Rehab Hospital
Rehab Hospital in Fort Myers, FL publishes cash prices for 466 common procedures listed here, from its own machine-readable price file updated Mar 26, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Florida median for 11 of 11 procedures. Select a procedure to compare it with other hospitals nearby.
2776 CLEVELAND AVE, FORT MYERS, FL 33901-5864 Collected Sep 23, 2026 Source price file Check a bill from this hospital
Some prices here are not compared
Rehab Hospital is an inpatient rehabilitation hospital. Its price file also lists scans, lab tests and procedures, but these are generally provided to its own inpatients, not booked by outside patients, so they are not compared with other hospitals here. Only its physical, occupational and speech therapy prices are compared.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Florida | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 HC CT Abd W/WO Adrenal | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast CPT 74170 HC CT Abd W/WO Pancreas | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast CPT 74170 HC CT Abd W & W/O Contrast | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast CPT 74170 HC CT Abd W/WO Gallbladder-Cholangiocarcinoma | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast CPT 74170 HC CT Abd W/WO Renal Mass Lesion Cyst | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast CPT 74170 HC CT Abd W/WO Liver | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast CPT 74170 HC CT Abdomen W/WO Contrast-Gastrography | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abd W & W/O Contrast | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abd W/WO Renal Mass Lesion Cyst | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abd W/WO Gallbladder-Cholangiocarcinoma | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abdomen W/WO Contrast-Gastrography | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abd W/WO Liver | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abd W/WO Pancreas | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abd W/WO Adrenal | $1,818.20 | $9,091.00 | $3,636.40–$7,272.80 | — | 80% |
| Abdominal X-ray, 2 views CPT 74019 HC Abdomen 2 Views | $271.00 | $1,355.00 | $542.00–$1,084.00 | — | 80% |
| Abdominal X-ray, 2 views CPT 74019 HC Rad Abd Flat/Upr W/O Ches(&/or De | $271.00 | $1,355.00 | $542.00–$1,084.00 | — | 80% |
| Abdominal X-ray, 2 views inpatient CPT 74019 HC Abdomen 2 Views | $271.00 | $1,355.00 | $542.00–$1,084.00 | — | 80% |
| Abdominal X-ray, 2 views inpatient CPT 74019 HC Rad Abd Flat/Upr W/O Ches(&/or De | $271.00 | $1,355.00 | $542.00–$1,084.00 | — | 80% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 HC Rad Ankle Complete Min 3 Views-Right | $264.40 | $1,322.00 | $528.80–$1,057.60 | — | 80% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 HC Rad Ankle Complete Min 3 Views-Left | $264.40 | $1,322.00 | $528.80–$1,057.60 | — | 80% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 HC Rad Ankle Complete Min 3 Views-Left | $264.40 | $1,322.00 | $528.80–$1,057.60 | — | 80% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 HC Rad Ankle Complete Min 3 Views-Right | $264.40 | $1,322.00 | $528.80–$1,057.60 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC U/L Bilat Extrem Art 1-2 Lev | $264.40 | $1,322.00 | $528.80–$1,057.60 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC Abi Limited Bilat 1-2 Lev | $309.20 | $1,546.00 | $618.40–$1,236.80 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC Ult Dop Art 1-2 Levels Bil | $308.80 | $1,544.00 | $617.60–$1,235.20 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 HC U/L Unilat Extrem Art 1-2 Lev | $154.80 | $774.00 | $309.60–$619.20 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 HC U/L Unilat Extrem Art >3 Lev | $264.40 | $1,322.00 | $528.80–$1,057.60 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 HC Abi Limited Unilat 1-2 Lev | $308.80 | $1,544.00 | $617.60–$1,235.20 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 HC Abi Comp Unilat Min 3 Lvl | $475.60 | $2,378.00 | $951.20–$1,902.40 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC U/L Bilat Extrem Art 1-2 Lev | $264.40 | $1,322.00 | $528.80–$1,057.60 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC Abi Limited Bilat 1-2 Lev | $309.20 | $1,546.00 | $618.40–$1,236.80 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC Ult Dop Art 1-2 Levels Bil | $308.80 | $1,544.00 | $617.60–$1,235.20 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 HC U/L Unilat Extrem Art 1-2 Lev | $154.80 | $774.00 | $309.60–$619.20 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 HC U/L Unilat Extrem Art >3 Lev | $264.40 | $1,322.00 | $528.80–$1,057.60 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 HC Abi Limited Unilat 1-2 Lev | $308.80 | $1,544.00 | $617.60–$1,235.20 | — | 80% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 HC Abi Comp Unilat Min 3 Lvl | $475.60 | $2,378.00 | $951.20–$1,902.40 | — | 80% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 HC CT Upper Ext W/O Contrast-Left | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 HC CT Upper Ext W/O Contrast-Right | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 HC CT Dect Gout Protocol Upper Extremity WO Contrast-Left | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 HC CT Dect Gout Protocol Upper Extremity WO Contrast-Right | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 HC CT Upper Ext W/O Contrast-Left | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 HC CT Upper Ext W/O Contrast-Right | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 HC CT Dect Gout Protocol Upper Extremity WO Contrast-Right | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 HC CT Dect Gout Protocol Upper Extremity WO Contrast-Left | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 HC or Barium Swallow | $186.80 | $934.00 | $373.60–$747.20 | — | 80% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 HC Xr Barium Swallow(Esophagram) Mmbs Protocol | $280.40 | $1,402.00 | $560.80–$1,121.60 | — | 80% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 HC Xr Barium Swallow (Esophagram)-Inc Scout/Delayed Images | $280.40 | $1,402.00 | $560.80–$1,121.60 | — | 80% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 HC Xr Gastrografin/Omni Swallow-Inc Scout/Delayed Images | $280.40 | $1,402.00 | $560.80–$1,121.60 | — | 80% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC or Barium Swallow | $186.80 | $934.00 | $373.60–$747.20 | — | 80% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC Xr Barium Swallow(Esophagram) Mmbs Protocol | $280.40 | $1,402.00 | $560.80–$1,121.60 | — | 80% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC Xr Gastrografin/Omni Swallow-Inc Scout/Delayed Images | $280.40 | $1,402.00 | $560.80–$1,121.60 | — | 80% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC Xr Barium Swallow (Esophagram)-Inc Scout/Delayed Images | $280.40 | $1,402.00 | $560.80–$1,121.60 | — | 80% |
| Bone scan, whole body (nuclear medicine) CPT 78306 HC Nuc Scan Bone Whole Body | $154.60 | $773.00 | $309.20–$618.40 | — | 80% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC Nuc Scan Bone Whole Body | $154.60 | $773.00 | $309.20–$618.40 | — | 80% |
| Breast ultrasound, complete, one breast both sides CPT 76641 HC Mam Mammo US Breast Comp Bilat | $408.20 | $2,041.00 | $816.40–$1,632.80 | — | 80% |
| Breast ultrasound, complete, one breast both sides CPT 76641 HC Ult Breast Complete Bilat Sono | $511.80 | $2,559.00 | $1,023.60–$2,047.20 | — | 80% |
| Breast ultrasound, complete, one breast one side CPT 76641 HC Mam Mammo US Breast Comp Unilat-Right | $271.20 | $1,356.00 | $542.40–$1,084.80 | — | 80% |
| Breast ultrasound, complete, one breast one side CPT 76641 HC Mam Mammo US Breast Comp Unilat-Left | $271.20 | $1,356.00 | $542.40–$1,084.80 | — | 80% |
| Breast ultrasound, complete, one breast one side CPT 76641 HC Ult Breast Complete Unilat Sono-Right | $340.20 | $1,701.00 | $680.40–$1,360.80 | — | 80% |
| Breast ultrasound, complete, one breast one side CPT 76641 HC Ult Breast Complete Unilat Sono-Left | $340.20 | $1,701.00 | $680.40–$1,360.80 | — | 80% |
| Breast ultrasound, complete, one breast inpatient both sides CPT 76641 HC Mam Mammo US Breast Comp Bilat | $408.20 | $2,041.00 | $816.40–$1,632.80 | — | 80% |
| Breast ultrasound, complete, one breast inpatient both sides CPT 76641 HC Ult Breast Complete Bilat Sono | $511.80 | $2,559.00 | $1,023.60–$2,047.20 | — | 80% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 HC Mam Mammo US Breast Comp Unilat-Left | $271.20 | $1,356.00 | $542.40–$1,084.80 | — | 80% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 HC Mam Mammo US Breast Comp Unilat-Right | $271.20 | $1,356.00 | $542.40–$1,084.80 | — | 80% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 HC Ult Breast Complete Unilat Sono-Left | $340.20 | $1,701.00 | $680.40–$1,360.80 | — | 80% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 HC Ult Breast Complete Unilat Sono-Right | $340.20 | $1,701.00 | $680.40–$1,360.80 | — | 80% |
| Breast ultrasound, limited (one breast or one area) both sides CPT 76642 HC Mam Mammo US Breast Lmtd Bilat | $314.00 | $1,570.00 | $628.00–$1,256.00 | — | 80% |
| Breast ultrasound, limited (one breast or one area) both sides CPT 76642 HC Ult Breast Limited Bilat Sono | $394.00 | $1,970.00 | $788.00–$1,576.00 | — | 80% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC Mam Mammo US Breast Lmtd Unilat-Right | $208.60 | $1,043.00 | $417.20–$834.40 | — | 80% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC Mam Mammo US Breast Lmtd Unilat-Left | $208.60 | $1,043.00 | $417.20–$834.40 | — | 80% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC Ult Breast Limited Unilat Sono-Right | $261.80 | $1,309.00 | $523.60–$1,047.20 | — | 80% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC Ult Breast Limited Unilat Sono-Left | $261.80 | $1,309.00 | $523.60–$1,047.20 | — | 80% |
| Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 HC Mam Mammo US Breast Lmtd Bilat | $314.00 | $1,570.00 | $628.00–$1,256.00 | — | 80% |
| Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 HC Ult Breast Limited Bilat Sono | $394.00 | $1,970.00 | $788.00–$1,576.00 | — | 80% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HC Mam Mammo US Breast Lmtd Unilat-Right | $208.60 | $1,043.00 | $417.20–$834.40 | — | 80% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HC Mam Mammo US Breast Lmtd Unilat-Left | $208.60 | $1,043.00 | $417.20–$834.40 | — | 80% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HC Ult Breast Limited Unilat Sono-Right | $261.80 | $1,309.00 | $523.60–$1,047.20 | — | 80% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HC Ult Breast Limited Unilat Sono-Left | $261.80 | $1,309.00 | $523.60–$1,047.20 | — | 80% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC Cta Abd/Pelvis | $1,944.00 | $9,720.00 | $3,888.00–$7,776.00 | — | 80% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC Cta Abd/Pelvis | $1,944.00 | $9,720.00 | $3,888.00–$7,776.00 | — | 80% |
| CT angiography (CTA) of the head CPT 70496 HC Ctv Head | $1,460.20 | $7,301.00 | $2,920.40–$5,840.80 | — | 80% |
| CT angiography (CTA) of the head CPT 70496 HC Cta Head | $1,460.20 | $7,301.00 | $2,920.40–$5,840.80 | — | 80% |
| CT angiography (CTA) of the head inpatient CPT 70496 HC Cta Head | $1,460.20 | $7,301.00 | $2,920.40–$5,840.80 | — | 80% |
| CT angiography (CTA) of the head inpatient CPT 70496 HC Ctv Head | $1,460.20 | $7,301.00 | $2,920.40–$5,840.80 | — | 80% |
| CT angiography (CTA) of the neck CPT 70498 HC Cta Neck | $2,069.00 | $10,345.00 | $4,138.00–$8,276.00 | — | 80% |
| CT angiography (CTA) of the neck inpatient CPT 70498 HC Cta Neck | $2,069.00 | $10,345.00 | $4,138.00–$8,276.00 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC Cta Chest Gated Peds | $1,966.80 | $9,834.00 | $3,933.60–$7,867.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT Cta Chest-Pe Eval | $2,073.80 | $10,369.00 | $4,147.60–$8,295.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT Cta Chest-Aorta | $2,073.80 | $10,369.00 | $4,147.60–$8,295.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC Cta Tavr Chest/Abd/Pelvis | $2,073.80 | $10,369.00 | $4,147.60–$8,295.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC Cta Chest | $2,073.80 | $10,369.00 | $4,147.60–$8,295.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC Cta Tmvr Chest/Abd/Pelvis | $2,073.80 | $10,369.00 | $4,147.60–$8,295.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC Cta Tmvr-Chest Only | $2,073.80 | $10,369.00 | $4,147.60–$8,295.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC Cta Chest Gated Peds | $1,966.80 | $9,834.00 | $3,933.60–$7,867.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC Cta Tavr Chest/Abd/Pelvis | $2,073.80 | $10,369.00 | $4,147.60–$8,295.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC Cta Tmvr-Chest Only | $2,073.80 | $10,369.00 | $4,147.60–$8,295.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT Cta Chest-Pe Eval | $2,073.80 | $10,369.00 | $4,147.60–$8,295.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT Cta Chest-Aorta | $2,073.80 | $10,369.00 | $4,147.60–$8,295.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC Cta Tmvr Chest/Abd/Pelvis | $2,073.80 | $10,369.00 | $4,147.60–$8,295.20 | — | 80% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC Cta Chest | $2,073.80 | $10,369.00 | $4,147.60–$8,295.20 | — | 80% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Cta Overread Coronary Arteries-Heart Health | $381.40 | $1,907.00 | $762.80–$1,525.60 | — | 80% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Cta Coronary Arteries-Pop Health | $381.40 | $1,907.00 | $762.80–$1,525.60 | — | 80% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Cta Coronary Arteries-Heart Health | $381.40 | $1,907.00 | $762.80–$1,525.60 | — | 80% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Cta Overread Coronary Arteries-Pop Health | $381.40 | $1,907.00 | $762.80–$1,525.60 | — | 80% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC Cta Coronary Arteries | $1,194.80 | $5,974.00 | $2,389.60–$4,779.20 | — | 80% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC Cta Overread Coronary Arteries | $1,194.80 | $5,974.00 | $2,389.60–$4,779.20 | — | 80% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 Cta Overread Coronary Arteries-Heart Health | $381.40 | $1,907.00 | $762.80–$1,525.60 | — | 80% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 Cta Overread Coronary Arteries-Pop Health | $381.40 | $1,907.00 | $762.80–$1,525.60 | — | 80% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 Cta Coronary Arteries-Pop Health | $381.40 | $1,907.00 | $762.80–$1,525.60 | — | 80% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 Cta Coronary Arteries-Heart Health | $381.40 | $1,907.00 | $762.80–$1,525.60 | — | 80% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC Cta Overread Coronary Arteries | $1,194.80 | $5,974.00 | $2,389.60–$4,779.20 | — | 80% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC Cta Coronary Arteries | $1,194.80 | $5,974.00 | $2,389.60–$4,779.20 | — | 80% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT Heart Valve Calc Score W/O Contrast | $112.00 | $560.00 | $224.00–$448.00 | — | 80% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT Heart W/O Contrst-Eval Cal | $112.00 | $560.00 | $224.00–$448.00 | — | 80% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT Heart Valve Calc Score W/O Contrast | $112.00 | $560.00 | $224.00–$448.00 | — | 80% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT Heart W/O Contrst-Eval Cal | $112.00 | $560.00 | $224.00–$448.00 | — | 80% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT Abd/Pelvis W/O Contrast | $1,785.00 | $8,925.00 | $3,570.00–$7,140.00 | — | 80% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT Renal Stone Protocol | $1,785.00 | $8,925.00 | $3,570.00–$7,140.00 | — | 80% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT Renal Stone Protocol | $1,785.00 | $8,925.00 | $3,570.00–$7,140.00 | — | 80% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT Abd/Pelvis W/O Contrast | $1,785.00 | $8,925.00 | $3,570.00–$7,140.00 | — | 80% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abd/Pelvis W/ Contrast | $2,809.60 | $14,048.00 | $5,619.20–$11,238.40 | — | 80% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abd/Pelvis Dvt Protocol | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abd/Pelvis W/ Contrast | $2,809.60 | $14,048.00 | $5,619.20–$11,238.40 | — | 80% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abd/Pelvis Dvt Protocol | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Enterography | $1,580.60 | $7,903.00 | $3,161.20–$6,322.40 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Urogram | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Abd/Pelvis W/WO Pancreas | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Abd/Pelvis W/WO Gallbladder-Cholangiocarcinoma | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Abd/Pelvis W/WO Liver | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Abd/Pelvis W/WO Adrenal | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Abd/Pelvis W/WO Renal Mass Lesion Cyst | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Abd/Pel W/ W/O Cont | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Enterography | $1,580.60 | $7,903.00 | $3,161.20–$6,322.40 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Abd/Pelvis W/WO Adrenal | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Abd/Pelvis W/WO Gallbladder-Cholangiocarcinoma | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Abd/Pelvis W/WO Pancreas | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Abd/Pelvis W/WO Renal Mass Lesion Cyst | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Abd/Pel W/ W/O Cont | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Urogram | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Abd/Pelvis W/WO Liver | $3,305.00 | $16,525.00 | $6,610.00–$13,220.00 | — | 80% |
| CT scan of the abdomen with contrast CPT 74160 HC CT Abdomen W/ Contrast | $1,454.40 | $7,272.00 | $2,908.80–$5,817.60 | — | 80% |
| CT scan of the abdomen with contrast inpatient CPT 74160 HC CT Abdomen W/ Contrast | $1,454.40 | $7,272.00 | $2,908.80–$5,817.60 | — | 80% |
| CT scan of the abdomen without contrast CPT 74150 HC CT Abd W/O Contrast | $1,090.60 | $5,453.00 | $2,181.20–$4,362.40 | — | 80% |
| CT scan of the abdomen without contrast inpatient CPT 74150 HC CT Abd W/O Contrast | $1,090.60 | $5,453.00 | $2,181.20–$4,362.40 | — | 80% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT Sinuses W/O Contrast | $867.40 | $4,337.00 | $1,734.80–$3,469.60 | — | 80% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT Max/Facial W/O Contrast | $867.40 | $4,337.00 | $1,734.80–$3,469.60 | — | 80% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT Sinuses for Surgical Navigation WO Contrast | $867.40 | $4,337.00 | $1,734.80–$3,469.60 | — | 80% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT Max/Facial W/O Contrast | $867.40 | $4,337.00 | $1,734.80–$3,469.60 | — | 80% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT Sinuses W/O Contrast | $867.40 | $4,337.00 | $1,734.80–$3,469.60 | — | 80% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT Sinuses for Surgical Navigation WO Contrast | $867.40 | $4,337.00 | $1,734.80–$3,469.60 | — | 80% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head W/O Contrast-Peds Shunt | $1,099.40 | $5,497.00 | $2,198.80–$4,397.60 | — | 80% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head W/O Contrast Brainlab Protocol | $1,168.00 | $5,840.00 | $2,336.00–$4,672.00 | — | 80% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head W/O Contrast | $1,168.00 | $5,840.00 | $2,336.00–$4,672.00 | — | 80% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head W/O Contrast Stealth Protocol | $1,168.00 | $5,840.00 | $2,336.00–$4,672.00 | — | 80% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head W/O Contrast-Peds Shunt | $1,099.40 | $5,497.00 | $2,198.80–$4,397.60 | — | 80% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head W/O Contrast | $1,168.00 | $5,840.00 | $2,336.00–$4,672.00 | — | 80% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head W/O Contrast Brainlab Protocol | $1,168.00 | $5,840.00 | $2,336.00–$4,672.00 | — | 80% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head W/O Contrast Stealth Protocol | $1,168.00 | $5,840.00 | $2,336.00–$4,672.00 | — | 80% |
| CT scan of the head with contrast CPT 70460 HC CT Head With Contrast | $1,529.80 | $7,649.00 | $3,059.60–$6,119.20 | — | 80% |
| CT scan of the head with contrast inpatient CPT 70460 HC CT Head With Contrast | $1,529.80 | $7,649.00 | $3,059.60–$6,119.20 | — | 80% |
| CT scan of the head without and with contrast CPT 70470 HC CT Head W+W/O-Contrast | $1,541.80 | $7,709.00 | $3,083.60–$6,167.20 | — | 80% |
| CT scan of the head without and with contrast inpatient CPT 70470 HC CT Head W+W/O-Contrast | $1,541.80 | $7,709.00 | $3,083.60–$6,167.20 | — | 80% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT Lumbar Spine W/O Contrast�3d Firefly | $1,496.00 | $7,480.00 | $2,992.00–$5,984.00 | — | 80% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT Lumbar Spine W/O Contrast | $1,496.00 | $7,480.00 | $2,992.00–$5,984.00 | — | 80% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT Lumbar Spine W/O Contrast�7d Surgical | $1,496.00 | $7,480.00 | $2,992.00–$5,984.00 | — | 80% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT Lumbar Spine W/O Contrast�3d Firefly | $1,496.00 | $7,480.00 | $2,992.00–$5,984.00 | — | 80% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT Lumbar Spine W/O Contrast | $1,496.00 | $7,480.00 | $2,992.00–$5,984.00 | — | 80% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT Lumbar Spine W/O Contrast�7d Surgical | $1,496.00 | $7,480.00 | $2,992.00–$5,984.00 | — | 80% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT Cervical Spine W/O Contras | $1,548.00 | $7,740.00 | $3,096.00–$6,192.00 | — | 80% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT Cervical Spine W/O Contras | $1,548.00 | $7,740.00 | $3,096.00–$6,192.00 | — | 80% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/ Contrast | $2,172.00 | $10,860.00 | $4,344.00–$8,688.00 | — | 80% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/ Contrast | $2,172.00 | $10,860.00 | $4,344.00–$8,688.00 | — | 80% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 HC Ult Carotid Scan/Doppler | $437.20 | $2,186.00 | $874.40–$1,748.80 | — | 80% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 HC Carotid Scan/Doppler | $437.20 | $2,186.00 | $874.40–$1,748.80 | — | 80% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 HC Ult Carotid Scan/Doppler | $437.20 | $2,186.00 | $874.40–$1,748.80 | — | 80% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 HC Carotid Scan/Doppler | $437.20 | $2,186.00 | $874.40–$1,748.80 | — | 80% |
| Chest CT scan without and with contrast CPT 71270 HC CT Chest W&W/O Contrast | $1,501.20 | $7,506.00 | $3,002.40–$6,004.80 | — | 80% |
| Chest CT scan without and with contrast inpatient CPT 71270 HC CT Chest W&W/O Contrast | $1,501.20 | $7,506.00 | $3,002.40–$6,004.80 | — | 80% |
| Chest X-ray, 2 views CPT 71046 HC Rad Chest Pa/Lat (Cxr) | $186.00 | $930.00 | $372.00–$744.00 | — | 80% |
| Chest X-ray, 2 views CPT 71046 HC Rad Chest Inspiration/Expiration | $186.00 | $930.00 | $372.00–$744.00 | — | 80% |
| Chest X-ray, 2 views CPT 71046 HC Rad Chest Ap&Lat W/Fluoro | $186.00 | $930.00 | $372.00–$744.00 | — | 80% |
| Chest X-ray, 2 views inpatient CPT 71046 HC Rad Chest Pa/Lat (Cxr) | $186.00 | $930.00 | $372.00–$744.00 | — | 80% |
| Chest X-ray, 2 views inpatient CPT 71046 HC Rad Chest Ap&Lat W/Fluoro | $186.00 | $930.00 | $372.00–$744.00 | — | 80% |
| Chest X-ray, 2 views inpatient CPT 71046 HC Rad Chest Inspiration/Expiration | $186.00 | $930.00 | $372.00–$744.00 | — | 80% |
| Chest X-ray, single view CPT 71045 HC Rad Chest Ap or Pa | $143.60 | $718.00 | $287.20–$574.40 | — | 80% |
| Chest X-ray, single view CPT 71045 HC Rad Kiddygram-Peds Cxr/Abdomen | $143.60 | $718.00 | $287.20–$574.40 | — | 80% |
| Chest X-ray, single view one side CPT 71045 HC Rad Chest Decubs-Right | $143.60 | $718.00 | $287.20–$574.40 | — | 80% |
| Chest X-ray, single view one side CPT 71045 HC Rad Chest Decubs-Left | $143.60 | $718.00 | $287.20–$574.40 | — | 80% |
| Chest X-ray, single view inpatient CPT 71045 HC Rad Kiddygram-Peds Cxr/Abdomen | $143.60 | $718.00 | $287.20–$574.40 | — | 80% |
| Chest X-ray, single view inpatient CPT 71045 HC Rad Chest Ap or Pa | $143.60 | $718.00 | $287.20–$574.40 | — | 80% |
| Chest X-ray, single view inpatient one side CPT 71045 HC Rad Chest Decubs-Left | $143.60 | $718.00 | $287.20–$574.40 | — | 80% |
| Chest X-ray, single view inpatient one side CPT 71045 HC Rad Chest Decubs-Right | $143.60 | $718.00 | $287.20–$574.40 | — | 80% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 HC Rad Clavicle Complete -Right | $191.80 | $959.00 | $383.60–$767.20 | — | 80% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 HC Rad Clavicle Complete-Left | $191.80 | $959.00 | $383.60–$767.20 | — | 80% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 HC Rad Clavicle Complete-Left | $191.80 | $959.00 | $383.60–$767.20 | — | 80% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 HC Rad Clavicle Complete -Right | $191.80 | $959.00 | $383.60–$767.20 | — | 80% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC Ult Retroperitoneal Sono | $239.20 | $1,196.00 | $478.40–$956.80 | — | 80% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC Ult Renal/Bladder Only Sonogram | $239.20 | $1,196.00 | $478.40–$956.80 | — | 80% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC Ult Renal/Bladder Only Sonogram | $239.20 | $1,196.00 | $478.40–$956.80 | — | 80% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC Ult Retroperitoneal Sono | $239.20 | $1,196.00 | $478.40–$956.80 | — | 80% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC Mam Dexa Bone Density Study | $226.40 | $1,132.00 | $452.80–$905.60 | — | 80% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC Rad Dexa Bone Density Study | $289.20 | $1,446.00 | $578.40–$1,156.80 | — | 80% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC Mam Dexa Bone Density Study | $226.40 | $1,132.00 | $452.80–$905.60 | — | 80% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC Rad Dexa Bone Density Study | $289.20 | $1,446.00 | $578.40–$1,156.80 | — | 80% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC Mam Dexa Extremity | $103.60 | $518.00 | $207.20–$414.40 | — | 80% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC Mam Dexa Extremity | $103.60 | $518.00 | $207.20–$414.40 | — | 80% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC Ult Preg W/Ftl an Ex Sgl | $336.00 | $1,680.00 | $672.00–$1,344.00 | — | 80% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC Ult Preg W/Ftl an Ex Sgl | $336.00 | $1,680.00 | $672.00–$1,344.00 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Chest W/O Contrast Ion Protocol | $1,057.80 | $5,289.00 | $2,115.60–$4,231.20 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Chest W/O Contrast-Lung Screening Follow Up | $1,057.80 | $5,289.00 | $2,115.60–$4,231.20 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Chest W/O Contrast Pre Bronch Navigation | $1,065.00 | $5,325.00 | $2,130.00–$4,260.00 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Chest W/O Contrast | $1,123.00 | $5,615.00 | $2,246.00–$4,492.00 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Chest W/O Contrast -Hi Resolutn | $1,123.00 | $5,615.00 | $2,246.00–$4,492.00 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Esophogram Chest W/O Contrast | $1,123.00 | $5,615.00 | $2,246.00–$4,492.00 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Sternum-Shipley Research Only | $1,123.00 | $5,615.00 | $2,246.00–$4,492.00 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT Chest W/O Contrast Ion Protocol | $1,057.80 | $5,289.00 | $2,115.60–$4,231.20 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT Chest W/O Contrast-Lung Screening Follow Up | $1,057.80 | $5,289.00 | $2,115.60–$4,231.20 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT Chest W/O Contrast Pre Bronch Navigation | $1,065.00 | $5,325.00 | $2,130.00–$4,260.00 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT Chest W/O Contrast | $1,123.00 | $5,615.00 | $2,246.00–$4,492.00 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT Chest W/O Contrast -Hi Resolutn | $1,123.00 | $5,615.00 | $2,246.00–$4,492.00 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT Esophogram Chest W/O Contrast | $1,123.00 | $5,615.00 | $2,246.00–$4,492.00 | — | 80% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT Sternum-Shipley Research Only | $1,123.00 | $5,615.00 | $2,246.00–$4,492.00 | — | 80% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT Chest W/ Contrast | $1,352.40 | $6,762.00 | $2,704.80–$5,409.60 | — | 80% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT Esophogram Chest W/ Contrast | $1,352.40 | $6,762.00 | $2,704.80–$5,409.60 | — | 80% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT Esophogram Chest W/ Contrast | $1,352.40 | $6,762.00 | $2,704.80–$5,409.60 | — | 80% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT Chest W/ Contrast | $1,352.40 | $6,762.00 | $2,704.80–$5,409.60 | — | 80% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC MA Digital Diag Mammo Post Bx/Loc 2d-Bilat | $119.60 | $598.00 | $239.20–$478.40 | — | 80% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC MA Digital Diag Mammo Bilat 3d Tomosynthesis W or WO Cad | $119.60 | $598.00 | $239.20–$478.40 | — | 80% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC MA Digital Diag Mammo Post Bx/Loc 3d-Bilat | $119.60 | $598.00 | $239.20–$478.40 | — | 80% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC Mam Diag Mammo W/ or W/O Cad Bilat | $126.00 | $630.00 | $252.00–$504.00 | — | 80% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC MA Digital Diag Mammo Post Bx/Loc 2d-Bilat | $119.60 | $598.00 | $239.20–$478.40 | — | 80% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC MA Digital Diag Mammo Post Bx/Loc 3d-Bilat | $119.60 | $598.00 | $239.20–$478.40 | — | 80% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC MA Digital Diag Mammo Bilat 3d Tomosynthesis W or WO Cad | $119.60 | $598.00 | $239.20–$478.40 | — | 80% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mam Diag Mammo W/ or W/O Cad Bilat | $126.00 | $630.00 | $252.00–$504.00 | — | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MA Digital Diag Mammo Uni 3d Tomosynthesis W or WO Cad-Left | $99.60 | $498.00 | $199.20–$398.40 | — | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 3d-Right | $99.60 | $498.00 | $199.20–$398.40 | — | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 2d-Left | $99.60 | $498.00 | $199.20–$398.40 | — | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MA Digital Diag Mammo Uni 3d Tomosynthesis W or WO Cad-Right | $99.60 | $498.00 | $199.20–$398.40 | — | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 3d-Left | $99.60 | $498.00 | $199.20–$398.40 | — | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 2d-Right | $99.60 | $498.00 | $199.20–$398.40 | — | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mam Diag Mammo Uni W/ or W/O Cad Right | $104.60 | $523.00 | $209.20–$418.40 | — | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mam Diag Mammo Uni W/ or W/O Cad Left | $104.60 | $523.00 | $209.20–$418.40 | — | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 3d-Left | $99.60 | $498.00 | $199.20–$398.40 | — | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MA Digital Diag Mammo Uni 3d Tomosynthesis W or WO Cad-Right | $99.60 | $498.00 | $199.20–$398.40 | — | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MA Digital Diag Mammo Uni 3d Tomosynthesis W or WO Cad-Left | $99.60 | $498.00 | $199.20–$398.40 | — | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 2d-Left | $99.60 | $498.00 | $199.20–$398.40 | — | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 3d-Right | $99.60 | $498.00 | $199.20–$398.40 | — | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 2d-Right | $99.60 | $498.00 | $199.20–$398.40 | — | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mam Diag Mammo Uni W/ or W/O Cad Right | $104.60 | $523.00 | $209.20–$418.40 | — | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mam Diag Mammo Uni W/ or W/O Cad Left | $104.60 | $523.00 | $209.20–$418.40 | — | 80% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC Ult Dulpx Le Artery Bilat | $449.00 | $2,245.00 | $898.00–$1,796.00 | — | 80% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 HC Art Duplex US Low Extrem Bila | $449.00 | $2,245.00 | $898.00–$1,796.00 | — | 80% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC Ult Dulpx Le Artery Bilat | $449.00 | $2,245.00 | $898.00–$1,796.00 | — | 80% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 HC Art Duplex US Low Extrem Bila | $449.00 | $2,245.00 | $898.00–$1,796.00 | — | 80% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC Ult Venous Duplex/Dvt Bilat Leg | $477.20 | $2,386.00 | $954.40–$1,908.80 | — | 80% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC Ult Upper/Lower Venous Scan(Bilat | $477.20 | $2,386.00 | $954.40–$1,908.80 | — | 80% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC Upper/Lower Venous Scan(Bilat | $477.20 | $2,386.00 | $954.40–$1,908.80 | — | 80% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC Ult Venous Duplex/Dvt Bilat Arms | $477.20 | $2,386.00 | $954.40–$1,908.80 | — | 80% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC Lower Venous Scan Bilat for Reflux | $477.20 | $2,386.00 | $954.40–$1,908.80 | — | 80% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC Lower Venous Scan Bilat for Venous Insufficiency | $596.60 | $2,983.00 | $1,193.20–$2,386.40 | — | 80% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC Ult Venous Duplex/Dvt Bilat Leg | $477.20 | $2,386.00 | $954.40–$1,908.80 | — | 80% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC Ult Upper/Lower Venous Scan(Bilat | $477.20 | $2,386.00 | $954.40–$1,908.80 | — | 80% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC Ult Venous Duplex/Dvt Bilat Arms | $477.20 | $2,386.00 | $954.40–$1,908.80 | — | 80% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC Upper/Lower Venous Scan(Bilat | $477.20 | $2,386.00 | $954.40–$1,908.80 | — | 80% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC Lower Venous Scan Bilat for Reflux | $477.20 | $2,386.00 | $954.40–$1,908.80 | — | 80% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC Lower Venous Scan Bilat for Venous Insufficiency | $596.60 | $2,983.00 | $1,193.20–$2,386.40 | — | 80% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC Echo Comp W Bubble Study | $918.40 | $4,592.00 | $1,836.80–$3,673.60 | — | 80% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC Echo Comp W/Dplr & Clr Flow | $918.40 | $4,592.00 | $1,836.80–$3,673.60 | — | 80% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC Echo Comp W Bubble Study | $918.40 | $4,592.00 | $1,836.80–$3,673.60 | — | 80% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC Echo Comp W/Dplr & Clr Flow | $918.40 | $4,592.00 | $1,836.80–$3,673.60 | — | 80% |
| Elbow X-ray, 2 views one side CPT 73070 HC Rad Elbow 1 View-Left | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Elbow X-ray, 2 views one side CPT 73070 HC Rad Elbow 2 Views-Right | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Elbow X-ray, 2 views one side CPT 73070 HC Rad Elbow 2 Views-Left | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Elbow X-ray, 2 views one side CPT 73070 HC Rad Elbow 1 View-Right | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 HC Rad Elbow 2 Views-Right | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 HC Rad Elbow 2 Views-Left | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 HC Rad Elbow 1 View-Left | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 HC Rad Elbow 1 View-Right | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 HC Rad Elbow Complete Min 3 Views-Right | $277.00 | $1,385.00 | $554.00–$1,108.00 | — | 80% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 HC Rad Elbow Complete Min 3 Views-Left | $277.00 | $1,385.00 | $554.00–$1,108.00 | — | 80% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 HC Rad Elbow Complete Min 3 Views-Left | $277.00 | $1,385.00 | $554.00–$1,108.00 | — | 80% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 HC Rad Elbow Complete Min 3 Views-Right | $277.00 | $1,385.00 | $554.00–$1,108.00 | — | 80% |
| Eye socket (orbit) CT scan without contrast CPT 70480 HC CT Temporal Bones/Iac's W/O | $908.40 | $4,542.00 | $1,816.80–$3,633.60 | — | 80% |
| Eye socket (orbit) CT scan without contrast CPT 70480 HC CT Orbits W/O Contrast | $908.40 | $4,542.00 | $1,816.80–$3,633.60 | — | 80% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT Temporal Bones/Iac's W/O | $908.40 | $4,542.00 | $1,816.80–$3,633.60 | — | 80% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT Orbits W/O Contrast | $908.40 | $4,542.00 | $1,816.80–$3,633.60 | — | 80% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 HC Rad Facial Bones Min 3 Views | $391.00 | $1,955.00 | $782.00–$1,564.00 | — | 80% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC Rad Facial Bones Min 3 Views | $391.00 | $1,955.00 | $782.00–$1,564.00 | — | 80% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 HC Rad Forearm 2 Views -Right | $251.60 | $1,258.00 | $503.20–$1,006.40 | — | 80% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 HC Rad Forearm 1 View-Left | $251.60 | $1,258.00 | $503.20–$1,006.40 | — | 80% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 HC Rad Forearm 1 View -Right | $251.60 | $1,258.00 | $503.20–$1,006.40 | — | 80% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 HC Rad Forearm 2 Views -Left | $251.60 | $1,258.00 | $503.20–$1,006.40 | — | 80% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 HC Rad Forearm 2 Views -Right | $251.60 | $1,258.00 | $503.20–$1,006.40 | — | 80% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 HC Rad Forearm 1 View-Left | $251.60 | $1,258.00 | $503.20–$1,006.40 | — | 80% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 HC Rad Forearm 2 Views -Left | $251.60 | $1,258.00 | $503.20–$1,006.40 | — | 80% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 HC Rad Forearm 1 View -Right | $251.60 | $1,258.00 | $503.20–$1,006.40 | — | 80% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM Hepatobiliary Scan-Bile Leak | $621.00 | $3,105.00 | $1,242.00–$2,484.00 | — | 80% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC Nuc Hepatobiliary/Pipida W/O Ef Scan | $621.00 | $3,105.00 | $1,242.00–$2,484.00 | — | 80% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC Nuc Hepatobiliary/Pipida W/O Ef Scan | $621.00 | $3,105.00 | $1,242.00–$2,484.00 | — | 80% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM Hepatobiliary Scan-Bile Leak | $621.00 | $3,105.00 | $1,242.00–$2,484.00 | — | 80% |
| Hand X-ray, 2 views both sides CPT 73120 HC Xr Hand Bilat 1 View | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Hand X-ray, 2 views one side CPT 73120 HC Rad Hand 1 View-Left | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Hand X-ray, 2 views one side CPT 73120 HC Rad Hand 1 View -Right | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Hand X-ray, 2 views one side CPT 73120 HC Rad Hand 2 Views-Right | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Hand X-ray, 2 views one side CPT 73120 HC Rad Hand 2 Views-Left | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Hand X-ray, 2 views inpatient both sides CPT 73120 HC Xr Hand Bilat 1 View | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HC Rad Hand 2 Views-Right | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HC Rad Hand 2 Views-Left | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HC Rad Hand 1 View -Right | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Hand X-ray, 2 views inpatient one side CPT 73120 HC Rad Hand 1 View-Left | $235.40 | $1,177.00 | $470.80–$941.60 | — | 80% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HC Rad Heel (Os Calcis)Min 2 Views-Right | $236.00 | $1,180.00 | $472.00–$944.00 | — | 80% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HC Rad Heel (Os Calcis)Min 2 Views-Left | $236.00 | $1,180.00 | $472.00–$944.00 | — | 80% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HC Rad Heel (Os Calcis)Min 2 Views-Right | $236.00 | $1,180.00 | $472.00–$944.00 | — | 80% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HC Rad Heel (Os Calcis)Min 2 Views-Left | $236.00 | $1,180.00 | $472.00–$944.00 | — | 80% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC Polysomnography/Bipap/Split | $1,761.60 | $8,808.00 | $3,523.20–$7,046.40 | — | 80% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC Polysomnography/Bipap/Split | $1,761.60 | $8,808.00 | $3,523.20–$7,046.40 | — | 80% |
| Knee X-ray, 3 views one side CPT 73562 HC Rad Knee 3 Views-Right | $277.20 | $1,386.00 | $554.40–$1,108.80 | — | 80% |
| Knee X-ray, 3 views one side CPT 73562 HC Rad Knee 3 Views-Left | $277.20 | $1,386.00 | $554.40–$1,108.80 | — | 80% |
| Knee X-ray, 3 views inpatient one side CPT 73562 HC Rad Knee 3 Views-Left | $277.20 | $1,386.00 | $554.40–$1,108.80 | — | 80% |
| Knee X-ray, 3 views inpatient one side CPT 73562 HC Rad Knee 3 Views-Right | $277.20 | $1,386.00 | $554.40–$1,108.80 | — | 80% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 HC Rad Knee Complete Min 4 Views-Left | $323.40 | $1,617.00 | $646.80–$1,293.60 | — | 80% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 HC Rad Knee Complete Min 4 Views-Right | $323.40 | $1,617.00 | $646.80–$1,293.60 | — | 80% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 HC Rad Knee Complete Min 4 Views-Right | $323.40 | $1,617.00 | $646.80–$1,293.60 | — | 80% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 HC Rad Knee Complete Min 4 Views-Left | $323.40 | $1,617.00 | $646.80–$1,293.60 | — | 80% |
| Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 HC CT Lower Extremity Bilat W/O Contrast Peds Rotational | $1,617.00 | $8,085.00 | $3,234.00–$6,468.00 | — | 80% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 HC CT Lower Ext W/O Contrast-Right | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 HC CT Dect Gout Protocol Lower Extremity WO Contrast-Left | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 HC CT Lower Ext W/O Contrast-Left | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 HC CT Dect Gout Protocol Lower Extremity WO Contrast-Right | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 HC CT Lower Extremity Bilat W/O Contrast Peds Rotational | $1,617.00 | $8,085.00 | $3,234.00–$6,468.00 | — | 80% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 HC CT Dect Gout Protocol Lower Extremity WO Contrast-Left | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 HC CT Lower Ext W/O Contrast-Right | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 HC CT Lower Ext W/O Contrast-Left | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 HC CT Dect Gout Protocol Lower Extremity WO Contrast-Right | $852.40 | $4,262.00 | $1,704.80–$3,409.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US Liver Lesion Pre-Histotripsy Mapping Sono | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US Pediatric Abdominal-Midgut Volvulus Sono | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US Pediatric Abdominal-Pyloric Stenosis/Midgut Volvulus Sono | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC Limited Emerg Abdomen Bedside US | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC Limited Emerg Abdomen Trauma (Fast) Bedside US | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US Pediatric Abdominal-Nec Sono | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US Pediatric Abdominal-Intussusception Sono | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC POC Limited Abdomen US | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC Limited Emerg Abdomen Gall Bladder Bedside US | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC Ult Sonogram Spleen | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC Ult Sonogram Appendix | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC Ult Sonogram/Limit Abd Study | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC Ult Sonogram Pylorus | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder one side CPT 76705 HC Ult Sonogram Right Upper Quadrant | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC Ult Sonogram Pylorus | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC Ult Sonogram/Limit Abd Study | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC Ult Sonogram Appendix | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US Liver Lesion Pre-Histotripsy Mapping Sono | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC Ult Sonogram Spleen | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US Pediatric Abdominal-Midgut Volvulus Sono | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US Pediatric Abdominal-Pyloric Stenosis/Midgut Volvulus Sono | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC POC Limited Abdomen US | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US Pediatric Abdominal-Intussusception Sono | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US Pediatric Abdominal-Nec Sono | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC Limited Emerg Abdomen Gall Bladder Bedside US | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC Limited Emerg Abdomen Trauma (Fast) Bedside US | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC Limited Emerg Abdomen Bedside US | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient one side CPT 76705 HC Ult Sonogram Right Upper Quadrant | $330.40 | $1,652.00 | $660.80–$1,321.60 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC Limited Emerg�Extrem Nonvasc Jnt/Soft Tissue US | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC POC Limited Extrem Nonvasc Jnt/Soft Tissue US | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC Mammo US Axilla-Left | $195.20 | $976.00 | $390.40–$780.80 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC Mammo US Axilla-Right | $195.20 | $976.00 | $390.40–$780.80 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC US Extremity Dynamic Non-Vasclr-Right | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC Ult Extrem Nonvasc Lmted Sono-Right | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC Ult Extrem Nonvasc Lmted Sono-Left | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC US Extremity Dynamic Non-Vasclr-Left | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC Limited Emerg�Extrem Nonvasc Jnt/Soft Tissue US | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC POC Limited Extrem Nonvasc Jnt/Soft Tissue US | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC Mammo US Axilla-Right | $195.20 | $976.00 | $390.40–$780.80 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC Mammo US Axilla-Left | $195.20 | $976.00 | $390.40–$780.80 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC US Extremity Dynamic Non-Vasclr-Left | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC Ult Extrem Nonvasc Lmted Sono-Right | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC Ult Extrem Nonvasc Lmted Sono-Left | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC US Extremity Dynamic Non-Vasclr-Right | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT Lung Cancer Screening Scan | $225.00 | $1,125.00 | $450.00–$900.00 | — | 80% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT Lung Cancer Screening Scan | $225.00 | $1,125.00 | $450.00–$900.00 | — | 80% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 HC Rad Tib-Fib 1 View-Left | $252.00 | $1,260.00 | $504.00–$1,008.00 | — | 80% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 HC Rad Leg Lower (Tib/Fib)2 Views-Right | $252.00 | $1,260.00 | $504.00–$1,008.00 | — | 80% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 HC Rad Leg Lower (Tib/Fib)2 Views-Left | $252.00 | $1,260.00 | $504.00–$1,008.00 | — | 80% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 HC Rad Tib-Fib 1 View-Right | $252.00 | $1,260.00 | $504.00–$1,008.00 | — | 80% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 HC Rad Leg Lower (Tib/Fib)2 Views-Left | $252.00 | $1,260.00 | $504.00–$1,008.00 | — | 80% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 HC Rad Tib-Fib 1 View-Left | $252.00 | $1,260.00 | $504.00–$1,008.00 | — | 80% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 HC Rad Leg Lower (Tib/Fib)2 Views-Right | $252.00 | $1,260.00 | $504.00–$1,008.00 | — | 80% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 HC Rad Tib-Fib 1 View-Right | $252.00 | $1,260.00 | $504.00–$1,008.00 | — | 80% |
| MR angiography (MRA) of the head without contrast CPT 70544 HC MRI Mra Head W/O Contrast | $1,190.40 | $5,952.00 | $2,380.80–$4,761.60 | — | 80% |
| MR angiography (MRA) of the head without contrast CPT 70544 HC MRI Mrv Head W/O Contrast | $1,190.40 | $5,952.00 | $2,380.80–$4,761.60 | — | 80% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRI Mrv Head W/O Contrast | $1,190.40 | $5,952.00 | $2,380.80–$4,761.60 | — | 80% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRI Mra Head W/O Contrast | $1,190.40 | $5,952.00 | $2,380.80–$4,761.60 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 HC MRI Lower Extremity Bilat W/O Contrast Peds Rotational | $914.00 | $4,570.00 | $1,828.00–$3,656.00 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Knee W/O Cont | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Knee W/O Cont-Left | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Hip W/O Contrast-Right | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Ankle W/O Cont-Left | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Knee W/O Cont-Right | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Ext Joint W/O Contrast-Peds Fast Msk-Left | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Ankle W/O Cont-Right | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Ext Joint W/O Contrast-Peds Fast Msk-Right | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Toes W/O Cont-Left | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Toes W/O Cont-Right | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Knee W/O Contrast-Visionaire Protocol Left | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Knee W/O Contrast-Visionaire Protocol Right | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Hip W/O Contrast-Left | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 HC MRI Lower Extremity Bilat W/O Contrast Peds Rotational | $914.00 | $4,570.00 | $1,828.00–$3,656.00 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Knee W/O Cont | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Lower Ext Joint W/O Contrast-Peds Fast Msk-Right | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Toes W/O Cont-Left | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Toes W/O Cont-Right | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Knee W/O Cont-Left | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Knee W/O Cont-Right | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Knee W/O Contrast-Visionaire Protocol Left | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Knee W/O Contrast-Visionaire Protocol Right | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Hip W/O Contrast-Left | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Hip W/O Contrast-Right | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Ankle W/O Cont-Left | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Ankle W/O Cont-Right | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Lower Ext Joint W/O Contrast-Peds Fast Msk-Left | $963.80 | $4,819.00 | $1,927.60–$3,855.20 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Toes W/ & W/O Conbtrast-Right | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Ankle W & W/O Contrast-Right | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Ankle W & W/O Contrast-Left | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Hip W/ & W/O Contrast-Right | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Hip W/ & W/O Contrast-Left | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Knee W&W/O Contrast-Right | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Knee W&W/O Contrast-Left | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Toes W/ & W/O Conbtrast-Left | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Hip W/ & W/O Contrast-Right | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Toes W/ & W/O Conbtrast-Left | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Toes W/ & W/O Conbtrast-Right | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Knee W&W/O Contrast-Left | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Knee W&W/O Contrast-Right | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Hip W/ & W/O Contrast-Left | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Ankle W & W/O Contrast-Right | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Ankle W & W/O Contrast-Left | $1,560.60 | $7,803.00 | $3,121.20–$6,242.40 | — | 80% |
| MRI of the abdomen without contrast CPT 74181 HC MRI Liver Iron Overload WO Contrast | $1,063.20 | $5,316.00 | $2,126.40–$4,252.80 | — | 80% |
| MRI of the abdomen without contrast CPT 74181 HC MRI Abd W/O Cont | $1,063.20 | $5,316.00 | $2,126.40–$4,252.80 | — | 80% |
| MRI of the abdomen without contrast CPT 74181 HC MRI Mrcp | $1,063.20 | $5,316.00 | $2,126.40–$4,252.80 | — | 80% |
| MRI of the abdomen without contrast inpatient CPT 74181 HC MRI Abd W/O Cont | $1,063.20 | $5,316.00 | $2,126.40–$4,252.80 | — | 80% |
| MRI of the abdomen without contrast inpatient CPT 74181 HC MRI Mrcp | $1,063.20 | $5,316.00 | $2,126.40–$4,252.80 | — | 80% |
| MRI of the abdomen without contrast inpatient CPT 74181 HC MRI Liver Iron Overload WO Contrast | $1,063.20 | $5,316.00 | $2,126.40–$4,252.80 | — | 80% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI Abdomen W/WO Contrast W/ Eovist | $1,722.40 | $8,612.00 | $3,444.80–$6,889.60 | — | 80% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI Enterography | $1,722.40 | $8,612.00 | $3,444.80–$6,889.60 | — | 80% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI Abd W/& W/O Cont | $1,722.40 | $8,612.00 | $3,444.80–$6,889.60 | — | 80% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Urogram | $1,722.40 | $8,612.00 | $3,444.80–$6,889.60 | — | 80% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI Enterography | $1,722.40 | $8,612.00 | $3,444.80–$6,889.60 | — | 80% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Urogram | $1,722.40 | $8,612.00 | $3,444.80–$6,889.60 | — | 80% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI Abd W/& W/O Cont | $1,722.40 | $8,612.00 | $3,444.80–$6,889.60 | — | 80% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI Abdomen W/WO Contrast W/ Eovist | $1,722.40 | $8,612.00 | $3,444.80–$6,889.60 | — | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Head W/O Contrast Brainlab Protocol | $966.60 | $4,833.00 | $1,933.20–$3,866.40 | — | 80% |
| MRI of the brain, no contrast dye CPT 70551 MRI Head W/O Contrast Etv Protocol | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Head W/O Contrast-3t | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Pituitary W/O Contrast | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Iacs W/O Contrast | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Head W/O Contrast Stealth Protocol | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Head W/O Contrast-Peds Fast Brain | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Pituitary W/Head W/O Contrast | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Head W/O Contrast | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI CSF Flow W/O Contrast | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Head W/O Contrast Brainlab Protocol | $966.60 | $4,833.00 | $1,933.20–$3,866.40 | — | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Head W/O Contrast-Peds Fast Brain | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Iacs W/O Contrast | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Pituitary W/Head W/O Contrast | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Pituitary W/O Contrast | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Head W/O Contrast Etv Protocol | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Head W/O Contrast Stealth Protocol | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Head W/O Contrast-3t | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI CSF Flow W/O Contrast | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Head W/O Contrast | $1,026.20 | $5,131.00 | $2,052.40–$4,104.80 | — | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Pituitary W/Head W&WO Cntrst | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Head W/W/O Contrast-3t | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Perfusion W/ W/O Contrast | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI CSF Flow W/ W/O Contrast | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Head W & W/O Contrast | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Iacs W/&W/O Contrast | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Pituitary W/&W/O Contrast | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Head W & W/O Contrast | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Perfusion W/ W/O Contrast | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Pituitary W/&W/O Contrast | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI CSF Flow W/ W/O Contrast | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Pituitary W/Head W&WO Cntrst | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Head W/W/O Contrast-3t | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Iacs W/&W/O Contrast | $1,654.20 | $8,271.00 | $3,308.40–$6,616.80 | — | 80% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Spine Lumbar W/O Contrast-3t | $1,375.40 | $6,877.00 | $2,750.80–$5,501.60 | — | 80% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Lumbar W/O Contrast | $1,375.40 | $6,877.00 | $2,750.80–$5,501.60 | — | 80% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Spine Lumbar W/O Contrast-3t | $1,375.40 | $6,877.00 | $2,750.80–$5,501.60 | — | 80% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Lumbar W/O Contrast | $1,375.40 | $6,877.00 | $2,750.80–$5,501.60 | — | 80% |
| MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI Lumb Spine W&W/O Contras | $1,810.00 | $9,050.00 | $3,620.00–$7,240.00 | — | 80% |
| MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI Spine Lumbar W/W/O Contrast-3t | $1,810.00 | $9,050.00 | $3,620.00–$7,240.00 | — | 80% |
| MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI Spine Lumbar W/W/O for Drop Metastases | $1,810.00 | $9,050.00 | $3,620.00–$7,240.00 | — | 80% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI Lumb Spine W&W/O Contras | $1,810.00 | $9,050.00 | $3,620.00–$7,240.00 | — | 80% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI Spine Lumbar W/W/O Contrast-3t | $1,810.00 | $9,050.00 | $3,620.00–$7,240.00 | — | 80% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI Spine Lumbar W/W/O for Drop Metastases | $1,810.00 | $9,050.00 | $3,620.00–$7,240.00 | — | 80% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI T-Spine Without Contrast | $1,590.60 | $7,953.00 | $3,181.20–$6,362.40 | — | 80% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI Spine Thoracic W/O Contrast-3t | $1,590.60 | $7,953.00 | $3,181.20–$6,362.40 | — | 80% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI Spine Thoracic W/O Contrast-3t | $1,590.60 | $7,953.00 | $3,181.20–$6,362.40 | — | 80% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI T-Spine Without Contrast | $1,590.60 | $7,953.00 | $3,181.20–$6,362.40 | — | 80% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI Spine Cervical W/W/O for Drop Metastases | $1,721.40 | $8,607.00 | $3,442.80–$6,885.60 | — | 80% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI Cerv Spine W &W/O Contras | $1,721.40 | $8,607.00 | $3,442.80–$6,885.60 | — | 80% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI Spine Cervical W/W/O Contrast-3t | $1,721.40 | $8,607.00 | $3,442.80–$6,885.60 | — | 80% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI Cerv Spine W &W/O Contras | $1,721.40 | $8,607.00 | $3,442.80–$6,885.60 | — | 80% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI Spine Cervical W/W/O for Drop Metastases | $1,721.40 | $8,607.00 | $3,442.80–$6,885.60 | — | 80% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI Spine Cervical W/W/O Contrast-3t | $1,721.40 | $8,607.00 | $3,442.80–$6,885.60 | — | 80% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI Spine Cervial W/O Contrast-3t | $1,504.00 | $7,520.00 | $3,008.00–$6,016.00 | — | 80% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI Cervical Spine W/O Contra | $1,504.00 | $7,520.00 | $3,008.00–$6,016.00 | — | 80% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI Cervical Spine W/O Contra | $1,504.00 | $7,520.00 | $3,008.00–$6,016.00 | — | 80% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI Spine Cervial W/O Contrast-3t | $1,504.00 | $7,520.00 | $3,008.00–$6,016.00 | — | 80% |
| MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis W/WO Contrast-Spica Cast Protocol | $1,403.60 | $7,018.00 | $2,807.20–$5,614.40 | — | 80% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI Pelvis-Limited W/WO Contrast | $1,413.40 | $7,067.00 | $2,826.80–$5,653.60 | — | 80% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI Pelvis W & W/O Contrast | $1,490.40 | $7,452.00 | $2,980.80–$5,961.60 | — | 80% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI Pelvis W/W/O Contrast-Rectal/Anal Protocol | $1,490.40 | $7,452.00 | $2,980.80–$5,961.60 | — | 80% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI Prostate W & W/O Contrast | $1,490.40 | $7,452.00 | $2,980.80–$5,961.60 | — | 80% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis W/WO Contrast-Spica Cast Protocol | $1,403.60 | $7,018.00 | $2,807.20–$5,614.40 | — | 80% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI Pelvis-Limited W/WO Contrast | $1,413.40 | $7,067.00 | $2,826.80–$5,653.60 | — | 80% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI Pelvis W & W/O Contrast | $1,490.40 | $7,452.00 | $2,980.80–$5,961.60 | — | 80% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI Pelvis W/W/O Contrast-Rectal/Anal Protocol | $1,490.40 | $7,452.00 | $2,980.80–$5,961.60 | — | 80% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI Prostate W & W/O Contrast | $1,490.40 | $7,452.00 | $2,980.80–$5,961.60 | — | 80% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis W/O Contrast-Spica Cast Protocol | $870.60 | $4,353.00 | $1,741.20–$3,482.40 | — | 80% |
| MRI of the pelvis, no contrast dye CPT 72195 HC MRI Pelvis W/O Contrast | $924.20 | $4,621.00 | $1,848.40–$3,696.80 | — | 80% |
| MRI of the pelvis, no contrast dye CPT 72195 HC MRI Pelvis-Limited W/O Contra | $924.20 | $4,621.00 | $1,848.40–$3,696.80 | — | 80% |
| MRI of the pelvis, no contrast dye CPT 72195 HC MRI Prostate W/O Contrast | $924.20 | $4,621.00 | $1,848.40–$3,696.80 | — | 80% |
| MRI of the pelvis, no contrast dye CPT 72195 HC MRI Pelvis W/O Contrast-Rectal/Anal Protocol | $924.20 | $4,621.00 | $1,848.40–$3,696.80 | — | 80% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis W/O Contrast-Spica Cast Protocol | $870.60 | $4,353.00 | $1,741.20–$3,482.40 | — | 80% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI Pelvis W/O Contrast-Rectal/Anal Protocol | $924.20 | $4,621.00 | $1,848.40–$3,696.80 | — | 80% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI Pelvis-Limited W/O Contra | $924.20 | $4,621.00 | $1,848.40–$3,696.80 | — | 80% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI Pelvis W/O Contrast | $924.20 | $4,621.00 | $1,848.40–$3,696.80 | — | 80% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI Prostate W/O Contrast | $924.20 | $4,621.00 | $1,848.40–$3,696.80 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 HC MRI Upper Ext Joint W/O Contrast-Peds Fast Msk-Left | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 HC MRI Elbow W/O Cont-Left | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 HC MRI Wrist W/O Cont-Right | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 HC MRI Fingers W/O Cont-Right | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 HC MRI Upper Ext Joint W/O Contrast-Peds Fast Msk-Right | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 HC MRI Fingers W/O Cont-Left | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 HC MRI Wrist W/O Cont-Left | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 HC MRI Shoulder W/O Cont-Right | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 HC MRI Shoulder W/O Cont-Left | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 HC MRI Elbow W/O Cont-Right | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 HC MRI Shoulder W/O Cont-Right | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 HC MRI Upper Ext Joint W/O Contrast-Peds Fast Msk-Left | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 HC MRI Upper Ext Joint W/O Contrast-Peds Fast Msk-Right | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 HC MRI Wrist W/O Cont-Left | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 HC MRI Wrist W/O Cont-Right | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 HC MRI Shoulder W/O Cont-Left | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 HC MRI Fingers W/O Cont-Left | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 HC MRI Fingers W/O Cont-Right | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 HC MRI Elbow W/O Cont-Left | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 HC MRI Elbow W/O Cont-Right | $1,369.60 | $6,848.00 | $2,739.20–$5,478.40 | — | 80% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC Rad Spine Cervical 4-5 Views | $403.40 | $2,017.00 | $806.80–$1,613.60 | — | 80% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC Rad Spine Cervical 4-5 Views | $403.40 | $2,017.00 | $806.80–$1,613.60 | — | 80% |
| Neck soft tissue CT scan with contrast CPT 70491 HC CT Neck Soft Tissue W/ Contra | $1,136.80 | $5,684.00 | $2,273.60–$4,547.20 | — | 80% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT Neck Soft Tissue W/ Contra | $1,136.80 | $5,684.00 | $2,273.60–$4,547.20 | — | 80% |
| Neck soft tissue CT scan without contrast CPT 70490 HC CT Neck Soft Tissue W/O Contr | $943.20 | $4,716.00 | $1,886.40–$3,772.80 | — | 80% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT Neck Soft Tissue W/O Contr | $943.20 | $4,716.00 | $1,886.40–$3,772.80 | — | 80% |
| Neck soft tissue X-ray CPT 70360 HC Rad Soft Tissue Neck | $152.20 | $761.00 | $304.40–$608.80 | — | 80% |
| Neck soft tissue X-ray inpatient CPT 70360 HC Rad Soft Tissue Neck | $152.20 | $761.00 | $304.40–$608.80 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Nuc Scan Lexihc Nuc Scan Rest/Stress | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Ht Muscle Image Spect, Mult | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Nuc Scan Dobutamine Rst/Str | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nuc Scan Ht Musc Image Spect, Mult | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Nuc Scan Persantine/Myoview-St/Rs | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Nuc Scan Adenosine Rst/Str | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Nuc Scan Sestimibi-Rest/Stress | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Nuc Scan Persantine/Sestimibi St/ | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Nuc Myocardial Perf Rst/Str Spec | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Nuc Scan Persantine/Thallium St/R | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Nuc Scan Myoview-Rest/Stress | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Nuc Scan Myocardial Spect Multi | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Nuc Scan Thallium/Stress & Reperf | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Nuc Scan Persantine/Thallium St/R | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Nuc Scan Myocardial Spect Multi | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Nuc Scan Lexihc Nuc Scan Rest/Stress | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Nuc Scan Dobutamine Rst/Str | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Nuc Scan Adenosine Rst/Str | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Nuc Myocardial Perf Rst/Str Spec | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Nuc Scan Persantine/Myoview-St/Rs | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Nuc Scan Myoview-Rest/Stress | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Nuc Scan Ht Musc Image Spect, Mult | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Ht Muscle Image Spect, Mult | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Nuc Scan Thallium/Stress & Reperf | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Nuc Scan Persantine/Sestimibi St/ | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Nuc Scan Sestimibi-Rest/Stress | $1,861.80 | $9,309.00 | $3,723.60–$7,447.20 | — | 80% |
| OCT scan of the retina (optical coherence tomography) CPT 92134 HC Comp Ophth Dx Img Post Seg | $65.00 | $325.00 | $130.00–$260.00 | — | 80% |
| OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 HC Comp Ophth Dx Img Post Seg | $65.00 | $325.00 | $130.00–$260.00 | — | 80% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC Pet W/ CT-Psma-Skull Base to Mid Thigh | $2,510.80 | $12,554.00 | $5,021.60–$10,043.20 | — | 80% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC Pet W/ CT Cierianna Skull Base to Mid Thigh | $2,667.60 | $13,338.00 | $5,335.20–$10,670.40 | — | 80% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC Pet W/ CT Detectnet-Skull Base to Mid Thigh | $2,667.60 | $13,338.00 | $5,335.20–$10,670.40 | — | 80% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC Nuc Pet W/ CT Skull Base-Mid Thig | $2,667.60 | $13,338.00 | $5,335.20–$10,670.40 | — | 80% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC Pet W/ CT-Psma-Skull Base to Mid Thigh | $2,510.80 | $12,554.00 | $5,021.60–$10,043.20 | — | 80% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC Nuc Pet W/ CT Skull Base-Mid Thig | $2,667.60 | $13,338.00 | $5,335.20–$10,670.40 | — | 80% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC Pet W/ CT Detectnet-Skull Base to Mid Thigh | $2,667.60 | $13,338.00 | $5,335.20–$10,670.40 | — | 80% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC Pet W/ CT Cierianna Skull Base to Mid Thigh | $2,667.60 | $13,338.00 | $5,335.20–$10,670.40 | — | 80% |
| Pelvic CT scan without contrast CPT 72192 HC CT Pelvis-Limited W/O Contrast | $1,204.60 | $6,023.00 | $2,409.20–$4,818.40 | — | 80% |
| Pelvic CT scan without contrast CPT 72192 HC CT Pelvis W/O Contrast�7d Surgical | $1,270.00 | $6,350.00 | $2,540.00–$5,080.00 | — | 80% |
| Pelvic CT scan without contrast CPT 72192 HC CT Cystogram | $1,270.00 | $6,350.00 | $2,540.00–$5,080.00 | — | 80% |
| Pelvic CT scan without contrast CPT 72192 HC CT Pelvis W/O Contrast | $1,270.00 | $6,350.00 | $2,540.00–$5,080.00 | — | 80% |
| Pelvic CT scan without contrast CPT 72192 HC CT Pelvis W/O Contrast�3d Firefly | $1,270.00 | $6,350.00 | $2,540.00–$5,080.00 | — | 80% |
| Pelvic CT scan without contrast inpatient CPT 72192 HC CT Pelvis-Limited W/O Contrast | $1,204.60 | $6,023.00 | $2,409.20–$4,818.40 | — | 80% |
| Pelvic CT scan without contrast inpatient CPT 72192 HC CT Pelvis W/O Contrast | $1,270.00 | $6,350.00 | $2,540.00–$5,080.00 | — | 80% |
| Pelvic CT scan without contrast inpatient CPT 72192 HC CT Pelvis W/O Contrast�7d Surgical | $1,270.00 | $6,350.00 | $2,540.00–$5,080.00 | — | 80% |
| Pelvic CT scan without contrast inpatient CPT 72192 HC CT Cystogram | $1,270.00 | $6,350.00 | $2,540.00–$5,080.00 | — | 80% |
| Pelvic CT scan without contrast inpatient CPT 72192 HC CT Pelvis W/O Contrast�3d Firefly | $1,270.00 | $6,350.00 | $2,540.00–$5,080.00 | — | 80% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC Ult Exam, Pelvic, Limited | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC POC Limited Pelvic US | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US Penile W/O Duplex Sono | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC Limited Emerg Transabdominal Preg Unknown/Not Preg US | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC Ult Sono Pelvc Limtd | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC POC Limited Pelvic US | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US Penile W/O Duplex Sono | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC Ult Sono Pelvc Limtd | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC Limited Emerg Transabdominal Preg Unknown/Not Preg US | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC Ult Exam, Pelvic, Limited | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC Ult Sonogram Pelvic | $421.60 | $2,108.00 | $843.20–$1,686.40 | — | 80% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC Ult Sonogram Pelvic | $421.60 | $2,108.00 | $843.20–$1,686.40 | — | 80% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC Ult Sono OB Over or Equal14wks | $248.40 | $1,242.00 | $496.80–$993.60 | — | 80% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC Ult Sono OB Over or Equal14wks | $248.40 | $1,242.00 | $496.80–$993.60 | — | 80% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC Ult Sono OB Less Than 14wks | $211.60 | $1,058.00 | $423.20–$846.40 | — | 80% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC Ult Sono OB Less Than 14wks | $211.60 | $1,058.00 | $423.20–$846.40 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC Limited Emerg Transabdominal Preg US | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC Ult Sonogram Fetal Presentation | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC Ult Sonogram Afi(Amnionic Fluid I | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC Ult Sono Fetal Heart Rate Chek | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC Ult Sonogram Guided OB Version | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC Ult Sonogram R/O Abruption | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US Estimated Fetal Weight Sono | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC POC Transabd Preg US | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC Ult OB Limited Sono | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC Ult Sonogram Location of Placenta | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC Ult OB Limited Sono | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC Ult Sono Fetal Heart Rate Chek | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC Ult Sonogram R/O Abruption | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC Ult Sonogram Afi(Amnionic Fluid I | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC Ult Sonogram Fetal Presentation | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC Ult Sonogram Location of Placenta | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC POC Transabd Preg US | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC Limited Emerg Transabdominal Preg US | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC Ult Sonogram Guided OB Version | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US Estimated Fetal Weight Sono | $394.20 | $1,971.00 | $788.40–$1,576.80 | — | 80% |
| Rib X-ray, one side, 2 views one side CPT 71100 HC Rad Ribs Unilat W/O Cxr Min 2 Views-Left | $302.40 | $1,512.00 | $604.80–$1,209.60 | — | 80% |
| Rib X-ray, one side, 2 views one side CPT 71100 HC Rad Ribs Unilat W/O Cxr Min 2 Views-Right | $302.40 | $1,512.00 | $604.80–$1,209.60 | — | 80% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC Rad Ribs Unilat W/O Cxr Min 2 Views-Right | $302.40 | $1,512.00 | $604.80–$1,209.60 | — | 80% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC Rad Ribs Unilat W/O Cxr Min 2 Views-Left | $302.40 | $1,512.00 | $604.80–$1,209.60 | — | 80% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 HC Rad Ribs Unilat W/Pa Cxr Min 3views-Right | $363.60 | $1,818.00 | $727.20–$1,454.40 | — | 80% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 HC Rad Ribs Unilat W/Pa Cxr Min 3views-Left | $363.60 | $1,818.00 | $727.20–$1,454.40 | — | 80% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 HC Rad Ribs Unilat W/Pa Cxr Min 3views-Right | $363.60 | $1,818.00 | $727.20–$1,454.40 | — | 80% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 HC Rad Ribs Unilat W/Pa Cxr Min 3views-Left | $363.60 | $1,818.00 | $727.20–$1,454.40 | — | 80% |
| Screening mammogram, both breasts both sides CPT 77067 HC Mam Screen Mammo W/Orw/O Cad Bilat | $90.00 | $450.00 | $180.00–$360.00 | — | 80% |
| Screening mammogram, both breasts both sides CPT 77067 HC MA Digital Screen Mammo Bilat 3d Tomosynthesis W or WO Cad | $94.60 | $473.00 | $189.20–$378.40 | — | 80% |
| Screening mammogram, both breasts one side CPT 77067 HC Mam Screen Mammo Uni W/Orw/O Cad Right | $83.00 | $415.00 | $166.00–$332.00 | — | 80% |
| Screening mammogram, both breasts one side CPT 77067 HC Mam Screen Mammo Uni W/Orw/O Cad Left | $83.00 | $415.00 | $166.00–$332.00 | — | 80% |
| Screening mammogram, both breasts one side CPT 77067 HC MA Digital Screen Mammo Uni 3d Tomosynthesis W or WO Cad-Left | $87.20 | $436.00 | $174.40–$348.80 | — | 80% |
| Screening mammogram, both breasts one side CPT 77067 HC MA Digital Screen Mammo Uni 3d Tomosynthesis W or WO Cad-Right | $87.20 | $436.00 | $174.40–$348.80 | — | 80% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Mam Screen Mammo W/Orw/O Cad Bilat | $90.00 | $450.00 | $180.00–$360.00 | — | 80% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC MA Digital Screen Mammo Bilat 3d Tomosynthesis W or WO Cad | $94.60 | $473.00 | $189.20–$378.40 | — | 80% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Mam Screen Mammo Uni W/Orw/O Cad Left | $83.00 | $415.00 | $166.00–$332.00 | — | 80% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Mam Screen Mammo Uni W/Orw/O Cad Right | $83.00 | $415.00 | $166.00–$332.00 | — | 80% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC MA Digital Screen Mammo Uni 3d Tomosynthesis W or WO Cad-Right | $87.20 | $436.00 | $174.40–$348.80 | — | 80% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC MA Digital Screen Mammo Uni 3d Tomosynthesis W or WO Cad-Left | $87.20 | $436.00 | $174.40–$348.80 | — | 80% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 HC Rad Shoulder Complete Min 2 Views-Left | $277.00 | $1,385.00 | $554.00–$1,108.00 | — | 80% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 HC Rad Shoulder Complete Min 2 Views-Right | $277.00 | $1,385.00 | $554.00–$1,108.00 | — | 80% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 HC Rad Shoulder Complete Min 2 Views-Left | $277.00 | $1,385.00 | $554.00–$1,108.00 | — | 80% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 HC Rad Shoulder Complete Min 2 Views-Right | $277.00 | $1,385.00 | $554.00–$1,108.00 | — | 80% |
| Sinus X-ray, complete, 3 or more views CPT 70220 HC Rad Sinuses Min 3 Views | $185.40 | $927.00 | $370.80–$741.60 | — | 80% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC Rad Sinuses Min 3 Views | $185.40 | $927.00 | $370.80–$741.60 | — | 80% |
| Skull X-ray, fewer than 4 views CPT 70250 HC Rad Skull 1-3 Views | $271.00 | $1,355.00 | $542.00–$1,084.00 | — | 80% |
| Skull X-ray, fewer than 4 views CPT 70250 HC Rad Skull Waters 1-3 Views | $271.00 | $1,355.00 | $542.00–$1,084.00 | — | 80% |
| Skull X-ray, fewer than 4 views CPT 70250 HC Xr Skull Shunt Valve 1-3 Views | $271.00 | $1,355.00 | $542.00–$1,084.00 | — | 80% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 HC Rad Skull Waters 1-3 Views | $271.00 | $1,355.00 | $542.00–$1,084.00 | — | 80% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 HC Xr Skull Shunt Valve 1-3 Views | $271.00 | $1,355.00 | $542.00–$1,084.00 | — | 80% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 HC Rad Skull 1-3 Views | $271.00 | $1,355.00 | $542.00–$1,084.00 | — | 80% |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography 12 Hrs | $1,601.60 | $8,008.00 | $3,203.20–$6,406.40 | — | 80% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnography 12 Hrs | $1,601.60 | $8,008.00 | $3,203.20–$6,406.40 | — | 80% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC Echo Stress W Cont Ecg | $655.60 | $3,278.00 | $1,311.20–$2,622.40 | — | 80% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC Stress Echocardiogram | $655.60 | $3,278.00 | $1,311.20–$2,622.40 | — | 80% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC Echo Stress W Cont Ecg | $655.60 | $3,278.00 | $1,311.20–$2,622.40 | — | 80% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC Stress Echocardiogram | $655.60 | $3,278.00 | $1,311.20–$2,622.40 | — | 80% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 HC Rad Aspiration Study | $273.80 | $1,369.00 | $547.60–$1,095.20 | — | 80% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC Rad Aspiration Study | $273.80 | $1,369.00 | $547.60–$1,095.20 | — | 80% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 HC Rad Femur Min 2 Views-Right | $233.80 | $1,169.00 | $467.60–$935.20 | — | 80% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 HC Rad Femur Min 2 Views-Left | $233.80 | $1,169.00 | $467.60–$935.20 | — | 80% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 HC Rad Femur Min 2 Views-Right | $233.80 | $1,169.00 | $467.60–$935.20 | — | 80% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 HC Rad Femur Min 2 Views-Left | $233.80 | $1,169.00 | $467.60–$935.20 | — | 80% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT Thoracic Spine W/O Contrast�7d Surgical | $1,373.60 | $6,868.00 | $2,747.20–$5,494.40 | — | 80% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT Thoracic Spine W/O Contras | $1,373.60 | $6,868.00 | $2,747.20–$5,494.40 | — | 80% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT Thoracic Spine W/O Contrast�3d Firefly | $1,373.60 | $6,868.00 | $2,747.20–$5,494.40 | — | 80% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT Thoracic Spine W/O Contras | $1,373.60 | $6,868.00 | $2,747.20–$5,494.40 | — | 80% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT Thoracic Spine W/O Contrast�3d Firefly | $1,373.60 | $6,868.00 | $2,747.20–$5,494.40 | — | 80% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT Thoracic Spine W/O Contrast�7d Surgical | $1,373.60 | $6,868.00 | $2,747.20–$5,494.40 | — | 80% |
| Toe X-ray, 2 or more views one side CPT 73660 HC Rad Toes Min 2 Views-Left | $122.40 | $612.00 | $244.80–$489.60 | — | 80% |
| Toe X-ray, 2 or more views one side CPT 73660 HC Rad Toes Min 2 Views -Right | $122.40 | $612.00 | $244.80–$489.60 | — | 80% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 HC Rad Toes Min 2 Views -Right | $122.40 | $612.00 | $244.80–$489.60 | — | 80% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 HC Rad Toes Min 2 Views-Left | $122.40 | $612.00 | $244.80–$489.60 | — | 80% |
| Transvaginal pelvic ultrasound CPT 76830 HC Ult Sono Transvaginal Non-OB | $368.60 | $1,843.00 | $737.20–$1,474.40 | — | 80% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC Ult Sono Transvaginal Non-OB | $368.60 | $1,843.00 | $737.20–$1,474.40 | — | 80% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC Ult Sono Transvag OB Cervicl Leng | $442.20 | $2,211.00 | $884.40–$1,768.80 | — | 80% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC Ult Sono Transvaginal Obstetrical | $442.20 | $2,211.00 | $884.40–$1,768.80 | — | 80% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC Ult Sono Transvaginal Obstetrical | $442.20 | $2,211.00 | $884.40–$1,768.80 | — | 80% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC Ult Sono Transvag OB Cervicl Leng | $442.20 | $2,211.00 | $884.40–$1,768.80 | — | 80% |
| Ultrasound of the abdomen, complete CPT 76700 HC Ult Sonogram Abdominal Survey | $429.60 | $2,148.00 | $859.20–$1,718.40 | — | 80% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC Ult Sonogram Abdominal Survey | $429.60 | $2,148.00 | $859.20–$1,718.40 | — | 80% |
| Ultrasound of the scrotum and testicles CPT 76870 HC Ult Sonogram Testicle W/Flow | $393.60 | $1,968.00 | $787.20–$1,574.40 | — | 80% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 HC Ult Sonogram Testicle W/Flow | $393.60 | $1,968.00 | $787.20–$1,574.40 | — | 80% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US Cervical Node Mapping | $301.20 | $1,506.00 | $602.40–$1,204.80 | — | 80% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC Ult Thyroid Sono | $301.20 | $1,506.00 | $602.40–$1,204.80 | — | 80% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC Limited Emerg�Soft Tissues Head/Neck US | $403.00 | $2,015.00 | $806.00–$1,612.00 | — | 80% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC Ult Sonogrm Soft Tissues Neck/Hea | $403.00 | $2,015.00 | $806.00–$1,612.00 | — | 80% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC POC Limited Soft Tissues Head/Neck US | $403.00 | $2,015.00 | $806.00–$1,612.00 | — | 80% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US Cervical Node Mapping | $301.20 | $1,506.00 | $602.40–$1,204.80 | — | 80% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC Ult Thyroid Sono | $301.20 | $1,506.00 | $602.40–$1,204.80 | — | 80% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC Limited Emerg�Soft Tissues Head/Neck US | $403.00 | $2,015.00 | $806.00–$1,612.00 | — | 80% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC Ult Sonogrm Soft Tissues Neck/Hea | $403.00 | $2,015.00 | $806.00–$1,612.00 | — | 80% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC POC Limited Soft Tissues Head/Neck US | $403.00 | $2,015.00 | $806.00–$1,612.00 | — | 80% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC Rad Ugi/Small Bowel Series | $386.20 | $1,931.00 | $772.40–$1,544.80 | — | 80% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC Xr Ugi-Inc Scout/Delayed Images | $386.20 | $1,931.00 | $772.40–$1,544.80 | — | 80% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC Xr Ugi W/Swallow-Inc Scout/Delayed Images | $386.20 | $1,931.00 | $772.40–$1,544.80 | — | 80% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC Xr Ugi W/Gastrografin/Omni-Inc Scout/Delayed Images | $386.20 | $1,931.00 | $772.40–$1,544.80 | — | 80% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC Xr Ugi-Inc Scout/Delayed Images | $386.20 | $1,931.00 | $772.40–$1,544.80 | — | 80% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC Xr Ugi W/Gastrografin/Omni-Inc Scout/Delayed Images | $386.20 | $1,931.00 | $772.40–$1,544.80 | — | 80% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC Xr Ugi W/Swallow-Inc Scout/Delayed Images | $386.20 | $1,931.00 | $772.40–$1,544.80 | — | 80% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC Rad Ugi/Small Bowel Series | $386.20 | $1,931.00 | $772.40–$1,544.80 | — | 80% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HC Rad Humerus 1 View-Left | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HC Rad Humerus Min 2 Views-Right | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HC Rad Humerus Min 2 Views-Left | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 HC Rad Humerus 1 View-Right | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HC Rad Humerus Min 2 Views-Left | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HC Rad Humerus Min 2 Views-Right | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HC Rad Humerus 1 View-Right | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HC Rad Humerus 1 View-Left | $225.80 | $1,129.00 | $451.60–$903.20 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study both sides CPT 93971 HC Venus Deplex Lower Bilat Limited | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study both sides CPT 93971 Venous Duplex Upper Bilat Limited | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study both sides CPT 93971 HC Ult Upper Venous Scan Bilat Lmtd | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study both sides CPT 93971 HC Ult Lower Venous Scan Bilat Lmtd | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC Upper/Lower Venous Scan(Unila | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC Venous Scan Lower Extremities Pre-Cabg Eval | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC Limited Emerg Dupl Scan Extrem Vein Bedside US | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC POC Limited Duplex Extremity Vein US | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC Ult Upper/Lower Venous Scan(Unila | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC Ult Venous Duplex/Dvt Uni/Lmtd Arm-Right | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC Ult Venous Duplex/Dvt Uni/Lmtd Arm-Left | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC Lower Venous Scan Unilat for Reflux | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC Ult Venous Duplex/Dvt Uni/Lmtd Leg-Left | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC Ult Venous Duplex/Dvt Uni/Lmtd Leg-Right | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC Lower Venous Scan Unilat for Venous Insufficiency-Left | $365.00 | $1,825.00 | $730.00–$1,460.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC Lower Venous Scan Unilat for Venous Insufficiency-Right | $365.00 | $1,825.00 | $730.00–$1,460.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient both sides CPT 93971 Venous Duplex Upper Bilat Limited | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient both sides CPT 93971 HC Venus Deplex Lower Bilat Limited | $275.00 | $1,375.00 | $550.00–$1,100.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient both sides CPT 93971 HC Ult Lower Venous Scan Bilat Lmtd | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient both sides CPT 93971 HC Ult Upper Venous Scan Bilat Lmtd | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC Venous Scan Lower Extremities Pre-Cabg Eval | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC POC Limited Duplex Extremity Vein US | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC Limited Emerg Dupl Scan Extrem Vein Bedside US | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC Upper/Lower Venous Scan(Unila | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC Ult Upper/Lower Venous Scan(Unila | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC Ult Venous Duplex/Dvt Uni/Lmtd Arm-Right | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC Ult Venous Duplex/Dvt Uni/Lmtd Leg-Left | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC Ult Venous Duplex/Dvt Uni/Lmtd Leg-Right | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC Lower Venous Scan Unilat for Reflux | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC Ult Venous Duplex/Dvt Uni/Lmtd Arm-Left | $292.00 | $1,460.00 | $584.00–$1,168.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC Lower Venous Scan Unilat for Venous Insufficiency-Left | $365.00 | $1,825.00 | $730.00–$1,460.00 | — | 80% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC Lower Venous Scan Unilat for Venous Insufficiency-Right | $365.00 | $1,825.00 | $730.00–$1,460.00 | — | 80% |
| Wrist X-ray, 2 views one side CPT 73100 HC Rad Wrist 2 Views-Right | $235.00 | $1,175.00 | $470.00–$940.00 | — | 80% |
| Wrist X-ray, 2 views one side CPT 73100 HC Rad Wrist 1 View-Right | $235.00 | $1,175.00 | $470.00–$940.00 | — | 80% |
| Wrist X-ray, 2 views one side CPT 73100 HC Rad Wrist 1 View-Left | $235.00 | $1,175.00 | $470.00–$940.00 | — | 80% |
| Wrist X-ray, 2 views one side CPT 73100 HC Rad Wrist 2 Views-Left | $235.00 | $1,175.00 | $470.00–$940.00 | — | 80% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 HC Rad Wrist 1 View-Left | $235.00 | $1,175.00 | $470.00–$940.00 | — | 80% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 HC Rad Wrist 2 Views-Right | $235.00 | $1,175.00 | $470.00–$940.00 | — | 80% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 HC Rad Wrist 2 Views-Left | $235.00 | $1,175.00 | $470.00–$940.00 | — | 80% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 HC Rad Wrist 1 View-Right | $235.00 | $1,175.00 | $470.00–$940.00 | — | 80% |
| Wrist X-ray, complete, 3 or more views CPT 73110 HC Rad Wrist Complete Min 3 Views | $275.80 | $1,379.00 | $551.60–$1,103.20 | — | 80% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 HC Rad Wrist Complete Min 3 Views-Right | $275.80 | $1,379.00 | $551.60–$1,103.20 | — | 80% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 HC Rad Wrist Complete Min 3 Views-Left | $275.80 | $1,379.00 | $551.60–$1,103.20 | — | 80% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC Rad Wrist Complete Min 3 Views | $275.80 | $1,379.00 | $551.60–$1,103.20 | — | 80% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 HC Rad Wrist Complete Min 3 Views-Left | $275.80 | $1,379.00 | $551.60–$1,103.20 | — | 80% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 HC Rad Wrist Complete Min 3 Views-Right | $275.80 | $1,379.00 | $551.60–$1,103.20 | — | 80% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC Rad Hip Unilat 2-3views, W/ or W/O Pelvis-Left | $108.00 | $540.00 | $216.00–$432.00 | — | 80% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC Rad Hip Unilat 2-3views, W/ or W/O Pelvis-Right | $108.00 | $540.00 | $216.00–$432.00 | — | 80% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC Rad Hip Unilat 2-3views, W/ or W/O Pelvis-Left | $108.00 | $540.00 | $216.00–$432.00 | — | 80% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC Rad Hip Unilat 2-3views, W/ or W/O Pelvis-Right | $108.00 | $540.00 | $216.00–$432.00 | — | 80% |
| X-ray of the abdomen, 1 view CPT 74018 HC Rad Abdomen for GI Tube Placement | $162.20 | $811.00 | $324.40–$648.80 | — | 80% |
| X-ray of the abdomen, 1 view CPT 74018 HC Rad Abd/Kub 1 View | $162.20 | $811.00 | $324.40–$648.80 | — | 80% |
| X-ray of the abdomen, 1 view CPT 74018 HC CT Kub of Abdomen (Abdomen Flat) | $172.20 | $861.00 | $344.40–$688.80 | — | 80% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC Rad Abdomen for GI Tube Placement | $162.20 | $811.00 | $324.40–$648.80 | — | 80% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC Rad Abd/Kub 1 View | $162.20 | $811.00 | $324.40–$648.80 | — | 80% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC CT Kub of Abdomen (Abdomen Flat) | $172.20 | $861.00 | $344.40–$688.80 | — | 80% |
| X-ray of the ankle, 2 views both sides CPT 73600 HC Xr Ankle Bilat 1 View | $227.40 | $1,137.00 | $454.80–$909.60 | — | 80% |
| X-ray of the ankle, 2 views one side CPT 73600 HC Rad Ankle 1 View-Left | $227.40 | $1,137.00 | $454.80–$909.60 | — | 80% |
| X-ray of the ankle, 2 views one side CPT 73600 HC Rad Ankle 1 View-Right | $227.40 | $1,137.00 | $454.80–$909.60 | — | 80% |
| X-ray of the ankle, 2 views one side CPT 73600 HC Rad Ankle 2 Views-Left | $227.40 | $1,137.00 | $454.80–$909.60 | — | 80% |
| X-ray of the ankle, 2 views one side CPT 73600 HC Rad Ankle 2 Views-Right | $227.40 | $1,137.00 | $454.80–$909.60 | — | 80% |
| X-ray of the ankle, 2 views inpatient both sides CPT 73600 HC Xr Ankle Bilat 1 View | $227.40 | $1,137.00 | $454.80–$909.60 | — | 80% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 HC Rad Ankle 2 Views-Left | $227.40 | $1,137.00 | $454.80–$909.60 | — | 80% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 HC Rad Ankle 2 Views-Right | $227.40 | $1,137.00 | $454.80–$909.60 | — | 80% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 HC Rad Ankle 1 View-Right | $227.40 | $1,137.00 | $454.80–$909.60 | — | 80% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 HC Rad Ankle 1 View-Left | $227.40 | $1,137.00 | $454.80–$909.60 | — | 80% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HC Rad Fingers Min 2 Views-Left | $215.00 | $1,075.00 | $430.00–$860.00 | — | 80% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HC Rad Fingers Min 2 Views-Right | $215.00 | $1,075.00 | $430.00–$860.00 | — | 80% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 HC Rad Fingers Min 2 Views-Left | $215.00 | $1,075.00 | $430.00–$860.00 | — | 80% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 HC Rad Fingers Min 2 Views-Right | $215.00 | $1,075.00 | $430.00–$860.00 | — | 80% |
| X-ray of the foot, 2 views both sides CPT 73620 HC Xr Foot Bilat 1 View | $254.00 | $1,270.00 | $508.00–$1,016.00 | — | 80% |
| X-ray of the foot, 2 views one side CPT 73620 HC Rad Foot 2 Views-Left | $254.00 | $1,270.00 | $508.00–$1,016.00 | — | 80% |
| X-ray of the foot, 2 views one side CPT 73620 HC Rad Foot 1 View-Left | $254.00 | $1,270.00 | $508.00–$1,016.00 | — | 80% |
| X-ray of the foot, 2 views one side CPT 73620 HC Rad Foot 1 View-Right | $254.00 | $1,270.00 | $508.00–$1,016.00 | — | 80% |
| X-ray of the foot, 2 views one side CPT 73620 HC Rad Foot 2 Views-Right | $254.00 | $1,270.00 | $508.00–$1,016.00 | — | 80% |
| X-ray of the foot, 2 views inpatient both sides CPT 73620 HC Xr Foot Bilat 1 View | $254.00 | $1,270.00 | $508.00–$1,016.00 | — | 80% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 HC Rad Foot 2 Views-Left | $254.00 | $1,270.00 | $508.00–$1,016.00 | — | 80% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 HC Rad Foot 1 View-Left | $254.00 | $1,270.00 | $508.00–$1,016.00 | — | 80% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 HC Rad Foot 2 Views-Right | $254.00 | $1,270.00 | $508.00–$1,016.00 | — | 80% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 HC Rad Foot 1 View-Right | $254.00 | $1,270.00 | $508.00–$1,016.00 | — | 80% |
| X-ray of the foot, complete, 3 or more views CPT 73630 HC Rad Foot Complete Min 3 Views | $288.60 | $1,443.00 | $577.20–$1,154.40 | — | 80% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 HC Rad Foot Complete Min 3 Views-Left | $288.60 | $1,443.00 | $577.20–$1,154.40 | — | 80% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 HC Rad Foot Complete Min 3 Views-Right | $288.60 | $1,443.00 | $577.20–$1,154.40 | — | 80% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC Rad Foot Complete Min 3 Views | $288.60 | $1,443.00 | $577.20–$1,154.40 | — | 80% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 HC Rad Foot Complete Min 3 Views-Right | $288.60 | $1,443.00 | $577.20–$1,154.40 | — | 80% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 HC Rad Foot Complete Min 3 Views-Left | $288.60 | $1,443.00 | $577.20–$1,154.40 | — | 80% |
| X-ray of the hand, 3 or more views one side CPT 73130 HC Rad Hand Min 3 Views-Left | $277.00 | $1,385.00 | $554.00–$1,108.00 | — | 80% |
| X-ray of the hand, 3 or more views one side CPT 73130 HC Rad Hand Min 3 Views-Right | $277.00 | $1,385.00 | $554.00–$1,108.00 | — | 80% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HC Rad Hand Min 3 Views-Left | $277.00 | $1,385.00 | $554.00–$1,108.00 | — | 80% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HC Rad Hand Min 3 Views-Right | $277.00 | $1,385.00 | $554.00–$1,108.00 | — | 80% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 HC Rad Knee 1-2 Views-Right | $228.80 | $1,144.00 | $457.60–$915.20 | — | 80% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 HC Rad Knee 1-2 Views-Left | $228.80 | $1,144.00 | $457.60–$915.20 | — | 80% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 HC Rad Knee 1-2 Views-Right | $228.80 | $1,144.00 | $457.60–$915.20 | — | 80% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 HC Rad Knee 1-2 Views-Left | $228.80 | $1,144.00 | $457.60–$915.20 | — | 80% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC Rad Spine Lumbar 2-3 Views | $329.80 | $1,649.00 | $659.60–$1,319.20 | — | 80% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC Rad Spine Lumbar 2-3 Views | $329.80 | $1,649.00 | $659.60–$1,319.20 | — | 80% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Rad Spine Lumbar Min 4 Views | $446.20 | $2,231.00 | $892.40–$1,784.80 | — | 80% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Rad Spine Lumbar Min 4 Views | $446.20 | $2,231.00 | $892.40–$1,784.80 | — | 80% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC Rad Spine Thoracic 2 Views | $290.20 | $1,451.00 | $580.40–$1,160.80 | — | 80% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC Rad Spine Thoracic 2 Views | $290.20 | $1,451.00 | $580.40–$1,160.80 | — | 80% |
| X-ray of the nasal bones, 3 or more views CPT 70160 HC Rad Nasal Bones Min 3 Views | $198.00 | $990.00 | $396.00–$792.00 | — | 80% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC Rad Nasal Bones Min 3 Views | $198.00 | $990.00 | $396.00–$792.00 | — | 80% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC Rad Spine Cervical 2-3 Views | $318.00 | $1,590.00 | $636.00–$1,272.00 | — | 80% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC Rad Spine Cervical 2-3 Views | $318.00 | $1,590.00 | $636.00–$1,272.00 | — | 80% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 HC Rad Pelvis 1-2 Views | $177.00 | $885.00 | $354.00–$708.00 | — | 80% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC Rad Pelvis 1-2 Views | $177.00 | $885.00 | $354.00–$708.00 | — | 80% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC Rad Sacrum/Coccyx Min 2 Views | $183.40 | $917.00 | $366.80–$733.60 | — | 80% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC Rad Sacrum/Coccyx Min 2 Views | $183.40 | $917.00 | $366.80–$733.60 | — | 80% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Florida | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC Lab Zz Alanine Amino (Alt) (Sgot) | $10.20 | $51.00 | $20.40–$40.80 | — | 80% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC Alt (Uc/Pol Only) | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC Hg Alt | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC Lab Sgpt (Alt) | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC Lab Zz Alanine Amino (Alt) (Sgot) | $10.20 | $51.00 | $20.40–$40.80 | — | 80% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC Lab Sgpt (Alt) | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC Hg Alt | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC Alt (Uc/Pol Only) | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 HC Hg Ast | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 HC Lab Sgot (Ast) | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 HC Ast (Uc/Pol Only) | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC Hg Ast | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC Ast (Uc/Pol Only) | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC Lab Sgot (Ast) | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC Lab Acute Hepatitis Profile | $86.20 | $431.00 | $172.40–$344.80 | — | 80% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC Lab Acute Hepatitis Profile | $86.20 | $431.00 | $172.40–$344.80 | — | 80% |
| Albumin blood test CPT 82040 HC Albumin (14966)* | $3.60 | $18.00 | $7.20–$14.40 | — | 80% |
| Albumin blood test CPT 82040 HC Lab Zz Albumin, Serum | $4.00 | $20.00 | $8.00–$16.00 | — | 80% |
| Albumin blood test CPT 82040 HC Lab Albumin | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Albumin blood test CPT 82040 HC Albumin, Serum (Uc/Pol Only) | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Albumin blood test CPT 82040 HC Lab Albumin Serum (Ms Profile) | $29.60 | $148.00 | $59.20–$118.40 | — | 80% |
| Albumin blood test inpatient CPT 82040 HC Albumin (14966)* | $3.60 | $18.00 | $7.20–$14.40 | — | 80% |
| Albumin blood test inpatient CPT 82040 HC Lab Zz Albumin, Serum | $4.00 | $20.00 | $8.00–$16.00 | — | 80% |
| Albumin blood test inpatient CPT 82040 HC Lab Albumin | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Albumin blood test inpatient CPT 82040 HC Albumin, Serum (Uc/Pol Only) | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Albumin blood test inpatient CPT 82040 HC Lab Albumin Serum (Ms Profile) | $29.60 | $148.00 | $59.20–$118.40 | — | 80% |
| Aldosterone blood test CPT 82088 HC Lab Aldosterone, 24hr Urine | $11.00 | $55.00 | $22.00–$44.00 | — | 80% |
| Aldosterone blood test CPT 82088 HC Lab Aldosterone Assay (16845) | $13.20 | $66.00 | $26.40–$52.80 | — | 80% |
| Aldosterone blood test inpatient CPT 82088 HC Lab Aldosterone, 24hr Urine | $11.00 | $55.00 | $22.00–$44.00 | — | 80% |
| Aldosterone blood test inpatient CPT 82088 HC Lab Aldosterone Assay (16845) | $13.20 | $66.00 | $26.40–$52.80 | — | 80% |
| Alkaline phosphatase (ALP) blood test CPT 84075 HC Lab Alk Phosphatase | $4.00 | $20.00 | $8.00–$16.00 | — | 80% |
| Alkaline phosphatase (ALP) blood test CPT 84075 HC Lab Alkaline Phosphatase | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Alkaline phosphatase (ALP) blood test CPT 84075 HC Lab Alkaline Phosphatase Bone | $17.60 | $88.00 | $35.20–$70.40 | — | 80% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC Lab Alk Phosphatase | $4.00 | $20.00 | $8.00–$16.00 | — | 80% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC Lab Alkaline Phosphatase | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC Lab Alkaline Phosphatase Bone | $17.60 | $88.00 | $35.20–$70.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Fusarium Monilforme, Ige | $1.20 | $6.00 | $2.40–$4.80 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Aureobasidium Pullulans, Ige | $1.20 | $6.00 | $2.40–$4.80 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Mucor, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Pecan, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Soybean, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen English Plantain, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Trout, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Melaleuca Leucadendron, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Milk, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Apple, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Scale, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Yellow Jacket, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Bald Cypress, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Latex, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Perennial Rye Grass, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Pineapple, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Queen Palm, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen White Pine, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Pear, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Goldenrod, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Privet Tree, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Dog Fennel, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cacao/Cocoa, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Eucalyptus, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Fire Ant, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Mushroom, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Halibut, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Peach, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Hamster Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Yellow Faced Hornet, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Hazelnut Tree, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Lime, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Ferret Epithlelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen White Faced Hornet, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Chicken Feathers, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Yeast (Bakers), Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Pecan Hickory, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Walnut Food, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cheese Cheddar, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Parsley, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen White Potato, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Gluten, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Oyster, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Orange, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Shrimp, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Candida Albicans, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Watermelon, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Egg Whole, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Sesame Seed, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Squid, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Vanilla, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Catfish, Ige, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Scallops, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Swordfish, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Turkey, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Onion, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Olive Food, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Mackerel, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Mustard, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Gerbil Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Asparagus, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Spinach, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Pine Nut, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Rye Grain, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Gelatin, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Walnut Tree, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Guar Gum, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Box Elder / Maple, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Pigeon Feathers, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Silver Birch, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Anchovy, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Rat Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Budgerigar Droppings, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Mosquito Species, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Orchard Grass, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Short Ragweed, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Grey Alder, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Pork, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Coriander, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Plum, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Chili Pepper, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cottonseed, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cranberry, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Apricot, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Bahia Grass, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Pisachio, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Timothy Grass, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Penicillium Notatum, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Mouse Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Mountain Cedar, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Raspberry, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Australian Pine, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Oak, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Rough Pigweed, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Dog Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Red Sorrel, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Rabbit Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Nettle, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Egg White, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Helminthospor Halodes, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Bermuda Grass, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Stemphyllium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Egg Yolk, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Rice, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Green Pepper, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Oat, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Wheat, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Hazelnut Food, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen House Dust / H.S. Lab, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Almond, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cat Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Brazil Nut, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Parika, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cashew, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Peanut, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Coconut, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cladosporium Herbarum, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Oregano, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Guinea Pig Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Spruce, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Blomia Tropicalis, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cataloupe Melon, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cabbage, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Buckwheat, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Broccoli, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Blueberry, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Black/White Pepper, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Beef, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Beets, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Lambs Quarter, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Whey, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Alternaria Tenuis, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Chaetomium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Penicillin V, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Penicillin G, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Barley, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Banana, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Avocado, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Mango Fruit, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Wasp Venom, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Blue Mussel, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Malt, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Tuna, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Flounder, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Corn / Maize, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Basil, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Tomato, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Papaya, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Honey Bee, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Macadamia Nut, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Mouse Urine Protein, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen House Dust Mites D.P., Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Sunflower, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Eggplant, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen House Dust Mites D.F., Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Thyme, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Sweet Potato, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Clove, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Lobster, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Lima Bean, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Lettuce, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Lemon, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Kidney Bean Red, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Green Pea, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Grapefruit, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Grape, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Goats Milk, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Garlic, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cucumber, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Crab, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Coffee Bean Green, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cinnamon, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Chicken, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cherry, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Celery, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Carrot, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Blackberry, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Red Dye, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Horse Dander, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Codfish, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Chick Pea, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen String Bean Green, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Pumpkin Seed, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Finch Feathers, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Cockroach, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Kiwi Fruit, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Strawberry, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Salmon, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Clam, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen White Bean, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Lentil, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen House Dust Panel, Ige | $6.20 | $31.00 | $12.40–$24.80 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Peanut Component With Reflex, Ige | $6.40 | $32.00 | $12.80–$25.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Bayberry Wax Myrtle, Ige | $6.60 | $33.00 | $13.20–$26.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Haddock, Ige | $6.60 | $33.00 | $13.20–$26.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Gelatin Porcine, Ige | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Red Snapper, Ige | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Perch, Ige | $7.00 | $35.00 | $14.00–$28.00 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Feather Panel 2 Ige | $7.40 | $37.00 | $14.80–$29.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Annatto Seed, Ige | $8.00 | $40.00 | $16.00–$32.00 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen White Hickory, Ige | $8.40 | $42.00 | $16.80–$33.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Tilapia, Ige | $8.40 | $42.00 | $16.80–$33.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Milk Processed, Ige | $8.60 | $43.00 | $17.20–$34.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Mandarin | $8.60 | $43.00 | $17.20–$34.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Corn Pollen, Ige | $8.60 | $43.00 | $17.20–$34.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 C Lab Allergen Megrim | $8.60 | $43.00 | $17.20–$34.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Squash | $8.60 | $43.00 | $17.20–$34.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Sugar Cane, Ige | $9.20 | $46.00 | $18.40–$36.80 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Wingscale, Ige | $9.20 | $46.00 | $18.40–$36.80 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Fennel Seed Ige | $9.20 | $46.00 | $18.40–$36.80 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Oak Live, Ige | $11.60 | $58.00 | $23.20–$46.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC Lab Allergen Aspergillus Fumigatus, Ige | $13.00 | $65.00 | $26.00–$52.00 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Fusarium Monilforme, Ige | $1.20 | $6.00 | $2.40–$4.80 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Aureobasidium Pullulans, Ige | $1.20 | $6.00 | $2.40–$4.80 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Carrot, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Lambs Quarter, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Box Elder / Maple, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Short Ragweed, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Oak, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Bermuda Grass, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen House Dust / H.S. Lab, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Mucor, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Yellow Jacket, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Yellow Faced Hornet, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen White Faced Hornet, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Walnut Food, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Shrimp, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Sesame Seed, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Scallops, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Wasp Venom, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Corn / Maize, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Honey Bee, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen House Dust Mites D.P., Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen House Dust Mites D.F., Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Codfish, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cockroach, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Clam, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cladosporium Herbarum, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Blomia Tropicalis, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Alternaria Tenuis, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Walnut Tree, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Silver Birch, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Mosquito Species, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cottonseed, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Raspberry, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Dog Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Egg White, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Egg Yolk, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Wheat, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cat Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Peanut, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Soybean, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Milk, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Latex, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Hamster Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Hazelnut Tree, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Ferret Epithlelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Chicken Feathers, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Pecan Hickory, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cheese Cheddar, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Gluten, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Candida Albicans, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Egg Whole, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Squid, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Catfish, Ige, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Swordfish, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Mackerel, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Blue Mussel, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Flounder, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Basil, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Papaya, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Macadamia Nut, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Mouse Urine Protein, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Sunflower, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Eggplant, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Thyme, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Clove, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Blackberry, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Red Dye, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Horse Dander, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Chick Pea, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Pumpkin Seed, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Finch Feathers, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Kiwi Fruit, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Salmon, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen White Bean, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Lentil, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Oregano, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Spruce, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Beets, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Whey, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Chaetomium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Penicillin V, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Penicillin G, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Mango Fruit, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Pine Nut, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Gelatin, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Guar Gum, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Pigeon Feathers, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Anchovy, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Budgerigar Droppings, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Orchard Grass, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Grey Alder, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Coriander, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Chili Pepper, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cranberry, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Bahia Grass, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Timothy Grass, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Penicillium Notatum, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Mountain Cedar, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Australian Pine, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Rough Pigweed, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Red Sorrel, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Nettle, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Helminthospor Halodes, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Stemphyllium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Rice, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Oat, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Hazelnut Food, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Almond, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Brazil Nut, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cashew, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Coconut, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Pecan, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen English Plantain, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Melaleuca Leucadendron, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Scale, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Bald Cypress, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Perennial Rye Grass, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Queen Palm, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen White Pine, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Goldenrod, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Privet Tree, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Eucalyptus, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Fire Ant, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Halibut, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Mushroom, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cacao/Cocoa, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Dog Fennel, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Apple, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Apricot, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Asparagus, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Avocado, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Banana, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Barley, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Beef, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Black/White Pepper, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Blueberry, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Broccoli, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Buckwheat, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cabbage, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cataloupe Melon, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Celery, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cherry, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Chicken, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cinnamon, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Coffee Bean Green, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Crab, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Cucumber, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Garlic, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Goats Milk, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Grape, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Grapefruit, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Green Pea, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Kidney Bean Red, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Lemon, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Lettuce, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Lima Bean, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Lobster, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Malt, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Mustard, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Olive Food, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Onion, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Orange, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Oyster, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Parsley, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Peach, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Pear, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Pineapple, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Pisachio, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Plum, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Pork, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Rye Grain, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Spinach, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Strawberry, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen String Bean Green, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Sweet Potato, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Tomato, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Tuna, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Turkey, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Vanilla, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Watermelon, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen White Potato, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Yeast (Bakers), Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Lime, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Trout, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Parika, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Green Pepper, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Rabbit Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Mouse Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Rat Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Gerbil Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Guinea Pig Epithelium, Ige | $1.40 | $7.00 | $2.80–$5.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen House Dust Panel, Ige | $6.20 | $31.00 | $12.40–$24.80 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Peanut Component With Reflex, Ige | $6.40 | $32.00 | $12.80–$25.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Haddock, Ige | $6.60 | $33.00 | $13.20–$26.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Bayberry Wax Myrtle, Ige | $6.60 | $33.00 | $13.20–$26.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Gelatin Porcine, Ige | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Red Snapper, Ige | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Perch, Ige | $7.00 | $35.00 | $14.00–$28.00 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Feather Panel 2 Ige | $7.40 | $37.00 | $14.80–$29.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Annatto Seed, Ige | $8.00 | $40.00 | $16.00–$32.00 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen White Hickory, Ige | $8.40 | $42.00 | $16.80–$33.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Tilapia, Ige | $8.40 | $42.00 | $16.80–$33.60 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 C Lab Allergen Megrim | $8.60 | $43.00 | $17.20–$34.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Mandarin | $8.60 | $43.00 | $17.20–$34.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Corn Pollen, Ige | $8.60 | $43.00 | $17.20–$34.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Milk Processed, Ige | $8.60 | $43.00 | $17.20–$34.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Squash | $8.60 | $43.00 | $17.20–$34.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Fennel Seed Ige | $9.20 | $46.00 | $18.40–$36.80 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Wingscale, Ige | $9.20 | $46.00 | $18.40–$36.80 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Sugar Cane, Ige | $9.20 | $46.00 | $18.40–$36.80 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Oak Live, Ige | $11.60 | $58.00 | $23.20–$46.40 | — | 80% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Lab Allergen Aspergillus Fumigatus, Ige | $13.00 | $65.00 | $26.00–$52.00 | — | 80% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 HC Lab Alpha Fetoprotein, Serum* | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 HC Lab Alpha-Fetoprotein | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC Lab Alpha Fetoprotein, Serum* | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC Lab Alpha-Fetoprotein | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Ammonia blood test CPT 82140 HC Lab Ammonia | $27.60 | $138.00 | $55.20–$110.40 | — | 80% |
| Ammonia blood test inpatient CPT 82140 HC Lab Ammonia | $27.60 | $138.00 | $55.20–$110.40 | — | 80% |
| Amylase blood test CPT 82150 HC Macroamylase (Rf) 36187 | $11.20 | $56.00 | $22.40–$44.80 | — | 80% |
| Amylase blood test CPT 82150 HC Lab Amylase Pancreatic Serum | $11.40 | $57.00 | $22.80–$45.60 | — | 80% |
| Amylase blood test CPT 82150 Lab Amylase, Peritoneal Fluid | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Amylase blood test CPT 82150 HC Lab Amylase | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Amylase blood test CPT 82150 HC Lab Amylase 12 Hr Urine | $14.00 | $70.00 | $28.00–$56.00 | — | 80% |
| Amylase blood test CPT 82150 HC Lab Amylase 24 Hr Urine | $14.00 | $70.00 | $28.00–$56.00 | — | 80% |
| Amylase blood test CPT 82150 HC Lab Amylase 2 Hr Urine | $14.00 | $70.00 | $28.00–$56.00 | — | 80% |
| Amylase blood test CPT 82150 HC Lab Amylase, Other Fluid | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Amylase blood test CPT 82150 HC Lab Amylase, Pancreatic Cyst | $46.80 | $234.00 | $93.60–$187.20 | — | 80% |
| Amylase blood test inpatient CPT 82150 HC Macroamylase (Rf) 36187 | $11.20 | $56.00 | $22.40–$44.80 | — | 80% |
| Amylase blood test inpatient CPT 82150 HC Lab Amylase Pancreatic Serum | $11.40 | $57.00 | $22.80–$45.60 | — | 80% |
| Amylase blood test inpatient CPT 82150 HC Lab Amylase | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Amylase blood test inpatient CPT 82150 Lab Amylase, Peritoneal Fluid | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Amylase blood test inpatient CPT 82150 HC Lab Amylase 12 Hr Urine | $14.00 | $70.00 | $28.00–$56.00 | — | 80% |
| Amylase blood test inpatient CPT 82150 HC Lab Amylase 24 Hr Urine | $14.00 | $70.00 | $28.00–$56.00 | — | 80% |
| Amylase blood test inpatient CPT 82150 HC Lab Amylase 2 Hr Urine | $14.00 | $70.00 | $28.00–$56.00 | — | 80% |
| Amylase blood test inpatient CPT 82150 HC Lab Amylase, Other Fluid | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Amylase blood test inpatient CPT 82150 HC Lab Amylase, Pancreatic Cyst | $46.80 | $234.00 | $93.60–$187.20 | — | 80% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC Lab Cyclic Citru Peptide (CCP) Ab | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC Lab Cyclic Citru Peptide (CCP) Ab | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC Lab Antinuclear Antibodies (Ana) | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC Ana Screen With Cascading Reflex | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC Ana Screen | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC Lab Antinuclear Antibodies (Ana) | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC Ana Screen With Cascading Reflex | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC Ana Screen | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC Lab Bnp (Nt Pro Bnp) | $57.60 | $288.00 | $115.20–$230.40 | — | 80% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC Lab Bnp (Nt Pro Bnp) | $57.60 | $288.00 | $115.20–$230.40 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Mb Cf Respiratory Culture* | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Mb Environmental Culture | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Culture, Respiratory, Upper | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Mb Body Fluid Culture* | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Mb Respiratory Culture | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Candida Auris Screen | $19.80 | $99.00 | $39.60–$79.20 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Mb Culture Routine* | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Mb Cath Tip Culture | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Culture, Bone Aspirate | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Mb Culture CSF* | $22.80 | $114.00 | $45.60–$91.20 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Mb Tissue Culture (Not Quant) | $37.00 | $185.00 | $74.00–$148.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Mb Body Fluid Culture* | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Culture, Respiratory, Upper | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Mb Respiratory Culture | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Mb Cf Respiratory Culture* | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Mb Environmental Culture | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Candida Auris Screen | $19.80 | $99.00 | $39.60–$79.20 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Mb Culture Routine* | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Culture, Bone Aspirate | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Mb Cath Tip Culture | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Mb Culture CSF* | $22.80 | $114.00 | $45.60–$91.20 | — | 80% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Mb Tissue Culture (Not Quant) | $37.00 | $185.00 | $74.00–$148.00 | — | 80% |
| Basic metabolic panel (blood test) CPT 80048 HC Lab Basic Metabolic Panel | $15.60 | $78.00 | $31.20–$62.40 | — | 80% |
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Uc/Pol Only) | $15.60 | $78.00 | $31.20–$62.40 | — | 80% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel (Uc/Pol Only) | $15.60 | $78.00 | $31.20–$62.40 | — | 80% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Lab Basic Metabolic Panel | $15.60 | $78.00 | $31.20–$62.40 | — | 80% |
| Bilirubin blood test, total CPT 82247 HC Lab Bilirubin-Tot | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Bilirubin blood test, total CPT 82247 HC Lab Zz Bilirubin, Total | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Bilirubin blood test, total CPT 82247 HC Lab Bilirubin Neonatal | $19.40 | $97.00 | $38.80–$77.60 | — | 80% |
| Bilirubin blood test, total CPT 82247 HC Lab Bilirubin Total* | $19.40 | $97.00 | $38.80–$77.60 | — | 80% |
| Bilirubin blood test, total CPT 82247 HC Lab Bilirubin, Body Fluid | $24.40 | $122.00 | $48.80–$97.60 | — | 80% |
| Bilirubin blood test, total inpatient CPT 82247 HC Lab Bilirubin-Tot | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Bilirubin blood test, total inpatient CPT 82247 HC Lab Zz Bilirubin, Total | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Bilirubin blood test, total inpatient CPT 82247 HC Lab Bilirubin Neonatal | $19.40 | $97.00 | $38.80–$77.60 | — | 80% |
| Bilirubin blood test, total inpatient CPT 82247 HC Lab Bilirubin Total* | $19.40 | $97.00 | $38.80–$77.60 | — | 80% |
| Bilirubin blood test, total inpatient CPT 82247 HC Lab Bilirubin, Body Fluid | $24.40 | $122.00 | $48.80–$97.60 | — | 80% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC Hp Surg Path Level 4 | $198.40 | $992.00 | $396.80–$793.60 | — | 80% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC Hp Surg Path Level 4 | $198.40 | $992.00 | $396.80–$793.60 | — | 80% |
| Blood culture for bacteria CPT 87040 HC Mb Blood Culture | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| Blood culture for bacteria inpatient CPT 87040 HC Mb Blood Culture | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Lab Prometheus Collect Process | $3.20 | $16.00 | $6.40–$12.80 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Tgh Lifelink Collect Process | $4.40 | $22.00 | $8.80–$17.60 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Progenity Collect Process | $5.40 | $27.00 | $10.80–$21.60 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Lab Spectracell Collect Process | $5.40 | $27.00 | $10.80–$21.60 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Lab Invitae Collect Process | $5.60 | $28.00 | $11.20–$22.40 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Lab Specimen Collection Venipunct | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Nicu/Picu Lab Draw Peripheral | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC OB ED Venipuncture Blood Collection | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Ucc Venipuncture Blood Collection | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Venipuncture Blood Collection | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Lab Aspira Collect Process | $6.20 | $31.00 | $12.40–$24.80 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Lab Natera Collect Process | $6.60 | $33.00 | $13.20–$26.40 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Astellas Labs, Visit 9 | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Astellas Labs, Visit 10 | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Astellas Labs, Visit 7 | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Astellas Labs, Visit 1 | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Astellas Labs, Visit 6 | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Astellas Labs, Visit 8 | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Astellas Labs, Visit 4 | $26.60 | $133.00 | $53.20–$106.40 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Astellas Labs, Visit 3 | $26.60 | $133.00 | $53.20–$106.40 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Astellas Labs, Visit 5 | $26.60 | $133.00 | $53.20–$106.40 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Astellas Labs, Visit 2 (Pre-OP) | $42.40 | $212.00 | $84.80–$169.60 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Lab Specimen Collection Venipunct | $87.00 | $435.00 | $174.00–$348.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Lab Prometheus Collect Process | $3.20 | $16.00 | $6.40–$12.80 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Tgh Lifelink Collect Process | $4.40 | $22.00 | $8.80–$17.60 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Progenity Collect Process | $5.40 | $27.00 | $10.80–$21.60 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Lab Spectracell Collect Process | $5.40 | $27.00 | $10.80–$21.60 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Lab Invitae Collect Process | $5.60 | $28.00 | $11.20–$22.40 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC OB ED Venipuncture Blood Collection | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Nicu/Picu Lab Draw Peripheral | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Lab Specimen Collection Venipunct | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Ucc Venipuncture Blood Collection | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Venipuncture Blood Collection | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Lab Aspira Collect Process | $6.20 | $31.00 | $12.40–$24.80 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Lab Natera Collect Process | $6.60 | $33.00 | $13.20–$26.40 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Astellas Labs, Visit 1 | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Astellas Labs, Visit 10 | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Astellas Labs, Visit 7 | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Astellas Labs, Visit 8 | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Astellas Labs, Visit 9 | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Astellas Labs, Visit 6 | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Astellas Labs, Visit 5 | $26.60 | $133.00 | $53.20–$106.40 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Astellas Labs, Visit 3 | $26.60 | $133.00 | $53.20–$106.40 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Astellas Labs, Visit 4 | $26.60 | $133.00 | $53.20–$106.40 | — | 80% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Astellas Labs, Visit 2 (Pre-OP) | $42.40 | $212.00 | $84.80–$169.60 | — | 80% |
| Blood glucose (sugar) test CPT 82947 HC Lab Glucose Serum | $8.00 | $40.00 | $16.00–$32.00 | — | 80% |
| Blood glucose (sugar) test CPT 82947 HC Lab Glucose (Ascorbic Acid Patients) | $8.00 | $40.00 | $16.00–$32.00 | — | 80% |
| Blood glucose (sugar) test CPT 82947 HC Lab Glucose 2hr Pp | $8.00 | $40.00 | $16.00–$32.00 | — | 80% |
| Blood glucose (sugar) test CPT 82947 HC Lab Glucose Serum (High) | $8.00 | $40.00 | $16.00–$32.00 | — | 80% |
| Blood glucose (sugar) test CPT 82947 HC Lab Glucose, Blood - POCT | $11.00 | $55.00 | $22.00–$44.00 | — | 80% |
| Blood glucose (sugar) test inpatient CPT 82947 HC Lab Glucose Serum (High) | $8.00 | $40.00 | $16.00–$32.00 | — | 80% |
| Blood glucose (sugar) test inpatient CPT 82947 HC Lab Glucose Serum | $8.00 | $40.00 | $16.00–$32.00 | — | 80% |
| Blood glucose (sugar) test inpatient CPT 82947 HC Lab Glucose (Ascorbic Acid Patients) | $8.00 | $40.00 | $16.00–$32.00 | — | 80% |
| Blood glucose (sugar) test inpatient CPT 82947 HC Lab Glucose 2hr Pp | $8.00 | $40.00 | $16.00–$32.00 | — | 80% |
| Blood glucose (sugar) test inpatient CPT 82947 HC Lab Glucose, Blood - POCT | $11.00 | $55.00 | $22.00–$44.00 | — | 80% |
| Blood lead test CPT 83655 HC Zz Lead/Creatinine Ratio, U | $4.00 | $20.00 | $8.00–$16.00 | — | 80% |
| Blood lead test CPT 83655 HC Lab Lead Blood | $6.00 | $30.00 | $12.00–$24.00 | — | 80% |
| Blood lead test CPT 83655 HC Lab Lead, Heavy Metals, 24hr UR | $6.60 | $33.00 | $13.20–$26.40 | — | 80% |
| Blood lead test inpatient CPT 83655 HC Zz Lead/Creatinine Ratio, U | $4.00 | $20.00 | $8.00–$16.00 | — | 80% |
| Blood lead test inpatient CPT 83655 HC Lab Lead Blood | $6.00 | $30.00 | $12.00–$24.00 | — | 80% |
| Blood lead test inpatient CPT 83655 HC Lab Lead, Heavy Metals, 24hr UR | $6.60 | $33.00 | $13.20–$26.40 | — | 80% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC Lab Hcg Qual W/Quant Hcg if Posit | $14.60 | $73.00 | $29.20–$58.40 | — | 80% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC Lab Hcg Qual (Serum) | $14.60 | $73.00 | $29.20–$58.40 | — | 80% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC Lab Hcg Qual (Serum) | $14.60 | $73.00 | $29.20–$58.40 | — | 80% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC Lab Hcg Qual W/Quant Hcg if Posit | $14.60 | $73.00 | $29.20–$58.40 | — | 80% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO | $14.00 | $70.00 | $28.00–$56.00 | — | 80% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO | $14.00 | $70.00 | $28.00–$56.00 | — | 80% |
| Blood urea nitrogen (BUN) test CPT 84520 HC Lab Urea Body Fluid | $8.80 | $44.00 | $17.60–$35.20 | — | 80% |
| Blood urea nitrogen (BUN) test CPT 84520 HC Lab Bun | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test CPT 84520 HC Lab Bun, Venous | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test CPT 84520 HC Lab Bun, Systemic | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test CPT 84520 HC Lab Bun, Pre Dialysis, Serum | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test CPT 84520 HC Lab Bun, Post Dialysis, Serum | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test CPT 84520 HC Lab Bun POC | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test CPT 84520 HC Lab Bun, Arterial | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Lab Urea Body Fluid | $8.80 | $44.00 | $17.60–$35.20 | — | 80% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Lab Bun POC | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Lab Bun, Venous | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Lab Bun, Arterial | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Lab Bun | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Lab Bun, Post Dialysis, Serum | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Lab Bun, Pre Dialysis, Serum | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Lab Bun, Systemic | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| C-peptide blood test CPT 84681 HC Lab C-Peptide Assay | $10.00 | $50.00 | $20.00–$40.00 | — | 80% |
| C-peptide blood test inpatient CPT 84681 HC Lab C-Peptide Assay | $10.00 | $50.00 | $20.00–$40.00 | — | 80% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC Lab Crp (Ibdsgi) | $4.80 | $24.00 | $9.60–$19.20 | — | 80% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC Lab C-Reactive Protein | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC Lab Crp (Ibdsgi) | $4.80 | $24.00 | $9.60–$19.20 | — | 80% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC Lab C-Reactive Protein | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| C. difficile toxin gene test (stool PCR) CPT 87493 HC Lab C Difficile Pcr (Gl) | $61.20 | $306.00 | $122.40–$244.80 | — | 80% |
| C. difficile toxin gene test (stool PCR) CPT 87493 HC Mb C Difficile Pcr | $61.20 | $306.00 | $122.40–$244.80 | — | 80% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC Mb C Difficile Pcr | $61.20 | $306.00 | $122.40–$244.80 | — | 80% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC Lab C Difficile Pcr (Gl) | $61.20 | $306.00 | $122.40–$244.80 | — | 80% |
| CA 19-9 blood test (tumor marker) CPT 86301 HC Lab Ca 19-9 | $33.40 | $167.00 | $66.80–$133.60 | — | 80% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC Lab Ca 19-9 | $33.40 | $167.00 | $66.80–$133.60 | — | 80% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 HC Lab Ca 125 | $31.40 | $157.00 | $62.80–$125.60 | — | 80% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC Lab Ca 125 | $31.40 | $157.00 | $62.80–$125.60 | — | 80% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC Sars Coronavirus 2, Rna, Biofire | $36.00 | $180.00 | $72.00–$144.00 | — | 80% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC Sars Coronavirus 2, Rna, Simplexa | $36.00 | $180.00 | $72.00–$144.00 | — | 80% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC Sars Coronavirus 2, Rna, Xpert | $36.00 | $180.00 | $72.00–$144.00 | — | 80% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC Sars Coronavirus 2, Rna, ID Now | $36.00 | $180.00 | $72.00–$144.00 | — | 80% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC Sars Coronavirus 2, Rna, T2 | $36.00 | $180.00 | $72.00–$144.00 | — | 80% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC Sars Coronavirus 2, Rna, Panther | $36.00 | $180.00 | $72.00–$144.00 | — | 80% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC Sars Coronavirus 2, Rna, Simplexa | $36.00 | $180.00 | $72.00–$144.00 | — | 80% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC Sars Coronavirus 2, Rna, ID Now | $36.00 | $180.00 | $72.00–$144.00 | — | 80% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC Sars Coronavirus 2, Rna, Xpert | $36.00 | $180.00 | $72.00–$144.00 | — | 80% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC Sars Coronavirus 2, Rna, Panther | $36.00 | $180.00 | $72.00–$144.00 | — | 80% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC Sars Coronavirus 2, Rna, T2 | $36.00 | $180.00 | $72.00–$144.00 | — | 80% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC Sars Coronavirus 2, Rna, Biofire | $36.00 | $180.00 | $72.00–$144.00 | — | 80% |
| Calcium blood test, total CPT 82310 HC Lab Calcium (Ca/ Alb Ratio), Serum* | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Calcium blood test, total CPT 82310 HC Lab Calcium | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Calcium blood test, total CPT 82310 HC Lab Calcium Random Urine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Calcium blood test, total inpatient CPT 82310 HC Lab Calcium (Ca/ Alb Ratio), Serum* | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Calcium blood test, total inpatient CPT 82310 HC Lab Calcium | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Calcium blood test, total inpatient CPT 82310 HC Lab Calcium Random Urine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Carcinoembryonic antigen (CEA) test CPT 82378 HC Lab Cea CSF | $9.60 | $48.00 | $19.20–$38.40 | — | 80% |
| Carcinoembryonic antigen (CEA) test CPT 82378 HC Lab Cea | $28.60 | $143.00 | $57.20–$114.40 | — | 80% |
| Carcinoembryonic antigen (CEA) test CPT 82378 HC Lab Cea, Pancreatic Cyst Fluid | $30.00 | $150.00 | $60.00–$120.00 | — | 80% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC Lab Cea CSF | $9.60 | $48.00 | $19.20–$38.40 | — | 80% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC Lab Cea | $28.60 | $143.00 | $57.20–$114.40 | — | 80% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC Lab Cea, Pancreatic Cyst Fluid | $30.00 | $150.00 | $60.00–$120.00 | — | 80% |
| Chickenpox (varicella) immunity blood test CPT 86787 HC Lab Varicella-Zoster Ab, Igm | $6.00 | $30.00 | $12.00–$24.00 | — | 80% |
| Chickenpox (varicella) immunity blood test CPT 86787 HC Lab Varicella Screen | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Chickenpox (varicella) immunity blood test CPT 86787 HC Lab Zz Varicella Zoster (Vzv) Ab, Igg | $20.00 | $100.00 | $40.00–$80.00 | — | 80% |
| Chickenpox (varicella) immunity blood test CPT 86787 HC Lab Varicella Zoster (Vzv) Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC Lab Varicella-Zoster Ab, Igm | $6.00 | $30.00 | $12.00–$24.00 | — | 80% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC Lab Varicella Screen | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC Lab Zz Varicella Zoster (Vzv) Ab, Igg | $20.00 | $100.00 | $40.00–$80.00 | — | 80% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC Lab Varicella Zoster (Vzv) Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC Lab C. Trachomatis, Rna, Eye | $11.20 | $56.00 | $22.40–$44.80 | — | 80% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC Lab C. Trachomatis, Rna, Urine | $11.80 | $59.00 | $23.60–$47.20 | — | 80% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC Mb Chlamydia Trach Dna Probeampl | $37.80 | $189.00 | $75.60–$151.20 | — | 80% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC Lab C. Trachomatis, Rna, Eye | $11.20 | $56.00 | $22.40–$44.80 | — | 80% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC Lab C. Trachomatis, Rna, Urine | $11.80 | $59.00 | $23.60–$47.20 | — | 80% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC Mb Chlamydia Trach Dna Probeampl | $37.80 | $189.00 | $75.60–$151.20 | — | 80% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lab Zz Lipid Panel | $8.20 | $41.00 | $16.40–$32.80 | — | 80% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lab Lipid Profile | $24.80 | $124.00 | $49.60–$99.20 | — | 80% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Profile With Reflex to Direct Ldl | $24.80 | $124.00 | $49.60–$99.20 | — | 80% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Hg Lipid Panel | $25.40 | $127.00 | $50.80–$101.60 | — | 80% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lab Zz Lipid Panel | $8.20 | $41.00 | $16.40–$32.80 | — | 80% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lab Lipid Profile | $24.80 | $124.00 | $49.60–$99.20 | — | 80% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Profile With Reflex to Direct Ldl | $24.80 | $124.00 | $49.60–$99.20 | — | 80% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Hg Lipid Panel | $25.40 | $127.00 | $50.80–$101.60 | — | 80% |
| Complete blood count (CBC) with differential CPT 85025 HC Lab Cbc With Automated Diff | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Lab Cbc With Automated Diff | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Complete blood count (CBC), no differential CPT 85027 HC Lab Cbc (No Diff)* | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Complete blood count (CBC), no differential CPT 85027 HC Lab Cbc (No Diff) | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Complete blood count (CBC), no differential CPT 85027 HC Lab Cbc, Automated | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Lab Cbc (No Diff) | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Lab Cbc (No Diff)* | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Lab Cbc, Automated | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel (Uc/Pol Only) | $22.00 | $110.00 | $44.00–$88.00 | — | 80% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Bmp to Cmp Add On | $22.00 | $110.00 | $44.00–$88.00 | — | 80% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Lab Comprehensive Metabolic Panel | $23.60 | $118.00 | $47.20–$94.40 | — | 80% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel (Uc/Pol Only) | $22.00 | $110.00 | $44.00–$88.00 | — | 80% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Bmp to Cmp Add On | $22.00 | $110.00 | $44.00–$88.00 | — | 80% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Lab Comprehensive Metabolic Panel | $23.60 | $118.00 | $47.20–$94.40 | — | 80% |
| Cortisol blood test, total CPT 82533 HC Cortisol, Baseline | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Cortisol blood test, total CPT 82533 HC Cortisol, 30 Minutes | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Cortisol blood test, total CPT 82533 HC Lab Cortisol | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Cortisol blood test, total CPT 82533 HC Lab Cortisol, Am | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Cortisol blood test, total CPT 82533 HC Lab Cortisol, Pm | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Cortisol blood test, total CPT 82533 HC Cortisol, 60 Minutes | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Cortisol blood test, total inpatient CPT 82533 HC Lab Cortisol, Pm | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Cortisol blood test, total inpatient CPT 82533 HC Lab Cortisol, Am | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Cortisol blood test, total inpatient CPT 82533 HC Cortisol, 60 Minutes | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Cortisol blood test, total inpatient CPT 82533 HC Cortisol, 30 Minutes | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Cortisol blood test, total inpatient CPT 82533 HC Cortisol, Baseline | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Cortisol blood test, total inpatient CPT 82533 HC Lab Cortisol | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Creatine kinase (CK) blood test, total CPT 82550 HC Lab Cpk | $13.40 | $67.00 | $26.80–$53.60 | — | 80% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 HC Lab Cpk | $13.40 | $67.00 | $26.80–$53.60 | — | 80% |
| Creatinine blood test CPT 82565 HC Creatinine, Plasma | $8.20 | $41.00 | $16.40–$32.80 | — | 80% |
| Creatinine blood test CPT 82565 HC Lab Creatinine Serum | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Creatinine blood test CPT 82565 HC Lab Creatinine Blood, POC | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Creatinine blood test CPT 82565 HC Lab Gfr | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Creatinine blood test CPT 82565 HC Lab Creatinine Serum (Rcc Only) | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Creatinine blood test inpatient CPT 82565 HC Creatinine, Plasma | $8.20 | $41.00 | $16.40–$32.80 | — | 80% |
| Creatinine blood test inpatient CPT 82565 HC Lab Creatinine Serum | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Creatinine blood test inpatient CPT 82565 HC Lab Gfr | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Creatinine blood test inpatient CPT 82565 HC Lab Creatinine Serum (Rcc Only) | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Creatinine blood test inpatient CPT 82565 HC Lab Creatinine Blood, POC | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Cytomegalovirus (CMV) antibody test CPT 86644 HC Lab Cytomegalovirus (Cmv) Ab Igg | $11.80 | $59.00 | $23.60–$47.20 | — | 80% |
| Cytomegalovirus (CMV) antibody test CPT 86644 HC Lab Cytomegalovirus (Cmv) Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Cytomegalovirus (CMV) antibody test CPT 86644 HC Lab Zz Cytomegalovirus (Cmv) Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC Lab Cytomegalovirus (Cmv) Ab Igg | $11.80 | $59.00 | $23.60–$47.20 | — | 80% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC Lab Cytomegalovirus (Cmv) Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC Lab Zz Cytomegalovirus (Cmv) Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| D-dimer blood test (blood clot marker) CPT 85379 HC Lab D-Dimer (Fdp) | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| D-dimer blood test (blood clot marker) CPT 85379 HC Lab D-Dimer, OB | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| D-dimer blood test (blood clot marker) CPT 85379 HC Lab D-Dimer (Rf) | $24.80 | $124.00 | $49.60–$99.20 | — | 80% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 HC Lab D-Dimer, OB | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 HC Lab D-Dimer (Fdp) | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 HC Lab D-Dimer (Rf) | $24.80 | $124.00 | $49.60–$99.20 | — | 80% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Lab Drug Screen, Drugs of Abuse, Serum | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Lab Drugs of Abuse Screen 5, Meconium | $17.00 | $85.00 | $34.00–$68.00 | — | 80% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Drug Tox Monitor 1, With Confirm, Oral Fluid | $19.00 | $95.00 | $38.00–$76.00 | — | 80% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Lab Methadone Screen, Meconium | $20.40 | $102.00 | $40.80–$81.60 | — | 80% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Lab Drug Screen, Serum | $20.60 | $103.00 | $41.20–$82.40 | — | 80% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Drug Screen Umbilical | $28.60 | $143.00 | $57.20–$114.40 | — | 80% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Lab Drug Screen, Drugs of Abuse, Serum | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Lab Drugs of Abuse Screen 5, Meconium | $17.00 | $85.00 | $34.00–$68.00 | — | 80% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Drug Tox Monitor 1, With Confirm, Oral Fluid | $19.00 | $95.00 | $38.00–$76.00 | — | 80% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Lab Methadone Screen, Meconium | $20.40 | $102.00 | $40.80–$81.60 | — | 80% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Lab Drug Screen, Serum | $20.60 | $103.00 | $41.20–$82.40 | — | 80% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Drug Screen Umbilical | $28.60 | $143.00 | $57.20–$114.40 | — | 80% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC Electrolytes, Serum (Uc/Pol Only) | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC Lab Electrolytes | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC Electrolytes, POC | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC Lab Electrolytes | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC Electrolytes, Serum (Uc/Pol Only) | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC Electrolytes, POC | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 HC Lab Epstein-Barr Virus Vca Ab, Igm | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 HC Lab Zz Epstein-Barr Virus (Ebv) Vca Ab, Igm | $27.00 | $135.00 | $54.00–$108.00 | — | 80% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 HC Lab Epstein-Barr Virus (Ebv) Vca Ab, Igg | $27.00 | $135.00 | $54.00–$108.00 | — | 80% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 HC Lab Epstein-Barr Virus (Ebv) Vca Ab, Igm | $27.00 | $135.00 | $54.00–$108.00 | — | 80% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 HC Lab Epstein-Barr Virus (Ebv) Vca Ab, Igg (Ebv Pnl)* | $77.80 | $389.00 | $155.60–$311.20 | — | 80% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 HC Lab Epstein-Barr Virus (Ebv) Vca Ab, Igg (Ebv Pnl W Ea)* | $98.60 | $493.00 | $197.20–$394.40 | — | 80% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC Lab Epstein-Barr Virus Vca Ab, Igm | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC Lab Epstein-Barr Virus (Ebv) Vca Ab, Igm | $27.00 | $135.00 | $54.00–$108.00 | — | 80% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC Lab Zz Epstein-Barr Virus (Ebv) Vca Ab, Igm | $27.00 | $135.00 | $54.00–$108.00 | — | 80% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC Lab Epstein-Barr Virus (Ebv) Vca Ab, Igg | $27.00 | $135.00 | $54.00–$108.00 | — | 80% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC Lab Epstein-Barr Virus (Ebv) Vca Ab, Igg (Ebv Pnl)* | $77.80 | $389.00 | $155.60–$311.20 | — | 80% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC Lab Epstein-Barr Virus (Ebv) Vca Ab, Igg (Ebv Pnl W Ea)* | $98.60 | $493.00 | $197.20–$394.40 | — | 80% |
| Estradiol blood test CPT 82670 HC Lab Estradiol | $42.00 | $210.00 | $84.00–$168.00 | — | 80% |
| Estradiol blood test inpatient CPT 82670 HC Lab Estradiol | $42.00 | $210.00 | $84.00–$168.00 | — | 80% |
| FSH (follicle-stimulating hormone) test CPT 83001 HC Lab Fsh | $27.20 | $136.00 | $54.40–$108.80 | — | 80% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC Lab Fsh | $27.20 | $136.00 | $54.40–$108.80 | — | 80% |
| Fecal calprotectin (stool inflammation test) CPT 83993 HC Lab Calprotectin | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC Lab Calprotectin | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Ferritin blood test (iron stores) CPT 82728 HC Lab Thal/Hem Assay of Ferritin (Thev1) | $21.40 | $107.00 | $42.80–$85.60 | — | 80% |
| Ferritin blood test (iron stores) CPT 82728 HC Lab Ferritin | $21.80 | $109.00 | $43.60–$87.20 | — | 80% |
| Ferritin blood test (iron stores) inpatient CPT 82728 HC Lab Thal/Hem Assay of Ferritin (Thev1) | $21.40 | $107.00 | $42.80–$85.60 | — | 80% |
| Ferritin blood test (iron stores) inpatient CPT 82728 HC Lab Ferritin | $21.80 | $109.00 | $43.60–$87.20 | — | 80% |
| Fibrinogen blood test CPT 85384 HC Zz Fibrogen, Activity K Angle | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Fibrinogen blood test CPT 85384 HC Lab Fibrinogin (Rf) | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Fibrinogen blood test CPT 85384 HC Lab Fibrinogen Activity | $21.60 | $108.00 | $43.20–$86.40 | — | 80% |
| Fibrinogen blood test inpatient CPT 85384 HC Zz Fibrogen, Activity K Angle | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Fibrinogen blood test inpatient CPT 85384 HC Lab Fibrinogin (Rf) | $16.00 | $80.00 | $32.00–$64.00 | — | 80% |
| Fibrinogen blood test inpatient CPT 85384 HC Lab Fibrinogen Activity | $21.60 | $108.00 | $43.20–$86.40 | — | 80% |
| Folate (folic acid) blood test CPT 82746 HC Folate, Serum | $8.80 | $44.00 | $17.60–$35.20 | — | 80% |
| Folate (folic acid) blood test CPT 82746 HC Lab Folate | $21.80 | $109.00 | $43.60–$87.20 | — | 80% |
| Folate (folic acid) blood test inpatient CPT 82746 HC Folate, Serum | $8.80 | $44.00 | $17.60–$35.20 | — | 80% |
| Folate (folic acid) blood test inpatient CPT 82746 HC Lab Folate | $21.80 | $109.00 | $43.60–$87.20 | — | 80% |
| Free T3 thyroid hormone test CPT 84481 HC Lab Triiodothyronine T3, Free | $21.80 | $109.00 | $43.60–$87.20 | — | 80% |
| Free T3 thyroid hormone test CPT 84481 HC Lab T3 Free | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Free T3 thyroid hormone test inpatient CPT 84481 HC Lab Triiodothyronine T3, Free | $21.80 | $109.00 | $43.60–$87.20 | — | 80% |
| Free T3 thyroid hormone test inpatient CPT 84481 HC Lab T3 Free | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 HC Lab T4 (Thyroxine), Free by Dialysis, Serum | $7.20 | $36.00 | $14.40–$28.80 | — | 80% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 HC Lab T4 Free | $19.80 | $99.00 | $39.60–$79.20 | — | 80% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC Lab T4 (Thyroxine), Free by Dialysis, Serum | $7.20 | $36.00 | $14.40–$28.80 | — | 80% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC Lab T4 Free | $19.80 | $99.00 | $39.60–$79.20 | — | 80% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC Lab Ggtp | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC Lab Zz Glutamyltransferase, Gamma | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC Lab Ggtp | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC Lab Zz Glutamyltransferase, Gamma | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC Lab Glucose Challenge 2 Hour | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC Lab Glucose Challenge 1 Hour | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC Lab Glucose Challenge 2 Hour | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC Lab Glucose Challenge 1 Hour | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Glucose tolerance test, 3 samples CPT 82951 HC Lab Glucose Tolerance, 3 Specimens | $23.00 | $115.00 | $46.00–$92.00 | — | 80% |
| Glucose tolerance test, 3 samples CPT 82951 HC Lab Zz Tolerance Test, 3 Specimens | $23.20 | $116.00 | $46.40–$92.80 | — | 80% |
| Glucose tolerance test, 3 samples CPT 82951 HC Lab Lactose Tolerance, 3 Specimens | $24.40 | $122.00 | $48.80–$97.60 | — | 80% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 HC Lab Glucose Tolerance, 3 Specimens | $23.00 | $115.00 | $46.00–$92.00 | — | 80% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 HC Lab Zz Tolerance Test, 3 Specimens | $23.20 | $116.00 | $46.40–$92.80 | — | 80% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 HC Lab Lactose Tolerance, 3 Specimens | $24.40 | $122.00 | $48.80–$97.60 | — | 80% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC Lab N. Gonorrhoea, Rna, Other | $12.00 | $60.00 | $24.00–$48.00 | — | 80% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC Lab N. Gonorrhoeae, Rna, Urine | $12.60 | $63.00 | $25.20–$50.40 | — | 80% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC Mb Gc Dna Probe Amplif | $37.80 | $189.00 | $75.60–$151.20 | — | 80% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC Lab N. Gonorrhoea, Rna, Other | $12.00 | $60.00 | $24.00–$48.00 | — | 80% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC Lab N. Gonorrhoeae, Rna, Urine | $12.60 | $63.00 | $25.20–$50.40 | — | 80% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC Mb Gc Dna Probe Amplif | $37.80 | $189.00 | $75.60–$151.20 | — | 80% |
| H. pylori stool antigen test CPT 87338 HC Mb H Pylori Antigen | $31.40 | $157.00 | $62.80–$125.60 | — | 80% |
| H. pylori stool antigen test inpatient CPT 87338 HC Mb H Pylori Antigen | $31.40 | $157.00 | $62.80–$125.60 | — | 80% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC Lab Hiv-1/2 Antigen and Antibodies | $34.00 | $170.00 | $68.00–$136.00 | — | 80% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC Lab Hiv-1/2 Antigen and Antibodies | $34.00 | $170.00 | $68.00–$136.00 | — | 80% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HC Hp Hpv Dna Tissue Testing | $7.40 | $37.00 | $14.80–$29.60 | — | 80% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC Hp Hpv Dna Tissue Testing | $7.40 | $37.00 | $14.80–$29.60 | — | 80% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC Lab Hemoglobin A1c | $6.00 | $30.00 | $12.00–$24.00 | — | 80% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC Lab Glyco Hemoglobin | $18.00 | $90.00 | $36.00–$72.00 | — | 80% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC Lab Hemoglobin A1c | $6.00 | $30.00 | $12.00–$24.00 | — | 80% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC Lab Glyco Hemoglobin | $18.00 | $90.00 | $36.00–$72.00 | — | 80% |
| Hemoglobin blood test CPT 85018 HC Lab Zz Blood Count, Hemoglobin (17365) | $3.80 | $19.00 | $7.60–$15.20 | — | 80% |
| Hemoglobin blood test CPT 85018 HC Lab Hemoglobin | $13.60 | $68.00 | $27.20–$54.40 | — | 80% |
| Hemoglobin blood test inpatient CPT 85018 HC Lab Zz Blood Count, Hemoglobin (17365) | $3.80 | $19.00 | $7.60–$15.20 | — | 80% |
| Hemoglobin blood test inpatient CPT 85018 HC Lab Hemoglobin | $13.60 | $68.00 | $27.20–$54.40 | — | 80% |
| Hepatitis B core antibody test (total) CPT 86704 HC Lab Hepatitis Bc Antibodies Total | $6.40 | $32.00 | $12.80–$25.60 | — | 80% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HC Lab Hepatitis Bc Antibodies Total | $6.40 | $32.00 | $12.80–$25.60 | — | 80% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC Lab Anti-Hbs | $22.60 | $113.00 | $45.20–$90.40 | — | 80% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC Lab Anti-Hbs | $22.60 | $113.00 | $45.20–$90.40 | — | 80% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HC Lab Hepatitis B Surface Ag | $16.20 | $81.00 | $32.40–$64.80 | — | 80% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC Lab Hepatitis B Surface Ag | $16.20 | $81.00 | $32.40–$64.80 | — | 80% |
| Hepatitis C antibody blood test (screening) CPT 86803 HC Lab Hepatitis C Antibody | $27.20 | $136.00 | $54.40–$108.80 | — | 80% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC Lab Hepatitis C Antibody | $27.20 | $136.00 | $54.40–$108.80 | — | 80% |
| Herpes blood test, HSV-1 antibody CPT 86695 HC Lab Zz Herpes Simplex-1 Ab Igg | $4.80 | $24.00 | $9.60–$19.20 | — | 80% |
| Herpes blood test, HSV-1 antibody CPT 86695 HC Hsv 1 Ab Titer, Igm | $10.80 | $54.00 | $21.60–$43.20 | — | 80% |
| Herpes blood test, HSV-1 antibody CPT 86695 HC Lab Herpes Simplex Virus (Hsv) Type 1 Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Herpes blood test, HSV-1 antibody CPT 86695 HC Lab Zz Herpes Simplex Virus (Hsv) Type 1 Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Herpes blood test, HSV-1 antibody CPT 86695 HC Lab Herpes Simplex Virus (Hsv) Type 1 Ab, Igg* | $41.60 | $208.00 | $83.20–$166.40 | — | 80% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC Lab Zz Herpes Simplex-1 Ab Igg | $4.80 | $24.00 | $9.60–$19.20 | — | 80% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC Hsv 1 Ab Titer, Igm | $10.80 | $54.00 | $21.60–$43.20 | — | 80% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC Lab Herpes Simplex Virus (Hsv) Type 1 Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC Lab Zz Herpes Simplex Virus (Hsv) Type 1 Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC Lab Herpes Simplex Virus (Hsv) Type 1 Ab, Igg* | $41.60 | $208.00 | $83.20–$166.40 | — | 80% |
| Herpes blood test, HSV-2 antibody CPT 86696 HC 2 Ab Titer, Igm | $11.40 | $57.00 | $22.80–$45.60 | — | 80% |
| Herpes blood test, HSV-2 antibody CPT 86696 HC Lab Herpes Simplex Virus (Hsv) Type 2 Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Herpes blood test, HSV-2 antibody CPT 86696 HC Lab Zz Herpes Simplex Virus (Hsv) Type 2 Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Herpes blood test, HSV-2 antibody CPT 86696 HC Lab Hsv 2 Igg Inhibition | $37.20 | $186.00 | $74.40–$148.80 | — | 80% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC 2 Ab Titer, Igm | $11.40 | $57.00 | $22.80–$45.60 | — | 80% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC Lab Herpes Simplex Virus (Hsv) Type 2 Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC Lab Zz Herpes Simplex Virus (Hsv) Type 2 Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC Lab Hsv 2 Igg Inhibition | $37.20 | $186.00 | $74.40–$148.80 | — | 80% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 HC Lab Crp High Sensitivity | $24.60 | $123.00 | $49.20–$98.40 | — | 80% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC Lab Crp High Sensitivity | $24.60 | $123.00 | $49.20–$98.40 | — | 80% |
| Homocysteine blood test CPT 83090 HC Lab Homocysteine Serum | $31.40 | $157.00 | $62.80–$125.60 | — | 80% |
| Homocysteine blood test inpatient CPT 83090 HC Lab Homocysteine Serum | $31.40 | $157.00 | $62.80–$125.60 | — | 80% |
| Insulin blood test CPT 83525 HC Lab Insulin, Serum | $6.40 | $32.00 | $12.80–$25.60 | — | 80% |
| Insulin blood test CPT 83525 HC Lab Insulin, Intact Assay | $10.00 | $50.00 | $20.00–$40.00 | — | 80% |
| Insulin blood test CPT 83525 HC Lab Insulin | $22.00 | $110.00 | $44.00–$88.00 | — | 80% |
| Insulin blood test inpatient CPT 83525 HC Lab Insulin, Serum | $6.40 | $32.00 | $12.80–$25.60 | — | 80% |
| Insulin blood test inpatient CPT 83525 HC Lab Insulin, Intact Assay | $10.00 | $50.00 | $20.00–$40.00 | — | 80% |
| Insulin blood test inpatient CPT 83525 HC Lab Insulin | $22.00 | $110.00 | $44.00–$88.00 | — | 80% |
| Iron blood test (serum iron) CPT 83540 HC Lab Iron | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Iron blood test (serum iron) CPT 83540 HC Lab Zz Iron, Serum | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Iron blood test (serum iron) inpatient CPT 83540 HC Lab Zz Iron, Serum | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Iron blood test (serum iron) inpatient CPT 83540 HC Lab Iron | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Iron-binding capacity (TIBC) test CPT 83550 HC Lab Iron Binding Capacity | $26.80 | $134.00 | $53.60–$107.20 | — | 80% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 HC Lab Iron Binding Capacity | $26.80 | $134.00 | $53.60–$107.20 | — | 80% |
| Kidney function blood test panel CPT 80069 HC Lab Renal Panel | $18.00 | $90.00 | $36.00–$72.00 | — | 80% |
| Kidney function blood test panel inpatient CPT 80069 HC Lab Renal Panel | $18.00 | $90.00 | $36.00–$72.00 | — | 80% |
| LH (luteinizing hormone) test CPT 83002 HC Lab Lh | $28.80 | $144.00 | $57.60–$115.20 | — | 80% |
| LH (luteinizing hormone) test CPT 83002 HC Lh, Pediatrics | $41.40 | $207.00 | $82.80–$165.60 | — | 80% |
| LH (luteinizing hormone) test inpatient CPT 83002 HC Lab Lh | $28.80 | $144.00 | $57.60–$115.20 | — | 80% |
| LH (luteinizing hormone) test inpatient CPT 83002 HC Lh, Pediatrics | $41.40 | $207.00 | $82.80–$165.60 | — | 80% |
| Lactate (lactic acid) blood test CPT 83605 HC Lab Lactic Acid, CSF | $7.40 | $37.00 | $14.80–$29.60 | — | 80% |
| Lactate (lactic acid) blood test CPT 83605 HC Lab Lactic Acid | $19.80 | $99.00 | $39.60–$79.20 | — | 80% |
| Lactate (lactic acid) blood test CPT 83605 HC Lactic Acid - POCT | $19.80 | $99.00 | $39.60–$79.20 | — | 80% |
| Lactate (lactic acid) blood test inpatient CPT 83605 HC Lab Lactic Acid, CSF | $7.40 | $37.00 | $14.80–$29.60 | — | 80% |
| Lactate (lactic acid) blood test inpatient CPT 83605 HC Lab Lactic Acid | $19.80 | $99.00 | $39.60–$79.20 | — | 80% |
| Lactate (lactic acid) blood test inpatient CPT 83605 HC Lactic Acid - POCT | $19.80 | $99.00 | $39.60–$79.20 | — | 80% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 HC Ldh, Serum (Uc/Pol Only) | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 HC Lab Ldh | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Lab Ldh Pleural Fluid | $11.00 | $55.00 | $22.00–$44.00 | — | 80% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 HC Lab Lactate Dehydrogenase (Ld), (Ldh)* | $11.40 | $57.00 | $22.80–$45.60 | — | 80% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 HC Ldh, Peritoneal Fluid | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 HC Lab Ldh, Other Fluid | $18.00 | $90.00 | $36.00–$72.00 | — | 80% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC Lab Ldh | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC Ldh, Serum (Uc/Pol Only) | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lab Ldh Pleural Fluid | $11.00 | $55.00 | $22.00–$44.00 | — | 80% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC Lab Lactate Dehydrogenase (Ld), (Ldh)* | $11.40 | $57.00 | $22.80–$45.60 | — | 80% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC Ldh, Peritoneal Fluid | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC Lab Ldh, Other Fluid | $18.00 | $90.00 | $36.00–$72.00 | — | 80% |
| Lipase blood test (pancreas enzyme) CPT 83690 HC Lab Lipase, Pancreatic Fluid | $7.60 | $38.00 | $15.20–$30.40 | — | 80% |
| Lipase blood test (pancreas enzyme) CPT 83690 HC Lab Lipase, Body Fluid | $12.00 | $60.00 | $24.00–$48.00 | — | 80% |
| Lipase blood test (pancreas enzyme) CPT 83690 HC Lab Lipase | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC Lab Lipase, Pancreatic Fluid | $7.60 | $38.00 | $15.20–$30.40 | — | 80% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC Lab Lipase, Body Fluid | $12.00 | $60.00 | $24.00–$48.00 | — | 80% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC Lab Lipase | $12.80 | $64.00 | $25.60–$51.20 | — | 80% |
| Liver function blood test panel CPT 80076 HC Liver Profile (Uc/Pol Only) | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Liver function blood test panel CPT 80076 HC Lab Liver Profile | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Liver function blood test panel inpatient CPT 80076 HC Lab Liver Profile | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Liver function blood test panel inpatient CPT 80076 HC Liver Profile (Uc/Pol Only) | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Lyme disease antibody test CPT 86618 HC Lab Lyme Disease Serology | $6.40 | $32.00 | $12.80–$25.60 | — | 80% |
| Lyme disease antibody test inpatient CPT 86618 HC Lab Lyme Disease Serology | $6.40 | $32.00 | $12.80–$25.60 | — | 80% |
| Magnesium blood test CPT 83735 HC Lab Magnesium | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Magnesium blood test CPT 83735 HC Lab Magnesium Random Urine | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Magnesium blood test CPT 83735 HC Lab Magnesium (OB) | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Magnesium blood test CPT 83735 HC Lab Magnesium 24 Hr Urine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Magnesium blood test inpatient CPT 83735 HC Lab Magnesium | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Magnesium blood test inpatient CPT 83735 HC Lab Magnesium (OB) | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Magnesium blood test inpatient CPT 83735 HC Lab Magnesium Random Urine | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Magnesium blood test inpatient CPT 83735 HC Lab Magnesium 24 Hr Urine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Measles (rubeola) antibody test CPT 86765 HC Lab Zz Rubeola Ab Igm | $6.60 | $33.00 | $13.20–$26.40 | — | 80% |
| Measles (rubeola) antibody test CPT 86765 HC Lab Rubeola (Measles) Ab Igg * | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Measles (rubeola) antibody test CPT 86765 HC Rubeola Ab, Igg, CSF* | $7.40 | $37.00 | $14.80–$29.60 | — | 80% |
| Measles (rubeola) antibody test CPT 86765 HC Zz Rubeola Ab, Igm, CSF | $7.40 | $37.00 | $14.80–$29.60 | — | 80% |
| Measles (rubeola) antibody test CPT 86765 HC Lab Rubeola (Measles) Antibody | $8.00 | $40.00 | $16.00–$32.00 | — | 80% |
| Measles (rubeola) antibody test CPT 86765 HC Lab Rubeola (Measles) Ab Igm | $14.00 | $70.00 | $28.00–$56.00 | — | 80% |
| Measles (rubeola) antibody test CPT 86765 HC Lab Rubeola (Measles) Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Measles (rubeola) antibody test CPT 86765 HC Lab Zz Rubeola (Measles) Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Measles (rubeola) antibody test inpatient CPT 86765 HC Lab Zz Rubeola Ab Igm | $6.60 | $33.00 | $13.20–$26.40 | — | 80% |
| Measles (rubeola) antibody test inpatient CPT 86765 HC Lab Rubeola (Measles) Ab Igg * | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Measles (rubeola) antibody test inpatient CPT 86765 HC Zz Rubeola Ab, Igm, CSF | $7.40 | $37.00 | $14.80–$29.60 | — | 80% |
| Measles (rubeola) antibody test inpatient CPT 86765 HC Rubeola Ab, Igg, CSF* | $7.40 | $37.00 | $14.80–$29.60 | — | 80% |
| Measles (rubeola) antibody test inpatient CPT 86765 HC Lab Rubeola (Measles) Antibody | $8.00 | $40.00 | $16.00–$32.00 | — | 80% |
| Measles (rubeola) antibody test inpatient CPT 86765 HC Lab Rubeola (Measles) Ab Igm | $14.00 | $70.00 | $28.00–$56.00 | — | 80% |
| Measles (rubeola) antibody test inpatient CPT 86765 HC Lab Zz Rubeola (Measles) Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Measles (rubeola) antibody test inpatient CPT 86765 HC Lab Rubeola (Measles) Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HC Lab Mono Screen | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HC Lab Io Mono Screen | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC Lab Io Mono Screen | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC Lab Mono Screen | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Mumps immunity blood test CPT 86735 HC Lab Zz Mumps Virus Ab Igm | $5.40 | $27.00 | $10.80–$21.60 | — | 80% |
| Mumps immunity blood test CPT 86735 HC Lab Mumps Virus Antibody Igg* | $5.60 | $28.00 | $11.20–$22.40 | — | 80% |
| Mumps immunity blood test CPT 86735 HC Lab Mumps Ab, Igm | $7.00 | $35.00 | $14.00–$28.00 | — | 80% |
| Mumps immunity blood test CPT 86735 HC Lab Mumps Igg Screen | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Mumps immunity blood test CPT 86735 HC Lab Mumps Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Mumps immunity blood test CPT 86735 HC Lab Mumps Ab, Igg (Mmr Pnl)* | $64.20 | $321.00 | $128.40–$256.80 | — | 80% |
| Mumps immunity blood test CPT 86735 HC Lab Mumps Ab, Igg (Mmrv Pnl)* | $84.20 | $421.00 | $168.40–$336.80 | — | 80% |
| Mumps immunity blood test inpatient CPT 86735 HC Lab Zz Mumps Virus Ab Igm | $5.40 | $27.00 | $10.80–$21.60 | — | 80% |
| Mumps immunity blood test inpatient CPT 86735 HC Lab Mumps Virus Antibody Igg* | $5.60 | $28.00 | $11.20–$22.40 | — | 80% |
| Mumps immunity blood test inpatient CPT 86735 HC Lab Mumps Ab, Igm | $7.00 | $35.00 | $14.00–$28.00 | — | 80% |
| Mumps immunity blood test inpatient CPT 86735 HC Lab Mumps Igg Screen | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Mumps immunity blood test inpatient CPT 86735 HC Lab Mumps Ab, Igg | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Mumps immunity blood test inpatient CPT 86735 HC Lab Mumps Ab, Igg (Mmr Pnl)* | $64.20 | $321.00 | $128.40–$256.80 | — | 80% |
| Mumps immunity blood test inpatient CPT 86735 HC Lab Mumps Ab, Igg (Mmrv Pnl)* | $84.20 | $421.00 | $168.40–$336.80 | — | 80% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Lab Psa, Free | $7.00 | $35.00 | $14.00–$28.00 | — | 80% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Lab Psa, Free | $7.00 | $35.00 | $14.00–$28.00 | — | 80% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Lab Total Psa | $7.80 | $39.00 | $15.60–$31.20 | — | 80% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Lab Psa, Ultrasensitive | $11.40 | $57.00 | $22.80–$45.60 | — | 80% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Lab Psa | $27.80 | $139.00 | $55.60–$111.20 | — | 80% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Lab Total Psa | $7.80 | $39.00 | $15.60–$31.20 | — | 80% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Lab Psa, Ultrasensitive | $11.40 | $57.00 | $22.80–$45.60 | — | 80% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Lab Psa | $27.80 | $139.00 | $55.60–$111.20 | — | 80% |
| Parathyroid hormone (PTH) blood test CPT 83970 HC Lab Pth Intact | $47.40 | $237.00 | $94.80–$189.60 | — | 80% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC Lab Pth Intact | $47.40 | $237.00 | $94.80–$189.60 | — | 80% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ptt, Activated (15540) | $8.40 | $42.00 | $16.80–$33.60 | — | 80% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Lab Aptt | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Lab Heparin Absorbed Aptt | $17.00 | $85.00 | $34.00–$68.00 | — | 80% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Ptt, Activated (15540) | $8.40 | $42.00 | $16.80–$33.60 | — | 80% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Lab Aptt | $13.80 | $69.00 | $27.60–$55.20 | — | 80% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Lab Heparin Absorbed Aptt | $17.00 | $85.00 | $34.00–$68.00 | — | 80% |
| Phosphorus (phosphate) blood test CPT 84100 HC Lab Phosphorus | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 HC Lab Phosphorus | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Potassium blood test CPT 84132 HC Serum Potassium, R/O Hyperkalemia | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Potassium blood test CPT 84132 HC Lab Potassium | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Potassium blood test CPT 84132 HC Plasma Potassium, R/O Hyperkalemia | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Potassium blood test CPT 84132 HC Lab Potassium - POCT | $32.20 | $161.00 | $64.40–$128.80 | — | 80% |
| Potassium blood test inpatient CPT 84132 HC Plasma Potassium, R/O Hyperkalemia | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Potassium blood test inpatient CPT 84132 HC Serum Potassium, R/O Hyperkalemia | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Potassium blood test inpatient CPT 84132 HC Lab Potassium | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Potassium blood test inpatient CPT 84132 HC Lab Potassium - POCT | $32.20 | $161.00 | $64.40–$128.80 | — | 80% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC Lab Cell-Free Fetal Dna Testing | $204.00 | $1,020.00 | $408.00–$816.00 | — | 80% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC Lab Cell-Free Fetal Dna Testing | $204.00 | $1,020.00 | $408.00–$816.00 | — | 80% |
| Prolactin blood test CPT 84146 HC Lab Assay of Prolactin, Monomeric | $13.20 | $66.00 | $26.40–$52.80 | — | 80% |
| Prolactin blood test CPT 84146 HC Lab Assay of Prolactin, Total | $14.20 | $71.00 | $28.40–$56.80 | — | 80% |
| Prolactin blood test CPT 84146 HC Lab Prolactin | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Prolactin blood test inpatient CPT 84146 HC Lab Assay of Prolactin, Monomeric | $13.20 | $66.00 | $26.40–$52.80 | — | 80% |
| Prolactin blood test inpatient CPT 84146 HC Lab Assay of Prolactin, Total | $14.20 | $71.00 | $28.40–$56.80 | — | 80% |
| Prolactin blood test inpatient CPT 84146 HC Lab Prolactin | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Pain Prothrombin Time | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Hg Prothrombin Time POCT | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Lab Prothrombin Time | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Pain Prothrombin Time | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Hg Prothrombin Time POCT | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Lab Prothrombin Time | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Lab Zz Methadone Urine Screen | $8.40 | $42.00 | $16.80–$33.60 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Drug Screen , Cocaine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Drug Screen , Oxycodone | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Drug Screen , Methadone | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Drug Screen , Benzodiazepines | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Drug Screen , Barbituates | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Drug Screen , Methylenedioxymethamphetamine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Drug Screen , Phencyclidine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Drug Screen , Methamphetamine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Drug Screen , Amphetamines | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Drug Screen , Opiates | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Drug Screen , Marijuana | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Io Urine Drug Screen | $17.20 | $86.00 | $34.40–$68.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Drug Screen, 6 Panel, Urine (Gnuc Only) | $25.00 | $125.00 | $50.00–$100.00 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Pain Lab Urine Drug POCT | $28.40 | $142.00 | $56.80–$113.60 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Lab Drug Screen, Urine | $118.60 | $593.00 | $237.20–$474.40 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Lab Zz Methadone Urine Screen | $8.40 | $42.00 | $16.80–$33.60 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Drug Screen , Phencyclidine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Drug Screen , Amphetamines | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Drug Screen , Oxycodone | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Drug Screen , Methylenedioxymethamphetamine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Drug Screen , Cocaine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Drug Screen , Methamphetamine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Drug Screen , Opiates | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Drug Screen , Methadone | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Drug Screen , Benzodiazepines | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Drug Screen , Barbituates | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Drug Screen , Marijuana | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Io Urine Drug Screen | $17.20 | $86.00 | $34.40–$68.80 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Drug Screen, 6 Panel, Urine (Gnuc Only) | $25.00 | $125.00 | $50.00–$100.00 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Pain Lab Urine Drug POCT | $28.40 | $142.00 | $56.80–$113.60 | — | 80% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Lab Drug Screen, Urine | $118.60 | $593.00 | $237.20–$474.40 | — | 80% |
| Rapid flu test (influenza antigen) CPT 87804 HC Mb Influenza a Antigen Screen* | $17.60 | $88.00 | $35.20–$70.40 | — | 80% |
| Rapid flu test (influenza antigen) CPT 87804 HC Mb *Zz Influenza B Antigen Scree | $17.60 | $88.00 | $35.20–$70.40 | — | 80% |
| Rapid flu test (influenza antigen) CPT 87804 HC Lab Io Influenza a & B (Automated) | $21.60 | $108.00 | $43.20–$86.40 | — | 80% |
| Rapid flu test (influenza antigen) CPT 87804 HC Lab Zz Influenza B Antigen Screen | $21.60 | $108.00 | $43.20–$86.40 | — | 80% |
| Rapid flu test (influenza antigen) CPT 87804 HC Lab Influenza a Antigen Screen (G | $23.00 | $115.00 | $46.00–$92.00 | — | 80% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 HC Mb Influenza a Antigen Screen* | $17.60 | $88.00 | $35.20–$70.40 | — | 80% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 HC Mb *Zz Influenza B Antigen Scree | $17.60 | $88.00 | $35.20–$70.40 | — | 80% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 HC Lab Io Influenza a & B (Automated) | $21.60 | $108.00 | $43.20–$86.40 | — | 80% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 HC Lab Zz Influenza B Antigen Screen | $21.60 | $108.00 | $43.20–$86.40 | — | 80% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 HC Lab Influenza a Antigen Screen (G | $23.00 | $115.00 | $46.00–$92.00 | — | 80% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC Mb Strep Screen | $13.60 | $68.00 | $27.20–$54.40 | — | 80% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC Mb Io Strep Screen | $16.40 | $82.00 | $32.80–$65.60 | — | 80% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC Mb Strep Screen | $13.60 | $68.00 | $27.20–$54.40 | — | 80% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC Mb Io Strep Screen | $16.40 | $82.00 | $32.80–$65.60 | — | 80% |
| Renin blood test CPT 84244 HC Lab Renin Activity Plasma | $8.20 | $41.00 | $16.40–$32.80 | — | 80% |
| Renin blood test CPT 84244 HC Lab Renin Activity Assay (16845) | $13.00 | $65.00 | $26.00–$52.00 | — | 80% |
| Renin blood test inpatient CPT 84244 HC Lab Renin Activity Plasma | $8.20 | $41.00 | $16.40–$32.80 | — | 80% |
| Renin blood test inpatient CPT 84244 HC Lab Renin Activity Assay (16845) | $13.00 | $65.00 | $26.00–$52.00 | — | 80% |
| Rh blood typing CPT 86901 HC Ts Zz Rh Consult | $5.40 | $27.00 | $10.80–$21.60 | — | 80% |
| Rh blood typing CPT 86901 HC Ts Rh | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rh blood typing inpatient CPT 86901 HC Ts Zz Rh Consult | $5.40 | $27.00 | $10.80–$21.60 | — | 80% |
| Rh blood typing inpatient CPT 86901 HC Ts Rh | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Rheumatoid factor (RF) test CPT 86431 HC Lab Rheumatoid Factor Quantitative | $11.00 | $55.00 | $22.00–$44.00 | — | 80% |
| Rheumatoid factor (RF) test inpatient CPT 86431 HC Lab Rheumatoid Factor Quantitative | $11.00 | $55.00 | $22.00–$44.00 | — | 80% |
| Rubella antibody test (immunity check) CPT 86762 HC Lab Rubella Immunity Screen | $17.60 | $88.00 | $35.20–$70.40 | — | 80% |
| Rubella antibody test (immunity check) CPT 86762 Rubella Ab, Igm | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Rubella antibody test (immunity check) CPT 86762 HC Zz Rubella Ab, Igm (Torch Igm) | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Rubella antibody test (immunity check) CPT 86762 HC Lab Zz Rubella Ab, Igg | $22.60 | $113.00 | $45.20–$90.40 | — | 80% |
| Rubella antibody test (immunity check) CPT 86762 HC Lab Rubella Ab, Igg | $22.60 | $113.00 | $45.20–$90.40 | — | 80% |
| Rubella antibody test (immunity check) inpatient CPT 86762 HC Lab Rubella Immunity Screen | $17.60 | $88.00 | $35.20–$70.40 | — | 80% |
| Rubella antibody test (immunity check) inpatient CPT 86762 HC Zz Rubella Ab, Igm (Torch Igm) | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Ab, Igm | $20.80 | $104.00 | $41.60–$83.20 | — | 80% |
| Rubella antibody test (immunity check) inpatient CPT 86762 HC Lab Zz Rubella Ab, Igg | $22.60 | $113.00 | $45.20–$90.40 | — | 80% |
| Rubella antibody test (immunity check) inpatient CPT 86762 HC Lab Rubella Ab, Igg | $22.60 | $113.00 | $45.20–$90.40 | — | 80% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC Lab Sed Rate Automated | $9.20 | $46.00 | $18.40–$36.80 | — | 80% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC Lab Sed Rate Automated | $9.20 | $46.00 | $18.40–$36.80 | — | 80% |
| Sodium blood test CPT 84295 HC Lab Sodium Serum | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Sodium blood test CPT 84295 HC Lab Sodium Serum - POCT | $28.80 | $144.00 | $57.60–$115.20 | — | 80% |
| Sodium blood test inpatient CPT 84295 HC Lab Sodium Serum | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Sodium blood test inpatient CPT 84295 HC Lab Sodium Serum - POCT | $28.80 | $144.00 | $57.60–$115.20 | — | 80% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Io Occult Blood, Slide, Hemaprompt | $7.60 | $38.00 | $15.20–$30.40 | — | 80% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 HC Occult Blood Feces | $8.40 | $42.00 | $16.80–$33.60 | — | 80% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Io Occult Blood, Slide, Hemaprompt | $7.60 | $38.00 | $15.20–$30.40 | — | 80% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC Occult Blood Feces | $8.40 | $42.00 | $16.80–$33.60 | — | 80% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC Lab Occult Blood, Stool, Immunochemical (Ifobt) | $26.20 | $131.00 | $52.40–$104.80 | — | 80% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC Lab Occult Blood, Stool, Immunochemical (Ifobt) | $26.20 | $131.00 | $52.40–$104.80 | — | 80% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 HC Lab Fta-Abs | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC Lab Fta-Abs | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC Lab Vdrl CSF | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC Lab Vdrl, Serum | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC Lab Rpr | $10.60 | $53.00 | $21.20–$42.40 | — | 80% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC Lab Vdrl, Serum | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC Lab Vdrl CSF | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC Lab Rpr | $10.60 | $53.00 | $21.20–$42.40 | — | 80% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC Lab Quantiferon-TB Gold | $45.80 | $229.00 | $91.60–$183.20 | — | 80% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC Lab Quantiferon-TB Gold | $45.80 | $229.00 | $91.60–$183.20 | — | 80% |
| Testosterone blood test, total (not free testosterone) CPT 84403 HC Lab Testosterone Serum | $18.60 | $93.00 | $37.20–$74.40 | — | 80% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC Lab Testosterone Serum | $18.60 | $93.00 | $37.20–$74.40 | — | 80% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 HC Lab Thyroid Peroxidase Antibodies (Tpo) | $6.60 | $33.00 | $13.20–$26.40 | — | 80% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 HC Lab Liver-Kidney Microsome Type 1 | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 HC Lab Thyroperoxidase Ab | $13.40 | $67.00 | $26.80–$53.60 | — | 80% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 HC Lab Liver Cytosol Antibodies (Lc | $32.00 | $160.00 | $64.00–$128.00 | — | 80% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 HC Lab Liver Cytosol (Lc-1) Ab, Igg | $48.80 | $244.00 | $97.60–$195.20 | — | 80% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Lab Thyroid Peroxidase Antibodies (Tpo) | $6.60 | $33.00 | $13.20–$26.40 | — | 80% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Lab Liver-Kidney Microsome Type 1 | $6.80 | $34.00 | $13.60–$27.20 | — | 80% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Lab Thyroperoxidase Ab | $13.40 | $67.00 | $26.80–$53.60 | — | 80% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Lab Liver Cytosol Antibodies (Lc | $32.00 | $160.00 | $64.00–$128.00 | — | 80% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Lab Liver Cytosol (Lc-1) Ab, Igg | $48.80 | $244.00 | $97.60–$195.20 | — | 80% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Lab Tsh, Neonate (< 30 Days) | $11.40 | $57.00 | $22.80–$45.60 | — | 80% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Lab Tsh | $28.80 | $144.00 | $57.60–$115.20 | — | 80% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Cascade | $28.80 | $144.00 | $57.60–$115.20 | — | 80% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Lab Tsh With Reflex to Free T4 | $28.80 | $144.00 | $57.60–$115.20 | — | 80% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Lab Tsh, Neonate (< 30 Days) | $11.40 | $57.00 | $22.80–$45.60 | — | 80% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Lab Tsh | $28.80 | $144.00 | $57.60–$115.20 | — | 80% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Cascade | $28.80 | $144.00 | $57.60–$115.20 | — | 80% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Lab Tsh With Reflex to Free T4 | $28.80 | $144.00 | $57.60–$115.20 | — | 80% |
| Total IgE blood test CPT 82785 HC Lab Ige (Immunoglobulin E) | $7.00 | $35.00 | $14.00–$28.00 | — | 80% |
| Total IgE blood test inpatient CPT 82785 HC Lab Ige (Immunoglobulin E) | $7.00 | $35.00 | $14.00–$28.00 | — | 80% |
| Total cholesterol blood test CPT 82465 HC Lab Cholesterol | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Total cholesterol blood test inpatient CPT 82465 HC Lab Cholesterol | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Total thyroxine (T4) blood test CPT 84436 HC Lab T4 Total | $14.00 | $70.00 | $28.00–$56.00 | — | 80% |
| Total thyroxine (T4) blood test inpatient CPT 84436 HC Lab T4 Total | $14.00 | $70.00 | $28.00–$56.00 | — | 80% |
| Total triiodothyronine (T3) blood test CPT 84480 HC Lab T3 Total | $21.60 | $108.00 | $43.20–$86.40 | — | 80% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 HC Lab T3 Total | $21.60 | $108.00 | $43.20–$86.40 | — | 80% |
| Transferrin blood test CPT 84466 HC Lab Transferrin | $27.60 | $138.00 | $55.20–$110.40 | — | 80% |
| Transferrin blood test inpatient CPT 84466 HC Lab Transferrin | $27.60 | $138.00 | $55.20–$110.40 | — | 80% |
| Trichomonas test (NAAT) CPT 87661 HC Trichomonas Vaginalis, Rna (Male) | $11.00 | $55.00 | $22.00–$44.00 | — | 80% |
| Trichomonas test (NAAT) CPT 87661 HC Trichomonas Vaginalis, Amplified Probe | $11.80 | $59.00 | $23.60–$47.20 | — | 80% |
| Trichomonas test (NAAT) CPT 87661 HC Lab Trich Vaginitis | $23.20 | $116.00 | $46.40–$92.80 | — | 80% |
| Trichomonas test (NAAT) CPT 87661 HC Lab Trichomonas Vaginalis, Rna Probe | $38.60 | $193.00 | $77.20–$154.40 | — | 80% |
| Trichomonas test (NAAT) inpatient CPT 87661 HC Trichomonas Vaginalis, Rna (Male) | $11.00 | $55.00 | $22.00–$44.00 | — | 80% |
| Trichomonas test (NAAT) inpatient CPT 87661 HC Trichomonas Vaginalis, Amplified Probe | $11.80 | $59.00 | $23.60–$47.20 | — | 80% |
| Trichomonas test (NAAT) inpatient CPT 87661 HC Lab Trich Vaginitis | $23.20 | $116.00 | $46.40–$92.80 | — | 80% |
| Trichomonas test (NAAT) inpatient CPT 87661 HC Lab Trichomonas Vaginalis, Rna Probe | $38.60 | $193.00 | $77.20–$154.40 | — | 80% |
| Triglycerides blood test CPT 84478 HC Lab Triglyceride, Pleural Fluid | $6.00 | $30.00 | $12.00–$24.00 | — | 80% |
| Triglycerides blood test CPT 84478 HC Lab Triglycerides, Peritoneal Fluid | $6.00 | $30.00 | $12.00–$24.00 | — | 80% |
| Triglycerides blood test CPT 84478 HC Lab Triglycerides | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Triglycerides blood test inpatient CPT 84478 HC Lab Triglyceride, Pleural Fluid | $6.00 | $30.00 | $12.00–$24.00 | — | 80% |
| Triglycerides blood test inpatient CPT 84478 HC Lab Triglycerides, Peritoneal Fluid | $6.00 | $30.00 | $12.00–$24.00 | — | 80% |
| Triglycerides blood test inpatient CPT 84478 HC Lab Triglycerides | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Troponin test, quantitative CPT 84484 HC High Sensitivity Troponin I, 3 Hr | $32.60 | $163.00 | $65.20–$130.40 | — | 80% |
| Troponin test, quantitative CPT 84484 HC High Sensitivity Troponin I | $32.60 | $163.00 | $65.20–$130.40 | — | 80% |
| Troponin test, quantitative CPT 84484 HC High Sensitivity Troponin I, 2 Hr | $32.60 | $163.00 | $65.20–$130.40 | — | 80% |
| Troponin test, quantitative CPT 84484 HC High Sensitivity Troponin I, Random | $32.60 | $163.00 | $65.20–$130.40 | — | 80% |
| Troponin test, quantitative CPT 84484 HC Lab Troponin | $34.60 | $173.00 | $69.20–$138.40 | — | 80% |
| Troponin test, quantitative CPT 84484 HC Lab Troponin, POC | $34.60 | $173.00 | $69.20–$138.40 | — | 80% |
| Troponin test, quantitative inpatient CPT 84484 HC High Sensitivity Troponin I | $32.60 | $163.00 | $65.20–$130.40 | — | 80% |
| Troponin test, quantitative inpatient CPT 84484 HC High Sensitivity Troponin I, Random | $32.60 | $163.00 | $65.20–$130.40 | — | 80% |
| Troponin test, quantitative inpatient CPT 84484 HC High Sensitivity Troponin I, 3 Hr | $32.60 | $163.00 | $65.20–$130.40 | — | 80% |
| Troponin test, quantitative inpatient CPT 84484 HC High Sensitivity Troponin I, 2 Hr | $32.60 | $163.00 | $65.20–$130.40 | — | 80% |
| Troponin test, quantitative inpatient CPT 84484 HC Lab Troponin | $34.60 | $173.00 | $69.20–$138.40 | — | 80% |
| Troponin test, quantitative inpatient CPT 84484 HC Lab Troponin, POC | $34.60 | $173.00 | $69.20–$138.40 | — | 80% |
| Uric acid blood test CPT 84550 HC Lab Uric Acid | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Uric acid blood test CPT 84550 HC Lab Uric Acid (Elitek Patient) | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Uric acid blood test inpatient CPT 84550 HC Lab Uric Acid | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Uric acid blood test inpatient CPT 84550 HC Lab Uric Acid (Elitek Patient) | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Urinalysis with microscope exam, automated CPT 81001 HC Lab *Urinalysis With Microscopy | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopic | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Lab *Urinalysis With Microscopy | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis With Microscopic | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Protein Qual Random Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Ph Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Nitrite Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Leukocyte Esterase Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Ketones Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Glucose Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Blood Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Bilirubin Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Io Urine Dip � Automated | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Urobilinogen Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Specific Gravity Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis (No Microscopic) | $8.20 | $41.00 | $16.40–$32.80 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Urinalysis Routine | $8.20 | $41.00 | $16.40–$32.80 | — | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Urinalysis W/C&S if Indicated | $8.20 | $41.00 | $16.40–$32.80 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Specific Gravity Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Io Urine Dip � Automated | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Ph Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Nitrite Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Leukocyte Esterase Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Ketones Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Glucose Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Blood Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Urobilinogen Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Bilirubin Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Protein Qual Random Urine | $5.80 | $29.00 | $11.60–$23.20 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis (No Microscopic) | $8.20 | $41.00 | $16.40–$32.80 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Urinalysis Routine | $8.20 | $41.00 | $16.40–$32.80 | — | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Urinalysis W/C&S if Indicated | $8.20 | $41.00 | $16.40–$32.80 | — | 80% |
| Urinalysis without microscope exam, manual CPT 81002 HC Urine Dips | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urine Dips | $9.00 | $45.00 | $18.00–$36.00 | — | 80% |
| Urine microalbumin (albumin) test CPT 82043 HC Lab Microalbumin Urine Random | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Urine microalbumin (albumin) test CPT 82043 HC Lab Microalbumin 24 Hour Urine | $15.20 | $76.00 | $30.40–$60.80 | — | 80% |
| Urine microalbumin (albumin) test inpatient CPT 82043 HC Lab Microalbumin Urine Random | $14.80 | $74.00 | $29.60–$59.20 | — | 80% |
| Urine microalbumin (albumin) test inpatient CPT 82043 HC Lab Microalbumin 24 Hour Urine | $15.20 | $76.00 | $30.40–$60.80 | — | 80% |
| Urine pregnancy test, read by color change CPT 81025 HC Lab Pregnancy Test Urine - POCT | $10.60 | $53.00 | $21.20–$42.40 | — | 80% |
| Urine pregnancy test, read by color change CPT 81025 HC Lab Io Pregnancy Test, Urine | $11.20 | $56.00 | $22.40–$44.80 | — | 80% |
| Urine pregnancy test, read by color change CPT 81025 HC Lab Pregnancy Test Urine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Urine pregnancy test, read by color change CPT 81025 HC Pregnancy Test U | $12.60 | $63.00 | $25.20–$50.40 | — | 80% |
| Urine pregnancy test, read by color change inpatient CPT 81025 HC Lab Pregnancy Test Urine - POCT | $10.60 | $53.00 | $21.20–$42.40 | — | 80% |
| Urine pregnancy test, read by color change inpatient CPT 81025 HC Lab Io Pregnancy Test, Urine | $11.20 | $56.00 | $22.40–$44.80 | — | 80% |
| Urine pregnancy test, read by color change inpatient CPT 81025 HC Lab Pregnancy Test Urine | $12.20 | $61.00 | $24.40–$48.80 | — | 80% |
| Urine pregnancy test, read by color change inpatient CPT 81025 HC Pregnancy Test U | $12.60 | $63.00 | $25.20–$50.40 | — | 80% |
| Vitamin B12 (cobalamin) blood test CPT 82607 HC Lab Vitamin B-12 | $21.80 | $109.00 | $43.60–$87.20 | — | 80% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC Lab Vitamin B-12 | $21.80 | $109.00 | $43.60–$87.20 | — | 80% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC Lab Vitamin D, 25-Hydroxy | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC Lab Vitamin D, 25-Hydroxy | $30.80 | $154.00 | $61.60–$123.20 | — | 80% |
| Zinc blood test CPT 84630 HC Lab Zinc Serum | $6.20 | $31.00 | $12.40–$24.80 | — | 80% |
| Zinc blood test inpatient CPT 84630 HC Lab Zinc Serum | $6.20 | $31.00 | $12.40–$24.80 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Lab Zz Hcg (1st Tri Sc) | $9.20 | $46.00 | $18.40–$36.80 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Lab Zz Hcg (Afp3) | $10.00 | $50.00 | $20.00–$40.00 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Lab Zz Hcg, Quant | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Lab Zz Hcg (Sequent Integr Sc 1) | $24.40 | $122.00 | $48.80–$97.60 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Lab Zz Hcg (Maternal Sc Integ) | $25.80 | $129.00 | $51.60–$103.20 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Lab Zz Hcg (Serum Integr Sc 2) | $26.80 | $134.00 | $53.60–$107.20 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Lab Zz Hcg (Sequent Integr Sc 2) | $27.00 | $135.00 | $54.00–$108.00 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Lab Hcg Quant (Serum) | $27.20 | $136.00 | $54.40–$108.80 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Lab Zz Hcg (1st Tri Sc) | $9.20 | $46.00 | $18.40–$36.80 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Lab Zz Hcg (Afp3) | $10.00 | $50.00 | $20.00–$40.00 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Lab Zz Hcg, Quant | $21.00 | $105.00 | $42.00–$84.00 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Lab Zz Hcg (Sequent Integr Sc 1) | $24.40 | $122.00 | $48.80–$97.60 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Lab Zz Hcg (Maternal Sc Integ) | $25.80 | $129.00 | $51.60–$103.20 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Lab Zz Hcg (Serum Integr Sc 2) | $26.80 | $134.00 | $53.60–$107.20 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Lab Zz Hcg (Sequent Integr Sc 2) | $27.00 | $135.00 | $54.00–$108.00 | — | 80% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Lab Hcg Quant (Serum) | $27.20 | $136.00 | $54.40–$108.80 | — | 80% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Florida | Off list |
|---|---|---|---|---|---|
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 Removal Adenoids,Primary,<12 Y/O | $4,323.39 | $21,616.96 | $8,646.78–$17,293.57 | — | 80% |
| Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 Arthrodesis Ant Interbody Inc Discectomy, Cervical Below C2 | $21,418.71 | $107,093.53 | $42,837.41–$85,674.82 | — | 80% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Knee Scope,Aid Ant Cruciate Repair | $21,765.17 | $108,825.83 | $43,530.33–$87,060.66 | — | 80% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 Shldr Arthroscop,Surg,W/Rotat Cuff Repr | $15,893.47 | $79,467.36 | $31,786.94–$63,573.89 | — | 80% |
| Balloon dilation of the maxillary sinus opening, one side CPT 31295 Nasal/Sinus Endoscopy,W/Dilat Maxillary Sinus Ostium | $8,037.43 | $40,187.16 | $16,074.86–$32,149.73 | — | 80% |
| Botox injections for chronic migraine CPT 64615 HC Botox Injection - Other | $354.20 | $1,771.00 | $708.40–$1,416.80 | — | 80% |
| Botox injections for chronic migraine inpatient CPT 64615 HC Botox Injection - Other | $354.20 | $1,771.00 | $708.40–$1,416.80 | — | 80% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 HC Stereotactic Breast Bx, 1st Lesion-Right | $1,629.00 | $8,145.00 | $3,258.00–$6,516.00 | — | 80% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 HC MA Stereo Breast Bx, 3d Tomosynthesis-1st Lesion-Left | $1,629.00 | $8,145.00 | $3,258.00–$6,516.00 | — | 80% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 HC Stereotactic Breast Bx, 1st Lesion-Left | $1,629.00 | $8,145.00 | $3,258.00–$6,516.00 | — | 80% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 HC MA Stereo Breast Bx,3d Tomosynthesis-1st Lesion-Right | $1,629.00 | $8,145.00 | $3,258.00–$6,516.00 | — | 80% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 HC Stereotactic Breast Bx, 1st Lesion-Left | $2,363.08 | $11,815.40 | $4,726.16–$9,452.32 | — | 80% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 HC Stereotactic Breast Bx, 1st Lesion-Right | $1,629.00 | $8,145.00 | $3,258.00–$6,516.00 | — | 80% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 HC Stereotactic Breast Bx, 1st Lesion-Left | $1,629.00 | $8,145.00 | $3,258.00–$6,516.00 | — | 80% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 HC MA Stereo Breast Bx,3d Tomosynthesis-1st Lesion-Right | $1,629.00 | $8,145.00 | $3,258.00–$6,516.00 | — | 80% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 HC MA Stereo Breast Bx, 3d Tomosynthesis-1st Lesion-Left | $1,629.00 | $8,145.00 | $3,258.00–$6,516.00 | — | 80% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Correct Bunion,Metatarsal Osteotomy | $9,676.58 | $48,382.91 | $19,353.16–$38,706.33 | — | 80% |
| Bunion correction with removal of part of the big toe joint CPT 28292 Correct Bunion,Keller/Mcbride/Mayo | $5,708.46 | $28,542.30 | $11,416.92–$22,833.84 | — | 80% |
| Cardiac catheterization with coronary angiogram CPT 93458 HC Lhc W Cors W-WO Lv Gram | $5,571.20 | $27,856.00 | $11,142.40–$22,284.80 | — | 80% |
| Cardiac catheterization with coronary angiogram inpatient CPT 93458 HC Lhc W Cors W-WO Lv Gram | $5,571.20 | $27,856.00 | $11,142.40–$22,284.80 | — | 80% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC Ucc Cardioversion External | $689.20 | $3,446.00 | $1,378.40–$2,756.80 | — | 80% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC Cardioversion External | $689.20 | $3,446.00 | $1,378.40–$2,756.80 | — | 80% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC Cardioversion-Cath | $689.20 | $3,446.00 | $1,378.40–$2,756.80 | — | 80% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC Cardioversion | $794.40 | $3,972.00 | $1,588.80–$3,177.60 | — | 80% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC Cardioversion-Cath | $689.20 | $3,446.00 | $1,378.40–$2,756.80 | — | 80% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC Cardioversion External | $689.20 | $3,446.00 | $1,378.40–$2,756.80 | — | 80% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC Ucc Cardioversion External | $689.20 | $3,446.00 | $1,378.40–$2,756.80 | — | 80% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC Cardioversion | $794.40 | $3,972.00 | $1,588.80–$3,177.60 | — | 80% |
| Carpal tunnel release, open surgery CPT 64721 Revise Median N/Carpal Tunnel Surg | $3,845.97 | $19,229.86 | $7,691.94–$15,383.89 | — | 80% |
| Cataract surgery with lens implant CPT 66984 Remv Cataract Extracap,Insert Lens | $3,904.65 | $19,523.25 | $7,809.30–$15,618.60 | — | 80% |
| Catheter ablation for atrial fibrillation CPT 93656 HC Pv Isolation Ablation With Eps/ Cs/ Ts/ 3d Map/ Ice | $18,524.80 | $92,624.00 | $37,049.60–$74,099.20 | — | 80% |
| Catheter ablation for atrial fibrillation inpatient CPT 93656 HC Pv Isolation Ablation With Eps/ Cs/ Ts/ 3d Map/ Ice | $18,524.80 | $92,624.00 | $37,049.60–$74,099.20 | — | 80% |
| Cervical biopsy CPT 57500 Biopsy/Excis Cervical Lesn | $4,385.36 | $21,926.82 | $8,770.73–$17,541.46 | — | 80% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Circumcision,Othr | $3,124.67 | $15,623.36 | $6,249.34–$12,498.69 | — | 80% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC Circumcision-Newborn | $192.20 | $961.00 | $384.40–$768.80 | — | 80% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC Circumcision-Newborn | $192.20 | $961.00 | $384.40–$768.80 | — | 80% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC Circumcision-Newborn | $192.20 | $961.00 | $384.40–$768.80 | — | 80% |
| Circumcision, surgical, older than a newborn CPT 54160 Circumcision,Othr,Newborn | $233.50 | $1,167.50 | $467.00–$934.00 | — | 80% |
| Colonoscopy with endoscopic ultrasound CPT 45391 Colonoscopy W/Endoscope US | $4,018.85 | $20,094.23 | $8,037.69–$16,075.38 | — | 80% |
| Colonoscopy with polyp removal CPT 45385 Colonoscopy,Remv Lesn,Snare | $2,520.94 | $12,604.68 | $5,041.87–$10,083.74 | — | 80% |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy,Biopsy | $2,684.69 | $13,423.44 | $5,369.38–$10,738.75 | — | 80% |
| Colonoscopy, diagnostic CPT 45378 Colonoscopy,Diagnostic | $1,283.73 | $6,418.67 | $2,567.47–$5,134.94 | — | 80% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 Colposcopy,Loop Electrd Cervix Excis | $1,500.80 | $7,504.00 | $3,001.60–$6,003.20 | — | 80% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC Colposcopy W/Bx and Ecc | $131.40 | $657.00 | $262.80–$525.60 | — | 80% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC Colposcopy W/Bx and Ecc | $144.00 | $720.00 | $288.00–$576.00 | — | 80% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC Colposcopy W/Bx and Ecc | $131.40 | $657.00 | $262.80–$525.60 | — | 80% |
| Complex cataract surgery with lens implant CPT 66982 Cataract Surgery, Complex | $4,235.67 | $21,178.36 | $8,471.34–$16,942.69 | — | 80% |
| Coronary stent placement, one artery CPT 92928 HC Stent Cor Bm Single Major Vessel and/ or Branches Single Lesion | $9,869.00 | $49,345.00 | $19,738.00–$39,476.00 | — | 80% |
| Coronary stent placement, one artery inpatient CPT 92928 HC Stent Cor Bm Single Major Vessel and/ or Branches Single Lesion | $9,869.00 | $49,345.00 | $19,738.00–$39,476.00 | — | 80% |
| Cystoscopy with ureteral stent placement CPT 52332 HC Cystoscopy Insert Ureteral Stent | $1,441.20 | $7,206.00 | $2,882.40–$5,764.80 | — | 80% |
| Cystoscopy with ureteral stent placement CPT 52332 Cystoscopy,Insert Ureteral Stent | $8,045.70 | $40,228.51 | $16,091.40–$32,182.81 | — | 80% |
| Cystoscopy with ureteral stent placement inpatient CPT 52332 HC Cystoscopy Insert Ureteral Stent | $1,441.20 | $7,206.00 | $2,882.40–$5,764.80 | — | 80% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC Cystourethroscopy | $281.20 | $1,406.00 | $562.40–$1,124.80 | — | 80% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC Dx Cystoscopy | $736.00 | $3,680.00 | $1,472.00–$2,944.00 | — | 80% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC Ucc Dx Cystoscopy | $736.00 | $3,680.00 | $1,472.00–$2,944.00 | — | 80% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC Cystourethroscopy | $4,641.74 | $23,208.71 | $9,283.48–$18,566.97 | — | 80% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC Cystourethroscopy | $281.20 | $1,406.00 | $562.40–$1,124.80 | — | 80% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC Dx Cystoscopy | $736.00 | $3,680.00 | $1,472.00–$2,944.00 | — | 80% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC Ucc Dx Cystoscopy | $736.00 | $3,680.00 | $1,472.00–$2,944.00 | — | 80% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 Dilation/Curettage,Diagnostic | $3,251.81 | $16,259.05 | $6,503.62–$13,007.24 | — | 80% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruc Premalignant,First Lesion | $289.20 | $1,446.00 | $578.40–$1,156.80 | — | 80% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 HC Cc Remove Impacted Ear Wax Irrig/Lavage Uni | $59.00 | $295.00 | $118.00–$236.00 | — | 80% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 HC Cc Remove Impacted Ear Wax Irrig/Lavage Bil | $117.20 | $586.00 | $234.40–$468.80 | — | 80% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC Cc Remove Impacted Ear Wax Irrig/Lavage Uni | $59.00 | $295.00 | $118.00–$236.00 | — | 80% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC Cc Remove Impacted Ear Wax Irrig/Lavage Bil | $117.20 | $586.00 | $234.40–$468.80 | — | 80% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Biopsy of Uterus Lining | $229.40 | $1,147.00 | $458.80–$917.60 | — | 80% |
| Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 Nasal Scopy,Remv Totl Ethmoid | $10,919.94 | $54,599.72 | $21,839.89–$43,679.78 | — | 80% |
| Endoscopic sinus surgery: opening the frontal sinus CPT 31276 Nasal Scopy,Explor Frontal Sinus | $13,625.68 | $68,128.41 | $27,251.36–$54,502.73 | — | 80% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 Nasal Scopy,Open Maxill Sinus | $11,278.20 | $56,391.00 | $22,556.40–$45,112.80 | — | 80% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 Nasal Scopy,Rmv Tiss Maxill Sinus | $12,127.07 | $60,635.35 | $24,254.14–$48,508.28 | — | 80% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC IR Epidural Inject, Cerv or Thor, W/ Imaging | $659.20 | $3,296.00 | $1,318.40–$2,636.80 | — | 80% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC CT Epidural Inject, Cerv or Thor, W/ Imaging | $700.00 | $3,500.00 | $1,400.00–$2,800.00 | — | 80% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn | $791.26 | $3,956.30 | $1,582.52–$3,165.04 | — | 80% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC IR Epidural Inject, Cerv or Thor, W/ Imaging | $659.20 | $3,296.00 | $1,318.40–$2,636.80 | — | 80% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC CT Epidural Inject, Cerv or Thor, W/ Imaging | $700.00 | $3,500.00 | $1,400.00–$2,800.00 | — | 80% |
| Eye injection into the vitreous (intravitreal injection) CPT 67028 HC Injection Eye Drug | $153.80 | $769.00 | $307.60–$615.20 | — | 80% |
| Eye injection into the vitreous (intravitreal injection) CPT 67028 Inject Intravitreal Pharmcologic | $12,598.54 | $62,992.70 | $25,197.08–$50,394.16 | — | 80% |
| Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HC Injection Eye Drug | $153.80 | $769.00 | $307.60–$615.20 | — | 80% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC CT Inj Paraver Fac L/S L1 W/Flo | $728.80 | $3,644.00 | $1,457.60–$2,915.20 | — | 80% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC CT Inj Paraver Fac L/S L1 W/Flo | $1,586.80 | $7,934.00 | $3,173.60–$6,347.20 | — | 80% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC CT Inj Paraver Fac L/S L1 W/Flo | $728.80 | $3,644.00 | $1,457.60–$2,915.20 | — | 80% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Rpr Aa Hernia 1st 3-10 Cm Reducible | $15,389.91 | $76,949.56 | $30,779.82–$61,559.65 | — | 80% |
| First repair of a front abdominal hernia larger than 10 cm CPT 49595 Rpr Aa Hernia 1st > 10 Cm Reducible | $18,378.49 | $91,892.44 | $36,756.98–$73,513.95 | — | 80% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Rpr Aa Hernia 1st < 3 Cm Reducible | $8,319.15 | $41,595.76 | $16,638.30–$33,276.61 | — | 80% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy,Diagnostic | $1,890.69 | $9,453.44 | $3,781.38–$7,562.75 | — | 80% |
| Gallbladder removal, laparoscopic CPT 47562 Lap,Cholecystectomy | $11,736.65 | $58,683.27 | $23,473.31–$46,946.62 | — | 80% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Lap,Cholecystectomy/Graph | $12,659.16 | $63,295.80 | $25,318.32–$50,636.64 | — | 80% |
| Hammertoe correction surgery CPT 28285 Repair of Hammertoe,One | $10,427.75 | $52,138.75 | $20,855.50–$41,711.00 | — | 80% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 Ligation of Hemorrhoid(S) | $1,685.75 | $8,428.77 | $3,371.51–$6,743.02 | — | 80% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorrhoidectomy,Int/Ext,Simple | $5,667.68 | $28,338.40 | $11,335.36–$22,670.72 | — | 80% |
| Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 Conv Prev Hip Surg to Tot Hip Arthroplas | $27,376.70 | $136,883.48 | $54,753.39–$109,506.78 | — | 80% |
| Hysterectomy through an abdominal incision (total) CPT 58150 Total Abdom Hysterectomy | $14,590.21 | $72,951.03 | $29,180.41–$58,360.82 | — | 80% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC Ult Inject Hysterosalping (Hsg) | $324.80 | $1,624.00 | $649.60–$1,299.20 | — | 80% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC Rad Hysterogr/Sis Contr/Saline Inj | $324.80 | $1,624.00 | $649.60–$1,299.20 | — | 80% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC Rad Hysterogr/Sis Contr/Saline Inj | $975.93 | $4,879.66 | $1,951.86–$3,903.73 | — | 80% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC Ult Inject Hysterosalping (Hsg) | $324.80 | $1,624.00 | $649.60–$1,299.20 | — | 80% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC Rad Hysterogr/Sis Contr/Saline Inj | $324.80 | $1,624.00 | $649.60–$1,299.20 | — | 80% |
| Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy, Ablation | $8,145.56 | $40,727.82 | $16,291.13–$32,582.26 | — | 80% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy,W/Endo Bx | $5,598.94 | $27,994.69 | $11,197.88–$22,395.75 | — | 80% |
| IUD insertion (the device itself billed separately) CPT 58300 HC Insert Intrauterine Device | $275.40 | $1,377.00 | $550.80–$1,101.60 | — | 80% |
| IUD insertion (the device itself billed separately) CPT 58300 HC Insert Intrauterine Device | $1,786.93 | $8,934.65 | $3,573.86–$7,147.72 | — | 80% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 HC Insert Intrauterine Device | $275.40 | $1,377.00 | $550.80–$1,101.60 | — | 80% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Drain Skin Abscess Simple | $735.20 | $3,676.00 | $1,470.40–$2,940.80 | — | 80% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC Repair Ing Hernia 5+Y/O Reducibl | $1,498.00 | $7,490.00 | $2,996.00–$5,992.00 | — | 80% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair Ing Hernia,5+Y/O,Reducibl | $7,980.98 | $39,904.88 | $15,961.95–$31,923.90 | — | 80% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HC Repair Ing Hernia 5+Y/O Reducibl | $1,498.00 | $7,490.00 | $2,996.00–$5,992.00 | — | 80% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inject Tendon Sheath/Ligament | $653.00 | $3,265.00 | $1,306.00–$2,612.00 | — | 80% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC IR Drain/Inj Major Jnt/Bursa | $222.60 | $1,113.00 | $445.20–$890.40 | — | 80% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC Rad Joint Asp/Inj Large (Hip,Knee)-Left | $222.60 | $1,113.00 | $445.20–$890.40 | — | 80% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC Rad Joint Asp/Inj Large (Hip,Knee)-Right | $222.60 | $1,113.00 | $445.20–$890.40 | — | 80% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC CT Asp/Inj Joint Large (Hip, Knee) Left | $236.40 | $1,182.00 | $472.80–$945.60 | — | 80% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC CT Asp/Inj Joint Large (Hip, Knee) Right | $236.40 | $1,182.00 | $472.80–$945.60 | — | 80% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC Rad Joint Asp/Inj Large (Hip,Knee)-Right | $488.66 | $2,443.30 | $977.32–$1,954.64 | — | 80% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC IR Drain/Inj Major Jnt/Bursa | $222.60 | $1,113.00 | $445.20–$890.40 | — | 80% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC Rad Joint Asp/Inj Large (Hip,Knee)-Right | $222.60 | $1,113.00 | $445.20–$890.40 | — | 80% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC Rad Joint Asp/Inj Large (Hip,Knee)-Left | $222.60 | $1,113.00 | $445.20–$890.40 | — | 80% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC CT Asp/Inj Joint Large (Hip, Knee) Left | $236.40 | $1,182.00 | $472.80–$945.60 | — | 80% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC CT Asp/Inj Joint Large (Hip, Knee) Right | $236.40 | $1,182.00 | $472.80–$945.60 | — | 80% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC Insertion Drug Implant Device | $92.60 | $463.00 | $185.20–$370.40 | — | 80% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC Implanon/Nexplanon Placement (Patient Supplied Iud) | $92.60 | $463.00 | $185.20–$370.40 | — | 80% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC Insert Antibacterial Pouch | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC Insert Antibacterial Pouch | $10,749.59 | $53,747.97 | $21,499.19–$42,998.38 | — | 80% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC Implanon/Nexplanon Placement (Patient Supplied Iud) | $92.60 | $463.00 | $185.20–$370.40 | — | 80% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC Insertion Drug Implant Device | $92.60 | $463.00 | $185.20–$370.40 | — | 80% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC Insert Antibacterial Pouch | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC IR Drain/Inj Interm Jnt/Bursa | $212.20 | $1,061.00 | $424.40–$848.80 | — | 80% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 HC Rad Joint Asp/Inj Med (Wrist/Ankle)-Left | $212.20 | $1,061.00 | $424.40–$848.80 | — | 80% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 HC Rad Joint Asp/Inj Med (Wrist/Ankle)-Right | $212.20 | $1,061.00 | $424.40–$848.80 | — | 80% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 HC CT Asp/Inj Joint Med(Wrist, Ankle) Left | $212.20 | $1,061.00 | $424.40–$848.80 | — | 80% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 HC CT Asp/Inj Joint Med (Wrist, Ankle) Right | $212.20 | $1,061.00 | $424.40–$848.80 | — | 80% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 HC Rad Joint Asp/Inj Med (Wrist/Ankle)-Left | $1,506.20 | $7,531.00 | $3,012.40–$6,024.80 | — | 80% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC IR Drain/Inj Interm Jnt/Bursa | $212.20 | $1,061.00 | $424.40–$848.80 | — | 80% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 HC Rad Joint Asp/Inj Med (Wrist/Ankle)-Left | $212.20 | $1,061.00 | $424.40–$848.80 | — | 80% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 HC Rad Joint Asp/Inj Med (Wrist/Ankle)-Right | $212.20 | $1,061.00 | $424.40–$848.80 | — | 80% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 HC CT Asp/Inj Joint Med(Wrist, Ankle) Left | $212.20 | $1,061.00 | $424.40–$848.80 | — | 80% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 HC CT Asp/Inj Joint Med (Wrist, Ankle) Right | $212.20 | $1,061.00 | $424.40–$848.80 | — | 80% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC IR Drain/Inject Sm Jnt/Bursa | $200.80 | $1,004.00 | $401.60–$803.20 | — | 80% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Drain/Inject Small Joint/Bursa | $3,780.01 | $18,900.03 | $7,560.01–$15,120.02 | — | 80% |
| Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 HC CT Asp/Inj Joint Small (Finger, Toe) Left | $200.80 | $1,004.00 | $401.60–$803.20 | — | 80% |
| Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 HC CT Asp/Inj Joint Small (Finger, Toe) Right | $200.80 | $1,004.00 | $401.60–$803.20 | — | 80% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC IR Drain/Inject Sm Jnt/Bursa | $200.80 | $1,004.00 | $401.60–$803.20 | — | 80% |
| Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 HC CT Asp/Inj Joint Small (Finger, Toe) Left | $200.80 | $1,004.00 | $401.60–$803.20 | — | 80% |
| Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 HC CT Asp/Inj Joint Small (Finger, Toe) Right | $200.80 | $1,004.00 | $401.60–$803.20 | — | 80% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Knee Scope,Med or Lat Menis Repair | $16,659.51 | $83,297.57 | $33,319.03–$66,638.06 | — | 80% |
| Knee arthroscopy with meniscus trim CPT 29881 Knee Scope,Med/Lat Menisectomy | $7,935.92 | $39,679.60 | $15,871.84–$31,743.68 | — | 80% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Knee Scope,Single Menisectomy | $6,045.87 | $30,229.37 | $12,091.75–$24,183.50 | — | 80% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Knee Scope,Shave Articular Cart | $10,722.12 | $53,610.62 | $21,444.25–$42,888.50 | — | 80% |
| Laparoscopic Roux-en-Y gastric bypass, standard limb length CPT 43644 Lap Gastric Bypass/Roux-en-Y | $30,771.11 | $153,855.53 | $61,542.21–$123,084.42 | — | 80% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Lap,Appendectomy | $10,766.77 | $53,833.85 | $21,533.54–$43,067.08 | — | 80% |
| Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 Lap,Esophagogast Fundoplasty | $18,326.25 | $91,631.25 | $36,652.50–$73,305.00 | — | 80% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 Laparoscopy W Tot Hysterect Uterus 250 Gram or Less | $16,515.13 | $82,575.65 | $33,030.26–$66,060.52 | — | 80% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 Laparoscopy W Tot Hysterectuterus <=250 Gram W Tube/Ovary | $16,319.80 | $81,599.02 | $32,639.61–$65,279.22 | — | 80% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 HC Lap Inguinal Hernia Repr Initial | $2,343.60 | $11,718.00 | $4,687.20–$9,374.40 | — | 80% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 Lap,Inguinal Hernia Repr,Initial | $13,621.53 | $68,107.66 | $27,243.06–$54,486.13 | — | 80% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 HC Lap Inguinal Hernia Repr Initial | $2,343.60 | $11,718.00 | $4,687.20–$9,374.40 | — | 80% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Lap,Inguinal Hernia Repr,Recur | $13,341.51 | $66,707.55 | $26,683.02–$53,366.04 | — | 80% |
| Laparoscopic removal of an adjustable gastric band and its port CPT 43774 Lap, Remove Adjust Gast Band/Port | $13,851.44 | $69,257.20 | $27,702.88–$55,405.76 | — | 80% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Lap,Rmv Adnexal Structure | $9,867.81 | $49,339.03 | $19,735.61–$39,471.22 | — | 80% |
| Laparoscopic sleeve gastrectomy for weight loss CPT 43775 Lap, Gast Restrict Proc, Longitudinal Gastrectomy | $24,544.88 | $122,724.39 | $49,089.76–$98,179.51 | — | 80% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Layr Clos Wnd Trunk,Arm,Leg <2.5cm | $4,911.08 | $24,555.41 | $9,822.16–$19,644.33 | — | 80% |
| Left heart catheterization, diagnostic CPT 93452 HC Lhc WO Cors W-WO Lv Gram | $5,571.20 | $27,856.00 | $11,142.40–$22,284.80 | — | 80% |
| Left heart catheterization, diagnostic inpatient CPT 93452 HC Lhc WO Cors W-WO Lv Gram | $5,571.20 | $27,856.00 | $11,142.40–$22,284.80 | — | 80% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC IR Epidural Inject, Lumbr or Sacrl, W/ Imaging | $757.20 | $3,786.00 | $1,514.40–$3,028.80 | — | 80% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Rad Xr Lumbar Puncture W/ Injection | $757.20 | $3,786.00 | $1,514.40–$3,028.80 | — | 80% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC CT Epidural Inject, Lumbr or Sacrl, W/ Imaging | $804.00 | $4,020.00 | $1,608.00–$3,216.00 | — | 80% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Rad Xr Lumbar Puncture W/ Injection | $975.06 | $4,875.30 | $1,950.12–$3,900.24 | — | 80% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Rad Xr Lumbar Puncture W/ Injection | $757.20 | $3,786.00 | $1,514.40–$3,028.80 | — | 80% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC IR Epidural Inject, Lumbr or Sacrl, W/ Imaging | $757.20 | $3,786.00 | $1,514.40–$3,028.80 | — | 80% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC CT Epidural Inject, Lumbr or Sacrl, W/ Imaging | $804.00 | $4,020.00 | $1,608.00–$3,216.00 | — | 80% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn | $4,097.43 | $20,487.16 | $8,194.86–$16,389.73 | — | 80% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj,Foramen,L/S,1 Level | $1,013.08 | $5,065.40 | $2,026.16–$4,052.32 | — | 80% |
| Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 Excis Lumbar Disk,One Level | $13,457.71 | $67,288.54 | $26,915.42–$53,830.83 | — | 80% |
| Lumbar fusion with interbody cage and posterolateral graft (TLIF), one level CPT 22633 Arthdsis Post/Posterolatrl/Postinterbody Lumbar | $29,786.24 | $148,931.19 | $59,572.48–$119,144.95 | — | 80% |
| Lumbar interbody fusion (PLIF or TLIF), one level CPT 22630 Lumbar Spine Fusn,Post Intrbdy | $34,888.40 | $174,442.00 | $69,776.80–$139,553.60 | — | 80% |
| Lumbar laminectomy (spinal decompression), one level CPT 63047 Laminec/Facetect/Foramin,Lumbar | $13,551.98 | $67,759.92 | $27,103.97–$54,207.94 | — | 80% |
| Lumbar spinal fusion (posterior), one level CPT 22612 Lumbar Spine Fusn,Post Tech | $20,183.70 | $100,918.50 | $40,367.40–$80,734.80 | — | 80% |
| Lumpectomy (partial mastectomy) CPT 19301 Mastectomy, Partial | $11,963.79 | $59,818.94 | $23,927.58–$47,855.15 | — | 80% |
| Mastectomy (total removal of the breast) CPT 19303 Mastectomy, Simple, Complete | $23,926.22 | $119,631.09 | $47,852.44–$95,704.87 | — | 80% |
| Miscarriage treatment with D&C, first trimester CPT 59820 Surg Rx Missed Abortn,1st Tri | $3,382.42 | $16,912.08 | $6,764.83–$13,529.66 | — | 80% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc Skin Benig <0.5cm Trunk,Arm,Leg | $5,695.26 | $28,476.28 | $11,390.51–$22,781.02 | — | 80% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Exc Skin Benig <0.5cm Face,Facial | $3,944.88 | $19,724.40 | $7,889.76–$15,779.52 | — | 80% |
| Nail removal (partial or complete), one nail CPT 11730 Removal of Nail Plate | $3,109.86 | $15,549.30 | $6,219.72–$12,439.44 | — | 80% |
| Occipital nerve block (injection for headaches) CPT 64405 Inject Nerv Blck,Great Occiptl | $755.73 | $3,778.65 | $1,511.46–$3,022.92 | — | 80% |
| Pacemaker implant (dual chamber) CPT 33208 HC Ppm Ins/Repl Dc Gen & Leads | $5,654.80 | $28,274.00 | $11,309.60–$22,619.20 | — | 80% |
| Pacemaker implant (dual chamber) CPT 33208 HC Ppm Ins/Repl Dc Gen & Leads | $12,590.28 | $62,951.38 | $25,180.55–$50,361.10 | — | 80% |
| Pacemaker implant (dual chamber) inpatient CPT 33208 HC Ppm Ins/Repl Dc Gen & Leads | $5,654.80 | $28,274.00 | $11,309.60–$22,619.20 | — | 80% |
| Paracentesis with imaging guidance CPT 49083 HC Ult Paracntsis-Diag-W Labs WO Album | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance CPT 49083 HC Ult Paracentesis-Diagn W Labs Sono | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance CPT 49083 HC Ult Paracentesis-Therap WO Lab Sono | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance CPT 49083 HC Ult Paracentesis Sono | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance CPT 49083 HC Paracentesis | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance CPT 49083 HC Ult Paracntsis-Diag-W Labs W Album | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance CPT 49083 HC Ult Paracntsis-Thrp-WO Labs WO Album | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance CPT 49083 HC Ult Paracntsis-Thrp-WO Labs W Album | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance CPT 49083 HC CT Paracentesis | $517.20 | $2,586.00 | $1,034.40–$2,068.80 | — | 80% |
| Paracentesis with imaging guidance CPT 49083 HC Ult Paracentesis-Therap WO Lab Sono | $698.20 | $3,491.00 | $1,396.40–$2,792.80 | — | 80% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC Ult Paracntsis-Thrp-WO Labs W Album | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC Ult Paracntsis-Thrp-WO Labs WO Album | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC Ult Paracntsis-Diag-W Labs WO Album | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC Paracentesis | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC Ult Paracntsis-Diag-W Labs W Album | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC Ult Paracentesis-Diagn W Labs Sono | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC Ult Paracentesis Sono | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC Ult Paracentesis-Therap WO Lab Sono | $500.00 | $2,500.00 | $1,000.00–$2,000.00 | — | 80% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC CT Paracentesis | $517.20 | $2,586.00 | $1,034.40–$2,068.80 | — | 80% |
| Partial knee replacement (one compartment) CPT 27446 Plasty Knee,Med or Lat Compartmt | $20,969.14 | $104,845.70 | $41,938.28–$83,876.56 | — | 80% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Removal of Nail Bed | $2,868.48 | $14,342.41 | $5,736.96–$11,473.93 | — | 80% |
| Prostate biopsy CPT 55700 HC CT Biopsy Prostate | $423.80 | $2,119.00 | $847.60–$1,695.20 | — | 80% |
| Prostate biopsy CPT 55700 Biopsy of Prostate,Needle/Punch | $7,946.15 | $39,730.75 | $15,892.30–$31,784.60 | — | 80% |
| Prostate biopsy inpatient CPT 55700 HC CT Biopsy Prostate | $423.80 | $2,119.00 | $847.60–$1,695.20 | — | 80% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 Lap,Prostatectomy,Radical,W/Nerve Spare | $31,460.78 | $157,303.91 | $62,921.56–$125,843.13 | — | 80% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral | $2,367.90 | $11,839.50 | $4,735.80–$9,471.60 | — | 80% |
| Removal of a breast lump, open surgery CPT 19120 Excise Breast Cyst | $4,217.05 | $21,085.23 | $8,434.09–$16,868.18 | — | 80% |
| Removal of a foreign object under the skin, simple CPT 10120 Remove Foreign Body Simple | $5,463.16 | $27,315.81 | $10,926.32–$21,852.65 | — | 80% |
| Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 Thyroid Lobectomy,Unilat | $12,979.62 | $64,898.11 | $25,959.24–$51,918.49 | — | 80% |
| Septoplasty to straighten the nasal septum CPT 30520 Repair of Nasal Septum | $9,473.69 | $47,368.43 | $18,947.37–$37,894.74 | — | 80% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 HC Fragment Kidney Stone/ Eswl | $1,441.20 | $7,206.00 | $2,882.40–$5,764.80 | — | 80% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 Fragmenting of Kidney Stone | $9,304.12 | $46,520.60 | $18,608.24–$37,216.48 | — | 80% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 HC Fragment Kidney Stone/ Eswl | $1,441.20 | $7,206.00 | $2,882.40–$5,764.80 | — | 80% |
| Short arm splint (forearm and hand) CPT 29125 HC Ot Apply Static Short Arm Spl | $160.80 | $804.00 | $321.60–$643.20 | — | 80% |
| Short arm splint (forearm and hand) CPT 29125 HC Pt Apply Static Short Arm Spl | $160.80 | $804.00 | $321.60–$643.20 | — | 80% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC Pt Apply Static Short Arm Spl | $160.80 | $804.00 | $321.60–$643.20 | — | 80% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC Ot Apply Static Short Arm Spl | $160.80 | $804.00 | $321.60–$643.20 | — | 80% |
| Short leg cast (below the knee) CPT 29405 Apply Short Leg Cast | $3,028.30 | $15,141.50 | $6,056.60–$12,113.20 | — | 80% |
| Short leg splint (calf to foot) both sides CPT 29515 HC Ot App Short Leg Splint Bi | $302.80 | $1,514.00 | $605.60–$1,211.20 | — | 80% |
| Short leg splint (calf to foot) CPT 29515 HC App Lower Leg Splint Static | $71.60 | $358.00 | $143.20–$286.40 | — | 80% |
| Short leg splint (calf to foot) CPT 29515 HC Apply Foot Splint | $116.20 | $581.00 | $232.40–$464.80 | — | 80% |
| Short leg splint (calf to foot) inpatient both sides CPT 29515 HC Ot App Short Leg Splint Bi | $302.80 | $1,514.00 | $605.60–$1,211.20 | — | 80% |
| Short leg splint (calf to foot) inpatient CPT 29515 HC App Lower Leg Splint Static | $71.60 | $358.00 | $143.20–$286.40 | — | 80% |
| Short leg splint (calf to foot) inpatient CPT 29515 HC Apply Foot Splint | $116.20 | $581.00 | $232.40–$464.80 | — | 80% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Shldr Arthroscop,Surg,Dis Claviculectomy | $14,568.77 | $72,843.85 | $29,137.54–$58,275.08 | — | 80% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shldr Arthroscop,Part Acromioplas | $15,494.05 | $77,470.23 | $30,988.09–$61,976.18 | — | 80% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Repr Superf Wnd Body <2.5cm | $524.81 | $2,624.06 | $1,049.62–$2,099.25 | — | 80% |
| Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy Skin Single Lesion | $762.10 | $3,810.50 | $1,524.20–$3,048.40 | — | 80% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Exc Skin Malig <0.5cm Trunk,Arm,Leg | $6,596.55 | $32,982.76 | $13,193.10–$26,386.21 | — | 80% |
| Skin tag removal, up to 15 tags CPT 11200 Removal of Skin Tags | $3,961.91 | $19,809.53 | $7,923.81–$15,847.62 | — | 80% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Lumbar Puncture Dx W/O Imaging | $368.60 | $1,843.00 | $737.20–$1,474.40 | — | 80% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Ucc Lumbar Puncture Dx W/O Imaging | $368.60 | $1,843.00 | $737.20–$1,474.40 | — | 80% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Lumbar Puncture Dx W/O Imaging | $1,098.48 | $5,492.40 | $2,196.96–$4,393.92 | — | 80% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC Lumbar Puncture Dx W/O Imaging | $368.60 | $1,843.00 | $737.20–$1,474.40 | — | 80% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC Ucc Lumbar Puncture Dx W/O Imaging | $368.60 | $1,843.00 | $737.20–$1,474.40 | — | 80% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Repr Sup Npterf Wnd Body 2.6-7.5 | $725.20 | $3,626.00 | $1,450.40–$2,900.80 | — | 80% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Repr Superf Wnd Face <2.5cm | $381.50 | $1,907.50 | $763.00–$1,526.00 | — | 80% |
| TURP (transurethral resection of the prostate) CPT 52601 Transurethral Elec-Surg Prostatectom | $10,027.68 | $50,138.38 | $20,055.35–$40,110.70 | — | 80% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential Biopsy Skin Single Lesion | $1,737.80 | $8,689.00 | $3,475.60–$6,951.20 | — | 80% |
| Thoracentesis with imaging guidance CPT 32555 HC US Thoracentesis - Diagn W Labs Sono-Side to Be Determined by Rad | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance CPT 32555 HC Thoracentesis | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance CPT 32555 HC US Thoracentesis -Therapy WO Lab Sono-Side to Be Determined by Rad | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance CPT 32555 HC Thoracentesis Needle or Cath Aspir W/ Img | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance one side CPT 32555 HC Ult Thoracentesis -Therapy WO Lab Sono-Left | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance one side CPT 32555 HC Ult Thoracentesis - Diagn W Labs Sono-Right | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance one side CPT 32555 HC Ult Thoracentesis -Therapy WO Lab Sono-Right | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance one side CPT 32555 HC Ult Thoracentesis - Diagn W Labs Sono-Left | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance one side CPT 32555 HC CT Thoracentesis-Right | $1,036.20 | $5,181.00 | $2,072.40–$4,144.80 | — | 80% |
| Thoracentesis with imaging guidance one side CPT 32555 HC CT Thoracentesis-Left | $1,036.20 | $5,181.00 | $2,072.40–$4,144.80 | — | 80% |
| Thoracentesis with imaging guidance one side CPT 32555 HC Ult Thoracentesis - Diagn W Labs Sono-Right | $1,279.99 | $6,399.95 | $2,559.98–$5,119.96 | — | 80% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC US Thoracentesis - Diagn W Labs Sono-Side to Be Determined by Rad | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC Thoracentesis | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC Thoracentesis Needle or Cath Aspir W/ Img | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC US Thoracentesis -Therapy WO Lab Sono-Side to Be Determined by Rad | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 HC Ult Thoracentesis - Diagn W Labs Sono-Right | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 HC Ult Thoracentesis -Therapy WO Lab Sono-Right | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 HC Ult Thoracentesis - Diagn W Labs Sono-Left | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 HC Ult Thoracentesis -Therapy WO Lab Sono-Left | $1,003.60 | $5,018.00 | $2,007.20–$4,014.40 | — | 80% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 HC CT Thoracentesis-Left | $1,036.20 | $5,181.00 | $2,072.40–$4,144.80 | — | 80% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 HC CT Thoracentesis-Right | $1,036.20 | $5,181.00 | $2,072.40–$4,144.80 | — | 80% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 Remove Tonsils/Adenoids,12+ Y/O | $4,197.14 | $20,985.68 | $8,394.27–$16,788.54 | — | 80% |
| Tonsil and adenoid removal, child under 12 CPT 42820 Remove Tonsils/Adenoids,<12 Y/O | $4,177.18 | $20,885.92 | $8,354.37–$16,708.74 | — | 80% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Removal of Tonsils,12+ Y/O | $4,403.31 | $22,016.56 | $8,806.62–$17,613.25 | — | 80% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 Removal of Tonsils,<12 Y/O | $5,657.40 | $28,286.98 | $11,314.79–$22,629.58 | — | 80% |
| Total hip replacement CPT 27130 Total Hip Arthroplasty | $21,611.77 | $108,058.87 | $43,223.55–$86,447.10 | — | 80% |
| Total knee replacement CPT 27447 Total Knee Arthroplasty | $22,238.53 | $111,192.66 | $44,477.06–$88,954.13 | — | 80% |
| Total shoulder replacement CPT 23472 Reconstr Total Shoulder Implant | $24,140.85 | $120,704.25 | $48,281.70–$96,563.40 | — | 80% |
| Total thyroid removal (thyroidectomy) CPT 60240 Thyroidectomy | $16,238.95 | $81,194.75 | $32,477.90–$64,955.80 | — | 80% |
| Trigger finger release surgery CPT 26055 Incise Finger Tendon Sheath | $3,816.24 | $19,081.18 | $7,632.47–$15,264.94 | — | 80% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Inject Trigger Point, 1 or 2 | $794.12 | $3,970.60 | $1,588.24–$3,176.48 | — | 80% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 Lap,Tubal Cautery | $9,052.07 | $45,260.33 | $18,104.13–$36,208.26 | — | 80% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 HC Mammo US Breast Bx, 1st Lesion-Left | $1,070.00 | $5,350.00 | $2,140.00–$4,280.00 | — | 80% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 HC Mammo US Breast Bx, 1st Lesion-Right | $1,070.00 | $5,350.00 | $2,140.00–$4,280.00 | — | 80% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 HC Ult Breast Biopsy Sono-1st Lesion-Right | $1,435.40 | $7,177.00 | $2,870.80–$5,741.60 | — | 80% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 HC Ult Breast Biopsy Sono-1st Lesion-Left | $1,435.40 | $7,177.00 | $2,870.80–$5,741.60 | — | 80% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 HC Mammo US Breast Bx, 1st Lesion-Left | $1,733.65 | $8,668.26 | $3,467.30–$6,934.61 | — | 80% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 HC Mammo US Breast Bx, 1st Lesion-Left | $1,070.00 | $5,350.00 | $2,140.00–$4,280.00 | — | 80% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 HC Mammo US Breast Bx, 1st Lesion-Right | $1,070.00 | $5,350.00 | $2,140.00–$4,280.00 | — | 80% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 HC Ult Breast Biopsy Sono-1st Lesion-Left | $1,435.40 | $7,177.00 | $2,870.80–$5,741.60 | — | 80% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 HC Ult Breast Biopsy Sono-1st Lesion-Right | $1,435.40 | $7,177.00 | $2,870.80–$5,741.60 | — | 80% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Up GI Endoscopy,Ball Dil,30mm | $3,475.05 | $17,375.25 | $6,950.10–$13,900.20 | — | 80% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Upper GI Endoscopy,Biopsy | $3,023.28 | $15,116.39 | $6,046.56–$12,093.11 | — | 80% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 Upper GI Endoscopy,W/Dir Submuc Inj | $3,961.45 | $19,807.23 | $7,922.89–$15,845.78 | — | 80% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Up GI Endoscopy,Remv Tumor,Snare | $3,518.25 | $17,591.27 | $7,036.51–$14,073.02 | — | 80% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Up GI Endoscopy,Dilatn W Guide | $2,967.39 | $14,836.93 | $5,934.77–$11,869.54 | — | 80% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Upper GI Endoscopy,Diagnosis | $1,816.65 | $9,083.25 | $3,633.30–$7,266.60 | — | 80% |
| Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 Upper GI Endoscopy,Drain Pseudocyst | $9,135.57 | $45,677.86 | $18,271.14–$36,542.29 | — | 80% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 HC Cysto/Uretero/Pyeloscopy W/Lithotripsy | $2,114.40 | $10,572.00 | $4,228.80–$8,457.60 | — | 80% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 Cysto/Uretero/Pyeloscopy W/Lithotripsy | $10,981.56 | $54,907.79 | $21,963.12–$43,926.23 | — | 80% |
| Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 HC Cysto/Uretero/Pyeloscopy W/Lithotripsy | $2,114.40 | $10,572.00 | $4,228.80–$8,457.60 | — | 80% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt | $13,022.50 | $65,112.50 | $26,045.00–$52,090.00 | — | 80% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Removal of Sperm Duct(S) | $3,354.51 | $16,772.55 | $6,709.02–$13,418.04 | — | 80% |
| Vein ablation, radiofrequency, first vein CPT 36475 HC Endovenous Rf Ablation Incompetent Vein, Initial | $1,558.60 | $7,793.00 | $3,117.20–$6,234.40 | — | 80% |
| Vein ablation, radiofrequency, first vein CPT 36475 Endovenous Rf, 1st Vein | $9,611.17 | $48,055.85 | $19,222.34–$38,444.68 | — | 80% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC Endovenous Rf Ablation Incompetent Vein, Initial | $1,558.60 | $7,793.00 | $3,117.20–$6,234.40 | — | 80% |
| Wart removal, up to 14 warts CPT 17110 Destruc Flat Warts, Up to 14 Lesions | $637.00 | $3,185.00 | $1,274.00–$2,548.00 | — | 80% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC ED Debride Skin to Sq Tissue 1st 20 Cm | $300.20 | $1,501.00 | $600.40–$1,200.80 | — | 80% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Ucc Debride Skin to Sq Tissue 1st 20 Cm | $300.20 | $1,501.00 | $600.40–$1,200.80 | — | 80% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Cc Debride Skin to Sq Tissue 1st 20 Cm | $300.20 | $1,501.00 | $600.40–$1,200.80 | — | 80% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC ED Debride Skin to Sq Tissue 1st 20 Cm | $600.40 | $3,002.00 | $1,200.80–$2,401.60 | — | 80% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC ED Debride Skin to Sq Tissue 1st 20 Cm | $300.20 | $1,501.00 | $600.40–$1,200.80 | — | 80% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC Ucc Debride Skin to Sq Tissue 1st 20 Cm | $300.20 | $1,501.00 | $600.40–$1,200.80 | — | 80% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC Cc Debride Skin to Sq Tissue 1st 20 Cm | $300.20 | $1,501.00 | $600.40–$1,200.80 | — | 80% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 Open Rx Distal Radius Fx, Extra-Articular | $10,762.31 | $53,811.56 | $21,524.62–$43,049.25 | — | 80% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Florida | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 HC Transfus Blood/Blood Products | $401.00 | $2,005.00 | $802.00–$1,604.00 | — | 80% |
| Blood transfusion (giving blood or blood components) CPT 36430 HC OB ED Transfus Blood/Blood Products | $401.00 | $2,005.00 | $802.00–$1,604.00 | — | 80% |
| Blood transfusion (giving blood or blood components) CPT 36430 HC Ucc Transfus Blood/Blood Products | $401.00 | $2,005.00 | $802.00–$1,604.00 | — | 80% |
| Blood transfusion (giving blood or blood components) CPT 36430 HC Transfus Blood/Blood Products | $1,012.70 | $5,063.50 | $2,025.40–$4,050.80 | — | 80% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC Transfus Blood/Blood Products | $401.00 | $2,005.00 | $802.00–$1,604.00 | — | 80% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC OB ED Transfus Blood/Blood Products | $401.00 | $2,005.00 | $802.00–$1,604.00 | — | 80% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC Ucc Transfus Blood/Blood Products | $401.00 | $2,005.00 | $802.00–$1,604.00 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Airway Inhalation Treatment | $93.40 | $467.00 | $186.80–$373.60 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Updraft Tx Sub | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Peds Updraft | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Meter-Dose Tx Sub | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Ban-Updrafts Initial | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Ucc Peds Updraft | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Ban-Updrafts Subseq | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Updraft Tx Initial | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Sput Induct W/Tx | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Peds Updraft Tx Sub | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Metered-Dose Inhaler Tx | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Opep Sub | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Pep W/Updraft Neb | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Aerogen Neb Tx Init | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Ippb Initial Tx | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Aerogen Neb Tx Sub | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Ippb Sub Tx | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Opep Ini | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Airway Inhalation Treatment | $93.40 | $467.00 | $186.80–$373.60 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Meter-Dose Tx Sub | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Ucc Peds Updraft | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Updraft Tx Initial | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Metered-Dose Inhaler Tx | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Sput Induct W/Tx | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Updraft Tx Sub | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Ban-Updrafts Initial | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Ban-Updrafts Subseq | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Peds Updraft Tx Sub | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Peds Updraft | $98.20 | $491.00 | $196.40–$392.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Aerogen Neb Tx Init | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Ippb Initial Tx | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Ippb Sub Tx | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Opep Ini | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Opep Sub | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Pep W/Updraft Neb | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Aerogen Neb Tx Sub | $122.20 | $611.00 | $244.40–$488.80 | — | 80% |
| Chemotherapy IV infusion, first hour CPT 96413 HC Chemo Infusion 0-1 Hr | $475.40 | $2,377.00 | $950.80–$1,901.60 | — | 80% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 HC Chemo Infusion 0-1 Hr | $475.40 | $2,377.00 | $950.80–$1,901.60 | — | 80% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC Comp Aud Thr Eval & Speech Re | $89.00 | $445.00 | $178.00–$356.00 | — | 80% |
| Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC Comp Aud Thr Eval & Speech Re | $89.00 | $445.00 | $178.00–$356.00 | — | 80% |
| Critical care, first 30 to 74 minutes CPT 99291 HC ED Critical Care 30-74 Min | $1,703.20 | $8,516.00 | $3,406.40–$6,812.80 | — | 80% |
| Critical care, first 30 to 74 minutes CPT 99291 HC OB ED Critical Care 30-74 Min | $1,703.20 | $8,516.00 | $3,406.40–$6,812.80 | — | 80% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 HC OB ED Critical Care 30-74 Min | $1,703.20 | $8,516.00 | $3,406.40–$6,812.80 | — | 80% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 HC ED Critical Care 30-74 Min | $1,703.20 | $8,516.00 | $3,406.40–$6,812.80 | — | 80% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 HC Eeg: Awake & Drowsy | $347.40 | $1,737.00 | $694.80–$1,389.60 | — | 80% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC Eeg: Awake & Drowsy | $347.40 | $1,737.00 | $694.80–$1,389.60 | — | 80% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC 12 Lead Ekg; Tracing Only | $143.20 | $716.00 | $286.40–$572.80 | — | 80% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC 12 Lead Ekg; Tracing Only | $143.20 | $716.00 | $286.40–$572.80 | — | 80% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC OB ED Level 1 | $161.60 | $808.00 | $323.20–$646.40 | — | 80% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED Level 1 | $161.60 | $808.00 | $323.20–$646.40 | — | 80% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC OB ED Level 1 | $161.60 | $808.00 | $323.20–$646.40 | — | 80% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED Level 1 | $161.60 | $808.00 | $323.20–$646.40 | — | 80% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC OB ED Level 2 | $322.80 | $1,614.00 | $645.60–$1,291.20 | — | 80% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED Level 2 | $322.80 | $1,614.00 | $645.60–$1,291.20 | — | 80% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC OB ED Level 2 | $322.80 | $1,614.00 | $645.60–$1,291.20 | — | 80% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED Level 2 | $322.80 | $1,614.00 | $645.60–$1,291.20 | — | 80% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC OB ED Level 3 | $483.60 | $2,418.00 | $967.20–$1,934.40 | — | 80% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED Level 3 | $483.60 | $2,418.00 | $967.20–$1,934.40 | — | 80% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED Level 3 | $483.60 | $2,418.00 | $967.20–$1,934.40 | — | 80% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC OB ED Level 3 | $483.60 | $2,418.00 | $967.20–$1,934.40 | — | 80% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED Level 4 | $913.40 | $4,567.00 | $1,826.80–$3,653.60 | — | 80% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC OB ED Level 4 | $913.40 | $4,567.00 | $1,826.80–$3,653.60 | — | 80% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC OB ED Level 4 | $913.40 | $4,567.00 | $1,826.80–$3,653.60 | — | 80% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED Level 4 | $913.40 | $4,567.00 | $1,826.80–$3,653.60 | — | 80% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC OB ED Level 5 | $1,342.40 | $6,712.00 | $2,684.80–$5,369.60 | — | 80% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED Level 5 | $1,342.40 | $6,712.00 | $2,684.80–$5,369.60 | — | 80% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED Level 5 | $1,342.40 | $6,712.00 | $2,684.80–$5,369.60 | — | 80% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC OB ED Level 5 | $1,342.40 | $6,712.00 | $2,684.80–$5,369.60 | — | 80% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC Cvslr Stress Test Tracing | $514.00 | $2,570.00 | $1,028.00–$2,056.00 | — | 80% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC Cvslr Stress Test Tracing | $514.00 | $2,570.00 | $1,028.00–$2,056.00 | — | 80% |
| Family therapy with the patient, 50 minutes CPT 90847 HC Family Therapy W/Pt | $230.00 | $1,150.00 | $460.00–$920.00 | — | 80% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Therapy W/Pt | $230.00 | $1,150.00 | $460.00–$920.00 | — | 80% |
| Family therapy without the patient, 50 minutes CPT 90846 HC Family Therapy Without Pt | $194.60 | $973.00 | $389.20–$778.40 | — | 80% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Family Therapy Without Pt | $194.60 | $973.00 | $389.20–$778.40 | — | 80% |
| Group psychotherapy session CPT 90853 HC Group Therapy Not Multi-Famil | $60.20 | $301.00 | $120.40–$240.80 | — | 80% |
| Group psychotherapy session inpatient CPT 90853 HC Group Therapy Not Multi-Famil | $60.20 | $301.00 | $120.40–$240.80 | — | 80% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC Ucc IV Hydration Infusion 1st Hr | $149.40 | $747.00 | $298.80–$597.60 | — | 80% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC OB ED IV Hydration Infusion 1st Hr | $149.40 | $747.00 | $298.80–$597.60 | — | 80% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC Ccl Ccl IV Hydration Infusion 1st Hr | $149.40 | $747.00 | $298.80–$597.60 | — | 80% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC OB IV Hydration Infusion 1st Hr | $149.40 | $747.00 | $298.80–$597.60 | — | 80% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV Hydration Infusion 1st Hr | $158.60 | $793.00 | $317.20–$634.40 | — | 80% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC Ucc IV Hydration Infusion 1st Hr | $149.40 | $747.00 | $298.80–$597.60 | — | 80% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC OB ED IV Hydration Infusion 1st Hr | $149.40 | $747.00 | $298.80–$597.60 | — | 80% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC Ccl Ccl IV Hydration Infusion 1st Hr | $149.40 | $747.00 | $298.80–$597.60 | — | 80% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC OB IV Hydration Infusion 1st Hr | $149.40 | $747.00 | $298.80–$597.60 | — | 80% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV Hydration Infusion 1st Hr | $158.60 | $793.00 | $317.20–$634.40 | — | 80% |
| IV infusion of a medicine, first hour CPT 96365 HC Ccl IV Infusion Tx Dx 1st Hr | $260.00 | $1,300.00 | $520.00–$1,040.00 | — | 80% |
| IV infusion of a medicine, first hour CPT 96365 HC OB ED IV Infusion Tx Dx 1st Hr | $260.00 | $1,300.00 | $520.00–$1,040.00 | — | 80% |
| IV infusion of a medicine, first hour CPT 96365 HC OB IV Infusion Tx Dx 1st Hr | $260.00 | $1,300.00 | $520.00–$1,040.00 | — | 80% |
| IV infusion of a medicine, first hour CPT 96365 HC Ucc IV Infusion Tx Dx 1st Hr | $260.00 | $1,300.00 | $520.00–$1,040.00 | — | 80% |
| IV infusion of a medicine, first hour CPT 96365 HC IV Infusion Tx Dx 1st Hr | $276.20 | $1,381.00 | $552.40–$1,104.80 | — | 80% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC Ccl IV Infusion Tx Dx 1st Hr | $260.00 | $1,300.00 | $520.00–$1,040.00 | — | 80% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC OB IV Infusion Tx Dx 1st Hr | $260.00 | $1,300.00 | $520.00–$1,040.00 | — | 80% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC Ucc IV Infusion Tx Dx 1st Hr | $260.00 | $1,300.00 | $520.00–$1,040.00 | — | 80% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC OB ED IV Infusion Tx Dx 1st Hr | $260.00 | $1,300.00 | $520.00–$1,040.00 | — | 80% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC IV Infusion Tx Dx 1st Hr | $276.20 | $1,381.00 | $552.40–$1,104.80 | — | 80% |
| IV push of a medicine, first drug CPT 96374 HC OB IV Injection Tx Dx 1st | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| IV push of a medicine, first drug CPT 96374 HC Ucc IV Injection Tx Dx 1st | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| IV push of a medicine, first drug CPT 96374 HC OB ED IV Injection Tx Dx 1st | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| IV push of a medicine, first drug CPT 96374 HC Ccl IV Injection Tx Dx 1st | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| IV push of a medicine, first drug CPT 96374 HC IV Injection Tx Dx 1st | $83.20 | $416.00 | $166.40–$332.80 | — | 80% |
| IV push of a medicine, first drug inpatient CPT 96374 HC Ccl IV Injection Tx Dx 1st | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| IV push of a medicine, first drug inpatient CPT 96374 HC Ucc IV Injection Tx Dx 1st | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| IV push of a medicine, first drug inpatient CPT 96374 HC OB IV Injection Tx Dx 1st | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| IV push of a medicine, first drug inpatient CPT 96374 HC OB ED IV Injection Tx Dx 1st | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| IV push of a medicine, first drug inpatient CPT 96374 HC IV Injection Tx Dx 1st | $83.20 | $416.00 | $166.40–$332.80 | — | 80% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC OB Im/Sq Injection Tx Dx | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC Im/Sq Injection Tx Dx | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC Ucc Im/Sq Injection Tx Dx | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC OB ED Im/Sq Injection Tx Dx | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC OB ED Im/Sq Injection Tx Dx | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC Ucc Im/Sq Injection Tx Dx | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC OB Im/Sq Injection Tx Dx | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC Im/Sq Injection Tx Dx | $78.40 | $392.00 | $156.80–$313.60 | — | 80% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Psych Dx Interview | $108.40 | $542.00 | $216.80–$433.60 | — | 80% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Psych Dx Interview | $108.40 | $542.00 | $216.80–$433.60 | — | 80% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC Nerve Conduct Studies 7-8 | $107.00 | $535.00 | $214.00–$428.00 | — | 80% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC Pain Nerve Conduct Studies 7-8 | $247.60 | $1,238.00 | $495.20–$990.40 | — | 80% |
| Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC Nerve Conduct Studies 7-8 | $107.00 | $535.00 | $214.00–$428.00 | — | 80% |
| Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC Pain Nerve Conduct Studies 7-8 | $247.60 | $1,238.00 | $495.20–$990.40 | — | 80% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC 15 Min Pt Neuromuscular Re-Educ | $56.00 | $280.00 | $112.00–$224.00 | 62% below | 80% |
| Neuromuscular re-education, 15 minutes CPT 97112 15 Min Ot Neuromuscular Re-Educ | $56.00 | $280.00 | $112.00–$224.00 | 62% below | 80% |
| Neuromuscular re-education, 15 minutes CPT 97112 15 Min Sp Neuromuscular Re-Educ | $56.00 | $280.00 | $112.00–$224.00 | 62% below | 80% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 15 Min Ot Neuromuscular Re-Educ | $56.00 | $280.00 | $112.00–$224.00 | — | 80% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC 15 Min Pt Neuromuscular Re-Educ | $56.00 | $280.00 | $112.00–$224.00 | — | 80% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 15 Min Sp Neuromuscular Re-Educ | $56.00 | $280.00 | $112.00–$224.00 | — | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC Level 3 New | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC Pain Lwc Level 3 New | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC Renal Level 3 New | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC Ucc Level 3 New | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC Level 3 New Obt | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC Opcard Level 3 New | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC OB Level 3 New Obt | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC OB Level 3 New Obt | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Renal Level 3 New | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Level 3 New | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Ucc Level 3 New | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Level 3 New Obt | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Pain Lwc Level 3 New | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Opcard Level 3 New | $150.00 | $750.00 | $300.00–$600.00 | — | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC Level 4 New Obt | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC Pain Lwc Level 4 New | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC Opcard Level 4 New | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC Level 4 New | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC Ucc Level 4 New | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC Renal Level 4 New | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC OB Level 4 New Obt | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Renal Level 4 New | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Ucc Level 4 New | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Level 4 New | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Level 4 New Obt | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Pain Lwc Level 4 New | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Opcard Level 4 New | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC OB Level 4 New Obt | $178.00 | $890.00 | $356.00–$712.00 | — | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC Renal Level 5 New | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC Ucc Level 5 New | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC Level 5 New | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC Level 5 New Obt | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC Pain Lwc Level 5 New | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC Opcard Level 5 New | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC OB Level 5 New Obt | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Pain Lwc Level 5 New | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Opcard Level 5 New | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC OB Level 5 New Obt | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Renal Level 5 New | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Ucc Level 5 New | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Level 5 New | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Level 5 New Obt | $240.20 | $1,201.00 | $480.40–$960.80 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC Level 2 New | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC Pain Lwc Level 2 New | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC Ucc Level 2� New | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OB Level 2 New Obt | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC Opcard Level 2 New | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC Renal Level 2 New | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC Level 2 New Obt | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC Opcard Level 2 New | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC OB Level 2 New Obt | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC Level 2 New | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC Renal Level 2 New | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC Ucc Level 2� New | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC Pain Lwc Level 2 New | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC Level 2 New Obt | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC Ini Nutrit Cnsl Renal 1/4h | $10.40 | $52.00 | $20.80–$41.60 | 84% below | 80% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC Renal Ini Nutrit Cnsl 1/4h | $10.40 | $52.00 | $20.80–$41.60 | 84% below | 80% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC Renal Ini Nutrit Cnsl 1/4h | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC Ini Nutrit Cnsl Renal 1/4h | $10.40 | $52.00 | $20.80–$41.60 | — | 80% |
| Occupational therapy evaluation, low complexity CPT 97165 30 Min Ot Low Comp | $64.40 | $322.00 | $128.80–$257.60 | 86% below | 80% |
| Occupational therapy evaluation, low complexity CPT 97165 45 Min Ot Low Comp | $83.80 | $419.00 | $167.60–$335.20 | 82% below | 80% |
| Occupational therapy evaluation, low complexity CPT 97165 60 Min Ot Low Comp | $115.20 | $576.00 | $230.40–$460.80 | 76% below | 80% |
| Occupational therapy evaluation, low complexity CPT 97165 HC Telehealth Ot Low Comp | $122.00 | $610.00 | $244.00–$488.00 | 74% below | 80% |
| Occupational therapy evaluation, low complexity CPT 97165 HC Ot Low Comp | $122.00 | $610.00 | $244.00–$488.00 | 74% below | 80% |
| Occupational therapy evaluation, low complexity CPT 97165 75 Min Ot Low Comp | $148.60 | $743.00 | $297.20–$594.40 | 69% below | 80% |
| Occupational therapy evaluation, low complexity CPT 97165 90 Min Ot Low Comp | $180.20 | $901.00 | $360.40–$720.80 | 62% below | 80% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 30 Min Ot Low Comp | $64.40 | $322.00 | $128.80–$257.60 | — | 80% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 45 Min Ot Low Comp | $83.80 | $419.00 | $167.60–$335.20 | — | 80% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 60 Min Ot Low Comp | $115.20 | $576.00 | $230.40–$460.80 | — | 80% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 HC Telehealth Ot Low Comp | $122.00 | $610.00 | $244.00–$488.00 | — | 80% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 HC Ot Low Comp | $122.00 | $610.00 | $244.00–$488.00 | — | 80% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 75 Min Ot Low Comp | $148.60 | $743.00 | $297.20–$594.40 | — | 80% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 90 Min Ot Low Comp | $180.20 | $901.00 | $360.40–$720.80 | — | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 30 Min Pt Eval High Comp | $80.00 | $400.00 | $160.00–$320.00 | 85% below | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC 45 Min Pt Eval High Comp | $100.40 | $502.00 | $200.80–$401.60 | 81% below | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC Pt Eval High Comp | $116.80 | $584.00 | $233.60–$467.20 | 78% below | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Telehealth Pt Eval High Comp | $116.80 | $584.00 | $233.60–$467.20 | 78% below | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC Telehealth Pt Eval High Comp | $124.00 | $620.00 | $248.00–$496.00 | 76% below | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC 60 Min Pt Eval High Comp | $129.00 | $645.00 | $258.00–$516.00 | 75% below | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 75 Min Pt Eval High Comp | $158.40 | $792.00 | $316.80–$633.60 | 70% below | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 90 Min Pt Eval High Comp | $187.20 | $936.00 | $374.40–$748.80 | 64% below | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 30 Min Pt Eval High Comp | $80.00 | $400.00 | $160.00–$320.00 | — | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC 45 Min Pt Eval High Comp | $100.40 | $502.00 | $200.80–$401.60 | — | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Telehealth Pt Eval High Comp | $116.80 | $584.00 | $233.60–$467.20 | — | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC Pt Eval High Comp | $116.80 | $584.00 | $233.60–$467.20 | — | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC Telehealth Pt Eval High Comp | $124.00 | $620.00 | $248.00–$496.00 | — | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC 60 Min Pt Eval High Comp | $129.00 | $645.00 | $258.00–$516.00 | — | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 75 Min Pt Eval High Comp | $158.40 | $792.00 | $316.80–$633.60 | — | 80% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 90 Min Pt Eval High Comp | $187.20 | $936.00 | $374.40–$748.80 | — | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC Pt Low Comp 30 | $66.80 | $334.00 | $133.60–$267.20 | 85% below | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 45 Min Pt Low Comp | $85.00 | $425.00 | $170.00–$340.00 | 81% below | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 60 Min Pt Low Comp | $102.60 | $513.00 | $205.20–$410.40 | 77% below | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Telehealth Pt Low Comp | $116.80 | $584.00 | $233.60–$467.20 | 74% below | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC Pt Low Comp | $116.80 | $584.00 | $233.60–$467.20 | 74% below | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 75 Min Pt Low Comp | $132.80 | $664.00 | $265.60–$531.20 | 70% below | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 90 Min Pt Low Comp | $135.40 | $677.00 | $270.80–$541.60 | 70% below | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC Pt Low Comp 30 | $66.80 | $334.00 | $133.60–$267.20 | — | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 45 Min Pt Low Comp | $85.00 | $425.00 | $170.00–$340.00 | — | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 60 Min Pt Low Comp | $102.60 | $513.00 | $205.20–$410.40 | — | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Telehealth Pt Low Comp | $116.80 | $584.00 | $233.60–$467.20 | — | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC Pt Low Comp | $116.80 | $584.00 | $233.60–$467.20 | — | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 75 Min Pt Low Comp | $132.80 | $664.00 | $265.60–$531.20 | — | 80% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 90 Min Pt Low Comp | $135.40 | $677.00 | $270.80–$541.60 | — | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 30 Min Pt Eval Mod Comp | $69.40 | $347.00 | $138.80–$277.60 | 85% below | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC 45 Min Pt Eval Mod Comp | $87.40 | $437.00 | $174.80–$349.60 | 81% below | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC 60 Min Pt Eval Mod Comp | $116.20 | $581.00 | $232.40–$464.80 | 74% below | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Telehealth Pt Eval Mod Comp | $116.80 | $584.00 | $233.60–$467.20 | 74% below | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC Pt Eval Mod Comp | $116.80 | $584.00 | $233.60–$467.20 | 74% below | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC 75 Min Pt Eval Mod Comp | $145.60 | $728.00 | $291.20–$582.40 | 68% below | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC 90 Min Pt Eval Mod Comp | $174.00 | $870.00 | $348.00–$696.00 | 61% below | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 30 Min Pt Eval Mod Comp | $69.40 | $347.00 | $138.80–$277.60 | — | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC 45 Min Pt Eval Mod Comp | $87.40 | $437.00 | $174.80–$349.60 | — | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC 60 Min Pt Eval Mod Comp | $116.20 | $581.00 | $232.40–$464.80 | — | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Telehealth Pt Eval Mod Comp | $116.80 | $584.00 | $233.60–$467.20 | — | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC Pt Eval Mod Comp | $116.80 | $584.00 | $233.60–$467.20 | — | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC 75 Min Pt Eval Mod Comp | $145.60 | $728.00 | $291.20–$582.40 | — | 80% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC 90 Min Pt Eval Mod Comp | $174.00 | $870.00 | $348.00–$696.00 | — | 80% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Pt Manual Therapy 1/4hr | $51.60 | $258.00 | $103.20–$206.40 | 60% below | 80% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 15 Min Ot Manual Therapy | $51.60 | $258.00 | $103.20–$206.40 | 60% below | 80% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC Pt Manual Therapy 1/4hr | $51.60 | $258.00 | $103.20–$206.40 | — | 80% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 15 Min Ot Manual Therapy | $51.60 | $258.00 | $103.20–$206.40 | — | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 15 Min Therapeutic Exercise | $56.00 | $280.00 | $112.00–$224.00 | 61% below | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Telehealth 15 Min Pt Therapeutic Exercise | $56.00 | $280.00 | $112.00–$224.00 | 61% below | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC 15 Min Pt Therapeutic Exercise | $56.00 | $280.00 | $112.00–$224.00 | 61% below | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Telehealth 15 Min Ot Therapeutic Exercise | $56.00 | $280.00 | $112.00–$224.00 | 61% below | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Telehealth 15 Min Ot Therapeutic Exercise | $56.00 | $280.00 | $112.00–$224.00 | — | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Telehealth 15 Min Pt Therapeutic Exercise | $56.00 | $280.00 | $112.00–$224.00 | — | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC 15 Min Pt Therapeutic Exercise | $56.00 | $280.00 | $112.00–$224.00 | — | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 15 Min Therapeutic Exercise | $56.00 | $280.00 | $112.00–$224.00 | — | 80% |
| Psychiatric evaluation with medical services CPT 90792 HC Psych Dx Evaluation W/ E & M Serv | $134.40 | $672.00 | $268.80–$537.60 | — | 80% |
| Psychiatric evaluation with medical services inpatient CPT 90792 HC Psych Dx Evaluation W/ E & M Serv | $134.40 | $672.00 | $268.80–$537.60 | — | 80% |
| Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HC Psych Test Eval Phys/Qhp 1st Hr | $142.80 | $714.00 | $285.60–$571.20 | — | 80% |
| Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 HC Psych Test Eval Phys/Qhp 1st Hr | $142.80 | $714.00 | $285.60–$571.20 | — | 80% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 HC Psytx Crisis Initial 60 Min | $101.20 | $506.00 | $202.40–$404.80 | — | 80% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC Psytx Crisis Initial 60 Min | $101.20 | $506.00 | $202.40–$404.80 | — | 80% |
| Psychotherapy session, 30 minutes CPT 90832 HC Psytx Pt&/Family 30 Minutes | $37.40 | $187.00 | $74.80–$149.60 | — | 80% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Psytx Pt&/Family 30 Minutes | $37.40 | $187.00 | $74.80–$149.60 | — | 80% |
| Psychotherapy session, 45 minutes CPT 90834 HC Psytx Pt&/Family 45 Minutes | $55.40 | $277.00 | $110.80–$221.60 | — | 80% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC Psytx Pt&/Family 45 Minutes | $55.40 | $277.00 | $110.80–$221.60 | — | 80% |
| Psychotherapy session, 60 minutes CPT 90837 HC Psytx Pt&/Family 60 Minutes | $82.60 | $413.00 | $165.20–$330.40 | — | 80% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC Psytx Pt&/Family 60 Minutes | $82.60 | $413.00 | $165.20–$330.40 | — | 80% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC Tobac-Use Couns Asypt 3-10 Min | $19.20 | $96.00 | $38.40–$76.80 | — | 80% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC Behav Chng Smoking 3-10 Min | $19.20 | $96.00 | $38.40–$76.80 | — | 80% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC Tobac-Use Couns Asypt 3-10 Min | $19.20 | $96.00 | $38.40–$76.80 | — | 80% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC Behav Chng Smoking 3-10 Min | $19.20 | $96.00 | $38.40–$76.80 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Level 5 Est Obt | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Opcard Level 5 Est | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Ucc Level 5 Est | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Level 5 Est | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Pain Lwc Level 5 Est | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OB Level 5 Est Obt | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Renal Level 5 Est | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Ucc Level 5 Est | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Renal Level 5 Est | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OB Level 5 Est Obt | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Opcard Level 5 Est | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Level 5 Est Obt | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Pain Lwc Level 5 Est | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Level 5 Est | $215.80 | $1,079.00 | $431.60–$863.20 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OB Level 3 Est Obt | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Renal Level 3 Est | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Level 3 Est Obt | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Opcard Level 3 Est | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Level 3 Est | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Pain Lwc Level 3 Est | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Ucc Level 3� Est | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Level 3 Est Obt | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OB Level 3 Est Obt | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Opcard Level 3 Est | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Renal Level 3 Est | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Pain Lwc Level 3 Est | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Level 3 Est | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Ucc Level 3� Est | $99.00 | $495.00 | $198.00–$396.00 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Ucc Level 4� Est | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Renal Level 4 Est | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OB Level 4 Est Obt | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Pain Lwc Level 4 Est | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Opcard Level 4 Est | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Level 4 Est Obt | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Level 4 Est | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Level 4 Est Obt | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Pain Lwc Level 4 Est | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Level 4 Est | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Ucc Level 4� Est | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Renal Level 4 Est | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OB Level 4 Est Obt | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Opcard Level 4 Est | $154.20 | $771.00 | $308.40–$616.80 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Renal Level 2 Est | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Opcard Level 2 Est | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Pain Lwc Level 2 Est | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Ucc Level 2� Est | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Level 2 Est | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Level 2 Est Obt | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OB Level 2 Est Obt | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Opcard Level 2 Est | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OB Level 2 Est Obt | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Renal Level 2 Est | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Pain Lwc Level 2 Est | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Level 2 Est | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Ucc Level 2� Est | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Level 2 Est Obt | $51.00 | $255.00 | $102.00–$204.00 | — | 80% |
| Speech and language evaluation CPT 92523 HC 30 Min Speech Sound Lang Comprehen | $65.00 | $325.00 | $130.00–$260.00 | 89% below | 80% |
| Speech and language evaluation CPT 92523 Telehealth 60 Min Speech Sound Lang Comprehen | $115.60 | $578.00 | $231.20–$462.40 | 80% below | 80% |
| Speech and language evaluation CPT 92523 60 Min Speech Sound Lang Comprehen | $140.80 | $704.00 | $281.60–$563.20 | 76% below | 80% |
| Speech and language evaluation CPT 92523 HC 90 Min Speech Sound Lang Comprehen | $194.60 | $973.00 | $389.20–$778.40 | 67% below | 80% |
| Speech and language evaluation inpatient CPT 92523 HC 30 Min Speech Sound Lang Comprehen | $65.00 | $325.00 | $130.00–$260.00 | — | 80% |
| Speech and language evaluation inpatient CPT 92523 Telehealth 60 Min Speech Sound Lang Comprehen | $115.60 | $578.00 | $231.20–$462.40 | — | 80% |
| Speech and language evaluation inpatient CPT 92523 60 Min Speech Sound Lang Comprehen | $140.80 | $704.00 | $281.60–$563.20 | — | 80% |
| Speech and language evaluation inpatient CPT 92523 HC 90 Min Speech Sound Lang Comprehen | $194.60 | $973.00 | $389.20–$778.40 | — | 80% |
| Speech therapy session, individual CPT 92507 15 Min Indiv | $51.60 | $258.00 | $103.20–$206.40 | 86% below | 80% |
| Speech therapy session, individual CPT 92507 HC 15 Min Indiv | $54.20 | $271.00 | $108.40–$216.80 | 85% below | 80% |
| Speech therapy session, individual CPT 92507 HC Telehealth 60 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | 72% below | 80% |
| Speech therapy session, individual CPT 92507 HC Telehealth 30 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | 72% below | 80% |
| Speech therapy session, individual CPT 92507 HC Telehealth 45 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | 72% below | 80% |
| Speech therapy session, individual CPT 92507 HC Telehealth 90 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | 72% below | 80% |
| Speech therapy session, individual CPT 92507 45 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | 72% below | 80% |
| Speech therapy session, individual CPT 92507 30 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | 72% below | 80% |
| Speech therapy session, individual CPT 92507 HC Telehealth 75 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | 72% below | 80% |
| Speech therapy session, individual CPT 92507 HC 90 Min Speech Therapy-Adult & Peds | $108.40 | $542.00 | $216.80–$433.60 | 70% below | 80% |
| Speech therapy session, individual CPT 92507 HC 75 Min Speech Therapy-Adult & Peds | $108.40 | $542.00 | $216.80–$433.60 | 70% below | 80% |
| Speech therapy session, individual CPT 92507 30 Min Indiv | $108.40 | $542.00 | $216.80–$433.60 | 70% below | 80% |
| Speech therapy session, individual CPT 92507 60 Min Speech Therapy-Adult & Peds | $117.80 | $589.00 | $235.60–$471.20 | 67% below | 80% |
| Speech therapy session, individual CPT 92507 HC 45 Min Indiv | $119.40 | $597.00 | $238.80–$477.60 | 67% below | 80% |
| Speech therapy session, individual CPT 92507 HC 60 Min Indiv | $129.80 | $649.00 | $259.60–$519.20 | 64% below | 80% |
| Speech therapy session, individual inpatient CPT 92507 15 Min Indiv | $51.60 | $258.00 | $103.20–$206.40 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 HC 15 Min Indiv | $54.20 | $271.00 | $108.40–$216.80 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 HC Telehealth 60 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 30 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 45 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 HC Telehealth 30 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 HC Telehealth 45 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 HC Telehealth 75 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 HC Telehealth 90 Min Speech Therapy-Adult & Peds | $102.00 | $510.00 | $204.00–$408.00 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 HC 90 Min Speech Therapy-Adult & Peds | $108.40 | $542.00 | $216.80–$433.60 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 HC 75 Min Speech Therapy-Adult & Peds | $108.40 | $542.00 | $216.80–$433.60 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 30 Min Indiv | $108.40 | $542.00 | $216.80–$433.60 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 60 Min Speech Therapy-Adult & Peds | $117.80 | $589.00 | $235.60–$471.20 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 HC 45 Min Indiv | $119.40 | $597.00 | $238.80–$477.60 | — | 80% |
| Speech therapy session, individual inpatient CPT 92507 HC 60 Min Indiv | $129.80 | $649.00 | $259.60–$519.20 | — | 80% |
| Spirometry (breathing test) CPT 94010 HC Spirometry W/O Bd | $121.20 | $606.00 | $242.40–$484.80 | — | 80% |
| Spirometry (breathing test) CPT 94010 HC PR Bedside Pft W/No Bd | $121.20 | $606.00 | $242.40–$484.80 | — | 80% |
| Spirometry (breathing test) inpatient CPT 94010 HC Spirometry W/O Bd | $121.20 | $606.00 | $242.40–$484.80 | — | 80% |
| Spirometry (breathing test) inpatient CPT 94010 HC PR Bedside Pft W/No Bd | $121.20 | $606.00 | $242.40–$484.80 | — | 80% |
| Spirometry before and after a bronchodilator CPT 94060 HC Bronchospasm - Pre & Post Bd | $235.20 | $1,176.00 | $470.40–$940.80 | — | 80% |
| Spirometry before and after a bronchodilator CPT 94060 HC Bedside Pft W/Bd | $235.20 | $1,176.00 | $470.40–$940.80 | — | 80% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 HC Bedside Pft W/Bd | $235.20 | $1,176.00 | $470.40–$940.80 | — | 80% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 HC Bronchospasm - Pre & Post Bd | $235.20 | $1,176.00 | $470.40–$940.80 | — | 80% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC Telehealth 15 Min Ot Therapeutic Activities | $51.60 | $258.00 | $103.20–$206.40 | 66% below | 80% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC 15 Min Pt Therapeutic Activities | $51.60 | $258.00 | $103.20–$206.40 | 66% below | 80% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC Telehealth 15 Min Pt Therapeutic Activities | $51.60 | $258.00 | $103.20–$206.40 | 66% below | 80% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 15 Min Ot Therapeutic Activities | $51.60 | $258.00 | $103.20–$206.40 | 66% below | 80% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC 15 Min Pt Therapeutic Activities | $51.60 | $258.00 | $103.20–$206.40 | — | 80% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC Telehealth 15 Min Pt Therapeutic Activities | $51.60 | $258.00 | $103.20–$206.40 | — | 80% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC Telehealth 15 Min Ot Therapeutic Activities | $51.60 | $258.00 | $103.20–$206.40 | — | 80% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 15 Min Ot Therapeutic Activities | $51.60 | $258.00 | $103.20–$206.40 | — | 80% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC Phlebotomy Therapeu | $85.00 | $425.00 | $170.00–$340.00 | — | 80% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC Ts Phlebotomy Therapeu | $90.00 | $450.00 | $180.00–$360.00 | — | 80% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC Phlebotomy Therapeu | $85.00 | $425.00 | $170.00–$340.00 | — | 80% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC Ts Phlebotomy Therapeu | $90.00 | $450.00 | $180.00–$360.00 | — | 80% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Florida | Off list |
|---|---|---|---|---|---|
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 MRNA VACC (MODERNA) 50 MCG/0.5ML IM SUSY | $99.26 | $496.30 | $198.52–$397.04 | — | 80% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID-19 MRNA VACC (MODERNA) 50 MCG/0.5ML IM SUSY | $99.26 | $496.30 | $198.52–$397.04 | — | 80% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML INJ SUSR | $243.45 | $1,217.25 | $486.90–$973.80 | — | 80% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML INJ SUSR | $243.45 | $1,217.25 | $486.90–$973.80 | — | 80% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP | $40.32 | $201.60 | $80.64–$161.28 | — | 80% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP | $40.32 | $201.60 | $80.64–$161.28 | — | 80% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY | $6.75 | $33.75 | $13.50–$27.00 | — | 80% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY | $6.75 | $33.75 | $13.50–$27.00 | — | 80% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY | $176.68 | $883.40 | $353.36–$706.72 | — | 80% |
| Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY | $176.68 | $883.40 | $353.36–$706.72 | — | 80% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSY | $58.01 | $290.05 | $116.02–$232.04 | — | 80% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 50 UNIT/ML IM SUSP | $93.46 | $467.30 | $186.92–$373.84 | — | 80% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSY | $58.01 | $290.05 | $116.02–$232.04 | — | 80% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE 50 UNIT/ML IM SUSP | $93.46 | $467.30 | $186.92–$373.84 | — | 80% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR | $24.97 | $124.85 | $49.94–$99.88 | — | 80% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR | $24.97 | $124.85 | $49.94–$99.88 | — | 80% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY | $25.63 | $128.15 | $51.26–$102.52 | — | 80% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY | $25.63 | $128.15 | $51.26–$102.52 | — | 80% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC INJ SOLR | $118.25 | $591.25 | $236.50–$473.00 | — | 80% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC INJ SOLR | $118.25 | $591.25 | $236.50–$473.00 | — | 80% |
| Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENING ACY&W-135 TETANUS CONJ IM SOLN | $148.73 | $743.65 | $297.46–$594.92 | — | 80% |
| Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENING ACY&W-135 TETANUS CONJ IM SOLN | $148.73 | $743.65 | $297.46–$594.92 | — | 80% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY | $313.25 | $1,566.25 | $626.50–$1,253.00 | — | 80% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY | $313.25 | $1,566.25 | $626.50–$1,253.00 | — | 80% |
| Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VACCINE INACTIVATED INJ SUSP | $39.10 | $195.50 | $78.20–$156.40 | — | 80% |
| Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOVIRUS VACCINE INACTIVATED INJ SUSP | $39.10 | $195.50 | $78.20–$156.40 | — | 80% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR | $369.18 | $1,845.90 | $738.36–$1,476.72 | — | 80% |
| Rabies vaccine, one dose CPT 90675 RABIES VIRUS VACCINE, HDC IM SUSR | $470.31 | $2,351.55 | $940.62–$1,881.24 | — | 80% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC IM SUSR | $369.18 | $1,845.90 | $738.36–$1,476.72 | — | 80% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VIRUS VACCINE, HDC IM SUSR | $470.31 | $2,351.55 | $940.62–$1,881.24 | — | 80% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP | $41.57 | $207.85 | $83.14–$166.28 | — | 80% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP | $41.57 | $207.85 | $83.14–$166.28 | — | 80% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP | $52.19 | $260.95 | $104.38–$208.76 | — | 80% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY | $63.15 | $315.75 | $126.30–$252.60 | — | 80% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP | $52.19 | $260.95 | $104.38–$208.76 | — | 80% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY | $63.15 | $315.75 | $126.30–$252.60 | — | 80% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Immunization Admin | $57.40 | $287.00 | $114.80–$229.60 | — | 80% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Ucc Immunization Admin | $57.40 | $287.00 | $114.80–$229.60 | — | 80% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC Immunization Admin | $57.40 | $287.00 | $114.80–$229.60 | — | 80% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC Ucc Immunization Admin | $57.40 | $287.00 | $114.80–$229.60 | — | 80% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC Cc Immunization Adm; Ea Addtl Vaccine | $19.00 | $95.00 | $38.00–$76.00 | — | 80% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC Ucc Immunization Adm; Ea Addtl Vaccine | $19.00 | $95.00 | $38.00–$76.00 | — | 80% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC Immunization Adm; Ea Addtl Vaccine | $19.00 | $95.00 | $38.00–$76.00 | — | 80% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC Immunization Adm; Ea Addtl Vaccine | $19.00 | $95.00 | $38.00–$76.00 | — | 80% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC Ucc Immunization Adm; Ea Addtl Vaccine | $19.00 | $95.00 | $38.00–$76.00 | — | 80% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC Cc Immunization Adm; Ea Addtl Vaccine | $19.00 | $95.00 | $38.00–$76.00 | — | 80% |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.
Source file: https://www.leehealth.org/machine-readable-files-lh-2026/99-2646504_REHAB-HOSPITAL_standardcharges_20260401.zip