient CPT 54160 Hc Circumcision Routine	$341.50	$683.00	—	—	50%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 Hc Paravertebral L/S Facet Bilateral	$1,269.00	$2,538.00	—	—	50%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 Hc Kx Paravertebral L/S Facet Bilateral	$1,269.00	$2,538.00	—	—	50%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 Hc Kx Paravertebral L/S Facet Lt	$1,027.00	$2,054.00	—	53% below	50%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 Hc Paravertebral L/S Facet Lt	$1,027.00	$2,054.00	—	53% below	50%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 Hc Paravertebral L/S Facet Rt	$1,027.00	$2,054.00	—	53% below	50%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 Hc Kx Paravertebral L/S Facet Rt	$1,027.00	$2,054.00	—	53% below	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 Hc Paravertebral L/S Facet Bilateral	$1,269.00	$2,538.00	—	—	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 Hc Kx Paravertebral L/S Facet Bilateral	$1,269.00	$2,538.00	—	—	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 Hc Paravertebral L/S Facet Lt	$1,027.00	$2,054.00	—	—	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 Hc Kx Paravertebral L/S Facet Lt	$1,027.00	$2,054.00	—	—	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 Hc Kx Paravertebral L/S Facet Rt	$1,027.00	$2,054.00	—	—	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 Hc Paravertebral L/S Facet Rt	$1,027.00	$2,054.00	—	—	50%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Hc Inj Hysterosalpingogram	$385.50	$771.00	—	1% above	50%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Hc Inj Hysterosalpingogram	$385.50	$771.00	—	—	50%
Incision and drainage of a simple or single skin abscess CPT 10060 Hc I&D Absc; Smpl Or Sgl	$239.50	$479.00	—	38% below	50%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Hc I&D Absc; Smpl Or Sgl	$239.50	$479.00	—	—	50%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Hc Inject Tendon/Ligament/Cyst	$329.50	$659.00	—	3% below	50%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Hc Inject Tendon/Ligament/Cyst	$329.50	$659.00	—	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 Hc Drain/Inject Joint/Bursa Bilateral	$409.00	$818.00	—	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Hc Drain/Inject Joint/Bursa Lg Bil Clinic	$409.00	$818.00	—	41% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Hc Arthrocentesis/Asp/Inj Maj Jnt	$544.00	$1,088.00	—	22% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Hc Drain/Inject Joint/Bursa Rt Slg	$329.50	$659.00	—	53% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Hc Drain/Inject Joint/Bursa Rt Lg Clinic	$329.50	$659.00	—	53% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Hc Drain/Inject Joint/Bursa Lt Lg Clinic	$329.50	$659.00	—	53% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Hc Drain/Inject Joint/Bursa Lt Slg	$329.50	$659.00	—	53% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient both sides CPT 20610 Hc Drain/Inject Joint/Bursa Bilateral	$409.00	$818.00	—	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Hc Drain/Inject Joint/Bursa Lg Bil Clinic	$409.00	$818.00	—	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Hc Arthrocentesis/Asp/Inj Maj Jnt	$544.00	$1,088.00	—	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Hc Drain/Inject Joint/Bursa Rt Lg Clinic	$329.50	$659.00	—	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Hc Drain/Inject Joint/Bursa Lt Slg	$329.50	$659.00	—	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Hc Drain/Inject Joint/Bursa Rt Slg	$329.50	$659.00	—	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Hc Drain/Inject Joint/Bursa Lt Lg Clinic	$329.50	$659.00	—	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/O Us	$343.50	$687.00	—	44% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 Hc Drain/Inject Joint/Bursa Rt Med Clinic	$329.50	$659.00	—	47% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 Hc Drain/Inject Joint/Bursa Rt Med	$329.50	$659.00	—	47% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 Hc Drain/Inject Joint/Bursa Lt Med Clinic	$329.50	$659.00	—	47% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 Hc Drain/Inject Joint/Bursa Lt Med	$329.50	$659.00	—	47% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/O Us	$343.50	$687.00	—	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 Hc Drain/Inject Joint/Bursa Rt Med Clinic	$329.50	$659.00	—	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 Hc Drain/Inject Joint/Bursa Rt Med	$329.50	$659.00	—	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 Hc Drain/Inject Joint/Bursa Lt Med Clinic	$329.50	$659.00	—	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 Hc Drain/Inject Joint/Bursa Lt Med	$329.50	$659.00	—	—	50%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Hc Arthrocentesis Aspir&/Inj Small Jt/Bursa W/O Us	$405.00	$810.00	—	18% below	50%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Hc Drain/Inject Joint/Bursa Bil Sm Clinic	$414.00	$828.00	—	16% below	50%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 Hc Drain/Inject Joint/Bursa Rt Sm Clinic	$329.50	$659.00	—	33% below	50%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 Hc Drain/Inject Joint/Bursa Lt Sm	$329.50	$659.00	—	33% below	50%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 Hc Drain/Inject Joint/Bursa Lt Sm Clinic	$329.50	$659.00	—	33% below	50%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Hc Arthrocentesis Aspir&/Inj Small Jt/Bursa W/O Us	$405.00	$810.00	—	—	50%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Hc Drain/Inject Joint/Bursa Bil Sm Clinic	$414.00	$828.00	—	—	50%
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 Hc Drain/Inject Joint/Bursa Lt Sm	$329.50	$659.00	—	—	50%
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 Hc Drain/Inject Joint/Bursa Lt Sm Clinic	$329.50	$659.00	—	—	50%
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 Hc Drain/Inject Joint/Bursa Rt Sm Clinic	$329.50	$659.00	—	—	50%
Lower-back epidural injection, with imaging guidance CPT 62323 Hc Inject Spine L/S (Cd)	$794.50	$1,589.00	—	61% below	50%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Hc Inject Spine L/S (Cd)	$794.50	$1,589.00	—	—	50%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 Hc Foramen Epid Inj L/S Bilat	$1,269.00	$2,538.00	—	—	50%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 Hc Foramen Epidural Inj L/S Lt	$1,027.00	$2,054.00	—	50% below	50%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 Hc Foramen Epidural Inj L/S Rt	$1,027.00	$2,054.00	—	50% below	50%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 Hc Foramen Epid Inj L/S Bilat	$1,269.00	$2,538.00	—	—	50%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 Hc Foramen Epidural Inj L/S Rt	$1,027.00	$2,054.00	—	—	50%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 Hc Foramen Epidural Inj L/S Lt	$1,027.00	$2,054.00	—	—	50%
Occipital nerve block (injection for headaches) both sides CPT 64405 Hc Nerve Block Inj Occipital Bilat	$409.00	$818.00	—	—	50%
Occipital nerve block (injection for headaches) CPT 64405 Hc Nerve Block Inj Occipital Bil Clinic	$409.00	$818.00	—	48% below	50%
Occipital nerve block (injection for headaches) one side CPT 64405 Hc Nerve Block Inj Occipital Rt Clinic	$329.50	$659.00	—	58% below	50%
Occipital nerve block (injection for headaches) one side CPT 64405 Hc Nerve Block Inj Occipital Lt	$329.50	$659.00	—	58% below	50%
Occipital nerve block (injection for headaches) one side CPT 64405 Hc Nerve Block Inj Occipital Lt Clinic	$329.50	$659.00	—	58% below	50%
Occipital nerve block (injection for headaches) inpatient both sides CPT 64405 Hc Nerve Block Inj Occipital Bilat	$409.00	$818.00	—	—	50%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Hc Nerve Block Inj Occipital Bil Clinic	$409.00	$818.00	—	—	50%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 Hc Nerve Block Inj Occipital Lt	$329.50	$659.00	—	—	50%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 Hc Nerve Block Inj Occipital Lt Clinic	$329.50	$659.00	—	—	50%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 Hc Nerve Block Inj Occipital Rt Clinic	$329.50	$659.00	—	—	50%
Pacemaker implant (dual chamber) CPT 33208 Hc Pacemaker Implant Dual A & V	$16,845.00	$33,690.00	—	8% above	50%
Pacemaker implant (dual chamber) inpatient CPT 33208 Hc Pacemaker Implant Dual A & V	$16,845.00	$33,690.00	—	—	50%
Paracentesis with imaging guidance CPT 49083 Hc Abd Paracentesis W/Imaging	$1,157.50	$2,315.00	—	33% below	50%
Paracentesis with imaging guidance inpatient CPT 49083 Hc Abd Paracentesis W/Imaging	$1,157.50	$2,315.00	—	—	50%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Hc Destroy Paravert Nrvs L/S Bil	$2,955.00	$5,910.00	—	11% below	50%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 Hc Destroy Paravertebral Nrv Lt L/S	$2,407.00	$4,814.00	—	28% below	50%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 Hc Destroy Paravertebral Nrv Rt L/S	$2,407.00	$4,814.00	—	28% below	50%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Hc Destroy Paravert Nrvs L/S Bil	$2,955.00	$5,910.00	—	—	50%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient one side CPT 64635 Hc Destroy Paravertebral Nrv Lt L/S	$2,407.00	$4,814.00	—	—	50%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient one side CPT 64635 Hc Destroy Paravertebral Nrv Rt L/S	$2,407.00	$4,814.00	—	—	50%
Skin biopsy, punch, one lesion CPT 11104 Hc Punch Bx Skin Single Lesion	$437.00	$874.00	—	2% below	50%
Skin biopsy, punch, one lesion inpatient CPT 11104 Hc Punch Bx Skin Single Lesion	$437.00	$874.00	—	—	50%
Thoracentesis with imaging guidance CPT 32555 Hc Thoracentesis W/ Imaging	$1,083.00	$2,166.00	—	38% below	50%
Thoracentesis with imaging guidance inpatient CPT 32555 Hc Thoracentesis W/ Imaging	$1,083.00	$2,166.00	—	—	50%
Trigger point injections, 1 or 2 muscles CPT 20552 Hc Inject Trigger Point 1-2 Mus Group Clinic	$329.50	$659.00	—	53% below	50%
Trigger point injections, 1 or 2 muscles CPT 20552 Hc Inject Trigger Point 1-2 Mus Group	$329.50	$659.00	—	53% below	50%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Hc Inject Trigger Point 1-2 Mus Group	$329.50	$659.00	—	—	50%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Hc Inject Trigger Point 1-2 Mus Group Clinic	$329.50	$659.00	—	—	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Hc Bx Breast Plcmnt Dev 1St Lesion Us Imag	$3,123.50	$6,247.00	—	6% below	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Hc Bx Breast Plcmnt Dev 1St Lesion Us Imag	$3,123.50	$6,247.00	—	—	50%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Hc Deb Subq Tissue 20 Sq Cm/<	$437.00	$874.00	—	44% below	50%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Hc Deb Subq Tissue 20 Sq Cm/<	$437.00	$874.00	—	—	50%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Hc Blood Transfusion	$794.50	$1,589.00	—	28% below	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Hc Blood Transfusion	$794.50	$1,589.00	—	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Metered Dose Inhaler	$56.00	$112.00	—	68% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hc Drug Aerosol	$241.50	$483.00	—	38% above	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Metered Dose Inhaler	$56.00	$112.00	—	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hc Drug Aerosol	$241.50	$483.00	—	—	50%
Chemotherapy IV infusion, first hour CPT 96413 Hc Chemo Infus Init 16-60 Min	$379.00	$758.00	—	51% below	50%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Hc Chemo Infus Init 16-60 Min	$379.00	$758.00	—	—	50%
Critical care, first 30 to 74 minutes CPT 99291 Hc Ed Critical Care:Init 30-74 Mn	$1,597.00	$3,194.00	—	46% below	50%
Critical care, first 30 to 74 minutes CPT 99291 Hc Critical Team Response>30 Min	$1,761.00	$3,522.00	—	40% below	50%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Hc Ed Critical Care:Init 30-74 Mn	$1,597.00	$3,194.00	—	—	50%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Hc Critical Team Response>30 Min	$1,761.00	$3,522.00	—	—	50%
EEG (brain wave test), awake and drowsy, routine CPT 95816 Hc Eeg Awake & Drowsy	$581.00	$1,162.00	—	39% below	50%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Hc Eeg Awake & Drowsy	$581.00	$1,162.00	—	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Hc Electrocardiogram	$120.50	$241.00	—	35% below	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Hc Electrocardiogram	$120.50	$241.00	—	—	50%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Hc Ed Level 1	$161.50	$323.00	—	48% below	50%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Hc Ed Level 1	$161.50	$323.00	—	—	50%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Hc Ed Level 2	$290.00	$580.00	—	43% below	50%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Hc Ed Level 2	$290.00	$580.00	—	—	50%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Hc Ed Level 3	$508.00	$1,016.00	—	40% below	50%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Hc Ed Level 3	$508.00	$1,016.00	—	—	50%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Hc Ed Level 4	$790.00	$1,580.00	—	41% below	50%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Hc Ed Level 4	$790.00	$1,580.00	—	—	50%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Hc Ed Level 5	$1,210.00	$2,420.00	—	30% below	50%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Hc Critical Team Response<30 Min	$1,447.00	$2,894.00	—	17% below	50%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Hc Ed Level 5	$1,210.00	$2,420.00	—	—	50%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Hc Critical Team Response<30 Min	$1,447.00	$2,894.00	—	—	50%
Exercise stress test, tracing only, the hospital charge CPT 93017 Hc Ekg Stress Test	$581.00	$1,162.00	—	35% below	50%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Hc Ekg Stress Test	$581.00	$1,162.00	—	—	50%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hc Iv Inf Hyd Init 31-60 Mins	$338.00	$676.00	—	19% below	50%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hc Ed Iv Inf Hyd Init 31-60 Mins	$338.00	$676.00	—	19% below	50%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hc Iv Inf Hyd Init 31-60 Mins	$338.00	$676.00	—	—	50%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hc Ed Iv Inf Hyd Init 31-60 Mins	$338.00	$676.00	—	—	50%
IV infusion of a medicine, first hour CPT 96365 Hc Ed Iv Inf Ther Init 16-60 Mins	$338.00	$676.00	—	22% below	50%
IV infusion of a medicine, first hour CPT 96365 Hc Iv Inf Ther Init 16-60 Mins	$338.00	$676.00	—	22% below	50%
IV infusion of a medicine, first hour inpatient CPT 96365 Hc Ed Iv Inf Ther Init 16-60 Mins	$338.00	$676.00	—	—	50%
IV infusion of a medicine, first hour inpatient CPT 96365 Hc Iv Inf Ther Init 16-60 Mins	$338.00	$676.00	—	—	50%
IV push of a medicine, first drug CPT 96374 Hc Ed Iv Push Initial	$338.00	$676.00	—	32% above	50%
IV push of a medicine, first drug CPT 96374 Hc Iv Push Initial	$338.00	$676.00	—	32% above	50%
IV push of a medicine, first drug inpatient CPT 96374 Hc Ed Iv Push Initial	$338.00	$676.00	—	—	50%
IV push of a medicine, first drug inpatient CPT 96374 Hc Iv Push Initial	$338.00	$676.00	—	—	50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Hc Ed Sq/Im Injection	$110.50	$221.00	—	22% below	50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Hc Sq/Im Injection	$110.50	$221.00	—	22% below	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Hc Ed Sq/Im Injection	$110.50	$221.00	—	—	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Hc Sq/Im Injection	$110.50	$221.00	—	—	50%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Hc Ind Psych Eval	$185.00	$370.00	—	41% below	50%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Hc Ind Psych Eval	$185.00	$370.00	—	—	50%
New patient office visit, about 30 minutes CPT 99203 Hc Office/Outpatient Visit New Tech	$38.00	$76.00	—	65% below	50%
New patient office visit, about 30 minutes inpatient CPT 99203 Hc Office/Outpatient Visit New Tech	$38.00	$76.00	—	—	50%
New patient office visit, about 45 minutes CPT 99204 Hc Office/Outpatient Visit New Tech	$53.50	$107.00	—	56% below	50%
New patient office visit, about 45 minutes inpatient CPT 99204 Hc Office/Outpatient Visit New Tech	$53.50	$107.00	—	—	50%
New patient office visit, about 60 minutes CPT 99205 Hc Office/Outpatient Visit New Tech	$70.50	$141.00	—	59% below	50%
New patient office visit, about 60 minutes inpatient CPT 99205 Hc Office/Outpatient Visit New Tech	$70.50	$141.00	—	—	50%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Hc Office/Outpatient Visit New Tech	$26.50	$53.00	—	74% below	50%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Hc Office/Outpatient Visit New Tech	$26.50	$53.00	—	—	50%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Hc Massage Manual Thpy 15Min	$21.00	$42.00	—	81% below	50%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Hc Massage Manual Thpy 15Min	$21.00	$42.00	—	—	50%
Psychotherapy session, 30 minutes CPT 90832 Hc Ind Psych 30Min	$185.00	$370.00	—	2% below	50%
Psychotherapy session, 30 minutes inpatient CPT 90832 Hc Ind Psych 30Min	$185.00	$370.00	—	—	50%
Psychotherapy session, 45 minutes CPT 90834 Hc Ind Psych 45Min	$185.00	$370.00	—	31% below	50%
Psychotherapy session, 45 minutes inpatient CPT 90834 Hc Ind Psych 45Min	$185.00	$370.00	—	—	50%
Psychotherapy session, 60 minutes CPT 90837 Hc Ind Psych 60Min	$185.00	$370.00	—	41% below	50%
Psychotherapy session, 60 minutes inpatient CPT 90837 Hc Ind Psych 60Min	$185.00	$370.00	—	—	50%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Hc Office/Outpatient Visit Est Tech	$47.00	$94.00	—	72% below	50%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Hc Office/Outpatient Visit Est Tech	$47.00	$94.00	—	—	50%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Hc Office/Outpatient Visit Est Tech	$23.50	$47.00	—	80% below	50%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Hc Office/Outpatient Visit Est Tech	$23.50	$47.00	—	—	50%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Hc Office/Outpatient Visit Est Tech	$34.00	$68.00	—	75% below	50%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Hc Office/Outpatient Visit Est Tech	$34.00	$68.00	—	—	50%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Hc Office/Outpatient Visit Est Tech	$15.50	$31.00	—	85% below	50%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Hc Office/Outpatient Visit Est Tech	$15.50	$31.00	—	—	50%
Specialist consultation, low complexity or 30+ minutes CPT 99243 Hc Office Consultation Tech	$64.50	$129.00	—	41% below	50%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Hc Office Consultation Tech	$64.50	$129.00	—	—	50%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Hc Office Consultation Tech	$65.50	$131.00	—	56% below	50%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Hc Office Consultation Tech	$65.50	$131.00	—	—	50%
Spirometry (breathing test) CPT 94010 Hc Flow Volume Loop	$204.00	$408.00	—	34% below	50%
Spirometry (breathing test) CPT 94010 Hc Pft Spirometry	$204.00	$408.00	—	34% below	50%
Spirometry (breathing test) inpatient CPT 94010 Hc Pft Spirometry	$204.00	$408.00	—	—	50%
Spirometry (breathing test) inpatient CPT 94010 Hc Flow Volume Loop	$204.00	$408.00	—	—	50%
Spirometry before and after a bronchodilator CPT 94060 Hc Bronchospasm Eval; Spirometry	$387.00	$774.00	—	32% below	50%
Spirometry before and after a bronchodilator inpatient CPT 94060 Hc Bronchospasm Eval; Spirometry	$387.00	$774.00	—	—	50%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Hc Therapeutic Phlebotomy	$228.00	$456.00	—	4% below	50%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Hc Therapeutic Phlebotomy	$228.00	$456.00	—	—	50%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACC LIVE (PF) 1350 UNIT/0.5 ML SUBQ SUSR	$289.88	$579.76	—	22% below	50%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACC LIVE (PF) 1350 UNIT/0.5 ML SUBQ SUSR	$289.88	$579.76	—	—	50%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DIPH,PERTUS(ACEL),TET,POL (PF) 15 LF-48 MCG- 5 LF UNIT/0.5ML IM SUSP	$105.90	$211.79	—	18% below	50%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DIPH,PERTUS(ACEL),TET,POL (PF) 15 LF-48 MCG- 5 LF UNIT/0.5ML IM SUSP	$105.90	$211.79	—	—	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH,PERTUS(ACEL),TET PED (PF) 25-58-10 LF-MCG-LF/0.5ML IM SUSP	$38.23	$76.46	—	41% below	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH,PERTUS(ACEL),TET PED (PF) 25-58-10 LF-MCG-LF/0.5ML IM SYRG	$41.78	$83.56	—	36% below	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPH,PERTUS(ACEL),TET PED (PF) 25-58-10 LF-MCG-LF/0.5ML IM SUSP	$38.23	$76.46	—	—	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPH,PERTUS(ACEL),TET PED (PF) 25-58-10 LF-MCG-LF/0.5ML IM SYRG	$41.78	$83.56	—	—	50%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HEP B-DP(A)T-POLIO VAC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRG	$117.44	$234.89	—	40% below	50%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HEP B-DP(A)T-POLIO VAC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRG	$117.44	$234.89	—	—	50%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACC TS2024-25 6MOS UP(PF) 45 MCG (15 MCG X 3)/0.5 ML IM SYRG	$28.55	$57.10	—	38% below	50%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACC TS2024-25 6MOS UP(PF) 45 MCG (15 MCG X 3)/0.5 ML IM SYRG	$28.55	$57.10	—	—	50%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SUSP	$371.88	$743.76	—	28% below	50%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SYRG	$422.39	$844.78	—	19% below	50%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SUSP	$371.88	$743.76	—	—	50%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SYRG	$422.39	$844.78	—	—	50%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEPATITIS A AND B VACCINE (PF) 720 ELISA UNIT- 20 MCG/ML IM SYRG	$176.73	$353.46	—	42% below	50%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEPATITIS A AND B VACCINE (PF) 720 ELISA UNIT- 20 MCG/ML IM SYRG	$176.73	$353.46	—	—	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRG	$53.22	$106.45	—	41% below	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRG	$53.22	$106.45	—	—	50%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACC.REC(PF) 20 MCG/ML IM SYRG	$83.36	$166.73	—	47% below	50%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACC.REC(PF) 20 MCG/ML IM SYRG	$83.36	$166.73	—	—	50%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPATITIS B VACC-CPG 1018 (PF) 20 MCG/0.5 ML IM SYRG	$213.14	$426.28	—	3% below	50%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEPATITIS B VACC-CPG 1018 (PF) 20 MCG/0.5 ML IM SYRG	$213.14	$426.28	—	—	50%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPH B POLY CONJ-TET TOX-PF 10 MCG/0.5 ML IM SOLR	$23.74	$47.49	—	22% below	50%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPH B POLY CONJ-TET TOX-PF 10 MCG/0.5 ML IM SOLR	$23.74	$47.49	—	—	50%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACC TS2024-25(65YR UP)-PF 180 MCG/0.5 ML IM SYRG	$98.36	$196.73	—	5% below	50%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VACC TS2024-25(65YR UP)-PF 180 MCG/0.5 ML IM SYRG	$98.36	$196.73	—	—	50%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR	$156.04	$312.09	—	25% below	50%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR	$156.04	$312.09	—	—	50%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENING VAC A,C,Y,W135 DIP (PF) 10-5 MCG/0.5 ML IM KIT	$180.54	$361.07	—	43% below	50%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENIN C,Y,W-135 VAC,1 OF 2(PF) 5 MCG X 3/ 0.5 ML (FINAL) IM SOLR	$187.11	$374.22	—	41% below	50%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENING VAC A,C,Y,W135 DIP (PF) 10-5 MCG/0.5 ML IM KIT	$180.54	$361.07	—	—	50%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENIN C,Y,W-135 VAC,1 OF 2(PF) 5 MCG X 3/ 0.5 ML (FINAL) IM SOLR	$187.11	$374.22	—	—	50%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B VACCINE,4-COMP 50-50-50-25 MCG/0.5 ML IM SYRG	$274.00	$548.01	—	50% below	50%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B VACCINE,4-COMP 50-50-50-25 MCG/0.5 ML IM SYRG	$274.00	$548.01	—	—	50%
Mpox and smallpox vaccine (Jynneos), 2-dose schedule CPT 90611 SMALLPOX,MPOX LIVE VACCINE(PF) 0.5X TO 3.95X 10EXP8 UNIT/0.5 SUBQ SUSP	$236.25	$472.50	—	54% below	50%
Mpox and smallpox vaccine (Jynneos), 2-dose schedule inpatient CPT 90611 SMALLPOX,MPOX LIVE VACCINE(PF) 0.5X TO 3.95X 10EXP8 UNIT/0.5 SUBQ SUSP	$236.25	$472.50	—	—	50%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG	$332.48	$664.97	—	24% below	50%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG	$332.48	$664.97	—	—	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOC 20-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG	$354.18	$708.36	—	46% below	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOC 20-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG	$354.18	$708.36	—	—	50%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG	$185.18	$370.35	—	33% below	50%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG	$185.18	$370.35	—	—	50%
Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP	$613.84	$1,227.69	—	865% above	50%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP	$613.84	$1,227.69	—	—	50%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 NIRSEVIMAB-ALIP 100 MG/ML IM SYRG	$771.18	$1,542.35	—	26% below	50%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 NIRSEVIMAB-ALIP 100 MG/ML IM SYRG	$771.18	$1,542.35	—	—	50%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5 ML IM SYRG	$771.18	$1,542.35	—	43% below	50%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5 ML IM SYRG	$771.18	$1,542.35	—	—	50%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE S.O.	$461.11	$922.22	—	52% below	50%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE S.O.	$461.11	$922.22	—	—	50%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 VARICELLA-ZOSTER GE-AS01B (PF) 50 MCG/0.5 ML IM SUSR	$275.74	$551.49	—	45% below	50%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 VARICELLA-ZOSTER GE VAC,2 OF 2 50 MCG IM SUSR	$300.08	$600.16	—	40% below	50%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 VARICELLA-ZOSTER GE-AS01B (PF) 50 MCG/0.5 ML IM SUSR	$275.74	$551.49	—	—	50%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 VARICELLA-ZOSTER GE VAC,2 OF 2 50 MCG IM SUSR	$300.08	$600.16	—	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG	$67.59	$135.18	—	25% below	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG	$67.59	$135.18	—	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG S.O.	$66.21	$132.42	—	40% below	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH,PERTUS(ACELL),TETANUS 2.5-8-5 LF-MCG-LF/0.5ML IM SYRG	$68.30	$136.59	—	38% below	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG S.O.	$66.21	$132.42	—	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTH,PERTUS(ACELL),TETANUS 2.5-8-5 LF-MCG-LF/0.5ML IM SYRG	$68.30	$136.59	—	—	50%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML IM SYRG	$227.59	$455.18	—	21% below	50%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML IM SYRG	$227.59	$455.18	—	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Hc Immunization Admin- 1 Vac	$110.50	$221.00	—	172% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Hc Immunization Admin- 1 Vac	$110.50	$221.00	—	—	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Hc Immun Admin Ea Add	$110.50	$221.00	—	218% above	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Hc Immun Admin Ea Add	$110.50	$221.00	—	—	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.parkview.com/-/media/parkview-media/file/price-transparency/341048666_parkview-montpelier-hospital_standardcharges.ashx