Hospital Rochester, NY

The Unity Hospital of Rochester

The Unity Hospital of Rochester in Rochester, NY publishes cash prices for 444 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the New York median for 339 of 442 procedures and below it for 94. By typical cash price it ranks #70 of 115 New York hospitals and #8 of 10 hospitals in the Rochester, NY area, cheapest first. Select a procedure to compare it with other hospitals nearby.

1555 Long Pond Road, Rochester, NY 14626 Collected Sep 23, 2026 Source price file Check a bill from this hospital (585) 723-7000

Acute care hospital Nonprofit hospital Emergency department CMS star rating 2 of 5 CCN 330226 · CMS hospital register NPI 1760421713

Financial assistance

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

The Unity Hospital of Rochester 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

New York law (Public Health Law §2807-k(9-a), as amended in October 2024): uninsured patients with income below 200% of the federal poverty level owe nothing for emergency and medically necessary hospital care; up to 400% they pay on a sliding scale of at most 10% or 20% of what Medicaid would pay. Emergency care is covered for New York residents, other care for people living in the hospital's service area; immigration status does not count. Ask for the Uniform Hospital Financial Assistance form. Other states' laws.

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 1 action for a hospital named The Unity Hospital of Rochester in Rochester, NY:

Apr 14, 2025 Met requirements

Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs New York	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN WO _ W CONTRAST	$795.04	$993.80	—	40% below	20%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN WO _ W CONTRAST	$795.04	$993.80	—	—	20%
Abdominal X-ray, 2 views CPT 74019 HC XR ABDOMEN 2 VIEWS	$338.66	$423.33	—	32% above	20%
Abdominal X-ray, 2 views inpatient CPT 74019 HC XR ABDOMEN 2 VIEWS	$338.66	$423.33	—	—	20%
Ankle X-ray, complete, 3 or more views CPT 73610 HC XR ANKLE_ COMPLETE_ MIN 3 VIEWS	$248.30	$310.38	—	23% above	20%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC XR ANKLE_ COMPLETE_ MIN 3 VIEWS	$248.30	$310.38	—	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC LIMITED BILATERAL NON INVASIVE VASCULAR STUDY_ 1_2 LEVELS	$360.21	$450.26	—	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC LIMITED BILATERAL NON INVASIVE VASCULAR STUDY_ 1_2 LEVELS	$360.21	$450.26	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY WO CONTRAST	$456.76	$570.95	—	39% below	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREMITY WO CONTRAST	$456.76	$570.95	—	—	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY	$414.21	$517.76	—	21% above	20%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY	$414.21	$517.76	—	—	20%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NUC BONE AND_OR JOINT IMAGING_WHOLE BODY	$1,146.14	$1,432.67	—	16% above	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NUC BONE AND_OR JOINT IMAGING_WHOLE BODY	$1,146.14	$1,432.67	—	—	20%
Breast ultrasound, complete, one breast CPT 76641 HC US BREAST_ UNILATERAL_ REAL TIME W_IMAGE DOCUMENTATION_ COMPLETE	$456.76	$570.95	—	41% above	20%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST_ UNILATERAL_ REAL TIME W_IMAGE DOCUMENTATION_ COMPLETE	$456.76	$570.95	—	—	20%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST_ UNILATERAL_ REAL TIME W_IMAGE DOC INCLUDING AXILLA WHEN PERFORMED_ LIMITED	$238.91	$298.64	—	6% below	20%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST_ UNILATERAL_ REAL TIME W_IMAGE DOC INCLUDING AXILLA WHEN PERFORMED_ LIMITED	$238.91	$298.64	—	—	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CT ANGIOGRAPHY_ ABDOMEN AND PELVIS _ ADD	$856.32	$1,070.40	—	51% below	20%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CT ANGIOGRAPHY_ ABDOMEN AND PELVIS _ ADD	$856.32	$1,070.40	—	—	20%
CT angiography (CTA) of the head CPT 70496 HC CT ANGIOGRAPHY HEAD WO _ W CONTRAST	$795.04	$993.80	—	36% below	20%
CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIOGRAPHY HEAD WO _ W CONTRAST	$795.04	$993.80	—	—	20%
CT angiography (CTA) of the neck CPT 70498 HC CT ANGIOGRAPHY NECK WO _ W CONTRAST	$795.04	$993.80	—	36% below	20%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIOGRAPHY NECK WO _ W CONTRAST	$795.04	$993.80	—	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIOGRAPHY CHEST WO _ W CONTRAST	$795.04	$993.80	—	39% below	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIOGRAPHY CHEST WO _ W CONTRAST	$795.04	$993.80	—	—	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CT ANGIO HEART CORONARY ART _ BYPASS GRAFT W CONTST 3D POSTPRO	$446.09	$557.61	—	66% below	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CT ANGIO HEART CORONARY ART _ BYPASS GRAFT W CONTST 3D POSTPRO	$446.09	$557.61	—	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC COMPUTED TOMOGRAPHY_ ABD _ PELVIS_ WO CONTRAST	$852.69	$1,065.86	—	26% below	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC COMPUTED TOMOGRAPHY_ ABD _ PELVIS_ WO CONTRAST	$852.69	$1,065.86	—	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC COMPUTED TOMOGRAPHY_ ABD _ PELVIS_ W CONTRAST	$960.11	$1,200.14	—	39% below	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC COMPUTED TOMOGRAPHY_ ABD _ PELVIS_ W CONTRAST	$960.11	$1,200.14	—	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC COMPUTED TOMOGRAPHY_ ABD _PELVIS_ W _ WO CONTRAST IN ONE OR BOTH BODY REGIONS	$960.11	$1,200.14	—	54% below	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC COMPUTED TOMOGRAPHY_ ABD _PELVIS_ W _ WO CONTRAST IN ONE OR BOTH BODY REGIONS	$960.11	$1,200.14	—	—	20%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST	$795.04	$993.80	—	31% below	20%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W CONTRAST	$795.04	$993.80	—	—	20%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CONTRAST	$489.02	$611.28	—	46% below	20%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN WO CONTRAST	$489.02	$611.28	—	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST	$489.02	$611.28	—	38% below	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST	$489.02	$611.28	—	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD_BRAIN WO CONTRAST	$489.02	$611.28	—	41% below	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD_BRAIN WO CONTRAST	$489.02	$611.28	—	—	20%
CT scan of the head with contrast CPT 70460 HC CT HEAD_BRAIN W CONTRAST	$795.04	$993.80	—	19% below	20%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD_BRAIN W CONTRAST	$795.04	$993.80	—	—	20%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD OR BRAIN WO _ W CONTRAST	$795.04	$993.80	—	25% below	20%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD OR BRAIN WO _ W CONTRAST	$795.04	$993.80	—	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONTRAST	$489.02	$611.28	—	45% below	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE WO CONTRAST	$489.02	$611.28	—	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL SPINE WO CONTRAST	$489.02	$611.28	—	47% below	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT CERVICAL SPINE WO CONTRAST	$489.02	$611.28	—	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST	$795.04	$993.80	—	23% below	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST	$795.04	$993.80	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 HC US DUPLEX SCAN_EXTRACRANIAL ARTERIES_BILATERAL	$940.07	$1,175.09	—	45% above	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 HC US DUPLEX SCAN_EXTRACRANIAL ARTERIES_BILATERAL	$940.07	$1,175.09	—	—	20%
Chest CT scan without and with contrast CPT 71270 HC CT THORAX WO _ W CONTRAST	$795.04	$993.80	—	39% below	20%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT THORAX WO _ W CONTRAST	$795.04	$993.80	—	—	20%
Chest X-ray, 2 views CPT 71046 HC XR CHEST 2 VIEWS	$248.30	$310.38	—	23% above	20%
Chest X-ray, 2 views inpatient CPT 71046 HC XR CHEST 2 VIEWS	$248.30	$310.38	—	—	20%
Chest X-ray, single view CPT 71045 HC XR CHEST SINGLE VIEW	$248.30	$310.38	—	25% above	20%
Chest X-ray, single view inpatient CPT 71045 HC XR CHEST SINGLE VIEW	$248.30	$310.38	—	—	20%
Collarbone (clavicle) X-ray, complete CPT 73000 HC XR CLAVICLE_ COMPLETE	$248.30	$310.38	—	23% above	20%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC XR CLAVICLE_ COMPLETE	$248.30	$310.38	—	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US ECHOGRAPHY_ RETROPERITONEAL_RENAL__ COMPLETE	$456.76	$570.95	—	8% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US ECHOGRAPHY_ RETROPERITONEAL_RENAL__ COMPLETE	$456.76	$570.95	—	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DXA BONE DENSITY STUDY 1_MORE SITES_AXIAL SKELETON	$338.66	$423.33	—	23% above	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DXA BONE DENSITY STUDY 1_MORE SITES_AXIAL SKELETON	$338.66	$423.33	—	—	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US PG UTERUS_FETAL ANATOMIC EXAM_SINGLE_1ST GESTATION	$796.06	$995.08	—	40% above	20%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US PG UTERUS_FETAL ANATOMIC EXAM_SINGLE_1ST GESTATION	$796.06	$995.08	—	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX WO CONTRAST	$489.02	$611.28	—	43% below	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX WO CONTRAST	$489.02	$611.28	—	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W CONTRAST	$795.04	$993.80	—	39% below	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX W CONTRAST	$795.04	$993.80	—	—	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUPLEX SCAN LOW EXTREM_ARTERIAL BYPASS GRAFTS_ COMPLETE BILATERAL STUDY	$940.07	$1,175.09	—	—	20%
Duplex ultrasound of the leg arteries, both legs CPT 93925 HC US DUPLEX_LWR EXTREMITY ARTERIES_BILATERAL	$940.07	$1,175.09	—	83% above	20%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUPLEX SCAN LOW EXTREM_ARTERIAL BYPASS GRAFTS_ COMPLETE BILATERAL STUDY	$940.07	$1,175.09	—	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 HC US DUPLEX_LWR EXTREMITY ARTERIES_BILATERAL	$940.07	$1,175.09	—	—	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 HC US DUPLEX_EXTREMITY VEINS_BILATERAL_PORTABLE	$940.07	$1,175.09	—	24% above	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 HC US DUPLEX_EXTREMITY VEINS_BILATERAL	$940.07	$1,175.09	—	24% above	20%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 HC US DUPLEX_EXTREMITY VEINS_BILATERAL_PORTABLE	$940.07	$1,175.09	—	—	20%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 HC US DUPLEX_EXTREMITY VEINS_BILATERAL	$940.07	$1,175.09	—	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO TRANSTH COMPLETE W_2D_M_MODE_SPECT DOP_COLOR FLOW DOP	$1,862.10	$2,327.63	—	69% above	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO TRANSTH COMPLETE W_2D_M_MODE_SPECT DOP_COLOR FLOW DOP	$1,862.10	$2,327.63	—	—	20%
Elbow X-ray, 2 views CPT 73070 HC XR ELBOW AP _ LAT_ 2 VIEWS	$248.30	$310.38	—	24% above	20%
Elbow X-ray, 2 views inpatient CPT 73070 HC XR ELBOW AP _ LAT_ 2 VIEWS	$248.30	$310.38	—	—	20%
Elbow X-ray, complete, 3 or more views CPT 73080 HC XR ELBOW AP _ LAT_ MIN 3 VIEWS	$248.30	$310.38	—	23% above	20%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC XR ELBOW AP _ LAT_ MIN 3 VIEWS	$248.30	$310.38	—	—	20%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT_POSTERIOR FOSSA WO CONTRAST	$489.02	$611.28	—	34% below	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT_POSTERIOR FOSSA WO CONTRAST	$489.02	$611.28	—	—	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC XR FACIAL BONES MIN 3 VIEWS	$338.66	$423.33	—	25% above	20%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC XR FACIAL BONES MIN 3 VIEWS	$338.66	$423.33	—	—	20%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC RADEX FOREARM 2 VIEWS	$248.30	$310.38	—	23% above	20%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC RADEX FOREARM 2 VIEWS	$248.30	$310.38	—	—	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC HEPATOBILIARY SYSTEM IMAGING_ INCLUDING GALLBLADDER WHEN PRESENT	$1,146.14	$1,432.67	—	11% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC HEPATOBILIARY SYSTEM IMAGING_ INCLUDING GALLBLADDER WHEN PRESENT	$1,146.14	$1,432.67	—	—	20%
Hand X-ray, 2 views CPT 73120 HC XR HAND 2 VIEWS	$338.66	$423.33	—	63% above	20%
Hand X-ray, 2 views inpatient CPT 73120 HC XR HAND 2 VIEWS	$338.66	$423.33	—	—	20%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC XR OS CALCIS_HEEL__ MIN 2 VIEWS	$248.30	$310.38	—	29% above	20%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC XR OS CALCIS_HEEL__ MIN 2 VIEWS	$248.30	$310.38	—	—	20%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STD AIRFLOW HRT RATE_O2 SAT EFFORT UNATT	$403.87	$504.84	—	3% above	20%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STD AIRFLOW HRT RATE_O2 SAT EFFORT UNATT	$403.87	$504.84	—	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMNOGRAPHY 6YRS OLDER SLEEP STAGING W_ INITIATION OF CPAP	$3,481.65	$4,352.06	—	63% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMNOGRAPHY 6YRS OLDER SLEEP STAGING W_ INITIATION OF CPAP	$3,481.65	$4,352.06	—	—	20%
Knee X-ray, 3 views CPT 73562 HC XR KNEE_ 3 VIEWS	$248.30	$310.38	—	21% above	20%
Knee X-ray, 3 views inpatient CPT 73562 HC XR KNEE_ 3 VIEWS	$248.30	$310.38	—	—	20%
Knee X-ray, complete, 4 or more views CPT 73564 HC XR KNEE_ COMPLETE _ 4 OR MORE VIEWS	$338.66	$423.33	—	23% above	20%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC XR KNEE_ COMPLETE _ 4 OR MORE VIEWS	$338.66	$423.33	—	—	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST	$489.02	$611.28	—	34% below	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST	$489.02	$611.28	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMINAL_ LIMITED	$456.76	$570.95	—	20% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMINAL_ LIMITED	$456.76	$570.95	—	—	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US EXTREMITY NONVASCULAR_ REAL_TIME_ W IMAGE DOC_ LIMITED_ ANATOMIC SPECIFIC	$456.76	$570.95	—	69% above	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US EXTREMITY NONVASCULAR_ REAL_TIME_ W IMAGE DOC_ LIMITED_ ANATOMIC SPECIFIC	$456.76	$570.95	—	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT THORAX LOW DOSE FOR LUNG CANCER SCREENING WO CONTRAST	$264.73	$330.91	—	39% below	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT THORAX LOW DOSE FOR LUNG CANCER SCREENING WO CONTRAST	$264.73	$330.91	—	—	20%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC RADIOLOGIC EXAMINATION TIBIA _ FIBULA 2 VIEWS	$248.30	$310.38	—	23% above	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC RADIOLOGIC EXAMINATION TIBIA _ FIBULA 2 VIEWS	$248.30	$310.38	—	—	20%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA_ HEAD WO CONTRAST	$1,307.22	$1,634.02	—	4% above	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA_ HEAD WO CONTRAST	$1,307.22	$1,634.02	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY ANY JOINT WO CONTRAST	$1,307.22	$1,634.02	—	9% above	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXTREMITY ANY JOINT WO CONTRAST	$1,307.22	$1,634.02	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY ANY JOINT WO _ W CONTRAST	$1,652.32	$2,065.40	—	19% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXTREMITY ANY JOINT WO _ W CONTRAST	$1,652.32	$2,065.40	—	—	20%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN WO CONTRAST	$1,307.22	$1,634.02	—	19% above	20%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN WO CONTRAST	$1,307.22	$1,634.02	—	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN WO _ W CONTRAST	$1,652.32	$2,065.40	—	1% below	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN WO _ W CONTRAST	$1,652.32	$2,065.40	—	—	20%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN INCLUDING BRAIN STEM WO CONTRAST	$1,307.22	$1,634.02	—	12% above	20%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN INCLUDING BRAIN STEM WO CONTRAST	$1,307.22	$1,634.02	—	—	20%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN WO _ W CONTRAST	$1,652.32	$2,065.40	—	7% below	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN WO _ W CONTRAST	$1,652.32	$2,065.40	—	—	20%
MRI of the lower back, no contrast dye CPT 72148 HC MRI SPINE LUMBAR WO CONTRAST	$1,307.22	$1,634.02	—	at median	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI SPINE LUMBAR WO CONTRAST	$1,307.22	$1,634.02	—	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI SPINE LUMBAR WO _ W CONTRAST	$1,652.32	$2,065.40	—	7% below	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI SPINE LUMBAR WO _ W CONTRAST	$1,652.32	$2,065.40	—	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI SPINE THORACIC WO CONTRAST	$1,307.22	$1,634.02	—	2% above	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI SPINE THORACIC WO CONTRAST	$1,307.22	$1,634.02	—	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI SPINE CERVICAL WO AND W CONTRAST	$1,652.32	$2,065.40	—	at median	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI SPINE CERVICAL WO AND W CONTRAST	$1,652.32	$2,065.40	—	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI SPINE CERVICAL WO CONTRAST	$1,307.22	$1,634.02	—	1% below	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI SPINE CERVICAL WO CONTRAST	$1,307.22	$1,634.02	—	—	20%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WO _ W CONTRAST	$1,652.32	$2,065.40	—	3% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS WO _ W CONTRAST	$1,652.32	$2,065.40	—	—	20%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST	$1,307.22	$1,634.02	—	22% above	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS WO CONTRAST	$1,307.22	$1,634.02	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXTREMITY ANY JOINT WO CONTRAST	$1,307.22	$1,634.02	—	1% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPER EXTREMITY ANY JOINT WO CONTRAST	$1,307.22	$1,634.02	—	—	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC RADEX SPINE CERVICAL 4 OR 5 VIEWS	$338.66	$423.33	—	20% above	20%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC RADEX SPINE CERVICAL 4 OR 5 VIEWS	$338.66	$423.33	—	—	20%
Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST	$795.04	$993.80	—	21% below	20%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST	$795.04	$993.80	—	—	20%
Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST	$489.02	$611.28	—	40% below	20%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST	$489.02	$611.28	—	—	20%
Neck soft tissue X-ray CPT 70360 HC XR NECK SOFT TISSUE	$238.91	$298.64	—	18% above	20%
Neck soft tissue X-ray inpatient CPT 70360 HC XR NECK SOFT TISSUE	$238.91	$298.64	—	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC MYOCARDIAL PERFUSION IMAGE_TOMOGRAPHIC_MULTI STUDY_REST_STRESS	$3,363.86	$4,204.83	—	26% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC MYOCARDIAL PERFUSION IMAGE_TOMOGRAPHIC_MULTI STUDY_REST_STRESS	$3,363.86	$4,204.83	—	—	20%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET W_CT_ SKULL BASE TO MID_THIGH	$4,299.63	$5,374.54	—	7% above	20%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC PET W_CT_ SKULL BASE TO MID_THIGH	$4,299.63	$5,374.54	—	—	20%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CONTRAST	$489.02	$611.28	—	41% below	20%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS WO CONTRAST	$489.02	$611.28	—	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC ULTRASOUND PELVIC _NONOBSTETRIC_ LIMITED OR F_U	$456.76	$570.95	—	52% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC ULTRASOUND PELVIC _NONOBSTETRIC_ LIMITED OR F_U	$456.76	$570.95	—	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC ULTRASOUND_ PELVIC _NONOBSTETRIC__ COMPLETE	$456.76	$570.95	—	14% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC ULTRASOUND_ PELVIC _NONOBSTETRIC__ COMPLETE	$456.76	$570.95	—	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US PREGNANT UTERUS_ AFTER 1ST TRIMESTER_ SINGLE OR 1ST GESTATION	$456.76	$570.95	—	21% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US PREGNANT UTERUS_ AFTER 1ST TRIMESTER_ SINGLE OR 1ST GESTATION	$456.76	$570.95	—	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US PREGNANT UTERUS_ 1ST TRIMESTER_ TRANSABD APPROACH_ SINGLE OR 1ST GESTATION	$456.76	$570.95	—	30% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US PREGNANT UTERUS_ 1ST TRIMESTER_ TRANSABD APPROACH_ SINGLE OR 1ST GESTATION	$456.76	$570.95	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US PREGNANT UTERUS_ LIMITED_ 1_MORE FETUSES	$456.76	$570.95	—	58% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US PREGNANT UTERUS_ LIMITED_ 1_MORE FETUSES	$456.76	$570.95	—	—	20%
Rib X-ray, one side, 2 views one side CPT 71100 HC XR RIBS 2 VIEWS_ UNILATERAL	$248.30	$310.38	—	18% above	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC XR RIBS 2 VIEWS_ UNILATERAL	$248.30	$310.38	—	—	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 HC XR RIBS UNILATERAL W CHEST MIN 3 VIEWS	$338.66	$423.33	—	30% above	20%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 HC XR RIBS UNILATERAL W CHEST MIN 3 VIEWS	$338.66	$423.33	—	—	20%
Screening mammogram, both breasts both sides CPT 77067 HC SCR MAMMO BI INCL CAD	$350.01	$437.51	—	—	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCR MAMMO BI INCL CAD	$350.01	$437.51	—	—	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS	$248.30	$310.38	—	18% above	20%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS	$248.30	$310.38	—	—	20%
Sinus X-ray, complete, 3 or more views CPT 70220 HC RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS	$248.30	$310.38	—	19% above	20%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS	$248.30	$310.38	—	—	20%
Skull X-ray, fewer than 4 views CPT 70250 HC XR SKULL _ 4 VIEWS	$456.76	$570.95	—	98% above	20%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC XR SKULL _ 4 VIEWS	$456.76	$570.95	—	—	20%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAPHY_ AGE 6 OR OLDER_ SLEEP STAGING W 4_MORE PARAMETERS_ TECH ATTENDED	$3,481.65	$4,352.06	—	66% above	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAPHY_ AGE 6 OR OLDER_ SLEEP STAGING W 4_MORE PARAMETERS_ TECH ATTENDED	$3,481.65	$4,352.06	—	—	20%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC ECHOCARDIOGRAPHY TRANSTHORACIC REAL TIME W_IMAGE DOC_W_PERFORMANCE CONTINUOUS ELECTRO	$1,862.10	$2,327.63	—	61% above	20%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC ECHOCARDIOGRAPHY TRANSTHORACIC REAL TIME W_IMAGE DOC_W_PERFORMANCE CONTINUOUS ELECTRO	$1,862.10	$2,327.63	—	—	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$414.21	$517.76	—	14% above	20%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$414.21	$517.76	—	—	20%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS	$248.30	$310.38	—	27% above	20%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS	$248.30	$310.38	—	—	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT THORACIC SPINE WO CONTRAST	$489.02	$611.28	—	45% below	20%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT THORACIC SPINE WO CONTRAST	$489.02	$611.28	—	—	20%
Toe X-ray, 2 or more views CPT 73660 HC RADEX TOE MINIMUM 2 VIEWS	$248.30	$310.38	—	48% above	20%
Toe X-ray, 2 or more views inpatient CPT 73660 HC RADEX TOE MINIMUM 2 VIEWS	$248.30	$310.38	—	—	20%
Transvaginal pelvic ultrasound CPT 76830 HC US ECHOGRAPHY_TRANSVAGINAL	$456.76	$570.95	—	20% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US ECHOGRAPHY_TRANSVAGINAL	$456.76	$570.95	—	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 HC US PREGNANT UTERUS_ TRANSVAGINAL	$456.76	$570.95	—	56% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US PREGNANT UTERUS_ TRANSVAGINAL	$456.76	$570.95	—	—	20%
Ultrasound of the abdomen, complete CPT 76700 HC US ECHOGRAPHY_ ABDOMINAL_ COMPLETE	$456.76	$570.95	—	3% below	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ECHOGRAPHY_ ABDOMINAL_ COMPLETE	$456.76	$570.95	—	—	20%
Ultrasound of the scrotum and testicles CPT 76870 HC US ECHOGRAPHY SCROTUM _ CONTENTS	$456.76	$570.95	—	24% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US ECHOGRAPHY SCROTUM _ CONTENTS	$456.76	$570.95	—	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US SOFT TISSUES OF HEAD _ NECK	$456.76	$570.95	—	24% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US SOFT TISSUES OF HEAD _ NECK	$456.76	$570.95	—	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY	$414.21	$517.76	—	1% below	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY	$414.21	$517.76	—	—	20%
Upper arm X-ray (humerus), 2 views CPT 73060 HC XR HUMERUS_ MIN 2 VIEWS	$248.30	$310.38	—	23% above	20%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XR HUMERUS_ MIN 2 VIEWS	$248.30	$310.38	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC DUPLEX_SCAN XTR VEINS UNILATERAL_LIMITED STUDY	$456.76	$570.95	—	25% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC US DUPLEX_EXTREMITY VEINS_UNILATERAL	$456.76	$570.95	—	25% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC US DUPLEX_EXTREMITY VEINS_UNILATERAL	$456.76	$570.95	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC DUPLEX_SCAN XTR VEINS UNILATERAL_LIMITED STUDY	$456.76	$570.95	—	—	20%
Wrist X-ray, 2 views CPT 73100 HC RADEX WRIST 2 VIEWS	$248.30	$310.38	—	27% above	20%
Wrist X-ray, 2 views inpatient CPT 73100 HC RADEX WRIST 2 VIEWS	$248.30	$310.38	—	—	20%
Wrist X-ray, complete, 3 or more views CPT 73110 HC XR WRIST_ COMPLETE_ MIN 3 VIEWS	$248.30	$310.38	—	23% above	20%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC XR WRIST_ COMPLETE_ MIN 3 VIEWS	$248.30	$310.38	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC RADEX HIP UNILATERAL WITH PELVIS 2_3 VIEWS	$248.30	$310.38	—	8% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC RADEX HIP UNILATERAL WITH PELVIS 2_3 VIEWS	$248.30	$310.38	—	—	20%
X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN 1 VIEW	$248.30	$310.38	—	19% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN 1 VIEW	$248.30	$310.38	—	—	20%
X-ray of the ankle, 2 views CPT 73600 HC RADIOLOGIC EXAMINATION ANKLE 2 VIEWS	$248.30	$310.38	—	29% above	20%
X-ray of the ankle, 2 views inpatient CPT 73600 HC RADIOLOGIC EXAMINATION ANKLE 2 VIEWS	$248.30	$310.38	—	—	20%
X-ray of the finger(s), 2 or more views CPT 73140 HC XR FINGER_S__ MIN 2 VIEWS	$248.30	$310.38	—	38% above	20%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XR FINGER_S__ MIN 2 VIEWS	$248.30	$310.38	—	—	20%
X-ray of the foot, 2 views CPT 73620 HC RADIOLOGIC EXAMINATION FOOT 2 VIEWS	$248.30	$310.38	—	26% above	20%
X-ray of the foot, 2 views inpatient CPT 73620 HC RADIOLOGIC EXAMINATION FOOT 2 VIEWS	$248.30	$310.38	—	—	20%
X-ray of the foot, complete, 3 or more views CPT 73630 HC XR FOOT_ COMPLETE_ MIN 3 VIEWS	$248.30	$310.38	—	23% above	20%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC XR FOOT_ COMPLETE_ MIN 3 VIEWS	$248.30	$310.38	—	—	20%
X-ray of the hand, 3 or more views CPT 73130 HC XR HAND_ MIN 3 VIEWS	$248.30	$310.38	—	18% above	20%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC XR HAND_ MIN 3 VIEWS	$248.30	$310.38	—	—	20%
X-ray of the knee, 1 or 2 views CPT 73560 HC XR KNEE _ONE OR TWO VIEWS	$248.30	$310.38	—	22% above	20%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC XR KNEE _ONE OR TWO VIEWS	$248.30	$310.38	—	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC RADEX SPINE LUMBOSACRAL 2_3 VIEWS	$338.66	$423.33	—	23% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC RADEX SPINE LUMBOSACRAL 2_3 VIEWS	$338.66	$423.33	—	—	20%
X-ray of the lower back, 4 or more views CPT 72110 HC RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS	$338.66	$423.33	—	12% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS	$338.66	$423.33	—	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC RADEX SPINE THORACIC 2 VIEWS	$338.66	$423.33	—	53% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC RADEX SPINE THORACIC 2 VIEWS	$338.66	$423.33	—	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 HC XR NASAL BONES MIN 3 VIEWS	$248.30	$310.38	—	23% above	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC XR NASAL BONES MIN 3 VIEWS	$248.30	$310.38	—	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC RADEX SPINE CERVICAL 2 OR 3 VIEWS	$230.98	$288.72	—	9% above	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC RADEX SPINE CERVICAL 2 OR 3 VIEWS	$230.98	$288.72	—	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC RADIOLOGIC EXAMINATION PELVIS 1_2 VIEWS	$338.66	$423.33	—	49% above	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC RADIOLOGIC EXAMINATION PELVIS 1_2 VIEWS	$338.66	$423.33	—	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC RADEX SACRUM _ COCCYX MINIMUM 2 VIEWS	$248.30	$310.38	—	23% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC RADEX SACRUM _ COCCYX MINIMUM 2 VIEWS	$248.30	$310.38	—	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs New York	Off list
ACTH blood test CPT 82024 HC ACTH_ADRENOCORTICOTROPC HORM	$172.02	$215.03	—	21% above	20%
ACTH blood test inpatient CPT 82024 HC ACTH_ADRENOCORTICOTROPC HORM	$172.02	$215.03	—	—	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC TRANSFERASE_ ALANINE AMINO _ALT_ _SGPT_	$23.60	$29.50	—	2% above	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC TRANSFERASE_ ALANINE AMINO _ALT_ _SGPT_	$23.60	$29.50	—	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC TRANSFERASE_ ASPARTATE AMINO _AST_ _SGOT_	$23.06	$28.83	—	4% below	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC TRANSFERASE_ ASPARTATE AMINO _AST_ _SGOT_	$23.06	$28.83	—	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS PANEL _ ACUTE	$212.17	$265.21	—	22% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS PANEL _ ACUTE	$212.17	$265.21	—	—	20%
Albumin blood test CPT 82040 HC ALBUMIN SERUM	$22.05	$27.56	—	21% above	20%
Albumin blood test inpatient CPT 82040 HC ALBUMIN SERUM	$22.05	$27.56	—	—	20%
Aldosterone blood test CPT 82088 HC ALDOSTERONE	$181.50	$226.88	—	45% above	20%
Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE	$181.50	$226.88	—	—	20%
Alkaline phosphatase (ALP) blood test CPT 84075 HC PHOSPHATASE_ ALKALINE	$23.06	$28.83	—	14% above	20%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC PHOSPHATASE_ ALKALINE	$23.06	$28.83	—	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HC RAST _ IGE	$23.24	$29.05	—	45% above	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC RAST _ IGE	$23.24	$29.05	—	—	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA_FETOPROTEIN _AFP__ SERUM	$74.72	$93.40	—	21% above	20%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA_FETOPROTEIN _AFP__ SERUM	$74.72	$93.40	—	—	20%
Ammonia blood test CPT 82140 HC AMMONIA	$64.91	$81.14	—	21% above	20%
Ammonia blood test inpatient CPT 82140 HC AMMONIA	$64.91	$81.14	—	—	20%
Amylase blood test CPT 82150 HC AMYLASE	$28.86	$36.07	—	5% below	20%
Amylase blood test CPT 82150 HC AMYLASE_SENDOUT	$523.58	$654.48	—	1632% above	20%
Amylase blood test inpatient CPT 82150 HC AMYLASE	$28.86	$36.07	—	—	20%
Amylase blood test inpatient CPT 82150 HC AMYLASE_SENDOUT	$523.58	$654.48	—	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CYCLIC CITRUL PEPTIDE AB _CCP_	$57.66	$72.07	—	21% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CYCLIC CITRUL PEPTIDE AB _CCP_	$57.66	$72.07	—	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTI NUCLEAR ABS	$53.84	$67.30	—	21% above	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTI NUCLEAR ABS	$53.84	$67.30	—	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE _BNP_	$151.17	$188.96	—	23% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE _BNP_	$151.17	$188.96	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC BACTERIAL CULTURE AEROBIC_ OTHER THAN URINE_ BLOOD OR STOOL_ W ISOLATION _ PRESUMPTIVE ID	$38.38	$47.98	—	21% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC BACTERIAL CULTURE AEROBIC_ OTHER THAN URINE_ BLOOD OR STOOL_ W ISOLATION _ PRESUMPTIVE ID	$38.38	$47.98	—	—	20%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL _8_	$37.67	$47.09	—	35% below	20%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL _8_	$37.67	$47.09	—	—	20%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN_ TOTAL	$22.34	$27.92	—	1% below	20%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN_ TOTAL	$22.34	$27.92	—	—	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC TISSUE LEVEL IV_ GROSS _ MICROSCOPIC EXAMINATION	$160.18	$200.22	—	5% above	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC TISSUE LEVEL IV_ GROSS _ MICROSCOPIC EXAMINATION	$160.18	$200.22	—	—	20%
Blood culture for bacteria CPT 87040 HC BLOOD CULTURE	$45.97	$57.46	—	27% below	20%
Blood culture for bacteria inpatient CPT 87040 HC BLOOD CULTURE	$45.97	$57.46	—	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE	$28.14	$35.17	—	87% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC 36415 COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE ED_OBS	$28.14	$35.17	—	87% above	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC 36415 COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE ED_OBS	$28.14	$35.17	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE	$28.14	$35.17	—	—	20%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE_ QUANTITATIVE_ BLOOD	$17.49	$21.86	—	3% below	20%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE_ QUANTITATIVE_ POINT OF CARE	$17.49	$21.86	—	3% below	20%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE_ QUANTITATIVE_ BLOOD	$17.49	$21.86	—	—	20%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE_ QUANTITATIVE_ POINT OF CARE	$17.49	$21.86	—	—	20%
Blood lead test CPT 83655 HC LEAD	$53.92	$67.40	—	23% above	20%
Blood lead test inpatient CPT 83655 HC LEAD	$53.92	$67.40	—	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN_ CHORIONIC _HCG__ QUAL _PREGNANCY TEST_	$33.52	$41.90	—	5% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC GONADOTROPIN_ CHORIONIC _HCG__ QUAL _PREGNANCY TEST_	$33.52	$41.90	—	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC ABO BLOOD TYPING	$336.64	$420.80	—	121% above	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC ABO BLOOD TYPING	$336.64	$420.80	—	—	20%
Blood urea nitrogen (BUN) test CPT 84520 HC BUN _UREA NITROGEN_	$17.61	$22.01	—	21% below	20%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC BUN _UREA NITROGEN_	$17.61	$22.01	—	—	20%
C-peptide blood test CPT 84681 HC C_PEPTIDE	$92.73	$115.91	—	8% above	20%
C-peptide blood test inpatient CPT 84681 HC C_PEPTIDE	$92.73	$115.91	—	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C REACTIVE PROTEIN	$23.06	$28.83	—	13% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C REACTIVE PROTEIN	$23.06	$28.83	—	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 HC CDIFF TOXIN B BY PCR	$156.33	$195.41	—	24% above	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC CDIFF TOXIN B BY PCR	$156.33	$195.41	—	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 HC IMMUNOASSAY FOR TUMOR ANTIGEN_ QUANTITATIVE_ CA 19_9	$92.73	$115.91	—	23% above	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC IMMUNOASSAY FOR TUMOR ANTIGEN_ QUANTITATIVE_ CA 19_9	$92.73	$115.91	—	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY FOR TUMOR ANTIGEN_ QUANTITATIVE_ CA 125	$92.73	$115.91	—	21% above	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC IMMUNOASSAY FOR TUMOR ANTIGEN_ QUANTITATIVE_ CA 125	$92.73	$115.91	—	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS_COV_2 COVID_19 AMPLIFIED PROBE TQ	$176.30	$220.37	—	80% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS_COV_2 COVID_19 AMPLIFIED PROBE TQ	$176.30	$220.37	—	—	20%
Calcium blood test, total CPT 82310 HC CALCIUM	$22.98	$28.73	—	9% below	20%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM	$22.98	$28.73	—	—	20%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CEA _CARCINOEMBRYONIC ANTIGEN_	$84.46	$105.58	—	5% above	20%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CEA FLUID	$501.94	$627.42	—	521% above	20%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CEA _CARCINOEMBRYONIC ANTIGEN_	$84.46	$105.58	—	—	20%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CEA FLUID	$501.94	$627.42	—	—	20%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER ANTIBODY	$57.36	$71.70	—	27% above	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER ANTIBODY	$57.36	$71.70	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS DNA BY PCR	$156.33	$195.41	—	56% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACHOMATIS DNA BY PCR	$156.33	$195.41	—	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PROFILE	$59.63	$74.54	—	12% below	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PROFILE	$59.63	$74.54	—	—	20%
Complete blood count (CBC) with differential CPT 85025 HC CBC WITH AUTO DIFFERENTIAL	$34.61	$43.26	—	16% below	20%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC WITH AUTO DIFFERENTIAL	$34.61	$43.26	—	—	20%
Complete blood count (CBC), no differential CPT 85027 HC CBC _HEMOGRAM _ PLT_	$28.80	$36.00	—	at median	20%
Complete blood count (CBC), no differential inpatient CPT 85027 HC CBC _HEMOGRAM _ PLT_	$28.80	$36.00	—	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METABOLIC PANEL _14_	$47.05	$58.81	—	19% below	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHENSIVE METABOLIC PANEL _14_	$47.05	$58.81	—	—	20%
Cortisol blood test, total CPT 82533 HC CORTISOL_ TOTAL	$72.60	$90.75	—	48% above	20%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL_ TOTAL	$72.60	$90.75	—	—	20%
Creatine kinase (CK) blood test, total CPT 82550 HC CREATINE KINASE _CK__ _CPK__ TOTAL	$29.01	$36.26	—	16% above	20%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CREATINE KINASE _CK__ _CPK__ TOTAL	$29.01	$36.26	—	—	20%
Creatinine blood test CPT 82565 HC CREATININE_ BLOOD	$22.85	$28.56	—	7% below	20%
Creatinine blood test inpatient CPT 82565 HC CREATININE_ BLOOD	$22.85	$28.56	—	—	20%
Cytomegalovirus (CMV) antibody test CPT 86644 HC CYTOMEGALOVIRUS_IGG	$64.12	$80.15	—	23% above	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC CYTOMEGALOVIRUS_IGG	$64.12	$80.15	—	—	20%
D-dimer blood test (blood clot marker) CPT 85379 HC D_DIMER_ QUANTITATIVE	$45.31	$56.64	—	21% above	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC D_DIMER_ QUANTITATIVE	$45.31	$56.64	—	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DHEA_S	$99.04	$123.80	—	17% above	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DHEA_S	$99.04	$123.80	—	—	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TESTS_ PRESUMPTIVE_ BY INSTRUMENTED CHEMISTRY ANALYZERS	$150.06	$187.57	—	23% above	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TESTS_ PRESUMPTIVE_ BY INSTRUMENTED CHEMISTRY ANALYZERS	$150.06	$187.57	—	—	20%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTES _ SERUM	$31.24	$39.05	—	at median	20%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTES _ SERUM	$31.24	$39.05	—	—	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EBV VCA	$80.82	$101.02	—	78% above	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EBV VCA	$80.82	$101.02	—	—	20%
Estradiol blood test CPT 82670 HC ESTRADIOL_ SERUM	$124.42	$155.52	—	22% above	20%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL_ SERUM	$124.42	$155.52	—	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 HC FOLICAL STIMULATING HORMONE _FSH_	$82.74	$103.43	—	10% above	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC FOLICAL STIMULATING HORMONE _FSH_	$82.74	$103.43	—	—	20%
Fecal calprotectin (stool inflammation test) CPT 83993 HC CALPROTECTIN_ FECAL	$87.46	$109.32	—	4% below	20%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC CALPROTECTIN_ FECAL	$87.46	$109.32	—	—	20%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN	$60.71	$75.89	—	at median	20%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN	$60.71	$75.89	—	—	20%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN BIOLOGIC ACTIVITY	$37.83	$47.29	—	at median	20%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN BIOLOGIC ACTIVITY	$37.83	$47.29	—	—	20%
Folate (folic acid) blood test CPT 82746 HC FOLATE _ SERUM	$65.49	$81.86	—	19% above	20%
Folate (folic acid) blood test inpatient CPT 82746 HC FOLATE _ SERUM	$65.49	$81.86	—	—	20%
Free T3 thyroid hormone test CPT 84481 HC FREE T_3	$75.48	$94.35	—	19% above	20%
Free T3 thyroid hormone test inpatient CPT 84481 HC FREE T_3	$75.48	$94.35	—	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC FREE THYROXINE	$40.15	$50.19	—	16% below	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC FREE THYROXINE	$40.15	$50.19	—	—	20%
Free testosterone test CPT 84402 HC TESTOSTERONE_ FREE	$113.46	$141.83	—	23% above	20%
Free testosterone test inpatient CPT 84402 HC TESTOSTERONE_ FREE	$113.46	$141.83	—	—	20%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GGTP _G_GLUTAMYLTRANSPEPTIDASE_	$32.06	$40.08	—	19% above	20%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GGTP _G_GLUTAMYLTRANSPEPTIDASE_	$32.06	$40.08	—	—	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PANEL	$69.95	$87.44	—	55% below	20%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC GENERAL HEALTH PANEL	$69.95	$87.44	—	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE_ POST GLUCOSE DOSE _INCLUDES GLUCOSE_	$21.14	$26.43	—	at median	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE_ POST GLUCOSE DOSE _INCLUDES GLUCOSE_	$21.14	$26.43	—	—	20%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE_ TOLERANCE TEST _GTT__ 3 SPECIMENS _INCLUDES GLUCOSE_	$57.33	$71.66	—	at median	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE_ TOLERANCE TEST _GTT__ 3 SPECIMENS _INCLUDES GLUCOSE_	$57.33	$71.66	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N. GONORROHEAE RNA	$156.33	$195.41	—	56% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N. GONORROHEAE RNA	$156.33	$195.41	—	—	20%
H. pylori antibody blood test CPT 86677 HC HELICOBACTER PYLORI ANTIBODY	$64.62	$80.78	—	23% above	20%
H. pylori antibody blood test inpatient CPT 86677 HC HELICOBACTER PYLORI ANTIBODY	$64.62	$80.78	—	—	20%
H. pylori stool antigen test CPT 87338 HC HELICOBACTER PYLORI ANTIGEN_ STOOL	$64.07	$80.09	—	20% above	20%
H. pylori stool antigen test inpatient CPT 87338 HC HELICOBACTER PYLORI ANTIGEN_ STOOL	$64.07	$80.09	—	—	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC RNA NY 1	$379.02	$473.78	—	62% above	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC RNA NY 1	$379.02	$473.78	—	—	20%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV_1 AND HIV_2_ SINGLE ASSAY	$61.06	$76.32	—	22% above	20%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV_1 AND HIV_2_ SINGLE ASSAY	$61.06	$76.32	—	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV_1 ANTIGENS_ WITH HIB_1 AND HIB_2 ANTIBODIES_ SINGLE RESULT	$107.26	$134.08	—	49% above	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV_1 ANTIGENS_ WITH HIB_1 AND HIB_2 ANTIBODIES_ SINGLE RESULT	$107.26	$134.08	—	—	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC HPV HIGH RISK	$156.33	$195.41	—	65% above	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC HPV HIGH RISK	$156.33	$195.41	—	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSOLATED HGB	$43.26	$54.07	—	21% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCOSOLATED HGB	$43.26	$54.07	—	—	20%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN BLOOD	$10.55	$13.19	—	27% below	20%
Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN BLOOD	$10.55	$13.19	—	—	20%
Hepatitis B core antibody test (total) CPT 86704 HC HEPATITIS B CORE ANTIBODY	$53.68	$67.10	—	23% above	20%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEPATITIS B CORE ANTIBODY	$53.68	$67.10	—	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE ANTIBODY _VOW NURSING HOME CONTRACT	$47.83	$59.79	—	21% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE ANTIBODY	$47.83	$59.79	—	21% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURFACE ANTIBODY _VOW NURSING HOME CONTRACT	$47.83	$59.79	—	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURFACE ANTIBODY	$47.83	$59.79	—	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC HEPATITIS B SURFACE ANTIGEN	$46.01	$57.51	—	23% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC HEPATITIS B SURFACE ANTIGEN	$46.01	$57.51	—	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY	$63.53	$79.41	—	20% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY	$63.53	$79.41	—	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C_ QUANTIFICATION	$190.78	$238.47	—	40% above	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C_ QUANTIFICATION	$190.78	$238.47	—	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX VIRUS 1 ANTIBODY	$58.73	$73.41	—	46% above	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES SIMPLEX VIRUS 1 ANTIBODY	$58.73	$73.41	—	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX VIRUS 2 ANTIBODY	$86.23	$107.79	—	49% above	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX VIRUS 2 ANTIBODY	$86.23	$107.79	—	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC CRP_ HIGH SENSITIVITY	$57.66	$72.07	—	21% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC CRP_ HIGH SENSITIVITY	$57.66	$72.07	—	—	20%
Homocysteine blood test CPT 83090 HC HOMOCYSTEINE	$75.14	$93.92	—	3% above	20%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTEINE	$75.14	$93.92	—	—	20%
Insulin blood test CPT 83525 HC INSULIN LEVEL_ SERUM	$50.90	$63.63	—	21% above	20%
Insulin blood test inpatient CPT 83525 HC INSULIN LEVEL_ SERUM	$50.90	$63.63	—	—	20%
Iron blood test (serum iron) CPT 83540 HC IRON_ LIVER BIOPSY	$28.82	$36.03	—	12% above	20%
Iron blood test (serum iron) CPT 83540 HC IRON 24 HR URINE	$28.82	$36.03	—	12% above	20%
Iron blood test (serum iron) CPT 83540 HC IRON	$28.82	$36.03	—	12% above	20%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON 24 HR URINE	$28.82	$36.03	—	—	20%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON_ LIVER BIOPSY	$28.82	$36.03	—	—	20%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON	$28.82	$36.03	—	—	20%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY _TIBC_	$38.93	$48.66	—	3% below	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY _TIBC_	$38.93	$48.66	—	—	20%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL	$38.67	$48.34	—	43% below	20%
Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL	$38.67	$48.34	—	—	20%
LH (luteinizing hormone) test CPT 83002 HC LUTEINIZING HORMONE	$82.46	$103.08	—	7% above	20%
LH (luteinizing hormone) test inpatient CPT 83002 HC LUTEINIZING HORMONE	$82.46	$103.08	—	—	20%
Lactate (lactic acid) blood test CPT 83605 HC LACTATE _LACTIC ACID_	$47.59	$59.49	—	18% above	20%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTATE _LACTIC ACID_	$47.59	$59.49	—	—	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE DEHYDROGENASE _LD__ _LDH_	$26.87	$33.59	—	21% above	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE DEHYDROGENASE _LD__ _LDH_	$26.87	$33.59	—	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE	$30.72	$38.40	—	9% above	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE	$30.72	$38.40	—	—	20%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL _7_	$36.40	$45.50	—	36% below	20%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL _7_	$36.40	$45.50	—	—	20%
Lyme disease antibody test CPT 86618 HC LYME ANTIBODY	$75.84	$94.80	—	56% above	20%
Lyme disease antibody test inpatient CPT 86618 HC LYME ANTIBODY	$75.84	$94.80	—	—	20%
Magnesium blood test CPT 83735 HC MAGNESIUM	$29.83	$37.29	—	21% above	20%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM	$29.83	$37.29	—	—	20%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA ANTIBODY	$57.36	$71.70	—	24% above	20%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA ANTIBODY	$57.36	$71.70	—	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETERO _ MONO SCREEN	$23.06	$28.83	—	33% below	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETERO _ MONO SCREEN	$23.06	$28.83	—	—	20%
Mumps immunity blood test CPT 86735 HC MUMPS ANTIBIODY	$58.12	$72.65	—	37% above	20%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS ANTIBIODY	$58.12	$72.65	—	—	20%
Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL	$130.45	$163.06	—	23% above	20%
Obstetric blood test panel inpatient CPT 80055 HC OBSTETRIC PANEL	$130.45	$163.06	—	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA_ FREE	$81.95	$102.44	—	23% above	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PSA_ FREE	$81.95	$102.44	—	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA_ TOTAL	$81.95	$102.44	—	23% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA_ TOTAL	$81.95	$102.44	—	—	20%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC GYN CYTOPATH_THIN LAYER _ DIAGNOSTIC PAP	$90.23	$112.79	—	29% above	20%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC GYN CYTOPATH_THIN LAYER _ DIAGNOSTIC PAP	$90.23	$112.79	—	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 HC PTH_ INTACT	$183.85	$229.81	—	25% above	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PTH_ INTACT	$183.85	$229.81	—	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC APTT	$26.77	$33.46	—	14% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC APTT	$26.77	$33.46	—	—	20%
Phosphorus (phosphate) blood test CPT 84100 HC PHOSPHORUS SERUM	$21.11	$26.39	—	4% above	20%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC PHOSPHORUS SERUM	$21.11	$26.39	—	—	20%
Potassium blood test CPT 84132 HC POTASSIUM_ SERUM_ PLASMA OR WHOLE BLOOD	$20.49	$25.61	—	11% below	20%
Potassium blood test inpatient CPT 84132 HC POTASSIUM_ SERUM_ PLASMA OR WHOLE BLOOD	$20.49	$25.61	—	—	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS	$2,601.66	$3,252.07	—	128% above	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS	$2,601.66	$3,252.07	—	—	20%
Progesterone blood test CPT 84144 HC PROGESTERONE	$92.94	$116.17	—	8% above	20%
Progesterone blood test inpatient CPT 84144 HC PROGESTERONE	$92.94	$116.17	—	—	20%
Prolactin blood test CPT 84146 HC PROLACTIN	$86.30	$107.88	—	20% above	20%
Prolactin blood test inpatient CPT 84146 HC PROLACTIN	$86.30	$107.88	—	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME	$17.49	$21.86	—	13% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME	$17.49	$21.86	—	—	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG TESTS_ PRESUMPTIVE READ BY DIRECT OPTICAL OBSERVATION ONLY	$43.29	$54.11	—	24% above	20%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC DRUG TESTS_ PRESUMPTIVE READ BY DIRECT OPTICAL OBSERVATION ONLY	$43.29	$54.11	—	—	20%
Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA ASSAY W_OPTIC	$59.71	$74.64	—	45% above	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFLUENZA ASSAY W_OPTIC	$59.71	$74.64	—	—	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREPTOCOCCUS GROUP A_ ANTIGEN DETECTION BY IMMUNOASSAY	$59.63	$74.54	—	49% above	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREPTOCOCCUS GROUP A_ ANTIGEN DETECTION BY IMMUNOASSAY	$59.63	$74.54	—	—	20%
Renin blood test CPT 84244 HC RENIN _ANGIOTENSIN I_	$97.95	$122.44	—	21% above	20%
Renin blood test inpatient CPT 84244 HC RENIN _ANGIOTENSIN I_	$97.95	$122.44	—	—	20%
Rh blood typing CPT 86901 HC RH_D_ TYPING	$114.45	$143.06	—	108% above	20%
Rh blood typing inpatient CPT 86901 HC RH_D_ TYPING	$114.45	$143.06	—	—	20%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR	$25.25	$31.56	—	21% above	20%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR	$25.25	$31.56	—	—	20%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY	$64.12	$80.15	—	44% above	20%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA ANTIBODY	$64.12	$80.15	—	—	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SED RATE	$12.02	$15.02	—	51% below	20%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SED RATE	$12.02	$15.02	—	—	20%
Sodium blood test CPT 84295 HC SODIUM SERUM	$21.43	$26.79	—	1% below	20%
Sodium blood test inpatient CPT 84295 HC SODIUM SERUM	$21.43	$26.79	—	—	20%
Stool ova and parasites exam CPT 87177 HC OVA PARASITES	$39.64	$49.55	—	21% above	20%
Stool ova and parasites exam inpatient CPT 87177 HC OVA PARASITES	$39.64	$49.55	—	—	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD_ FECAL SCREEN	$15.80	$19.75	—	11% above	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD_ FECAL SCREEN	$15.80	$19.75	—	—	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLOOD_ OCCULT_ BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOSASSY	$70.86	$88.57	—	45% above	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC BLOOD_ OCCULT_ BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOSASSY	$70.86	$88.57	—	—	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC TREPONEMA PALLIDUM AB	$58.94	$73.68	—	39% above	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC TREPONEMA PALLIDUM AB	$58.94	$73.68	—	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC NONTREALNEMIA ANTIBODY_ QUAL	$19.01	$23.76	—	21% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC NONTREALNEMIA ANTIBODY_ QUAL	$19.01	$23.76	—	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC QUANTIFERON _ TB GOLD IN TUBE	$276.06	$345.07	—	69% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC QUANTIFERON _ TB GOLD IN TUBE	$276.06	$345.07	—	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE_ TOTAL	$114.98	$143.73	—	23% above	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE_ TOTAL	$114.98	$143.73	—	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES_ EACH	$64.79	$80.99	—	22% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES_ EACH	$64.79	$80.99	—	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE _TSH_	$74.86	$93.57	—	2% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE _TSH_	$74.86	$93.57	—	—	20%
Total IgE blood test CPT 82785 HC GAMMAGLOBULIN _IMMUNOGLOBULIN__ IGE	$73.30	$91.63	—	21% above	20%
Total IgE blood test inpatient CPT 82785 HC GAMMAGLOBULIN _IMMUNOGLOBULIN__ IGE	$73.30	$91.63	—	—	20%
Total cholesterol blood test CPT 82465 HC CHOLESTEROL T_ SERUM	$19.38	$24.23	—	14% below	20%
Total cholesterol blood test inpatient CPT 82465 HC CHOLESTEROL T_ SERUM	$19.38	$24.23	—	—	20%
Total thyroxine (T4) blood test CPT 84436 HC THYROXINE _TT4_	$30.60	$38.25	—	5% above	20%
Total thyroxine (T4) blood test inpatient CPT 84436 HC THYROXINE _TT4_	$30.60	$38.25	—	—	20%
Total triiodothyronine (T3) blood test CPT 84480 HC TRIIODOTHYRONINE	$63.18	$78.98	—	at median	20%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC TRIIODOTHYRONINE	$63.18	$78.98	—	—	20%
Transferrin blood test CPT 84466 HC TRANSFERRIN	$56.85	$71.06	—	21% above	20%
Transferrin blood test inpatient CPT 84466 HC TRANSFERRIN	$56.85	$71.06	—	—	20%
Trichomonas test (NAAT) CPT 87661 HC TRICHOMONAS VAGINALIS_ AMPLIFIED PROBE	$84.22	$105.27	—	11% above	20%
Trichomonas test (NAAT) inpatient CPT 87661 HC TRICHOMONAS VAGINALIS_ AMPLIFIED PROBE	$84.22	$105.27	—	—	20%
Triglycerides blood test CPT 84478 HC TRIGLYCERIDE TOTAL	$25.58	$31.97	—	4% above	20%
Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDE TOTAL	$25.58	$31.97	—	—	20%
Troponin test, quantitative CPT 84484 HC TROPONIN I_ QUANTITATIVE	$44.98	$56.23	—	4% above	20%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN I_ QUANTITATIVE	$44.98	$56.23	—	—	20%
Uric acid blood test CPT 84550 HC URIC ACID_ BLOOD	$20.13	$25.16	—	at median	20%
Uric acid blood test inpatient CPT 84550 HC URIC ACID_ BLOOD	$20.13	$25.16	—	—	20%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS _ ROUTINE	$14.15	$17.69	—	56% below	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS _ ROUTINE	$14.15	$17.69	—	—	20%
Urinalysis with microscope exam, manual CPT 81000 HC URINALYSIS_ NON_AUTOMATED	$14.50	$18.13	—	23% above	20%
Urinalysis with microscope exam, manual inpatient CPT 81000 HC URINALYSIS_ NON_AUTOMATED	$14.50	$18.13	—	—	20%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS WO MICROSCOPY	$10.01	$12.51	—	41% below	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS WO MICROSCOPY	$10.01	$12.51	—	—	20%
Urinalysis without microscope exam, manual CPT 81002 HC URINE DIPSTICK_ NON_AUTOMATED	$12.56	$15.70	—	21% above	20%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINE DIPSTICK_ NON_AUTOMATED	$12.56	$15.70	—	—	20%
Urine culture for bacteria, with colony count CPT 87086 HC URINE CULTURE WITH COLONY COUNT	$35.93	$44.91	—	6% below	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC URINE CULTURE WITH COLONY COUNT	$35.93	$44.91	—	—	20%
Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN_ URINE	$25.76	$32.20	—	13% below	20%
Urine microalbumin (albumin) test inpatient CPT 82043 HC MICROALBUMIN_ URINE	$25.76	$32.20	—	—	20%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST_ VISUAL COLOR COMPARISON METHODS	$31.06	$38.82	—	8% above	20%
Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY TEST_ VISUAL COLOR COMPARISON METHODS	$31.06	$38.82	—	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 HC CYANOCOBALAMIN _VITAMIN B12_	$67.14	$83.93	—	21% above	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC CYANOCOBALAMIN _VITAMIN B12_	$67.14	$83.93	—	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D 25_OH	$131.86	$164.82	—	23% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D 25_OH	$131.86	$164.82	—	—	20%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC VITAMIN D 1_25 OH	$171.48	$214.35	—	60% above	20%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC VITAMIN D 1_25 OH	$171.48	$214.35	—	—	20%
Zinc blood test CPT 84630 HC ZINC	$50.73	$63.41	—	25% above	20%
Zinc blood test inpatient CPT 84630 HC ZINC	$50.73	$63.41	—	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN_ CHORIONIC _HCG__ QUANTITATIVE	$67.06	$83.83	—	21% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN_ CHORIONIC _HCG__ QUANTITATIVE	$67.06	$83.83	—	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs New York	Off list
Botox injections for chronic migraine CPT 64615 HC CHEMODENERVATION MUSCLE_S__INNERVATED FACIAL TRIGEMINAL CERVICAL SPINAL ACCESSORY NERVES BIL	$449.22	$561.52	—	3% above	20%
Botox injections for chronic migraine inpatient CPT 64615 HC CHEMODENERVATION MUSCLE_S__INNERVATED FACIAL TRIGEMINAL CERVICAL SPINAL ACCESSORY NERVES BIL	$449.22	$561.52	—	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC CLOSED TREATMENT DISTAL FIBULAR FX_ WO MANIPULATION	$762.41	$953.01	—	45% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC 27786 CLOSED TREATMENT DISTAL FIBULAR FRACTURE _LATERAL MALLEOLUS_ WO MANIPULATION	$819.58	$1,024.48	—	56% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC CLOSED TREATMENT DISTAL FIBULAR FX_ WO MANIPULATION	$762.41	$953.01	—	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC 27786 CLOSED TREATMENT DISTAL FIBULAR FRACTURE _LATERAL MALLEOLUS_ WO MANIPULATION	$819.58	$1,024.48	—	—	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC CLOSED TREATMENT METATARSAL FX_ WO MANIPULATION_ EACH	$819.58	$1,024.48	—	80% above	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC CLOSED TX METATARSAL FX WO MANIPULATION	$819.58	$1,024.48	—	80% above	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC CLOSED TREATMENT METATARSAL FX_ WO MANIPULATION_ EACH	$819.58	$1,024.48	—	—	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC CLOSED TX METATARSAL FX WO MANIPULATION	$819.58	$1,024.48	—	—	20%
Cardiac catheterization with coronary angiogram one side CPT 93458 HC CATH PLACEMENT CORONARY ART W INTRAPROCEDURAL INJ CORONARY ANGIO W LEFT HEART CATH	$8,881.74	$11,102.17	—	46% above	20%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 HC CATH PLACEMENT CORONARY ART W INTRAPROCEDURAL INJ CORONARY ANGIO W LEFT HEART CATH	$8,881.74	$11,102.17	—	—	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION _ ECG	$1,825.33	$2,281.66	—	77% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTRIC EXT	$1,825.33	$2,281.66	—	77% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC 92960 CARDIOVERSION_ ELECTIVE_ ELECTR. CONVERSION EXTERNAL ARRHYTHMIA	$1,825.33	$2,281.66	—	77% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION_ ELECTIVE_ ELECTRICAL CONVERSION OF ARRHYTHMIA_ EXTERNAL	$1,825.33	$2,281.66	—	77% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION_ELECTIVE_ELECTRICAL CONVERSION OF ARRHYTHMIA_EXTERNAL	$1,825.33	$2,281.66	—	77% above	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTRIC EXT	$1,825.33	$2,281.66	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION_ELECTIVE_ELECTRICAL CONVERSION OF ARRHYTHMIA_EXTERNAL	$1,825.33	$2,281.66	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION_ ELECTIVE_ ELECTRICAL CONVERSION OF ARRHYTHMIA_ EXTERNAL	$1,825.33	$2,281.66	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION _ ECG	$1,825.33	$2,281.66	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC 92960 CARDIOVERSION_ ELECTIVE_ ELECTR. CONVERSION EXTERNAL ARRHYTHMIA	$1,825.33	$2,281.66	—	—	20%
Cervical biopsy CPT 57500 HC BIOPSY OF CERVIX_ SINGLE OR MULTIPLE_ OR LOCAL EXCISION OF LESION_ W_WO FULGURATION	$2,068.82	$2,586.03	—	38% above	20%
Cervical biopsy inpatient CPT 57500 HC BIOPSY OF CERVIX_ SINGLE OR MULTIPLE_ OR LOCAL EXCISION OF LESION_ W_WO FULGURATION	$2,068.82	$2,586.03	—	—	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION W_CLAMP OR OTH DEV W_BLOCK	$223.33	$279.16	—	91% below	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC CIRCUMCISION W_CLAMP OR OTH DEV W_BLOCK	$223.33	$279.16	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC CLOSED TX DISTAL RADIAL FX_ EPIPHYSEAL SEPARATION_ WO MANIPULATION	$819.58	$1,024.48	—	46% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC 25600 CLOSED TREATMENT DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION_ WO MANIPULATION	$819.58	$1,024.48	—	46% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC 25600 CLOSED TREATMENT DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION_ WO MANIPULATION	$819.58	$1,024.48	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC CLOSED TX DISTAL RADIAL FX_ EPIPHYSEAL SEPARATION_ WO MANIPULATION	$819.58	$1,024.48	—	—	20%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC BX OF CERVIX W_SCOPE LEEP	$8,188.62	$10,235.78	—	117% above	20%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HC BX OF CERVIX W_SCOPE LEEP	$8,188.62	$10,235.78	—	—	20%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC COLOPOSCOPY OF THE CERVIX INC UPPER_ADJ VAGINA_W BIOPSY OF CERVIX_ENDOCERVICAL CURETTAGE	$1,028.98	$1,286.23	—	54% above	20%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC COLOPOSCOPY OF THE CERVIX INC UPPER_ADJ VAGINA_W BIOPSY OF CERVIX_ENDOCERVICAL CURETTAGE	$1,028.98	$1,286.23	—	—	20%
Coronary stent placement, one artery CPT 92928 HC PRQ TRLUML CORONARY STENT W_ANGIOPLASTY WHEN PERFORMED_ONE ART_BRA	$21,741.66	$27,177.08	—	56% above	20%
Coronary stent placement, one artery inpatient CPT 92928 HC PRQ TRLUML CORONARY STENT W_ANGIOPLASTY WHEN PERFORMED_ONE ART_BRA	$21,741.66	$27,177.08	—	—	20%
Cystoscopy with ureteral stent placement CPT 52332 HC CYSTOURETHROSCOPY_ W_INSERTION INDWELLING URETERAL STENT	$9,142.27	$11,427.84	—	109% above	20%
Cystoscopy with ureteral stent placement inpatient CPT 52332 HC CYSTOURETHROSCOPY_ W_INSERTION INDWELLING URETERAL STENT	$9,142.27	$11,427.84	—	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOURETHROSCOPY _SEPARATE PROCEDURE_	$1,857.51	$2,321.89	—	29% above	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC CYSTOURETHROSCOPY _SEPARATE PROCEDURE_	$1,857.51	$2,321.89	—	—	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HC DILATION AND CURETTAGE	$8,188.62	$10,235.78	—	118% above	20%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC DILATION AND CURETTAGE	$8,188.62	$10,235.78	—	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DESTRUCTION BENIGN_PREMALIGNANT LESIONS_ FIRST LESION	$627.20	$784.00	—	116% above	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DESTRUCTION BENIGN_PREMALIGNANT LESIONS_ FIRST LESION	$627.20	$784.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC REMOVAL IMPACTED CERUMEN USING IRRIGATION_LAVAGE_ UNILATERAL	$206.34	$257.93	—	71% above	20%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC REMOVAL IMPACTED CERUMEN IRRIGATION_LVG UNILAT	$206.34	$257.93	—	71% above	20%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 HC REMOVAL IMPACTED CERUMEN IRRIGATION_LVG UNILAT	$206.34	$257.93	—	—	20%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 HC REMOVAL IMPACTED CERUMEN USING IRRIGATION_LAVAGE_ UNILATERAL	$206.34	$257.93	—	—	20%
Earwax removal with instruments, one ear one side CPT 69210 HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION_ UNILATERAL	$206.34	$257.93	—	59% above	20%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION_ UNILATERAL	$206.34	$257.93	—	—	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC ENDOMETRIAL SAMPLING _BIOPSY_ W_O CERVICAL DILATION_ ANY METHOD SEPARATE PROCEDURE	$557.86	$697.33	—	21% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC ENDOMETRIAL BIOPSY WO CERVICAL DILATION_ ANY METHOD	$599.71	$749.64	—	30% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC ENDOMETRIAL SAMPLING _BIOPSY_ W_O CERVICAL DILATION_ ANY METHOD SEPARATE PROCEDURE	$557.86	$697.33	—	—	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC ENDOMETRIAL BIOPSY WO CERVICAL DILATION_ ANY METHOD	$599.71	$749.64	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC INJECTION EPIDURAL_SUBARACHNOID CERVICAL_THORACIC WITH IMAGING	$914.90	$1,143.63	—	34% below	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC INJECTION EPIDURAL_SUBARACHNOID CERVICAL_THORACIC WITH IMAGING	$914.90	$1,143.63	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJECTION_S__ DX_THERA AGENT_ PARAVERTEBRAL FACET JOINT_ LUMBAR_SACRAL_ SINGLE LEVEL	$2,349.42	$2,936.78	—	17% above	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJECTION_S__ DX_THERA AGENT_ PARAVERTEBRAL FACET JOINT_ LUMBAR_SACRAL_ SINGLE LEVEL	$2,349.42	$2,936.78	—	—	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC SIGMOIDOSCOPY FLX DX W_COLLJ SPEC BR_WA IF PFRMD	$2,569.51	$3,211.89	—	29% above	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC SIGMOIDOSCOPY FLX DX W_COLLJ SPEC BR_WA IF PFRMD	$2,569.51	$3,211.89	—	—	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC HEMORRHOIDECTOMY SIMPLE LIGATURE _EG RUBBER BAND_	$2,569.51	$3,211.89	—	125% above	20%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC HEMORRHOIDECTOMY SIMPLE LIGATURE _EG RUBBER BAND_	$2,569.51	$3,211.89	—	—	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC XR CATH_INTRO FOR HYSTEROSONOGRAPHY_HYSTEROSALPINOGRAPHY	$112.10	$140.13	—	63% below	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$245.28	$306.60	—	19% below	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC XR CATH_INTRO FOR HYSTEROSONOGRAPHY_HYSTEROSALPINOGRAPHY	$112.10	$140.13	—	—	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$245.28	$306.60	—	—	20%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HC HYSTEROSCOPY_ SURGICAL_ W BIOPSY ENDOMETRIUM __OR POLYPECTOMY	$8,188.62	$10,235.78	—	91% above	20%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HC HYSTEROSCOPY_ SURGICAL_ W BIOPSY ENDOMETRIUM __OR POLYPECTOMY	$8,188.62	$10,235.78	—	—	20%
IUD insertion (the device itself billed separately) CPT 58300 HC INSERTION OF INTRAUTERINE DEVICE _IUD_	$243.94	$304.93	—	40% below	20%
IUD insertion (the device itself billed separately) CPT 58300 HC INSERTION INTRAUTERINE DEVICE IUD	$511.43	$639.29	—	25% above	20%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC INSERTION OF INTRAUTERINE DEVICE _IUD_	$243.94	$304.93	—	—	20%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC INSERTION INTRAUTERINE DEVICE IUD	$511.43	$639.29	—	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I_D OF ABSCESS SIMPLE_SINGLE	$597.34	$746.67	—	48% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I_D OF ABSCESS_ SIMPLE_ SINGLE	$627.20	$784.00	—	55% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I_D ABSCESS_ SIMPLE OR SINGLE	$627.20	$784.00	—	55% above	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I_D OF ABSCESS SIMPLE_SINGLE	$597.34	$746.67	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I_D ABSCESS_ SIMPLE OR SINGLE	$627.20	$784.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I_D OF ABSCESS_ SIMPLE_ SINGLE	$627.20	$784.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ TENDON SHEATH_LIGAMENT	$342.02	$427.53	—	31% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJECTION_ SINGLE TENDON SHEATH_LIGAMENT_ APONEUROSIS	$449.22	$561.52	—	9% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ TENDON SHEATH_LIGAMENT	$342.02	$427.53	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJECTION_ SINGLE TENDON SHEATH_LIGAMENT_ APONEUROSIS	$449.22	$561.52	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENTESIS_ ASPIRATION __OR INJECTION_ MAJOR JOINT OR BURSA	$449.22	$561.52	—	11% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC 20610 ARTHROCENTESIS_ ASPIRATION_INJECTION_ MAJOR JOINT OR BURSA	$449.22	$561.52	—	11% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENTESIS_ ASPIRATION_INJECTION_ MAJOR JOINT_BURSA	$449.22	$561.52	—	11% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ARTHROCENTESIS_ ASPIRATION_INJECTION_ MAJOR JOINT_BURSA	$449.22	$561.52	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ARTHROCENTESIS_ ASPIRATION __OR INJECTION_ MAJOR JOINT OR BURSA	$449.22	$561.52	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC 20610 ARTHROCENTESIS_ ASPIRATION_INJECTION_ MAJOR JOINT OR BURSA	$449.22	$561.52	—	—	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERTION DRUG DELIVERY IMPLANT	$360.21	$450.26	—	28% above	20%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC INSERTION DRUG DELIVERY IMPLANT	$360.21	$450.26	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHOCENTESIS INTERMEDIATE JOINT_BURSA	$342.02	$427.53	—	25% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC 20605 ARTHROCENTESIS_ ASPIRATION_INJECTION_ INTERMEDIATE JOINT OR BURSA	$449.22	$561.52	—	2% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCENTESIS_ ASPIRATION_INJECTION_ INTERMEDIATE JOINT_BURSA	$449.22	$561.52	—	2% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCENTESIS_ ASPIRATION __OR INJECTION_ INTERMEDIATE JOINT OR BURSA	$449.22	$561.52	—	2% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHOCENTESIS_ ASPIRATON_INJ_ INTERMEDIATE JNT_BURSA	$449.22	$561.52	—	2% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHOCENTESIS INTERMEDIATE JOINT_BURSA	$342.02	$427.53	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHROCENTESIS_ ASPIRATION_INJECTION_ INTERMEDIATE JOINT_BURSA	$449.22	$561.52	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHROCENTESIS_ ASPIRATION __OR INJECTION_ INTERMEDIATE JOINT OR BURSA	$449.22	$561.52	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHOCENTESIS_ ASPIRATON_INJ_ INTERMEDIATE JNT_BURSA	$449.22	$561.52	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC 20605 ARTHROCENTESIS_ ASPIRATION_INJECTION_ INTERMEDIATE JOINT OR BURSA	$449.22	$561.52	—	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ARTHROCENTESIS_ ASPIRATION_INJECTION_ SMALL JOINT_BURSA	$449.22	$561.52	—	at median	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC 20600 ARTHROCENTESIS_ ASPIRATION_INJECTION_ SMALL JOINT OR BURSA	$449.22	$561.52	—	at median	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ARTHROCENTESIS_ ASPIRATION_INJECTION_ SMALL JOINT_BURSA	$449.22	$561.52	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC 20600 ARTHROCENTESIS_ ASPIRATION_INJECTION_ SMALL JOINT OR BURSA	$449.22	$561.52	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC REPAIR INTERMEDIATE S_A_T_E 2.5 CM__	$1,132.18	$1,415.23	—	91% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC REPAIR_ INTERMEDIATE_ 2.5CM OR LESS_ SCALP_ AXILLAE_ TRUNK_ __OR EXTREMITIES _EXC HANDS_FEET_	$1,188.79	$1,485.99	—	101% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC REPAIR INTERMEDIATE S_A_T_E 2.5 CM_	$1,188.79	$1,485.99	—	101% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC 12031 LAYER CLOSURE OF WOUNDS_ 2.5 CM OR LESS_ SCALP_ AXILLAE_ TRUNK _EXC HANDS _ FEET_	$1,188.79	$1,485.99	—	101% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC REPAIR INTERMEDIATE S_A_T_E 2.5 CM__	$1,132.18	$1,415.23	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC REPAIR_ INTERMEDIATE_ 2.5CM OR LESS_ SCALP_ AXILLAE_ TRUNK_ __OR EXTREMITIES _EXC HANDS_FEET_	$1,188.79	$1,485.99	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC 12031 LAYER CLOSURE OF WOUNDS_ 2.5 CM OR LESS_ SCALP_ AXILLAE_ TRUNK _EXC HANDS _ FEET_	$1,188.79	$1,485.99	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC REPAIR INTERMEDIATE S_A_T_E 2.5 CM_	$1,188.79	$1,485.99	—	—	20%
Left heart catheterization, diagnostic one side CPT 93452 HC LEFT HRT CATH W_VENTRCLGRPHY	$7,632.41	$9,540.51	—	10% above	20%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC LEFT HRT CATH W_VENTRCLGRPHY	$7,632.41	$9,540.51	—	—	20%
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJECTION EPIDURAL_SUBARACHNOID LUMBAR_SACRAL WITH IMAGING	$914.90	$1,143.63	—	39% below	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJECTION EPIDURAL_SUBARACHNOID LUMBAR_SACRAL WITH IMAGING	$914.90	$1,143.63	—	—	20%
Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX DX_THER SBST INTRLMNR LMBR_SAC W_O IMG GDN	$914.90	$1,143.63	—	37% below	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC NJX DX_THER SBST INTRLMNR LMBR_SAC W_O IMG GDN	$914.90	$1,143.63	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC NJX AA__STRD TFRML EPI LUMBAR_SACRAL 1 LEVEL	$2,349.42	$2,936.78	—	52% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ ANESTH__STEROID_TRANSFORAMINAL EPIDURAL_IMAGE GUIDE_FLUOR_CT__LUMBAR_SACARAL_SINGLE LVL	$2,349.42	$2,936.78	—	52% above	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC NJX AA__STRD TFRML EPI LUMBAR_SACRAL 1 LEVEL	$2,349.42	$2,936.78	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ ANESTH__STEROID_TRANSFORAMINAL EPIDURAL_IMAGE GUIDE_FLUOR_CT__LUMBAR_SACARAL_SINGLE LVL	$2,349.42	$2,936.78	—	—	20%
Miscarriage treatment with D&C, first trimester CPT 59820 HC TX MISSED ABORTION FIRST TRIMESTER SURGICAL	$7,973.88	$9,967.35	—	95% above	20%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC TX MISSED ABORTION FIRST TRIMESTER SURGICAL	$7,973.88	$9,967.35	—	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXCISE BENIGN LESION W MARGINS_ 0.5CM_LESS_ NOT SKIN TAG	$2,141.10	$2,676.38	—	98% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXCISE BENIGN LESION W MARGINS_ 0.5CM_LESS_ NOT SKIN TAG	$2,141.10	$2,676.38	—	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXCISION_ OTHER BENIGN LESION_ 0.5 CM_LESS	$2,141.10	$2,676.38	—	103% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC EXCISION_ OTHER BENIGN LESION_ 0.5 CM_LESS	$2,141.10	$2,676.38	—	—	20%
Nail removal (partial or complete), one nail CPT 11730 HC AVULSION OF NAIL PLATE_ PARTIAL OR COMPLETE_ SIMPLE_ SINGLE	$627.20	$784.00	—	88% above	20%
Nail removal (partial or complete), one nail CPT 11730 HC AVULSION OF NAIL PLATE_ PARTIAL_COMPLETE_ SIMPLE_ SINGLE	$627.20	$784.00	—	88% above	20%
Nail removal (partial or complete), one nail CPT 11730 HC 11730 AVULSION OF NAIL PLATE_ PARTIAL OR COMPLETE_ SIMPLE_ SINGLE	$627.20	$784.00	—	88% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC 11730 AVULSION OF NAIL PLATE_ PARTIAL OR COMPLETE_ SIMPLE_ SINGLE	$627.20	$784.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC AVULSION OF NAIL PLATE_ PARTIAL OR COMPLETE_ SIMPLE_ SINGLE	$627.20	$784.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC AVULSION OF NAIL PLATE_ PARTIAL_COMPLETE_ SIMPLE_ SINGLE	$627.20	$784.00	—	—	20%
Occipital nerve block (injection for headaches) CPT 64405 HC INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV	$408.64	$510.80	—	14% below	20%
Occipital nerve block (injection for headaches) CPT 64405 HC N BLOCK INJ OCCIPITAL	$449.22	$561.52	—	5% below	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV	$408.64	$510.80	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC N BLOCK INJ OCCIPITAL	$449.22	$561.52	—	—	20%
Pacemaker implant (dual chamber) CPT 33208 HC INSERT NEW_REPLACEMENT PERM PACEMAKER W TRANSVENOUS ELECTRODE_S__ ATRIAL _ VENTRICULAR	$12,755.65	$15,944.56	—	3% above	20%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC INSERT NEW_REPLACEMENT PERM PACEMAKER W TRANSVENOUS ELECTRODE_S__ ATRIAL _ VENTRICULAR	$12,755.65	$15,944.56	—	—	20%
Paracentesis with imaging guidance CPT 49083 HC 49083 ABDOMINAL PARACENTESIS _DIAGNOSTIC OR THERAPEUTIC__ W IMAGING GUIDANCE	$2,357.31	$2,946.64	—	65% above	20%
Paracentesis with imaging guidance CPT 49083 HC ABDOMINAL PARACENTESIS _DIAG OR THERAPEUTIC_ WITH IMAGING GUIDANCE	$2,357.31	$2,946.64	—	65% above	20%
Paracentesis with imaging guidance CPT 49083 HC ABD PARACENTESIS W_IMAGING	$2,357.31	$2,946.64	—	65% above	20%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABD PARACENTESIS W_IMAGING	$2,357.31	$2,946.64	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABDOMINAL PARACENTESIS _DIAG OR THERAPEUTIC_ WITH IMAGING GUIDANCE	$2,357.31	$2,946.64	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 HC 49083 ABDOMINAL PARACENTESIS _DIAGNOSTIC OR THERAPEUTIC__ W IMAGING GUIDANCE	$2,357.31	$2,946.64	—	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC 11750 EXCISION NAIL _ NAIL MATRIX_ PARTIAL OR COMPLETE_ PERMAMENT REMOVAL	$1,132.18	$1,415.23	—	54% above	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC EXCISION NAIL _ MATRIX PARTIAL_COMPLETE_ PERMANENT REMOVAL	$1,188.79	$1,485.99	—	62% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC 11750 EXCISION NAIL _ NAIL MATRIX_ PARTIAL OR COMPLETE_ PERMAMENT REMOVAL	$1,132.18	$1,415.23	—	—	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC EXCISION NAIL _ MATRIX PARTIAL_COMPLETE_ PERMANENT REMOVAL	$1,188.79	$1,485.99	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTRUCTION BY NEUROLYTIC AGNT PARVERTEB FCT NRV_SNGL JNT LUMBAR_SACRAL W IMAGE GUIDE	$5,885.82	$7,357.27	—	73% above	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DESTRUCTION BY NEUROLYTIC AGNT PARVERTEB FCT NRV_SNGL JNT LUMBAR_SACRAL W IMAGE GUIDE	$5,885.82	$7,357.27	—	—	20%
Removal of a breast lump, open surgery CPT 19120 HC EXC CYST_ABERRANT BREAST TISSUE OPEN 1__ LESION	$9,098.35	$11,372.94	—	101% above	20%
Removal of a breast lump, open surgery inpatient CPT 19120 HC EXC CYST_ABERRANT BREAST TISSUE OPEN 1__ LESION	$9,098.35	$11,372.94	—	—	20%
Removal of a foreign object under the skin, simple CPT 10120 HC REMOVE FOREIGN BODY	$1,188.79	$1,485.99	—	85% above	20%
Removal of a foreign object under the skin, simple CPT 10120 HC INCISION REMOVE FB FROM SUBCUTANEOUS TISSUE_ SIMPLE	$1,188.79	$1,485.99	—	85% above	20%
Removal of a foreign object under the skin, simple CPT 10120 HC INCISION _ REMOVAL OF FB_ SC TISSUES_ SIMPLE	$1,188.79	$1,485.99	—	85% above	20%
Removal of a foreign object under the skin, simple CPT 10120 HC INCISION _ REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$1,188.79	$1,485.99	—	85% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INCISION REMOVE FB FROM SUBCUTANEOUS TISSUE_ SIMPLE	$1,188.79	$1,485.99	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INCISION _ REMOVAL OF FB_ SC TISSUES_ SIMPLE	$1,188.79	$1,485.99	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INCISION _ REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$1,188.79	$1,485.99	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC REMOVE FOREIGN BODY	$1,188.79	$1,485.99	—	—	20%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 HC LITHOTRIPSY_ EXTRACORPOREAL SHOCK WAVE	$8,493.19	$10,616.49	—	57% above	20%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 HC LITHOTRIPSY_ EXTRACORPOREAL SHOCK WAVE	$8,493.19	$10,616.49	—	—	20%
Short arm cast (elbow to hand) CPT 29075 HC APPLICATION_ CAST_ ELBOW TO FINGER _SHORT ARM_	$913.43	$1,141.79	—	114% above	20%
Short arm cast (elbow to hand) CPT 29075 HC 29075 APPLICATION_ CAST_ SHORT ARM _ELBOW TO FINGER_	$913.43	$1,141.79	—	114% above	20%
Short arm cast (elbow to hand) inpatient CPT 29075 HC APPLICATION_ CAST_ ELBOW TO FINGER _SHORT ARM_	$913.43	$1,141.79	—	—	20%
Short arm cast (elbow to hand) inpatient CPT 29075 HC 29075 APPLICATION_ CAST_ SHORT ARM _ELBOW TO FINGER_	$913.43	$1,141.79	—	—	20%
Short arm splint (forearm and hand) CPT 29125 HC APPLICATION OF SHORT ARM SPLINT _FOREARM TO HAND__ STATIC	$360.21	$450.26	—	71% above	20%
Short arm splint (forearm and hand) CPT 29125 HC 29125 APPLICATION OF SHORT ARM SPLINT _FOREARM TO HAND__ STATIC	$360.21	$450.26	—	71% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 HC 29125 APPLICATION OF SHORT ARM SPLINT _FOREARM TO HAND__ STATIC	$360.21	$450.26	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLICATION OF SHORT ARM SPLINT _FOREARM TO HAND__ STATIC	$360.21	$450.26	—	—	20%
Short leg cast (below the knee) CPT 29405 HC APPLICATION OF SHORT LEG CAST _BELOW KNEE TO TOES_	$913.43	$1,141.79	—	86% above	20%
Short leg cast (below the knee) CPT 29405 HC 29405 APPLICATION OF SHORT LEG CAST _BELOW KNEE TO TOES__ ED	$913.43	$1,141.79	—	86% above	20%
Short leg cast (below the knee) inpatient CPT 29405 HC APPLICATION OF SHORT LEG CAST _BELOW KNEE TO TOES_	$913.43	$1,141.79	—	—	20%
Short leg cast (below the knee) inpatient CPT 29405 HC 29405 APPLICATION OF SHORT LEG CAST _BELOW KNEE TO TOES__ ED	$913.43	$1,141.79	—	—	20%
Short leg splint (calf to foot) CPT 29515 HC APPLICATION OF SHORT LEG SPLINT	$460.02	$575.03	—	61% above	20%
Short leg splint (calf to foot) CPT 29515 HC APPLICATION SHORT LEG SPLINT CALF FOOT	$519.69	$649.61	—	82% above	20%
Short leg splint (calf to foot) CPT 29515 HC 29515 APPLICATION SHORT LEG SPLINT _CALF TO FOOT_	$519.69	$649.61	—	82% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 HC APPLICATION OF SHORT LEG SPLINT	$460.02	$575.03	—	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 HC APPLICATION SHORT LEG SPLINT CALF FOOT	$519.69	$649.61	—	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 HC 29515 APPLICATION SHORT LEG SPLINT _CALF TO FOOT_	$519.69	$649.61	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC SIMPLE REPAIR WOUND 2.5_LESS_ SCALP_ NECK_ AXILLAE_ EXT GENITALIA_ TRUNK __OR EXTREMITIES	$627.20	$784.00	—	66% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC 12001 SIMPLE REPAIR_ SUPERFICIAL_ 2.5 CM OR LESS_ SCALP_ NECK_ AXILLAE_ TRUNK_ HANDS_FEET	$627.20	$784.00	—	66% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC SIMPLE REPAIR SCALP_NECK_AXILLAE_GENIT_TRUNK_EXTREMITIES 2.5CM OR LESS	$627.20	$784.00	—	66% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC 12001 SIMPLE REPAIR_ SUPERFICIAL_ 2.5 CM OR LESS_ SCALP_ NECK_ AXILLAE_ TRUNK_ HANDS_FEET	$627.20	$784.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC SIMPLE REPAIR SCALP_NECK_AXILLAE_GENIT_TRUNK_EXTREMITIES 2.5CM OR LESS	$627.20	$784.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC SIMPLE REPAIR WOUND 2.5_LESS_ SCALP_ NECK_ AXILLAE_ EXT GENITALIA_ TRUNK __OR EXTREMITIES	$627.20	$784.00	—	—	20%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION	$611.77	$764.71	—	11% below	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION	$611.77	$764.71	—	—	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC EXCISION MALIGNANT LESION_ 0.5 CM OR LESS_ TRUNK_ ARMS_ LEGS	$2,141.10	$2,676.38	—	149% above	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC EXCISION MALIGNANT LESION_ 0.5 CM OR LESS_ TRUNK_ ARMS_ LEGS	$2,141.10	$2,676.38	—	—	20%
Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL OF SKIN TAGS UP TO _ INCLUDE 15_LESS	$627.20	$784.00	—	72% above	20%
Skin tag removal, up to 15 tags CPT 11200 HC 11200 REMOVAL OF SKIN TAGS_ ANY AREA_ 15 LESIONS_LESS	$627.20	$784.00	—	72% above	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC REMOVAL OF SKIN TAGS UP TO _ INCLUDE 15_LESS	$627.20	$784.00	—	—	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC 11200 REMOVAL OF SKIN TAGS_ ANY AREA_ 15 LESIONS_LESS	$627.20	$784.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL PUNCTURE_ LUMBAR_ DX	$914.90	$1,143.63	—	23% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL PUNCTURE DIAGNOSTIC	$914.90	$1,143.63	—	23% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC 62270 SPINAL PUNCTURE_ LUMBAR DIAGNOSTIC	$914.90	$1,143.63	—	23% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL PUNCTURE_ LUMBAR DIAGNOSIS	$914.90	$1,143.63	—	23% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL FLUID TAP DIAGNOSTIC	$1,361.04	$1,701.30	—	15% above	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC 62270 SPINAL PUNCTURE_ LUMBAR DIAGNOSTIC	$914.90	$1,143.63	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL PUNCTURE_ LUMBAR_ DX	$914.90	$1,143.63	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL PUNCTURE DIAGNOSTIC	$914.90	$1,143.63	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL PUNCTURE_ LUMBAR DIAGNOSIS	$914.90	$1,143.63	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL FLUID TAP DIAGNOSTIC	$1,361.04	$1,701.30	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC SIMPLE REPAIR WOUND 2.6_7.5 CM_ SCALP_ NECK_ AXILLAE_ EXT GENITALIA_ TRUNK __OR EXTREMITIES	$627.20	$784.00	—	58% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC 12002 SIMPLE REPAIR_ SUPERFICIAL_ 2.6 _ 7.5 CM_ SCALP_ NECK_ AXILLAE_ TRUNK_ HANDS_FEET	$627.20	$784.00	—	58% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC SIMPLE REPAIR WOUND 2.6_7.5 CM_ SCALP_ NECK_ AXILLAE_ EXT GENITALIA_ TRUNK __OR EXTREMITIES	$627.20	$784.00	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC 12002 SIMPLE REPAIR_ SUPERFICIAL_ 2.6 _ 7.5 CM_ SCALP_ NECK_ AXILLAE_ TRUNK_ HANDS_FEET	$627.20	$784.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC 12011 SIMPLE REPAIR_ SUPERFICIAL_ 2.5 CM OR LESS_FACE_EYELIDS_EARS_NOSE_LIPS_MUCOUS MEMB	$627.20	$784.00	—	66% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC SIMPLE REPAIR_SUPERFICIAL_ 2.5 CM OR LESS_FACE_EARS_EYELIDS_NOSE_LIPS __OR MUCOUS MEMBRANES	$627.20	$784.00	—	66% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC 12011 SIMPLE REPAIR_ SUPERFICIAL_ 2.5 CM OR LESS_FACE_EYELIDS_EARS_NOSE_LIPS_MUCOUS MEMB	$627.20	$784.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC SIMPLE REPAIR_SUPERFICIAL_ 2.5 CM OR LESS_FACE_EARS_EYELIDS_NOSE_LIPS __OR MUCOUS MEMBRANES	$627.20	$784.00	—	—	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$611.77	$764.71	—	23% above	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$611.77	$764.71	—	23% above	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$611.77	$764.71	—	—	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$611.77	$764.71	—	—	20%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS_ NEEDLE_CATHETER_ ASPIRATION PLURAL SPACE_ W IMAGING GUIDANCE	$2,204.22	$2,755.28	—	72% above	20%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS_ ASPIRATION OF PLEURAL SPACE_ WITH IMAGING GUIDANCE	$2,204.22	$2,755.28	—	72% above	20%
Thoracentesis with imaging guidance CPT 32555 HC ASPIRATE PLEURA W_ IMAGING	$2,204.22	$2,755.28	—	72% above	20%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS_ASPIRATION OF PLEURAL SPACE_WITH IMAGING GUIDANCE	$2,204.22	$2,755.28	—	72% above	20%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS_ASPIRATION OF PLEURAL SPACE_WITH IMAGING GUIDANCE	$2,204.22	$2,755.28	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS_ ASPIRATION OF PLEURAL SPACE_ WITH IMAGING GUIDANCE	$2,204.22	$2,755.28	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 HC ASPIRATE PLEURA W_ IMAGING	$2,204.22	$2,755.28	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS_ NEEDLE_CATHETER_ ASPIRATION PLURAL SPACE_ W IMAGING GUIDANCE	$2,204.22	$2,755.28	—	—	20%
Total knee replacement CPT 27447 HC ARTHRP KHC NE CONDYLE_PLATU MEDIAL_LAT COMPARTMENTS	$17,146.00	$21,432.50	—	13% above	20%
Total knee replacement inpatient CPT 27447 HC ARTHRP KHC NE CONDYLE_PLATU MEDIAL_LAT COMPARTMENTS	$17,146.00	$21,432.50	—	—	20%
Trigger finger release surgery CPT 26055 HC TENDON SHEATH INCISION	$4,002.34	$5,002.93	—	53% above	20%
Trigger finger release surgery inpatient CPT 26055 HC TENDON SHEATH INCISION	$4,002.34	$5,002.93	—	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 HC 20552 INJECTION_S__ SINGLE OR MULTIPLE TRIGGER POINT_S__ 1 OR 2 MUSCLE_S_	$449.22	$561.52	—	7% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJECTION_ SINGLE_MULTIPLE TRIGGER POINT_S__ 1 OR 2 MUSCLE_S_	$449.22	$561.52	—	7% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJECTION_ SINGLE_MULTIPLE TRIGGER POINT_S__ 1 OR 2 MUSCLE_S_	$449.22	$561.52	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC 20552 INJECTION_S__ SINGLE OR MULTIPLE TRIGGER POINT_S__ 1 OR 2 MUSCLE_S_	$449.22	$561.52	—	—	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC EGD BALLOON DILATION ESOPHAGUS _30 MM DIAM	$4,333.02	$5,416.28	—	77% above	20%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC EGD BALLOON DILATION ESOPHAGUS _30 MM DIAM	$4,333.02	$5,416.28	—	—	20%
Upper endoscopy (EGD) with biopsy CPT 43239 HC EGD TRANSORAL BIOPSY SINGLE_MULTIPLE	$1,937.99	$2,422.49	—	16% above	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC EGD TRANSORAL BIOPSY SINGLE_MULTIPLE	$1,937.99	$2,422.49	—	—	20%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 HC EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS	$1,938.01	$2,422.51	—	56% above	20%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 HC EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS	$1,938.01	$2,422.51	—	—	20%
Upper endoscopy (EGD), diagnostic CPT 43235 HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$2,100.91	$2,626.14	—	28% above	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$2,100.91	$2,626.14	—	—	20%
Vein ablation, radiofrequency, first vein CPT 36475 HC ENDOVENOUS RF 1ST VEIN	$6,988.46	$8,735.57	—	54% above	20%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC ENDOVENOUS RF 1ST VEIN	$6,988.46	$8,735.57	—	—	20%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCTION BENIGN LESIONS UP TO 14	$627.20	$784.00	—	81% above	20%
Wart removal, up to 14 warts CPT 17110 HC DESTROY FLAT WARTS_UP TO 14 LESIONS	$627.20	$784.00	—	81% above	20%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCTION BENIGN LESIONS OTHER THAN SKIN TAGS	$627.20	$784.00	—	81% above	20%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCTION BENIGN LESIONS UP TO 14	$627.20	$784.00	—	—	20%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTROY FLAT WARTS_UP TO 14 LESIONS	$627.20	$784.00	—	—	20%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCTION BENIGN LESIONS OTHER THAN SKIN TAGS	$627.20	$784.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM__	$1,121.81	$1,402.26	—	33% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDEMENT SKIN _ SC TISSUE	$1,132.18	$1,415.23	—	34% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDEMENT_ SC TISSUE_ 1ST 20 SQ CM_LESS	$1,188.79	$1,485.99	—	41% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC 11042 DEBRIDEMENT SKIN AND SUBCUTANEOUS TISSUE	$1,188.79	$1,485.99	—	41% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM__	$1,121.81	$1,402.26	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDEMENT SKIN _ SC TISSUE	$1,132.18	$1,415.23	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC 11042 DEBRIDEMENT SKIN AND SUBCUTANEOUS TISSUE	$1,188.79	$1,485.99	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDEMENT_ SC TISSUE_ 1ST 20 SQ CM_LESS	$1,188.79	$1,485.99	—	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs New York	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC TRANSFUSION OF BLOOD OR BLOOD COMPONENT	$1,126.25	$1,407.81	—	54% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC TRANSFUSION OF BLOOD OR BLOOD COMPONENT	$1,126.25	$1,407.81	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHALATION TREATMENT FOR AIRWAY OBSTRUCTION	$318.66	$398.32	—	42% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC PRESURIZED_NONPRESSURIZED INHALATION TX FOR ACUTE AIRWAY OBSTRUCTION OR SPUTUM INDUCTION	$318.66	$398.32	—	42% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC COUGH ASSIST TREATMENT	$318.66	$398.32	—	42% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC NEBULIZER TX WITH MECH VENT	$318.66	$398.32	—	42% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC 94640 INHALATION TREATMENT ACUTE AIRWAY OBSTRUCTION_ SPUTUM INDUCTION	$318.66	$398.32	—	42% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC PRESSURIZED_NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION_ FOR THERAP	$318.66	$398.32	—	42% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC 94640 INHALATION TREATMENT ACUTE AIRWAY OBSTRUCTION_ SPUTUM INDUCTION	$318.66	$398.32	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC NEBULIZER TX WITH MECH VENT	$318.66	$398.32	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC PRESURIZED_NONPRESSURIZED INHALATION TX FOR ACUTE AIRWAY OBSTRUCTION OR SPUTUM INDUCTION	$318.66	$398.32	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC PRESSURIZED_NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION_ FOR THERAP	$318.66	$398.32	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC COUGH ASSIST TREATMENT	$318.66	$398.32	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHALATION TREATMENT FOR AIRWAY OBSTRUCTION	$318.66	$398.32	—	—	20%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO ADMIN IV INFUS UP TO 1 HR SINGLE_INITIAL SUB_DRUG	$761.03	$951.29	—	24% above	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO ADMIN IV INFUS UP TO 1 HR SINGLE_INITIAL SUB_DRUG	$761.03	$951.29	—	—	20%
Critical care, first 30 to 74 minutes CPT 99291 HC CRITICAL CARE_ E_M OF CRITICALLY ILL_INJURED_ FIRST 30 _74 MINUTES	$2,253.51	$2,816.89	—	31% above	20%
Critical care, first 30 to 74 minutes CPT 99291 HC CRITICAL CARE_ E_M OF CRITICALLY ILL_INJURED_ FIRST 30 _74 MINUTES	$2,464.49	$3,080.61	—	44% above	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC CRITICAL CARE_ E_M OF CRITICALLY ILL_INJURED_ FIRST 30 _74 MINUTES	$2,253.51	$2,816.89	—	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC CRITICAL CARE_ E_M OF CRITICALLY ILL_INJURED_ FIRST 30 _74 MINUTES	$2,464.49	$3,080.61	—	—	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE _ DROWSY 20_40 MIN	$934.83	$1,168.54	—	36% above	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG AWAKE _ DROWSY 20_40 MIN	$934.83	$1,168.54	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC 93005 ELECTROCARDIOGRAM_TRACING ONLY_ WO INTER_REPORT	$206.34	$257.93	—	44% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC 93005 ELECTROCARDIOGRAM_TRACING ONLY_ WO INTER_REPORT	$206.34	$257.93	—	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC EMERGENCY DEPT E_M VISIT_LEVEL I	$343.60	$429.50	—	38% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC EMERGENCY DEPT E_M VISIT_LEVEL I	$343.60	$429.50	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC EMERGENCY DEPT E_M VISIT_LEVEL II	$515.39	$644.24	—	53% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC EMERGENCY DEPT E_M VISIT_LEVEL II	$515.39	$644.24	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC EMERGENCY DEPT E_M VISIT_LEVEL III	$841.82	$1,052.27	—	50% above	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC EMERGENCY DEPT E_M VISIT_LEVEL III	$841.82	$1,052.27	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC EMERGENCY DEPT E_M VISIT_LEVEL IV	$1,136.42	$1,420.53	—	35% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC EMERGENCY DEPT E_M VISIT_LEVEL IV	$1,136.42	$1,420.53	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC EMERGENCY DEPT E_M VISIT_LEVEL V	$1,637.80	$2,047.25	—	38% above	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC EMERGENCY DEPT E_M VISIT_LEVEL V	$1,637.80	$2,047.25	—	—	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC STRESS TEST_ EKG_TRACING ONLY WO INTERPRETATION _ REPORT	$934.83	$1,168.54	—	70% above	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC STRESS TEST_ EKG_TRACING ONLY WO INTERPRETATION _ REPORT	$934.83	$1,168.54	—	—	20%
Family therapy with the patient, 50 minutes CPT 90847 HC OASAS FAMILY PSYCHOTHERAPY W_PATIENT PRESENT 50 MINS	$395.64	$494.55	—	41% above	20%
Family therapy with the patient, 50 minutes CPT 90847 HC OMH FAMILY PSYCHOTHERAPY _CONJOINT PSYCHOTHERAPY_ W PATIENT PRESENT	$415.42	$519.27	—	48% above	20%
Family therapy with the patient, 50 minutes CPT 90847 HC FAMILY PSYCHOTHERAPY _CONJOINT PSYCHOTHERAPY_ W PATIENT PRESENT	$415.42	$519.27	—	48% above	20%
Family therapy with the patient, 50 minutes CPT 90847 HC BHN FAMILY PSYCHOTHERAPY W PATIENT PRESENT	$415.42	$519.27	—	48% above	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC OASAS FAMILY PSYCHOTHERAPY W_PATIENT PRESENT 50 MINS	$395.64	$494.55	—	—	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC BHN FAMILY PSYCHOTHERAPY W PATIENT PRESENT	$415.42	$519.27	—	—	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC FAMILY PSYCHOTHERAPY _CONJOINT PSYCHOTHERAPY_ W PATIENT PRESENT	$415.42	$519.27	—	—	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC OMH FAMILY PSYCHOTHERAPY _CONJOINT PSYCHOTHERAPY_ W PATIENT PRESENT	$415.42	$519.27	—	—	20%
Family therapy without the patient, 50 minutes CPT 90846 HC BHN FAMILY PSYCHOTHERAPY WO PATIENT PRESENT	$415.42	$519.27	—	57% above	20%
Family therapy without the patient, 50 minutes CPT 90846 HC OASAS_ FAMILY PSYCHOTHERAPY WO PATIENT PRESENT	$415.42	$519.27	—	57% above	20%
Family therapy without the patient, 50 minutes CPT 90846 HC OMH FAMILY PSYCHOTHERAPY WO PATIENT PRESENT	$415.42	$519.27	—	57% above	20%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC OASAS_ FAMILY PSYCHOTHERAPY WO PATIENT PRESENT	$415.42	$519.27	—	—	20%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC OMH FAMILY PSYCHOTHERAPY WO PATIENT PRESENT	$415.42	$519.27	—	—	20%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC BHN FAMILY PSYCHOTHERAPY WO PATIENT PRESENT	$415.42	$519.27	—	—	20%
Group psychotherapy session CPT 90853 HC OMH GROUP PSYCHOTHERAPY_ OTHER THAN OF A MULTI_FAMILY GROUP	$241.98	$302.47	—	91% above	20%
Group psychotherapy session CPT 90853 HC BHN GROUP PSYCHOTHERAPY	$241.98	$302.47	—	91% above	20%
Group psychotherapy session CPT 90853 HC OASAS DRUG ORIENTATION_ GROUP PSYCHOTHERAPY _OTHER THAN MULTI_FAMILY GROUP_	$260.13	$325.16	—	105% above	20%
Group psychotherapy session CPT 90853 HC OASAS DRUG AOP STABILIZATION	$260.13	$325.16	—	105% above	20%
Group psychotherapy session CPT 90853 HC OASAS DRUG ADULTS IN RECOVERY_ GROUP PSYCHOTHERAPY _OTHER THAN MULTI_FAMILY GROUP_	$260.13	$325.16	—	105% above	20%
Group psychotherapy session CPT 90853 HC OASAS ALCOHOL ADULTS IN RECOVERY_ GROUP PSYCHOTHERAPY _OTHER THAN MULTI_FAMILY GROUP_	$260.13	$325.16	—	105% above	20%
Group psychotherapy session CPT 90853 HC OASAS ALCOHOL AOP STABILIZATION	$260.13	$325.16	—	105% above	20%
Group psychotherapy session CPT 90853 HC OASAS ALCOHOL ORIENTATION_ GROUP PSYCHOTHERAPY _OTHER THAN MULTI_FAMILY GROUP_	$260.13	$325.16	—	105% above	20%
Group psychotherapy session CPT 90853 HC OASAS GROUP PSYCHOTHERAPY	$277.40	$346.75	—	119% above	20%
Group psychotherapy session inpatient CPT 90853 HC OMH GROUP PSYCHOTHERAPY_ OTHER THAN OF A MULTI_FAMILY GROUP	$241.98	$302.47	—	—	20%
Group psychotherapy session inpatient CPT 90853 HC BHN GROUP PSYCHOTHERAPY	$241.98	$302.47	—	—	20%
Group psychotherapy session inpatient CPT 90853 HC OASAS DRUG ORIENTATION_ GROUP PSYCHOTHERAPY _OTHER THAN MULTI_FAMILY GROUP_	$260.13	$325.16	—	—	20%
Group psychotherapy session inpatient CPT 90853 HC OASAS ALCOHOL AOP STABILIZATION	$260.13	$325.16	—	—	20%
Group psychotherapy session inpatient CPT 90853 HC OASAS ALCOHOL ADULTS IN RECOVERY_ GROUP PSYCHOTHERAPY _OTHER THAN MULTI_FAMILY GROUP_	$260.13	$325.16	—	—	20%
Group psychotherapy session inpatient CPT 90853 HC OASAS ALCOHOL ORIENTATION_ GROUP PSYCHOTHERAPY _OTHER THAN MULTI_FAMILY GROUP_	$260.13	$325.16	—	—	20%
Group psychotherapy session inpatient CPT 90853 HC OASAS DRUG ADULTS IN RECOVERY_ GROUP PSYCHOTHERAPY _OTHER THAN MULTI_FAMILY GROUP_	$260.13	$325.16	—	—	20%
Group psychotherapy session inpatient CPT 90853 HC OASAS DRUG AOP STABILIZATION	$260.13	$325.16	—	—	20%
Group psychotherapy session inpatient CPT 90853 HC OASAS GROUP PSYCHOTHERAPY	$277.40	$346.75	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INFUSION_ HYDRATION_ INITIAL 31 MINUTES TO 1 HOUR	$428.75	$535.94	—	15% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC 96360 IV INFUSION HYDRATION_ INITIAL_ 31 MIN TO 1 HR	$428.75	$535.94	—	15% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV INFUSION_ HYDRATION_ INITIAL 31 MINUTES TO 1 HOUR	$428.75	$535.94	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC 96360 IV INFUSION HYDRATION_ INITIAL_ 31 MIN TO 1 HR	$428.75	$535.94	—	—	20%
IV infusion of a medicine, first hour CPT 96365 HC IV INF THERAPY_PROPH_DIAG_ INITIAL UP TO 1 HOUR	$428.75	$535.94	—	2% above	20%
IV infusion of a medicine, first hour CPT 96365 HC _ IV INFUSION THERAPY_PROPH_DIAG_INITIAL UP TO 1 HR	$428.75	$535.94	—	2% above	20%
IV infusion of a medicine, first hour CPT 96365 HC 96365 IV INFUSION THERAPY_PROPH_DIAG_ INITIAL_ UP TO ONE HOUR	$428.75	$535.94	—	2% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 HC _ IV INFUSION THERAPY_PROPH_DIAG_INITIAL UP TO 1 HR	$428.75	$535.94	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INF THERAPY_PROPH_DIAG_ INITIAL UP TO 1 HOUR	$428.75	$535.94	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 HC 96365 IV INFUSION THERAPY_PROPH_DIAG_ INITIAL_ UP TO ONE HOUR	$428.75	$535.94	—	—	20%
IV push of a medicine, first drug CPT 96374 HC THER_PROPH_DIAG INJ_ IV PUSH_ SINGLE_INITIAL SUBSTANCE_DRUG	$428.75	$535.94	—	68% above	20%
IV push of a medicine, first drug CPT 96374 HC THERA_PROPH_DIAG INJ_IV PUSH_SINGLE _ INITIAL SUBSTANCE_DRUG	$428.75	$535.94	—	68% above	20%
IV push of a medicine, first drug CPT 96374 HC 96374 THER_PROPH_DIAG INJ_ IV PUSH_ SINGLE_INITIAL_ SUBSTANCE_DRUG	$428.75	$535.94	—	68% above	20%
IV push of a medicine, first drug CPT 96374 HC THERAPEUTIC_ PROPH_DX INJ_IV PUSH SING_INIT SUBSTANCE_DRUG	$428.75	$535.94	—	68% above	20%
IV push of a medicine, first drug inpatient CPT 96374 HC THERA_PROPH_DIAG INJ_IV PUSH_SINGLE _ INITIAL SUBSTANCE_DRUG	$428.75	$535.94	—	—	20%
IV push of a medicine, first drug inpatient CPT 96374 HC THERAPEUTIC_ PROPH_DX INJ_IV PUSH SING_INIT SUBSTANCE_DRUG	$428.75	$535.94	—	—	20%
IV push of a medicine, first drug inpatient CPT 96374 HC 96374 THER_PROPH_DIAG INJ_ IV PUSH_ SINGLE_INITIAL_ SUBSTANCE_DRUG	$428.75	$535.94	—	—	20%
IV push of a medicine, first drug inpatient CPT 96374 HC THER_PROPH_DIAG INJ_ IV PUSH_ SINGLE_INITIAL SUBSTANCE_DRUG	$428.75	$535.94	—	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC THERA_PROPH_DIAG INJ_SUBCUTANEOUS OR INTRAMUSCULAR	$98.80	$123.50	—	11% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC THER_PROPH_DIAG INJ_ SC_IM	$98.80	$123.50	—	11% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC 96372 THER_PROPH_DIAG INJ_ SC_IM	$98.80	$123.50	—	11% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC THER_PROPH_DIAG INJ SC_IM	$98.80	$123.50	—	11% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC OMH THERAPEUTIC_ PROPHYLACTIC OR DIAGNOSTIC INJECTION_ SUBCUTANEOUS_INTRAMUSCULAR	$138.78	$173.48	—	25% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC OMH COMPREHENSIVE MEDICATION SERVICES _INJECTION__ W MONITORING_ PER 15 MINS	$138.78	$173.48	—	25% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC BHN THERAPEUTIC PROPHYLACTIC_DX INJ_ SC_IM	$138.78	$173.48	—	25% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC OASAS THERAPEUTIC_ PROPHYLACTIC OR DIAGNOSTIC INJECTION_ SUBCUTANEOUS_INTRAMUSCULAR	$159.26	$199.08	—	43% above	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC 96372 THER_PROPH_DIAG INJ_ SC_IM	$98.80	$123.50	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC THER_PROPH_DIAG INJ_ SC_IM	$98.80	$123.50	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC THER_PROPH_DIAG INJ SC_IM	$98.80	$123.50	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC THERA_PROPH_DIAG INJ_SUBCUTANEOUS OR INTRAMUSCULAR	$98.80	$123.50	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC OMH THERAPEUTIC_ PROPHYLACTIC OR DIAGNOSTIC INJECTION_ SUBCUTANEOUS_INTRAMUSCULAR	$138.78	$173.48	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC OMH COMPREHENSIVE MEDICATION SERVICES _INJECTION__ W MONITORING_ PER 15 MINS	$138.78	$173.48	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC BHN THERAPEUTIC PROPHYLACTIC_DX INJ_ SC_IM	$138.78	$173.48	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC OASAS THERAPEUTIC_ PROPHYLACTIC OR DIAGNOSTIC INJECTION_ SUBCUTANEOUS_INTRAMUSCULAR	$159.26	$199.08	—	—	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC OMH OLP EVALUATION_ 15 MINS	$85.03	$106.29	—	67% below	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC OMH PSYCHIATRIC DIAGNOSTIC EVAL 2ND ASSESSEMENTMINIMUM 45 MINUTES	$395.64	$494.55	—	56% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSYCHIATRIC DIAGNOSTIC EVALUATION	$415.42	$519.27	—	64% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC INSOMNIA INITIAL EVALUATION	$415.42	$519.27	—	64% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC OMH BARIATRIC CONSULT	$415.42	$519.27	—	64% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC OASAS THIRD ASSESSMENT 30 MINS	$446.39	$557.99	—	76% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC OASAS SECOND ASSESSMENT 30 MINS	$446.39	$557.99	—	76% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC OASAS FIRST ASSESSMENT 30 MINS	$446.39	$557.99	—	76% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC BHN DIAGNOSTIC EVALUATION	$461.57	$576.96	—	82% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC OMH PSYCHIATRIC DIAGNOSTIC EVALUATION_ 1ST ASSESSMENT	$461.57	$576.96	—	82% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC OASAS THIRD DIAGNOSTIC EVALUATION 75 MINS	$507.95	$634.94	—	100% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC OASAS SECOND DIAGNOSTIC EVALUATION 75 MINS	$507.95	$634.94	—	100% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC OASAS FIRST DIAGNOSTIC EVALUATION 75 MINS	$507.95	$634.94	—	100% above	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC OMH OLP EVALUATION_ 15 MINS	$85.03	$106.29	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC OMH PSYCHIATRIC DIAGNOSTIC EVAL 2ND ASSESSEMENTMINIMUM 45 MINUTES	$395.64	$494.55	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC OMH BARIATRIC CONSULT	$415.42	$519.27	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PSYCHIATRIC DIAGNOSTIC EVALUATION	$415.42	$519.27	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC INSOMNIA INITIAL EVALUATION	$415.42	$519.27	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC OASAS THIRD ASSESSMENT 30 MINS	$446.39	$557.99	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC OASAS SECOND ASSESSMENT 30 MINS	$446.39	$557.99	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC OASAS FIRST ASSESSMENT 30 MINS	$446.39	$557.99	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC OMH PSYCHIATRIC DIAGNOSTIC EVALUATION_ 1ST ASSESSMENT	$461.57	$576.96	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC BHN DIAGNOSTIC EVALUATION	$461.57	$576.96	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC OASAS THIRD DIAGNOSTIC EVALUATION 75 MINS	$507.95	$634.94	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC OASAS FIRST DIAGNOSTIC EVALUATION 75 MINS	$507.95	$634.94	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC OASAS SECOND DIAGNOSTIC EVALUATION 75 MINS	$507.95	$634.94	—	—	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC 7_8 NERVE CONDUCTION STUDIES	$934.83	$1,168.54	—	104% above	20%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC 7_8 NERVE CONDUCTION STUDIES	$934.83	$1,168.54	—	—	20%
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSCULAR RE_EDUCATION_ EA 15 MIN_ 1 OR MORE AREAS	$133.52	$166.90	—	63% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSCULAR RE_EDUCATION_ EA 15 MIN	$133.52	$166.90	—	63% above	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSCULAR RE_EDUCATION_ EA 15 MIN	$133.52	$166.90	—	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSCULAR RE_EDUCATION_ EA 15 MIN_ 1 OR MORE AREAS	$133.52	$166.90	—	—	20%
New patient office visit, about 30 minutes CPT 99203 HC OMH E_M MED MANAGEMENT NEW PATIENT LEVEL 3	$342.11	$427.64	—	53% above	20%
New patient office visit, about 30 minutes CPT 99203 HC BHN E_M NEW PATIENT LEVEL 3	$342.11	$427.64	—	53% above	20%
New patient office visit, about 30 minutes CPT 99203 HC OMH E_M NEW PATIENT LEVEL 3	$342.11	$427.64	—	53% above	20%
New patient office visit, about 30 minutes CPT 99203 HC OFFICE_OUTPATIENT NEW LOW MDM 30 MINUTES	$438.92	$548.65	—	97% above	20%
New patient office visit, about 30 minutes inpatient CPT 99203 HC OMH E_M NEW PATIENT LEVEL 3	$342.11	$427.64	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 HC OMH E_M MED MANAGEMENT NEW PATIENT LEVEL 3	$342.11	$427.64	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 HC BHN E_M NEW PATIENT LEVEL 3	$342.11	$427.64	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 HC OFFICE_OUTPATIENT NEW LOW MDM 30 MINUTES	$438.92	$548.65	—	—	20%
New patient office visit, about 45 minutes CPT 99204 HC BHN E_M NEW PATIENT LEVEL 4	$359.22	$449.03	—	21% above	20%
New patient office visit, about 45 minutes CPT 99204 HC OMH E_M NEW PATIENT LEVEL 4	$359.22	$449.03	—	21% above	20%
New patient office visit, about 45 minutes CPT 99204 HC OMH E_M MED MANAGEMENT NEW PATIENT LEVEL 4	$359.22	$449.03	—	21% above	20%
New patient office visit, about 45 minutes CPT 99204 HC OASAS ALCOHOL_ MED MANAGEMENT NEW PATIENT LEVEL 4	$386.16	$482.70	—	30% above	20%
New patient office visit, about 45 minutes CPT 99204 HC OFFICE_OUTPATIENT NEW MODERATE MDM 45 MINUTES	$545.47	$681.84	—	83% above	20%
New patient office visit, about 45 minutes inpatient CPT 99204 HC OMH E_M MED MANAGEMENT NEW PATIENT LEVEL 4	$359.22	$449.03	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 HC BHN E_M NEW PATIENT LEVEL 4	$359.22	$449.03	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 HC OMH E_M NEW PATIENT LEVEL 4	$359.22	$449.03	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 HC OASAS ALCOHOL_ MED MANAGEMENT NEW PATIENT LEVEL 4	$386.16	$482.70	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 HC OFFICE_OUTPATIENT NEW MODERATE MDM 45 MINUTES	$545.47	$681.84	—	—	20%
New patient office visit, about 60 minutes CPT 99205 HC OMH E_M MED MANAGEMENT NEW PATIENT LEVEL 5	$377.18	$471.48	—	at median	20%
New patient office visit, about 60 minutes CPT 99205 HC BHN E_M NEW PATIENT LEVEL 5	$377.18	$471.48	—	at median	20%
New patient office visit, about 60 minutes CPT 99205 HC OMH E_M NEW PATIENT LEVEL 5	$377.18	$471.48	—	at median	20%
New patient office visit, about 60 minutes CPT 99205 HC OFFICE_OUTPATIENT NEW HIGH MDM 60 MINUTES	$719.74	$899.68	—	91% above	20%
New patient office visit, about 60 minutes inpatient CPT 99205 HC OMH E_M MED MANAGEMENT NEW PATIENT LEVEL 5	$377.18	$471.48	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 HC BHN E_M NEW PATIENT LEVEL 5	$377.18	$471.48	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 HC OMH E_M NEW PATIENT LEVEL 5	$377.18	$471.48	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 HC OFFICE_OUTPATIENT NEW HIGH MDM 60 MINUTES	$719.74	$899.68	—	—	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OMH E_M MED MANAGEMENT NEW PATIENT LEVEL 2	$325.82	$407.28	—	87% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OMH E_M NEW PATIENT LEVEL 2	$325.82	$407.28	—	87% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC BHN E_M NEW PATIENT LEVEL 2	$325.82	$407.28	—	87% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OFFICE_OUTPATIENT NEW SF MDM 15 MINUTES	$378.95	$473.69	—	117% above	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC BHN E_M NEW PATIENT LEVEL 2	$325.82	$407.28	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC OMH E_M MED MANAGEMENT NEW PATIENT LEVEL 2	$325.82	$407.28	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC OMH E_M NEW PATIENT LEVEL 2	$325.82	$407.28	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC OFFICE_OUTPATIENT NEW SF MDM 15 MINUTES	$378.95	$473.69	—	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MNT IND INITIAL_MVP SESSION	$96.80	$121.00	—	83% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MEDICAL NUTRITION THERAPY_ INITIAL_ INDIVIDUAL_ EACH 15 MINUTES	$96.80	$121.00	—	83% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MNT_INITIAL INDIVIDUAL_ EACH 15 MINUTES	$96.80	$121.00	—	83% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MEDICAL NUTRITION THERAPY_ INITIAL_ INDIVIDUAL_ EACH 15 MINUTES	$96.80	$121.00	—	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MNT_INITIAL INDIVIDUAL_ EACH 15 MINUTES	$96.80	$121.00	—	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MNT IND INITIAL_MVP SESSION	$96.80	$121.00	—	—	20%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEX	$222.96	$278.70	—	30% above	20%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEX	$222.96	$278.70	—	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEX	$444.67	$555.84	—	68% above	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEX	$444.67	$555.84	—	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEX	$222.96	$278.70	—	24% above	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEX	$222.96	$278.70	—	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEX	$335.08	$418.85	—	40% above	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEX	$335.08	$418.85	—	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY TECHNIQUES_ EA 15 MIN	$105.85	$132.31	—	27% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY TECHNIQUES_ EA 15 MIN_ 1 OR MORE REGIONS	$105.85	$132.31	—	27% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY TECHNIQUES_ EA 15 MIN	$105.85	$132.31	—	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY TECHNIQUES_ EA 15 MIN_ 1 OR MORE REGIONS	$105.85	$132.31	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PULMONARY REHABILITATION THERAPEUTIC EXCERCISES EA 15 MINUTES	$89.50	$111.87	—	19% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE_ EA 15MIN_ 1 OR MORE AREAS	$115.06	$143.83	—	52% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE_ EA 15MIN_ 1 OR MORE AREAS	$115.06	$143.83	—	52% above	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC PULMONARY REHABILITATION THERAPEUTIC EXCERCISES EA 15 MINUTES	$89.50	$111.87	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE_ EA 15MIN_ 1 OR MORE AREAS	$115.06	$143.83	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE_ EA 15MIN_ 1 OR MORE AREAS	$115.06	$143.83	—	—	20%
Preventive checkup, new patient aged 18–39 CPT 99385 HC INITIAL PREVENTIVE E_M_ NEW PATIENT_ AGE 18 THROUGH 39 YEARS	$397.74	$497.18	—	97% above	20%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC INITIAL PREVENTIVE E_M_ NEW PATIENT_ AGE 18 THROUGH 39 YEARS	$397.74	$497.18	—	—	20%
Preventive checkup, new patient aged 40–64 CPT 99386 HC INITIAL PREVENTIVE E_M_ NEW PATIENT_ AGE 40 THROUGH 64 YEARS	$460.58	$575.73	—	105% above	20%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC INITIAL PREVENTIVE E_M_ NEW PATIENT_ AGE 40 THROUGH 64 YEARS	$460.58	$575.73	—	—	20%
Preventive checkup, new patient aged 65 or older CPT 99387 HC INITIAL PREVENTIVE E_M_ NEW PATIENT_ AGE 65 YEARS AND OLDER	$500.29	$625.36	—	95% above	20%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC INITIAL PREVENTIVE E_M_ NEW PATIENT_ AGE 65 YEARS AND OLDER	$500.29	$625.36	—	—	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC PERIODIC PREVENTIVE E_M_ ESTABLISHED PATIENT_ AGE 18 THROUGH 39 YEARS	$356.50	$445.62	—	76% above	20%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC PERIODIC PREVENTIVE E_M_ ESTABLISHED PATIENT_ AGE 18 THROUGH 39 YEARS	$356.50	$445.62	—	—	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC PERIODIC PREVENTIVE E_M_ ESTABLISHED PATIENT_ AGE 40 THROUGH 64 YEARS	$381.86	$477.32	—	63% above	20%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC PERIODIC PREVENTIVE E_M_ ESTABLISHED PATIENT_ AGE 40 THROUGH 64 YEARS	$381.86	$477.32	—	—	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC PERIODIC PREVENTIVE E_M_ ESTABLISHED PATIENT_ AGE 65 YEARS AND OLDER	$410.30	$512.88	—	101% above	20%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC PERIODIC PREVENTIVE E_M_ ESTABLISHED PATIENT_ AGE 65 YEARS AND OLDER	$410.30	$512.88	—	—	20%
Psychiatric evaluation with medical services CPT 90792 HC PSYCHIATRIC DIAGNOSTIC EVALUATION W MEDICAL SERVICES	$415.42	$519.27	—	39% above	20%
Psychiatric evaluation with medical services CPT 90792 HC INSOMNIA INITIAL EVAL W MED SERVICES	$415.42	$519.27	—	39% above	20%
Psychiatric evaluation with medical services CPT 90792 HC OMH PSYCHIATRIC DIAGNOSTIC EVALUATION W MEDICAL SERVICES	$415.42	$519.27	—	39% above	20%
Psychiatric evaluation with medical services CPT 90792 HC BHN DIAGNOSTIC EVALUATION W MEDICAL	$415.42	$519.27	—	39% above	20%
Psychiatric evaluation with medical services inpatient CPT 90792 HC PSYCHIATRIC DIAGNOSTIC EVALUATION W MEDICAL SERVICES	$415.42	$519.27	—	—	20%
Psychiatric evaluation with medical services inpatient CPT 90792 HC BHN DIAGNOSTIC EVALUATION W MEDICAL	$415.42	$519.27	—	—	20%
Psychiatric evaluation with medical services inpatient CPT 90792 HC INSOMNIA INITIAL EVAL W MED SERVICES	$415.42	$519.27	—	—	20%
Psychiatric evaluation with medical services inpatient CPT 90792 HC OMH PSYCHIATRIC DIAGNOSTIC EVALUATION W MEDICAL SERVICES	$415.42	$519.27	—	—	20%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HC PSYCL TST EVAL PHYS_QHP 1ST HOUR	$419.93	$524.91	—	21% above	20%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HC PSYCHOLOGICAL TST EVAL SVC PHYS_QHP FIRST HOUR	$481.90	$602.37	—	39% above	20%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 HC PSYCL TST EVAL PHYS_QHP 1ST HOUR	$419.93	$524.91	—	—	20%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 HC PSYCHOLOGICAL TST EVAL SVC PHYS_QHP FIRST HOUR	$481.90	$602.37	—	—	20%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC BHN PSYCHOTHERAPY FOR CRISIS OFF SITE	$415.42	$519.27	—	55% above	20%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC BHN PSYCHOTHERAPY FOR CRISIS	$415.42	$519.27	—	55% above	20%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC BHN PSYCHOTHERAPY FOR CRISIS	$415.42	$519.27	—	—	20%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC BHN PSYCHOTHERAPY FOR CRISIS OFF SITE	$415.42	$519.27	—	—	20%
Psychotherapy session, 30 minutes CPT 90832 HC BHN PSYCHOTHERAPY 30 MINS	$301.50	$376.87	—	52% above	20%
Psychotherapy session, 30 minutes CPT 90832 HC OMH PSYCHOTHERAPY_ 30 MINS_ W PATIENT AND_OR FAMILY MEMBER	$301.50	$376.87	—	52% above	20%
Psychotherapy session, 30 minutes CPT 90832 HC OASAS INDIVIDUAL COUNSELING _ PSYCHOTHERAPY_ UP TO 44 MINS	$323.24	$404.05	—	63% above	20%
Psychotherapy session, 30 minutes CPT 90832 HC INSOMNIA 20 TO 30 MINUTES	$415.42	$519.27	—	110% above	20%
Psychotherapy session, 30 minutes CPT 90832 HC PSYCHOTHERAPY 30 MINUTES WITH PATIENT AND_OR FAMILY MEMBER	$415.42	$519.27	—	110% above	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC BHN PSYCHOTHERAPY 30 MINS	$301.50	$376.87	—	—	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC OMH PSYCHOTHERAPY_ 30 MINS_ W PATIENT AND_OR FAMILY MEMBER	$301.50	$376.87	—	—	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC OASAS INDIVIDUAL COUNSELING _ PSYCHOTHERAPY_ UP TO 44 MINS	$323.24	$404.05	—	—	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC INSOMNIA 20 TO 30 MINUTES	$415.42	$519.27	—	—	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCHOTHERAPY 30 MINUTES WITH PATIENT AND_OR FAMILY MEMBER	$415.42	$519.27	—	—	20%
Psychotherapy session, 45 minutes CPT 90834 HC BHN PSYCHOTHERAPY 45MINS	$375.30	$469.13	—	43% above	20%
Psychotherapy session, 45 minutes CPT 90834 HC OMH PSYCHOTHERAPY_ 45 MINS_ W PATIENT AND_OR FAMILY MEMBER	$375.30	$469.13	—	43% above	20%
Psychotherapy session, 45 minutes CPT 90834 HC INSOMNIA 45 TO 50 MINUTES	$415.42	$519.27	—	59% above	20%
Psychotherapy session, 45 minutes CPT 90834 HC PSYCHOTHERAPY 45 MINUTES W PATIENT AND_OR FAMILY MEMBER	$415.42	$519.27	—	59% above	20%
Psychotherapy session, 45 minutes CPT 90834 HC OASAS INDIVIDUAL COUNSELING _ PSYCHOTHERAPY_ 45_ MINS	$415.61	$519.51	—	59% above	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC OMH PSYCHOTHERAPY_ 45 MINS_ W PATIENT AND_OR FAMILY MEMBER	$375.30	$469.13	—	—	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC BHN PSYCHOTHERAPY 45MINS	$375.30	$469.13	—	—	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCHOTHERAPY 45 MINUTES W PATIENT AND_OR FAMILY MEMBER	$415.42	$519.27	—	—	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC INSOMNIA 45 TO 50 MINUTES	$415.42	$519.27	—	—	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC OASAS INDIVIDUAL COUNSELING _ PSYCHOTHERAPY_ 45_ MINS	$415.61	$519.51	—	—	20%
Psychotherapy session, 60 minutes CPT 90837 HC OASAS PSYCHOTHERAPY 60 MINS W PATIENT AND_OR FAMILY MEMBER	$369.48	$461.85	—	24% above	20%
Psychotherapy session, 60 minutes CPT 90837 HC BHN PSYCHOTHERAPY 60 MINS	$415.42	$519.27	—	39% above	20%
Psychotherapy session, 60 minutes CPT 90837 HC PSYCHOTHERAPY 60 MINUTES W PATIENT	$415.42	$519.27	—	39% above	20%
Psychotherapy session, 60 minutes CPT 90837 HC OMH PSYCHOTHERAPY_ 60 MINS_ W PATIENT AND_OR FAMILY MEMBER	$415.42	$519.27	—	39% above	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC OASAS PSYCHOTHERAPY 60 MINS W PATIENT AND_OR FAMILY MEMBER	$369.48	$461.85	—	—	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC OMH PSYCHOTHERAPY_ 60 MINS_ W PATIENT AND_OR FAMILY MEMBER	$415.42	$519.27	—	—	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYCHOTHERAPY 60 MINUTES W PATIENT	$415.42	$519.27	—	—	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC BHN PSYCHOTHERAPY 60 MINS	$415.42	$519.27	—	—	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC SMOKE_TOBACCO USE CESSATION COUNSELING_ INTERMEDIATE_ 3 _ 10 MINUTES	$117.29	$146.61	—	151% above	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC SMOKING _ TOBACCO USE CESSATION COUNSELING VISIT_ INTERMEDIATE_ _ 3 MINS UP TO 10 MINS	$117.29	$146.61	—	151% above	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC SMOKING _ TOBACCO USE CESSATION COUNSELING VISIT_ INTERMEDIATE_ _ 3 MINS UP TO 10 MINS	$117.29	$146.61	—	—	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC SMOKE_TOBACCO USE CESSATION COUNSELING_ INTERMEDIATE_ 3 _ 10 MINUTES	$117.29	$146.61	—	—	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OASAS PYSCH EVALUATION EST PATIENT LEVEL 5	$314.31	$392.89	—	34% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC BHN E_M EST PATIENT LEVEL 5	$314.31	$392.89	—	34% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC BHN MED MANAGEMENT EST PT LEVEL 5	$314.31	$392.89	—	34% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OASAS HISTORY _ PHYSICAL EST PATIENT LEVEL 5	$314.31	$392.89	—	34% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OASAS E_M MED INDUCTION EST PATIENT LEVEL 5	$314.31	$392.89	—	34% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OMH E_M EST PATIENT LEVEL 5	$314.31	$392.89	—	34% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OMH E_M MED MANAGEMENT EST PATIENT LEVEL 5	$314.31	$392.89	—	34% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OASAS ACUTE MEDICAL EST PATIENT LEVEL 5	$314.31	$392.89	—	34% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OASAS MED MANAGEMENT EST PATIENT LEVEL 5	$314.31	$392.89	—	34% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OFFICE_OUTPATIENT ESTABLISHED HIGH MDM 40 MIN	$599.78	$749.72	—	155% above	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OMH E_M MED MANAGEMENT EST PATIENT LEVEL 5	$314.31	$392.89	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OASAS ACUTE MEDICAL EST PATIENT LEVEL 5	$314.31	$392.89	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC BHN MED MANAGEMENT EST PT LEVEL 5	$314.31	$392.89	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OMH E_M EST PATIENT LEVEL 5	$314.31	$392.89	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OASAS PYSCH EVALUATION EST PATIENT LEVEL 5	$314.31	$392.89	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OASAS MED MANAGEMENT EST PATIENT LEVEL 5	$314.31	$392.89	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OASAS HISTORY _ PHYSICAL EST PATIENT LEVEL 5	$314.31	$392.89	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OASAS E_M MED INDUCTION EST PATIENT LEVEL 5	$314.31	$392.89	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC BHN E_M EST PATIENT LEVEL 5	$314.31	$392.89	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OFFICE_OUTPATIENT ESTABLISHED HIGH MDM 40 MIN	$599.78	$749.72	—	—	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC BILIARY TUBE REMOVAL	$206.83	$258.54	—	13% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OASAS PYSCH EVALUATION EST PATIENT LEVEL 3	$285.10	$356.37	—	56% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OASAS MED MANAGEMENT EST PATIENT LEVEL 3	$285.10	$356.37	—	56% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OASAS HISTORY _ PHYSICAL EST PATIENT LEVEL 3	$285.10	$356.37	—	56% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OASAS ACUTE MEDICAL EST PATIENT LEVEL 3	$285.10	$356.37	—	56% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OASAS E_M MED INDUCTION EST PATIENT LEVEL 3	$285.10	$356.37	—	56% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC BHN E_M EST PATIENT LEVEL 3	$285.10	$356.37	—	56% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OMH E_M MED MANAGEMENT EST PATIENT LEVEL 3	$285.10	$356.37	—	56% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OMH E_M EST PATIENT LEVEL 3	$285.10	$356.37	—	56% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC BHN MED MANAGEMENT EST PT LEVEL 3	$285.10	$356.37	—	56% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OFFICE_OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$365.78	$457.22	—	100% above	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC BILIARY TUBE REMOVAL	$206.83	$258.54	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OMH E_M EST PATIENT LEVEL 3	$285.10	$356.37	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OASAS MED MANAGEMENT EST PATIENT LEVEL 3	$285.10	$356.37	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OASAS PYSCH EVALUATION EST PATIENT LEVEL 3	$285.10	$356.37	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC BHN E_M EST PATIENT LEVEL 3	$285.10	$356.37	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OASAS E_M MED INDUCTION EST PATIENT LEVEL 3	$285.10	$356.37	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OMH E_M MED MANAGEMENT EST PATIENT LEVEL 3	$285.10	$356.37	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC BHN MED MANAGEMENT EST PT LEVEL 3	$285.10	$356.37	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OASAS ACUTE MEDICAL EST PATIENT LEVEL 3	$285.10	$356.37	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OASAS HISTORY _ PHYSICAL EST PATIENT LEVEL 3	$285.10	$356.37	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OFFICE_OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$365.78	$457.22	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC BHN E_M EST PATIENT LEVEL 4	$299.35	$374.19	—	52% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC BHN MED MANAGEMENT EST PT LEVEL 4	$299.35	$374.19	—	52% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OASAS ACUTE MEDICAL EST PATIENT LEVEL 4	$299.35	$374.19	—	52% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OASAS MED MANAGEMENT EST PATIENT LEVEL 4	$299.35	$374.19	—	52% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OASAS E_M MED INDUCTION EST PATIENT LEVEL 4	$299.35	$374.19	—	52% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OMH E_M MED MANAGEMENT EST PATIENT LEVEL 4	$299.35	$374.19	—	52% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OMH E_M EST PATIENT LEVEL 4	$299.35	$374.19	—	52% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OASAS HISTORY _ PHYSICAL EST PATIENT LEVEL 4	$299.35	$374.19	—	52% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OASAS PYSCH EVALUATION EST PATIENT LEVEL 4	$299.35	$374.19	—	52% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OFFICE_OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$454.58	$568.23	—	130% above	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OASAS MED MANAGEMENT EST PATIENT LEVEL 4	$299.35	$374.19	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OASAS ACUTE MEDICAL EST PATIENT LEVEL 4	$299.35	$374.19	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OASAS HISTORY _ PHYSICAL EST PATIENT LEVEL 4	$299.35	$374.19	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC BHN MED MANAGEMENT EST PT LEVEL 4	$299.35	$374.19	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OMH E_M EST PATIENT LEVEL 4	$299.35	$374.19	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OASAS PYSCH EVALUATION EST PATIENT LEVEL 4	$299.35	$374.19	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC BHN E_M EST PATIENT LEVEL 4	$299.35	$374.19	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OMH E_M MED MANAGEMENT EST PATIENT LEVEL 4	$299.35	$374.19	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OASAS E_M MED INDUCTION EST PATIENT LEVEL 4	$299.35	$374.19	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OFFICE_OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$454.58	$568.23	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OFFICE_OUTPATIENT ESTABLISHED SF MDM 10 MIN POST_OP	$151.93	$189.91	—	9% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OASAS PYSCH EVALUATION EST PATIENT LEVEL 2	$271.51	$339.39	—	62% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OMH E_M EST PATIENT LEVEL 2	$271.51	$339.39	—	62% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OASAS MED MANAGEMENT EST PATIENT LEVEL 2	$271.51	$339.39	—	62% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OASAS ACUTE MEDICAL EST PATIENT LEVEL 2	$271.51	$339.39	—	62% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OASAS HISTORY _ PHYSICAL EST PATIENT LEVEL 2	$271.51	$339.39	—	62% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OASAS E_M MED INDUCTION EST PATIENT LEVEL 2	$271.51	$339.39	—	62% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC BHN E_M EST PATIENT LEVEL 2	$271.51	$339.39	—	62% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC BHN MED MANAGEMENT EST PT LEVEL 2	$271.51	$339.39	—	62% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OMH E_M MED MANAGEMENT EST PATIENT LEVEL 2	$271.51	$339.39	—	62% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OFFICE_OUTPATIENT ESTABLISHED SF MDM 10 MIN	$315.81	$394.76	—	88% above	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OFFICE_OUTPATIENT ESTABLISHED SF MDM 10 MIN POST_OP	$151.93	$189.91	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OMH E_M EST PATIENT LEVEL 2	$271.51	$339.39	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OASAS PYSCH EVALUATION EST PATIENT LEVEL 2	$271.51	$339.39	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OASAS E_M MED INDUCTION EST PATIENT LEVEL 2	$271.51	$339.39	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OASAS ACUTE MEDICAL EST PATIENT LEVEL 2	$271.51	$339.39	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OASAS MED MANAGEMENT EST PATIENT LEVEL 2	$271.51	$339.39	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC BHN E_M EST PATIENT LEVEL 2	$271.51	$339.39	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC BHN MED MANAGEMENT EST PT LEVEL 2	$271.51	$339.39	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OASAS HISTORY _ PHYSICAL EST PATIENT LEVEL 2	$271.51	$339.39	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OMH E_M MED MANAGEMENT EST PATIENT LEVEL 2	$271.51	$339.39	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OFFICE_OUTPATIENT ESTABLISHED SF MDM 10 MIN	$315.81	$394.76	—	—	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HC OFFICE CONSULT_ NEW_ESTABLISHED PATIENT_ MODERATE_ 40 MIN FACE_TO_FACE	$201.53	$251.91	—	32% below	20%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC OFFICE CONSULT_ NEW_ESTABLISHED PATIENT_ MODERATE_ 40 MIN FACE_TO_FACE	$201.53	$251.91	—	—	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC OFFICE CONSULT_ NEW_ESTABLISHED PATIENT_ MODERATE TO HIGH_ 60 MIN FACE_TO_FACE	$320.86	$401.08	—	7% above	20%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HC OFFICE CONSULT_ NEW_ESTABLISHED PATIENT_ MODERATE TO HIGH_ 60 MIN FACE_TO_FACE	$320.86	$401.08	—	—	20%
Speech and language evaluation CPT 92523 HC SPEECH SOUND LANG COMPREHEN	$737.17	$921.46	—	88% above	20%
Speech and language evaluation CPT 92523 HC EVALUATION OF SPEECH SOUND PRODUCTION_ W EVALUATION LANGUAGE COMPREHENSION_ EXPRESSION	$893.58	$1,116.97	—	128% above	20%
Speech and language evaluation inpatient CPT 92523 HC SPEECH SOUND LANG COMPREHEN	$737.17	$921.46	—	—	20%
Speech and language evaluation inpatient CPT 92523 HC EVALUATION OF SPEECH SOUND PRODUCTION_ W EVALUATION LANGUAGE COMPREHENSION_ EXPRESSION	$893.58	$1,116.97	—	—	20%
Speech therapy session, individual CPT 92507 HC TREAT SPEECH_LANG_VOICE COMM __OR AUDITORY PROCESSING DISORDER_ IND	$297.12	$371.40	—	77% above	20%
Speech therapy session, individual inpatient CPT 92507 HC TREAT SPEECH_LANG_VOICE COMM __OR AUDITORY PROCESSING DISORDER_ IND	$297.12	$371.40	—	—	20%
Spirometry (breathing test) CPT 94010 HC SPIROMETRY W GRAPHIC RECORD_ VIT CAP_ EXPIRATORY FLOW RATE	$517.84	$647.30	—	133% above	20%
Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY W GRAPHIC RECORD_ VIT CAP_ EXPIRATORY FLOW RATE	$517.84	$647.30	—	—	20%
Spirometry before and after a bronchodilator CPT 94060 HC BRONCHODILATION RESPONSIVENESS_ SPIROMETRY	$934.83	$1,168.54	—	141% above	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC BRONCHODILATION RESPONSIVENESS_ SPIROMETRY	$934.83	$1,168.54	—	—	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUTIC ACTIVITIES_ DIRECT_ EA 15 MIN	$148.70	$185.87	—	73% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPUTIC ACTIVITIES_ DIRECT_ EA 15 MIN	$148.70	$185.87	—	73% above	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUTIC ACTIVITIES_ DIRECT_ EA 15 MIN	$148.70	$185.87	—	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPUTIC ACTIVITIES_ DIRECT_ EA 15 MIN	$148.70	$185.87	—	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC THERAPEUTIC PHLEBOTOMY	$360.21	$450.26	—	69% above	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC THERAPEUTIC PHLEBOTOMY	$360.21	$450.26	—	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs New York	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 HC SARSCOV2 VACCINE 50 MCG_0.5ML FOR IM USE	$294.66	$368.32	—	44% above	20%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 HC SARSCOV2 VACCINE 50 MCG_0.5ML FOR IM USE	$294.66	$368.32	—	—	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 HC SARSCOV2 VACC 30MCG_0.3ML TRIS_SUCROSE IM USE	$241.57	$301.96	—	20% above	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 HC SARSCOV2 VACC 30MCG_0.3ML TRIS_SUCROSE IM USE	$241.57	$301.96	—	—	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 HC VARICELLA VIRUS VACCINE LIVE FOR SC USE	$474.62	$593.28	—	79% above	20%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 HC VARICELLA VIRUS VACCINE LIVE FOR SC USE	$474.62	$593.28	—	—	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 HC DTAP_IPV 4_6 YRS OF AGE	$150.90	$188.62	—	65% above	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 HC DTAP_IPV 4_6 YRS OF AGE	$150.90	$188.62	—	—	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 HC DTAP VACCINE FOR IM USE_ YOUNGER THAN 7 YRS OLD	$71.27	$89.09	—	45% above	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 HC DTAP VACCINE FOR IM USE_ YOUNGER THAN 7 YRS OLD	$71.27	$89.09	—	—	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HC DTAP_HEB_IPVIM USE	$166.86	$208.58	—	21% above	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HC DTAP_HEB_IPVIM USE	$166.86	$208.58	—	—	20%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 HC DTAP HIB IPV FOR IM USE	$278.81	$348.51	—	91% above	20%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 HC DTAP HIB IPV FOR IM USE	$278.81	$348.51	—	—	20%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 HC DTAP_IPV_HIB_HEPB VACCINE INTRAMUSCULAR	$259.71	$324.64	—	13% above	20%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 HC DTAP_IPV_HIB_HEPB VACCINE INTRAMUSCULAR	$259.71	$324.64	—	—	20%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 HC RIV3 VACCINE PRESERVATIVE FREE FOR IM USE	$209.09	$261.36	—	97% above	20%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 HC RIV3 VACCINE PRESERVATIVE FREE FOR IM USE	$209.09	$261.36	—	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$50.38	$62.98	—	78% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 HC IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$50.38	$62.98	—	—	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HC 9VHPV VACCINE 2 OR 3 DOSE SCHEDULE IM USE	$789.62	$987.03	—	58% above	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HC 9VHPV VACCINE 2 OR 3 DOSE SCHEDULE IM USE	$789.62	$987.03	—	—	20%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HC HEP A_HEP B VACC ADULT IM	$256.45	$320.56	—	13% above	20%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HC HEP A_HEP B VACC ADULT IM	$256.45	$320.56	—	—	20%
Hepatitis A vaccine, adult dose CPT 90632 HC HEP A VACCINE_ ADULT DOSAGE_ 1ST INJ_ INTRAMUSCULAR	$174.89	$218.61	—	70% above	20%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HC HEP A VACCINE_ ADULT DOSAGE_ 1ST INJ_ INTRAMUSCULAR	$174.89	$218.61	—	—	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HC HEP A VACCINE_ PEDIATRIC_ADOLESCENT DOSAGE_2 DOSE SCHEDULE_ IM	$73.78	$92.22	—	31% above	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HC HEP A VACCINE_ PEDIATRIC_ADOLESCENT DOSAGE_2 DOSE SCHEDULE_ IM	$73.78	$92.22	—	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC HEPATITIS B VACCINE_ ADULT _20YRS OF AGE	$97.19	$121.49	—	9% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HC HEPATITIS B VACCINE_ ADULT _20YRS OF AGE	$97.19	$121.49	—	—	20%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HC HEPATITIS B VACCINE ADULT 2 DOSE SCHEDULE FOR IM USE	$334.07	$417.59	—	38% above	20%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HC HEPATITIS B VACCINE ADULT 2 DOSE SCHEDULE FOR IM USE	$334.07	$417.59	—	—	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HC HEPATITIS B PED_ADOLESCENT IM USE 3 DOSE SCHEDULE.	$55.85	$69.81	—	23% above	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HC HEPATITIS B PED_ADOLESCENT IM USE 3 DOSE SCHEDULE.	$55.85	$69.81	—	—	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HC HIB PRP_OMP VACC 3 DOSE IM	$72.67	$90.84	—	16% above	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HC HIB PRP_OMP VACC 3 DOSE IM	$72.67	$90.84	—	—	20%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HC HIB_ RPR_T 4 DOSE SCHEDULE_ IM	$32.03	$40.04	—	at median	20%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HC HIB_ RPR_T 4 DOSE SCHEDULE_ IM	$32.03	$40.04	—	—	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM	$209.09	$261.36	—	88% above	20%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 HC IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM	$209.09	$261.36	—	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 HC MMR VACCINE SC_JET INJ USE	$226.25	$282.81	—	68% above	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 HC MMR VACCINE SC_JET INJ USE	$226.25	$282.81	—	—	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 HC MMRV_ LIVE_ SC USE	$699.75	$874.69	—	60% above	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 HC MMRV_ LIVE_ SC USE	$699.75	$874.69	—	—	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 HC MENINGOCOCCAL VACCINE FOR IM USE	$406.24	$507.80	—	99% above	20%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 HC MENINGOCOCCAL VACCINE FOR IM USE	$406.24	$507.80	—	—	20%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 HC MENACWY_TT CONJ VACC SEROGROUPS ACWY FOR IM USE	$387.88	$484.85	—	59% above	20%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 HC MENACWY_TT CONJ VACC SEROGROUPS ACWY FOR IM USE	$387.88	$484.85	—	—	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 HC MENB RECOMBINANT PROT W_OUT MEMBR VESIC VACC IM	$406.24	$507.80	—	23% above	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 HC MENB RECOMBINANT PROT W_OUT MEMBR VESIC VACC IM	$406.24	$507.80	—	—	20%
Meningococcal B vaccine (Trumenba) CPT 90621 HC MENB_FHBP RECOMBNT LIPOPROTEIN VACC 2_3 DOSE IM	$422.42	$528.03	—	22% above	20%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 HC MENB_FHBP RECOMBNT LIPOPROTEIN VACC 2_3 DOSE IM	$422.42	$528.03	—	—	20%
Nasal spray flu vaccine, live (FluMist) CPT 90660 HC INFLUENZA VIRUS VACCINE TRIVALENT LIVE _LAIV3_ INTRANASAL	$63.60	$79.50	—	47% above	20%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 HC INFLUENZA VIRUS VACCINE TRIVALENT LIVE _LAIV3_ INTRANASAL	$63.60	$79.50	—	—	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 HC PREVNAR	$569.32	$711.65	—	74% above	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 HC PREVNAR	$569.32	$711.65	—	—	20%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 HC PCV15 VACCINE FOR INTRAMUSCULAR USE	$540.95	$676.19	—	53% above	20%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 HC PCV15 VACCINE FOR INTRAMUSCULAR USE	$540.95	$676.19	—	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 HC PNEUMOCOCCAL CONJUGATE VACCINE 20 VALENT_PCV20_ INTRAMUSCULAR USE	$569.32	$711.65	—	33% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 HC PNEUMOCOCCAL CONJUGATE VACCINE 20 VALENT_PCV20_ INTRAMUSCULAR USE	$569.32	$711.65	—	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC PNEUMOVAX _PNEUMOCCAL IMMUNIZATION_ 2YRS OR OLDER	$257.16	$321.45	—	52% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HC PNEUMOVAX _PNEUMOCCAL IMMUNIZATION_ 2YRS OR OLDER	$257.16	$321.45	—	—	20%
Polio vaccine, inactivated (IPV) CPT 90713 HC POLIOVIRUS VACCINE INACTIVATED _IPV_ SC USE	$108.11	$135.14	—	27% above	20%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 HC POLIOVIRUS VACCINE INACTIVATED _IPV_ SC USE	$108.11	$135.14	—	—	20%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 HC RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE	$1,269.98	$1,587.47	—	23% above	20%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 HC RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE	$1,269.98	$1,587.47	—	—	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 HC RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE	$1,269.98	$1,587.47	—	23% above	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 HC RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE	$1,269.98	$1,587.47	—	—	20%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 HC RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$654.22	$817.77	—	55% above	20%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 HC RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$654.22	$817.77	—	—	20%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 HC RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE	$626.02	$782.53	—	54% above	20%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 HC RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE	$626.02	$782.53	—	—	20%
Rabies vaccine, one dose CPT 90675 HC RABIES VACCINE INTRAMUSCULAR	$974.14	$1,217.68	—	107% above	20%
Rabies vaccine, one dose inpatient CPT 90675 HC RABIES VACCINE INTRAMUSCULAR	$974.14	$1,217.68	—	—	20%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 HC RV1 VACC 2 DOSE LIVE ORAL	$214.50	$268.12	—	at median	20%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 HC RV1 VACC 2 DOSE LIVE ORAL	$214.50	$268.12	—	—	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 HC ROTAVIRUS VACCINE PENTAVALANT_ 3 DOSE SCHEDULE_ ORAL USE	$214.50	$268.12	—	63% above	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 HC ROTAVIRUS VACCINE PENTAVALANT_ 3 DOSE SCHEDULE_ ORAL USE	$214.50	$268.12	—	—	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HC ZOSTER VACC HZV RECOMBINANT ADJUVANTED IM NJX	$485.66	$607.08	—	23% above	20%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HC ZOSTER VACC HZV RECOMBINANT ADJUVANTED IM NJX	$485.66	$607.08	—	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 HC TETANUS _ DIPHTHERIA TOXOIDS_TD_ ADSORBED_PRESERVATIVE FREE_ __ 7 YEARS_ FOR IM USE	$102.61	$128.26	—	94% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 HC TETANUS _ DIPHTHERIA TOXOIDS_TD_ ADSORBED_PRESERVATIVE FREE_ __ 7 YEARS_ FOR IM USE	$102.61	$128.26	—	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC TDAP FOR 7 YRS AND OLDER FOR IM USE	$119.46	$149.33	—	115% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 HC TDAP FOR 7 YRS AND OLDER FOR IM USE	$119.46	$149.33	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMIN 1 VACCINE_ MENDICK OBS UNIT	$83.37	$104.21	—	1% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMINISTRATION_ 1 VACCINE	$83.37	$104.21	—	1% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMIN 1 VACCINE_ MENDICK OBS UNIT	$83.37	$104.21	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMINISTRATION_ 1 VACCINE	$83.37	$104.21	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMINISTRATION EACH ADDITIONAL	$43.76	$54.70	—	3% below	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADMINISTRATION EACH ADDITIONAL	$43.76	$54.70	—	—	20%

Dental

Procedure	Cash price	List price	Insurers pay	vs New York	Off list
Deep cleaning (scaling and root planing), 4 or more teeth in one quadrant CDT D4341 HC PERIODONTAL SCALING _ ROOT PLANING_ 4 OR MORE TEETH PER QUADRANT	$186.40	$233.00	—	88% below	20%
Deep cleaning (scaling and root planing), 4 or more teeth in one quadrant inpatient CDT D4341 HC PERIODONTAL SCALING _ ROOT PLANING_ 4 OR MORE TEETH PER QUADRANT	$186.40	$233.00	—	—	20%
Dental implant, surgical placement CDT D6010 HC SURGICAL PLACEMENT OF IMPLANT BODY_ ENDOSTEAL IMPLANT	$640.00	$800.00	—	47% below	20%
Dental implant, surgical placement inpatient CDT D6010 HC SURGICAL PLACEMENT OF IMPLANT BODY_ ENDOSTEAL IMPLANT	$640.00	$800.00	—	—	20%
Porcelain crown CDT D2740 HC CROWN_PORCELAIN_CERAMIC SUBSTRATE	$961.60	$1,202.00	—	11% below	20%
Porcelain crown inpatient CDT D2740 HC CROWN_PORCELAIN_CERAMIC SUBSTRATE	$961.60	$1,202.00	—	—	20%
Removal of an impacted tooth fully covered by bone, often a wisdom tooth CDT D7240 HC REMOVAL OF IMPACTED TOOTH_ COMPLETELY BONY	$336.00	$420.00	—	64% below	20%
Removal of an impacted tooth fully covered by bone, often a wisdom tooth inpatient CDT D7240 HC REMOVAL OF IMPACTED TOOTH_ COMPLETELY BONY	$336.00	$420.00	—	—	20%
Root canal treatment on a molar (back tooth), not including the final crown CDT D3330 HC ENDODONTIC THERAPY MOLAR	$780.00	$975.00	—	59% below	20%
Root canal treatment on a molar (back tooth), not including the final crown inpatient CDT D3330 HC ENDODONTIC THERAPY MOLAR	$780.00	$975.00	—	—	20%
Routine teeth cleaning (prophylaxis), adult or teen CDT D1110 HC PROPHYLAXIS ADULT	$82.40	$103.00	—	46% below	20%
Routine teeth cleaning (prophylaxis), adult or teen inpatient CDT D1110 HC PROPHYLAXIS ADULT	$82.40	$103.00	—	—	20%
Simple extraction of a tooth or exposed root that is above the gum CDT D7140 HC EXTRACTION_ ERUPTED TOOTH OR EXPOSED ROOT	$2,050.99	$2,563.74	—	9% above	20%
Simple extraction of a tooth or exposed root that is above the gum inpatient CDT D7140 HC EXTRACTION_ ERUPTED TOOTH OR EXPOSED ROOT	$2,050.99	$2,563.74	—	—	20%

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://msc.rochesterregional.org/practitionerPortal/docs/MRF2026/237221763_the-unity-hospital-of-rochester_standardcharges.csv