Hospital Richmond, VA

Bon Secours Memorial Regional Medical Center

Bon Secours Memorial Regional Medical Center in Mechanicsville, VA publishes cash prices for 448 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Virginia median for 283 of 445 procedures and below it for 124. By typical cash price it ranks #45 of 66 Virginia hospitals and #2 of 11 hospitals in the Richmond, VA area, cheapest first. Select a procedure to compare it with other hospitals nearby.

8260 Atlee Rd.,Mechanicsville,VA 23116 Collected Sep 23, 2026 Source price file Check a bill from this hospital (804) 764-6000

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 490069 · CMS hospital register NPI 1912969064

Financial assistance

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

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

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

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT Abd W&W/O Cont	$2,323.20	$3,872.00	—	23% above	40%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abd W&W/O Cont	$1,832.40	$3,054.00	—	—	40%
Abdominal X-ray, 2 views CPT 74019 HC X-Ray Exam Abdomen 2 Views	$307.80	$513.00	—	6% below	40%
Abdominal X-ray, 2 views inpatient CPT 74019 HC X-Ray Exam Abdomen 2 Views	$553.80	$923.00	—	—	40%
Ankle X-ray, complete, 3 or more views CPT 73610 HC X-Ray Ankle Rout 3 Views	$569.40	$949.00	—	69% above	40%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC X-Ray Ankle Rout 3 Views	$447.60	$746.00	—	—	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC Tcp02/Abi 1-2 Levels	$510.60	$851.00	—	32% above	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC Tcp02/Abi 1-2 Levels	$640.80	$1,068.00	—	—	40%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT Upper Extremity W/O Contrast	$1,824.60	$3,041.00	—	59% above	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT Upper Extremity W/O Contrast	$1,251.60	$2,086.00	—	—	40%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC Fluro Esophagram	$1,231.80	$2,053.00	—	154% above	40%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC Fluro Esophagram	$1,113.00	$1,855.00	—	—	40%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM Bone Scan Whole Body	$2,323.20	$3,872.00	—	67% above	40%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM Bone Scan Whole Body	$1,191.00	$1,985.00	—	—	40%
Breast ultrasound, complete, one breast CPT 76641 HC US Breast Comp	$717.00	$1,195.00	—	28% above	40%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US Breast Comp	$600.00	$1,000.00	—	—	40%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US Breast Ltd	$583.20	$972.00	—	18% above	40%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US Breast Ltd	$572.40	$954.00	—	—	40%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC Cta Abd & Pelvis W & W/O Cont	$3,399.00	$5,665.00	—	13% above	40%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC Cta Abd & Pelvis W & W/O Cont	$1,914.00	$3,190.00	—	—	40%
CT angiography (CTA) of the head CPT 70496 HC Cta Head W & W/O Cont	$2,505.60	$4,176.00	—	40% above	40%
CT angiography (CTA) of the head inpatient CPT 70496 HC Cta Head W & W/O Cont	$1,321.80	$2,203.00	—	—	40%
CT angiography (CTA) of the neck CPT 70498 HC Cta Neck/Carotid W & W/O Cont	$4,071.00	$6,785.00	—	111% above	40%
CT angiography (CTA) of the neck inpatient CPT 70498 HC Cta Neck/Carotid W & W/O Cont	$1,129.80	$1,883.00	—	—	40%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT Angio Chest W & W/O Cont	$2,503.80	$4,173.00	—	40% above	40%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT Angio Chest W & W/O Cont	$2,405.40	$4,009.00	—	—	40%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC Cta Heart W/WO Calcium	$2,494.80	$4,158.00	—	175% above	40%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC Cta Heart W/WO Calcium	$2,542.20	$4,237.00	—	—	40%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT Heart No Contrast Quant Eval Coronry Calcium	$129.00	$129.00	—	35% below	—
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT Heart No Contrast Quant Eval Coronry Calcium	$651.00	$651.00	—	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT Abd/Pelvis W/O Contrast	$2,201.40	$3,669.00	—	at median	40%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT Abd/Pelvis W/O Contrast	$2,295.00	$3,825.00	—	—	40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abd/Pel W Cont	$4,449.60	$7,416.00	—	44% above	40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abd/Pel W Cont	$2,972.40	$4,954.00	—	—	40%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Abd/Pelvis W W/O Contrast	$3,493.80	$5,823.00	—	1% above	40%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Abd/Pelvis W W/O Contrast	$2,581.80	$4,303.00	—	—	40%
CT scan of the abdomen with contrast CPT 74160 HC CT Abdomen W/ Cont	$2,604.00	$4,340.00	—	59% above	40%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT Abdomen W/ Cont	$1,723.80	$2,873.00	—	—	40%
CT scan of the abdomen without contrast CPT 74150 HC CT Abdomen W/O Cont	$1,969.20	$3,282.00	—	38% above	40%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT Abdomen W/O Cont	$1,391.40	$2,319.00	—	—	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT Facial Bones W/O Contrast	$1,481.40	$2,469.00	—	14% above	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT Facial Bones W/O Contrast	$1,274.40	$2,124.00	—	—	40%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT Brain W/O Contrast	$1,683.00	$2,805.00	—	27% above	40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Brain W/O Contrast	$976.80	$1,628.00	—	—	40%
CT scan of the head with contrast CPT 70460 HC CT Brain W/ Contrast	$2,964.00	$4,940.00	—	94% above	40%
CT scan of the head with contrast inpatient CPT 70460 HC CT Brain W/ Contrast	$612.60	$1,021.00	—	—	40%
CT scan of the head without and with contrast CPT 70470 HC CT Brain W/WO Contrast	$2,741.40	$4,569.00	—	56% above	40%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT Brain W/WO Contrast	$1,744.20	$2,907.00	—	—	40%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT L-Spine W/O Contrast	$1,447.80	$2,413.00	—	9% below	40%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT L-Spine W/O Contrast	$1,210.80	$2,018.00	—	—	40%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT C-Spine W/O Contrast	$1,830.60	$3,051.00	—	14% above	40%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT C-Spine W/O Contrast	$1,458.00	$2,430.00	—	—	40%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/ Contrast	$2,887.80	$4,813.00	—	70% above	40%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/ Contrast	$1,646.40	$2,744.00	—	—	40%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC Extracranial Bilat Study	$792.60	$1,321.00	—	—	40%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC Extracranial Bilat Study	$970.80	$1,618.00	—	—	40%
Chest X-ray, 2 views CPT 71046 HC X-Ray Exam Chest 2 Views	$485.40	$809.00	—	72% above	40%
Chest X-ray, 2 views inpatient CPT 71046 HC X-Ray Exam Chest 2 Views	$960.60	$1,601.00	—	—	40%
Chest X-ray, single view CPT 71045 HC X-Ray Exam Chest 1 View	$243.60	$406.00	—	4% above	40%
Chest X-ray, single view inpatient CPT 71045 HC X-Ray Exam Chest 1 View	$332.40	$554.00	—	—	40%
Collarbone (clavicle) X-ray, complete CPT 73000 HC X-Ray Clavicle	$775.20	$1,292.00	—	161% above	40%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC X-Ray Clavicle	$622.20	$1,037.00	—	—	40%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US Retroperitoneal Complete	$1,407.60	$2,346.00	—	121% above	40%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US Retroperitoneal Complete	$2,352.60	$3,921.00	—	—	40%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC Dexa Axial Skeleton	$898.20	$1,497.00	—	53% above	40%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC Dexa Axial Skeleton	$898.20	$1,497.00	—	—	40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Chest W/O Contrast	$1,629.60	$2,716.00	—	19% above	40%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT Chest W/O Contrast	$898.80	$1,498.00	—	—	40%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT Chest W/ Contrast	$1,986.60	$3,311.00	—	15% above	40%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT Chest W/ Contrast	$3,035.40	$5,059.00	—	—	40%
Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammo Dgx Bilateral Incl Cad if Perf	$433.80	$723.00	—	—	40%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammo Dgx Bilateral Incl Cad if Perf	$433.80	$723.00	—	—	40%
Diagnostic mammogram, one breast one side CPT 77065 HC Mammo Dgx Unilateral Incl Cad if Perf	$340.80	$568.00	—	at median	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammo Dgx Unilateral Incl Cad if Perf	$340.80	$568.00	—	—	40%
Duplex ultrasound of the leg arteries, both legs CPT 93925 HC Bil Niv Arterial Low Ext Duplex	$1,420.20	$2,367.00	—	at median	40%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 HC Bil Niv Arterial Low Ext Duplex	$1,244.40	$2,074.00	—	—	40%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC Niv Venous Duplex Bilat Study	$2,194.80	$3,658.00	—	—	40%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC Niv Venous Duplex Bilat Study	$1,473.00	$2,455.00	—	—	40%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC 2d Echo Without Contrast - With Dop/Color Flow	$3,630.60	$6,051.00	—	110% above	40%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC 2d Echo Without Contrast - With Dop/Color Flow	$2,138.40	$3,564.00	—	—	40%
Elbow X-ray, 2 views CPT 73070 HC Elbow 2 Views	$345.60	$576.00	—	29% above	40%
Elbow X-ray, 2 views inpatient CPT 73070 HC Elbow 2 Views	$357.60	$596.00	—	—	40%
Elbow X-ray, complete, 3 or more views CPT 73080 HC Elbow Min 3 Views	$762.60	$1,271.00	—	81% above	40%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC Elbow Min 3 Views	$568.80	$948.00	—	—	40%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT Orbit/Ear/Fossa W/O Contrast	$3,354.00	$5,590.00	—	148% above	40%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT Orbit/Ear/Fossa W/O Contrast	$1,330.20	$2,217.00	—	—	40%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC Facial Bones Min 3 Views	$664.20	$1,107.00	—	28% above	40%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC Facial Bones Min 3 Views	$597.00	$995.00	—	—	40%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC Forearm 2 Views	$496.20	$827.00	—	51% above	40%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC Forearm 2 Views	$408.00	$680.00	—	—	40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM Hepatobiliary Imaging WO Pharm	$3,612.00	$6,020.00	—	218% above	40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM Hepatobiliary Imaging WO Pharm	$930.00	$1,550.00	—	—	40%
Hand X-ray, 2 views CPT 73120 HC Hand 2 Views	$481.20	$802.00	—	91% above	40%
Hand X-ray, 2 views inpatient CPT 73120 HC Hand 2 Views	$438.00	$730.00	—	—	40%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC X-Ray Os Calcis Min 2 Views	$543.60	$906.00	—	94% above	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC X-Ray Os Calcis Min 2 Views	$432.60	$721.00	—	—	40%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC Sleep Study Unatt & Resp Efft	$718.80	$1,198.00	—	57% above	40%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC Sleep Study Unatt & Resp Efft	$718.80	$1,198.00	—	—	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC Adult Cpap Titration Study	$5,884.80	$9,808.00	—	163% above	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC Adult Cpap Titration Study	$5,884.80	$9,808.00	—	—	40%
Knee X-ray, 3 views CPT 73562 HC X-Ray Knee 3 Views	$645.00	$1,075.00	—	93% above	40%
Knee X-ray, 3 views inpatient CPT 73562 HC X-Ray Knee 3 Views	$460.20	$767.00	—	—	40%
Knee X-ray, complete, 4 or more views CPT 73564 HC X-Ray Knee Rout Inc Tun Pat Min 4 View	$1,069.80	$1,783.00	—	146% above	40%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC X-Ray Knee Rout Inc Tun Pat Min 4 View	$708.00	$1,180.00	—	—	40%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT Lower Ext W/O Cont	$1,528.20	$2,547.00	—	27% above	40%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT Lower Ext W/O Cont	$1,263.60	$2,106.00	—	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US Abdominal Limited	$868.20	$1,447.00	—	32% above	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US Abdominal Limited	$1,583.40	$2,639.00	—	—	40%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US Extrem Limited Nonvasc	$615.60	$1,026.00	—	101% above	40%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US Extrem Limited Nonvasc	$566.40	$944.00	—	—	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT Chest Screening Low Dose Wout Cont	$313.20	$522.00	—	11% above	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT Chest Screening Low Dose Wout Cont	$301.80	$503.00	—	—	40%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC X-Ray Tibia/Fibula 2 Views	$809.40	$1,349.00	—	160% above	40%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC X-Ray Tibia/Fibula 2 Views	$557.40	$929.00	—	—	40%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRI-Angio Head WO Contrast	$2,284.80	$3,808.00	—	at median	40%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRI-Angio Head WO Contrast	$607.80	$1,013.00	—	—	40%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Lower Ext Jnt W/O Cont	$2,225.40	$3,709.00	—	15% above	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Lower Ext Jnt W/O Cont	$1,884.00	$3,140.00	—	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI Lower Ext Jnt W&W/O Cont	$4,688.40	$7,814.00	—	37% above	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI Lower Ext Jnt W&W/O Cont	$2,434.20	$4,057.00	—	—	40%
MRI of the abdomen without contrast CPT 74181 HC MRI-Abdomen WO Contrast	$2,527.20	$4,212.00	—	55% above	40%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI-Abdomen WO Contrast	$1,722.60	$2,871.00	—	—	40%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI-Abdomen W & WO Contrast	$3,352.80	$5,588.00	—	17% above	40%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI-Abdomen W & WO Contrast	$4,324.80	$7,208.00	—	—	40%
MRI of the brain, no contrast dye CPT 70551 HC MRI Brain WO Ctrst	$2,070.00	$3,450.00	—	7% above	40%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain WO Ctrst	$1,244.40	$2,074.00	—	—	40%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI-Brain WO & W Contrast	$3,297.60	$5,496.00	—	21% above	40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI-Brain WO & W Contrast	$1,440.00	$2,400.00	—	—	40%
MRI of the lower back, no contrast dye CPT 72148 HC MRI-Spine Lumbar WO Contrast	$1,954.80	$3,258.00	—	2% below	40%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI-Spine Lumbar WO Contrast	$1,483.80	$2,473.00	—	—	40%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI-Spine Lumbar WO & W Cont	$3,340.20	$5,567.00	—	1% above	40%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI-Spine Lumbar WO & W Cont	$2,267.40	$3,779.00	—	—	40%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI-Spine Thoracic WO Contrast	$2,289.60	$3,816.00	—	14% above	40%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI-Spine Thoracic WO Contrast	$1,229.40	$2,049.00	—	—	40%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI-Spine Cervical W & WO Cont	$3,340.20	$5,567.00	—	2% above	40%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI-Spine Cervical W & WO Cont	$1,648.80	$2,748.00	—	—	40%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI-Spine Cervical WO Contrast	$2,087.40	$3,479.00	—	4% above	40%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI-Spine Cervical WO Contrast	$1,229.40	$2,049.00	—	—	40%
MRI of the pelvis without and with contrast CPT 72197 HC MRI-Pelvis WO & W Contrast	$3,834.60	$6,391.00	—	21% above	40%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI-Pelvis WO & W Contrast	$1,935.60	$3,226.00	—	—	40%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI-Pelvis WO Contrast	$2,658.00	$4,430.00	—	43% above	40%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI-Pelvis WO Contrast	$1,595.40	$2,659.00	—	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI-Upper Ext Jnt WO Cont	$2,204.40	$3,674.00	—	14% above	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI-Upper Ext Jnt WO Cont	$1,741.20	$2,902.00	—	—	40%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC C-Spine Min 4 Views	$1,011.60	$1,686.00	—	109% above	40%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC C-Spine Min 4 Views	$816.60	$1,361.00	—	—	40%
Neck soft tissue CT scan with contrast CPT 70491 HC CT Soft Tissue Neck W/ Contrast	$2,194.80	$3,658.00	—	31% above	40%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT Soft Tissue Neck W/ Contrast	$1,338.00	$2,230.00	—	—	40%
Neck soft tissue CT scan without contrast CPT 70490 HC CT Soft Tissue Neck W/O Contrast	$1,852.20	$3,087.00	—	117% above	40%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT Soft Tissue Neck W/O Contrast	$1,291.80	$2,153.00	—	—	40%
Neck soft tissue X-ray CPT 70360 HC Soft Tissue Lat Neck	$647.40	$1,079.00	—	88% above	40%
Neck soft tissue X-ray inpatient CPT 70360 HC Soft Tissue Lat Neck	$495.00	$825.00	—	—	40%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM Sest. Rest Stress Mult	$5,660.40	$9,434.00	—	79% above	40%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM Sest. Rest Stress Mult	$1,918.80	$3,198.00	—	—	40%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC Pet/CT Skull Base to Mid Thigh	$7,013.40	$11,689.00	—	59% above	40%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC Pet/CT Skull Base to Mid Thigh	$7,013.40	$11,689.00	—	—	40%
Pelvic CT scan without contrast CPT 72192 HC CT Pelvis W/O Contrast	$1,810.20	$3,017.00	—	23% above	40%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT Pelvis W/O Contrast	$1,330.20	$2,217.00	—	—	40%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US Pelvis Limited	$759.60	$1,266.00	—	77% above	40%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US Pelvis Limited	$756.00	$1,260.00	—	—	40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US Pelvis Complete	$1,611.00	$2,685.00	—	119% above	40%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US Pelvis Complete	$1,154.40	$1,924.00	—	—	40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC Fetal Eval 2-3 Trim Sgl Gest	$1,944.60	$3,241.00	—	222% above	40%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC Fetal Eval 2-3 Trim Sgl Gest	$1,105.80	$1,843.00	—	—	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC Fetal Eval 1st Tri Sgl Gest	$890.40	$1,484.00	—	86% above	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC Fetal Eval 1st Tri Sgl Gest	$890.40	$1,484.00	—	—	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US Fetal Evaluation-Limited	$829.80	$1,383.00	—	75% above	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US Fetal Evaluation-Limited	$600.60	$1,001.00	—	—	40%
Rib X-ray, one side, 2 views one side CPT 71100 HC Ribs Unilateral 2 Views	$448.80	$748.00	—	36% above	40%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC Ribs Unilateral 2 Views	$448.80	$748.00	—	—	40%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC X-Ray, Ribs, Pa Chest, 3	$924.00	$1,540.00	—	125% above	40%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC X-Ray, Ribs, Pa Chest, 3	$692.40	$1,154.00	—	—	40%
Screening mammogram, both breasts CPT 77067 HC Mammo Screening Incl Cad if Perf	$471.00	$785.00	—	13% above	40%
Screening mammogram, both breasts inpatient CPT 77067 HC Mammo Screening Incl Cad if Perf	$201.60	$336.00	—	—	40%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC Shoulder Complete Min 2 Views	$759.60	$1,266.00	—	138% above	40%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC Shoulder Complete Min 2 Views	$567.00	$945.00	—	—	40%
Sinus X-ray, complete, 3 or more views CPT 70220 HC Sinuses Min 3 Views	$995.40	$1,659.00	—	104% above	40%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC Sinuses Min 3 Views	$721.20	$1,202.00	—	—	40%
Skull X-ray, fewer than 4 views CPT 70250 HC Skull Less Than 4 Views	$642.00	$1,070.00	—	86% above	40%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC Skull Less Than 4 Views	$571.80	$953.00	—	—	40%
Sleep study in a lab (polysomnography) CPT 95810 HC Adult Sleep Study (Polysomnogram)	$5,349.00	$8,915.00	—	144% above	40%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Adult Sleep Study (Polysomnogram)	$5,349.00	$8,915.00	—	—	40%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC 2d Echo Stress Tst Rest&Cardio	$2,269.80	$3,783.00	—	32% above	40%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC 2d Echo Stress Tst Rest&Cardio	$2,269.80	$3,783.00	—	—	40%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC Dysphagia/Swallowing Study	$620.40	$1,034.00	—	28% above	40%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC Dysphagia/Swallowing Study	$942.00	$1,570.00	—	—	40%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-Ray Exam of Femur Min 2 Views	$776.40	$1,294.00	—	154% above	40%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC X-Ray Exam of Femur Min 2 Views	$465.60	$776.00	—	—	40%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT T-Spine W/O Contrast	$1,689.00	$2,815.00	—	5% above	40%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT T-Spine W/O Contrast	$852.00	$1,420.00	—	—	40%
Toe X-ray, 2 or more views CPT 73660 HC X-Ray Toes Min 2 Views	$430.80	$718.00	—	72% above	40%
Toe X-ray, 2 or more views inpatient CPT 73660 HC X-Ray Toes Min 2 Views	$323.40	$539.00	—	—	40%
Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal, Non OB	$1,605.00	$2,675.00	—	175% above	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal, Non OB	$1,364.40	$2,274.00	—	—	40%
Transvaginal ultrasound during pregnancy CPT 76817 HC US Transvaginal Obsetrical	$1,213.80	$2,023.00	—	153% above	40%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US Transvaginal Obsetrical	$1,838.40	$3,064.00	—	—	40%
Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete	$1,733.40	$2,889.00	—	100% above	40%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Abdomen Complete	$2,041.20	$3,402.00	—	—	40%
Ultrasound of the scrotum and testicles CPT 76870 HC US Scrotum & Contents	$1,098.00	$1,830.00	—	54% above	40%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US Scrotum & Contents	$1,823.40	$3,039.00	—	—	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC Soft Tissue Neck US	$945.60	$1,576.00	—	53% above	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC Soft Tissue Neck US	$588.00	$980.00	—	—	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC Rad Exam Upr GI Tract Single Contrast Study	$831.60	$1,386.00	—	at median	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC Rad Exam Upr GI Tract Single Contrast Study	$1,529.40	$2,549.00	—	—	40%
Upper arm X-ray (humerus), 2 views CPT 73060 HC Humerus Min 2 View	$594.60	$991.00	—	76% above	40%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC Humerus Min 2 View	$456.60	$761.00	—	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC Niv Venous Duplex Uni/Ltd Study	$1,344.60	$2,241.00	—	82% above	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC Niv Venous Duplex Uni/Ltd Study	$1,065.60	$1,776.00	—	—	40%
Wrist X-ray, 2 views CPT 73100 HC Xr Wrist 2 Views	$534.60	$891.00	—	110% above	40%
Wrist X-ray, 2 views inpatient CPT 73100 HC Xr Wrist 2 Views	$426.00	$710.00	—	—	40%
Wrist X-ray, complete, 3 or more views CPT 73110 HC Wrist Min 3 Views	$662.40	$1,104.00	—	116% above	40%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC Wrist Min 3 Views	$545.40	$909.00	—	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-Ray Exam Hip Uni 2-3 Views	$487.20	$812.00	—	94% above	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC X-Ray Exam Hip Uni 2-3 Views	$452.40	$754.00	—	—	40%
X-ray of the abdomen, 1 view CPT 74018 HC X-Ray Exam Abdomen 1 View	$620.40	$1,034.00	—	124% above	40%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC X-Ray Exam Abdomen 1 View	$640.80	$1,068.00	—	—	40%
X-ray of the ankle, 2 views CPT 73600 HC X-Ray Ankle 2 Views	$578.40	$964.00	—	115% above	40%
X-ray of the ankle, 2 views inpatient CPT 73600 HC X-Ray Ankle 2 Views	$431.40	$719.00	—	—	40%
X-ray of the finger(s), 2 or more views CPT 73140 HC Fingers Min 2 Views	$614.40	$1,024.00	—	158% above	40%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC Fingers Min 2 Views	$457.20	$762.00	—	—	40%
X-ray of the foot, 2 views CPT 73620 HC X-Ray Foot 2 Views	$385.80	$643.00	—	30% above	40%
X-ray of the foot, 2 views inpatient CPT 73620 HC X-Ray Foot 2 Views	$361.80	$603.00	—	—	40%
X-ray of the foot, complete, 3 or more views CPT 73630 HC X-Ray Foot Min 3 Views Complete	$576.00	$960.00	—	82% above	40%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC X-Ray Foot Min 3 Views Complete	$890.40	$1,484.00	—	—	40%
X-ray of the hand, 3 or more views CPT 73130 HC Hand Routine Min 3 Views	$712.80	$1,188.00	—	139% above	40%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC Hand Routine Min 3 Views	$474.00	$790.00	—	—	40%
X-ray of the knee, 1 or 2 views CPT 73560 HC X-Ray Knee 1-2 Views	$445.80	$743.00	—	70% above	40%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC X-Ray Knee 1-2 Views	$366.60	$611.00	—	—	40%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC L-Spine 2-3 Views	$868.20	$1,447.00	—	137% above	40%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC L-Spine 2-3 Views	$1,279.80	$2,133.00	—	—	40%
X-ray of the lower back, 4 or more views CPT 72110 HC L-Spine Min 4 Views	$1,033.80	$1,723.00	—	96% above	40%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC L-Spine Min 4 Views	$844.20	$1,407.00	—	—	40%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC T-Spine 2 Views	$924.00	$1,540.00	—	181% above	40%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC T-Spine 2 Views	$741.60	$1,236.00	—	—	40%
X-ray of the nasal bones, 3 or more views CPT 70160 HC Nasal Bones Min 3 Views	$511.80	$853.00	—	79% above	40%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC Nasal Bones Min 3 Views	$462.60	$771.00	—	—	40%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC C-Spine 2-3 Views	$591.60	$986.00	—	58% above	40%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC C-Spine 2-3 Views	$477.00	$795.00	—	—	40%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC Pelvis Ap Only	$603.60	$1,006.00	—	84% above	40%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC Pelvis Ap Only	$448.80	$748.00	—	—	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC Sacrum and Coccyx Min 2 Views	$776.40	$1,294.00	—	85% above	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC Sacrum and Coccyx Min 2 Views	$616.20	$1,027.00	—	—	40%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
ACTH blood test CPT 82024 HC So Acth	$205.80	$343.00	—	12% below	40%
ACTH blood test inpatient CPT 82024 HC So Acth	$305.40	$509.00	—	—	40%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC So Sgpt (Alt)	$16.80	$28.00	—	66% below	40%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC Sgpt (Alt)	$50.40	$84.00	—	1% above	40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC So Sgpt (Alt)	$16.80	$28.00	—	—	40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC Sgpt (Alt)	$54.00	$90.00	—	—	40%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC So Sgot (Ast)	$16.80	$28.00	—	66% below	40%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC Transferase Aspartate Amino Ast Sgot	$50.40	$84.00	—	1% above	40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC So Sgot (Ast)	$16.80	$28.00	—	—	40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC Transferase Aspartate Amino Ast Sgot	$54.00	$90.00	—	—	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC Acute Hepatitis Panel	$288.60	$481.00	—	at median	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC Acute Hepatitis Panel	$327.60	$546.00	—	—	40%
Albumin blood test CPT 82040 HC So Albumin	$34.20	$57.00	—	13% below	40%
Albumin blood test CPT 82040 HC Albumin Serum Plasma/Whole Blood	$73.80	$123.00	—	88% above	40%
Albumin blood test inpatient CPT 82040 HC So Albumin	$74.40	$124.00	—	—	40%
Albumin blood test inpatient CPT 82040 HC Albumin Serum Plasma/Whole Blood	$110.40	$184.00	—	—	40%
Aldosterone blood test CPT 82088 HC So Aldosterone, Serum	$213.00	$355.00	—	21% above	40%
Aldosterone blood test inpatient CPT 82088 HC So Aldosterone, Serum	$213.00	$355.00	—	—	40%
Alkaline phosphatase (ALP) blood test CPT 84075 HC Alkaline Phosphatase	$32.40	$54.00	—	12% below	40%
Alkaline phosphatase (ALP) blood test CPT 84075 HC So Alkaline Phosphatase	$36.00	$60.00	—	2% below	40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC So Alkaline Phosphatase	$36.60	$61.00	—	—	40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC Alkaline Phosphatase	$37.20	$62.00	—	—	40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC So1 Allergen Specific	$26.40	$44.00	—	7% above	40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC So Allergen Specific	$45.00	$75.00	—	82% above	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC So1 Allergen Specific	$26.40	$44.00	—	—	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC So Allergen Specific	$45.00	$75.00	—	—	40%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC So Alpha Fetoprotein	$175.20	$292.00	—	58% above	40%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC So Alpha Fetoprotein	$181.80	$303.00	—	—	40%
Ammonia blood test CPT 82140 HC Ammonia	$90.60	$151.00	—	1% below	40%
Ammonia blood test inpatient CPT 82140 HC Ammonia	$178.80	$298.00	—	—	40%
Amylase blood test CPT 82150 HC Amylase	$40.20	$67.00	—	28% below	40%
Amylase blood test CPT 82150 HC So Amylase	$40.20	$67.00	—	28% below	40%
Amylase blood test inpatient CPT 82150 HC So Amylase	$40.20	$67.00	—	—	40%
Amylase blood test inpatient CPT 82150 HC Amylase	$148.20	$247.00	—	—	40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC So Cyclic Citrullinated Peptd,Ab	$121.20	$202.00	—	66% above	40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC So Cyclic Citrullinated Peptd,Ab	$121.20	$202.00	—	—	40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC So Anti Nuclear Antibody	$145.20	$242.00	—	6% above	40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC So Anti Nuclear Antibody	$145.20	$242.00	—	—	40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC Natriuretic Peptide	$150.00	$250.00	—	23% below	40%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC Natriuretic Peptide	$263.40	$439.00	—	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC So Body Fluid Culture	$49.80	$83.00	—	28% below	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Cul Bact Xcpt Urine Blood/Stool Aerobic Isol	$71.40	$119.00	—	4% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Culture, Aerobic	$127.80	$213.00	—	85% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC So Body Fluid Culture	$49.80	$83.00	—	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Cul Bact Xcpt Urine Blood/Stool Aerobic Isol	$75.00	$125.00	—	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Culture, Aerobic	$240.60	$401.00	—	—	40%
Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel Calcium Total	$58.20	$97.00	—	22% below	40%
Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel Calcium Total	$171.00	$285.00	—	—	40%
Bilirubin blood test, total CPT 82247 HC Bilirubin Total	$84.00	$140.00	—	88% above	40%
Bilirubin blood test, total inpatient CPT 82247 HC Bilirubin Total	$183.60	$306.00	—	—	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC Tissue Level IV	$217.80	$363.00	—	at median	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC So Tissue Level IV	$259.80	$433.00	—	19% above	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC Tissue Level IV	$152.40	$254.00	—	—	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC So Tissue Level IV	$259.80	$433.00	—	—	40%
Blood culture for bacteria CPT 87040 HC Culture Blood	$57.60	$96.00	—	44% below	40%
Blood culture for bacteria inpatient CPT 87040 HC Culture Blood	$280.20	$467.00	—	—	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Collection Venous Blood Venipuncture	$26.40	$44.00	—	51% above	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Collection Venous Blood Venipuncture	$37.80	$63.00	—	—	40%
Blood glucose (sugar) test CPT 82947 HC Glucose, Fasting	$37.80	$63.00	—	16% below	40%
Blood glucose (sugar) test inpatient CPT 82947 HC Glucose, Fasting	$39.60	$66.00	—	—	40%
Blood lead test CPT 83655 HC So Lead	$70.20	$117.00	—	11% above	40%
Blood lead test inpatient CPT 83655 HC So Lead	$115.80	$193.00	—	—	40%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC Gonadotropin, Chorionic (Hcg) Qualitative	$184.20	$307.00	—	75% above	40%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC Gonadotropin, Chorionic (Hcg) Qualitative	$186.60	$311.00	—	—	40%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC Blood Typing, Abo	$90.60	$151.00	—	at median	40%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC Blood Typing, Abo	$133.20	$222.00	—	—	40%
Blood urea nitrogen (BUN) test CPT 84520 HC Assay of Urea Nitrogen Quantitative	$27.60	$46.00	—	47% below	40%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Assay of Urea Nitrogen Quantitative	$28.80	$48.00	—	—	40%
C-peptide blood test CPT 84681 HC So Peptide,C	$104.40	$174.00	—	4% below	40%
C-peptide blood test inpatient CPT 84681 HC So Peptide,C	$104.40	$174.00	—	—	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-Reactive Protein	$273.00	$455.00	—	219% above	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-Reactive Protein	$300.60	$501.00	—	—	40%
C. difficile toxin gene test (stool PCR) CPT 87493 HC Inf Agent Det Nucleic Acid Clostridium Amp Probe	$213.60	$356.00	—	69% above	40%
C. difficile toxin gene test (stool PCR) CPT 87493 HC So Clost Diff,Toxin Gene,Amp Prbe	$213.60	$356.00	—	69% above	40%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC So Clost Diff,Toxin Gene,Amp Prbe	$213.60	$356.00	—	—	40%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC Inf Agent Det Nucleic Acid Clostridium Amp Probe	$224.40	$374.00	—	—	40%
CA 19-9 blood test (tumor marker) CPT 86301 HC So Carbohydrate Antigen 19-9	$187.80	$313.00	—	83% above	40%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC So Carbohydrate Antigen 19-9	$193.80	$323.00	—	—	40%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC Immunoassay Tumor Antigen Quantitative Ca 125	$82.80	$138.00	—	32% below	40%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC So Ca 125	$120.00	$200.00	—	2% below	40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC Immunoassay Tumor Antigen Quantitative Ca 125	$82.80	$138.00	—	—	40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC So Ca 125	$120.00	$200.00	—	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC So Iadna Sars-Cov-2-19 Amp Probe Tq	$130.20	$217.00	—	69% above	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC So Iadna Sars-Cov-2-19 Amp Probe Tq	$130.20	$217.00	—	—	40%
Calcium blood test, total CPT 82310 HC Calcium Total	$40.80	$68.00	—	at median	40%
Calcium blood test, total inpatient CPT 82310 HC Calcium Total	$50.40	$84.00	—	—	40%
Carcinoembryonic antigen (CEA) test CPT 82378 HC Carcinoembryonic Antigen Cea	$115.20	$192.00	—	at median	40%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC Carcinoembryonic Antigen Cea	$156.00	$260.00	—	—	40%
Chickenpox (varicella) immunity blood test CPT 86787 HC So Varicella Igg Igm	$84.00	$140.00	—	20% below	40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC So Varicella Igg Igm	$84.00	$140.00	—	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC Chlamydia Amp Probe Tech, 1	$185.40	$309.00	—	40% above	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC Chlamydia Amp Probe Tech, 1	$187.80	$313.00	—	—	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel	$73.80	$123.00	—	13% below	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel	$168.60	$281.00	—	—	40%
Complete blood count (CBC) with differential CPT 85025 HC So Cbc	$28.80	$48.00	—	at median	40%
Complete blood count (CBC) with differential CPT 85025 HC POC Cbc	$54.00	$90.00	—	88% above	40%
Complete blood count (CBC) with differential CPT 85025 HC Cbc	$63.60	$106.00	—	121% above	40%
Complete blood count (CBC) with differential inpatient CPT 85025 HC So Cbc	$28.80	$48.00	—	—	40%
Complete blood count (CBC) with differential inpatient CPT 85025 HC POC Cbc	$54.00	$90.00	—	—	40%
Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc	$108.60	$181.00	—	—	40%
Complete blood count (CBC), no differential CPT 85027 HC Cbc (Hemogram)	$108.60	$181.00	—	32% above	40%
Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc (Hemogram)	$93.60	$156.00	—	—	40%
Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel	$70.80	$118.00	—	58% below	40%
Comprehensive metabolic panel (blood test) CPT 80053 HC So Comp Metabolic Panel	$97.80	$163.00	—	43% below	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC So Comp Metabolic Panel	$97.80	$163.00	—	—	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel	$397.80	$663.00	—	—	40%
Cortisol blood test, total CPT 82533 HC So Cortisol,Serum	$67.20	$112.00	—	23% below	40%
Cortisol blood test, total CPT 82533 HC Cortisol Total	$100.80	$168.00	—	16% above	40%
Cortisol blood test, total inpatient CPT 82533 HC So Cortisol,Serum	$67.20	$112.00	—	—	40%
Cortisol blood test, total inpatient CPT 82533 HC Cortisol Total	$198.60	$331.00	—	—	40%
Creatine kinase (CK) blood test, total CPT 82550 HC So Cpk (CK)	$46.80	$78.00	—	26% below	40%
Creatine kinase (CK) blood test, total CPT 82550 HC Creatine Kinase Total	$50.40	$84.00	—	21% below	40%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC So Cpk (CK)	$46.80	$78.00	—	—	40%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC Creatine Kinase Total	$121.20	$202.00	—	—	40%
Creatinine blood test CPT 82565 HC Creatinine,Serum	$78.00	$130.00	—	22% above	40%
Creatinine blood test inpatient CPT 82565 HC Creatinine,Serum	$25.80	$43.00	—	—	40%
Cytomegalovirus (CMV) antibody test CPT 86644 HC So Cytomegalovirus, Igg Antibody	$84.00	$140.00	—	23% above	40%
Cytomegalovirus (CMV) antibody test CPT 86644 HC Antibody Cytomegalovirus Cmv	$99.60	$166.00	—	46% above	40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC So Cytomegalovirus, Igg Antibody	$150.60	$251.00	—	—	40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC Antibody Cytomegalovirus Cmv	$158.40	$264.00	—	—	40%
D-dimer blood test (blood clot marker) CPT 85379 HC So D-Dimer, Quantitative	$60.00	$100.00	—	62% below	40%
D-dimer blood test (blood clot marker) CPT 85379 HC Fibrin Dgradj Products D-Dimer Quantitative	$199.20	$332.00	—	27% above	40%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC So D-Dimer, Quantitative	$60.00	$100.00	—	—	40%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC Fibrin Dgradj Products D-Dimer Quantitative	$133.80	$223.00	—	—	40%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC So Dhea Sulfate	$154.80	$258.00	—	29% above	40%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC So Dhea Sulfate	$167.40	$279.00	—	—	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Drug Tst Prsmv Instrmnt Chem Analyzers PR Date	$180.00	$300.00	—	17% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC So Drg Scrn Class List A	$321.60	$536.00	—	110% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC So2 Drg Scrn Class List A	$361.80	$603.00	—	136% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC So1 Drg Scrn Class List A	$361.80	$603.00	—	136% above	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC So Drg Scrn Class List A	$330.00	$550.00	—	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC So2 Drg Scrn Class List A	$361.80	$603.00	—	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC So1 Drg Scrn Class List A	$361.80	$603.00	—	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Drug Tst Prsmv Instrmnt Chem Analyzers PR Date	$660.60	$1,101.00	—	—	40%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC Electrolyte Panel	$51.60	$86.00	—	46% below	40%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC Electrolyte Panel	$51.60	$86.00	—	—	40%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC So Epstein-Barr Virus Vca	$138.00	$230.00	—	49% above	40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC So Epstein-Barr Virus Vca	$153.00	$255.00	—	—	40%
Estradiol blood test CPT 82670 HC Assay of Total Estradiol	$113.40	$189.00	—	7% below	40%
Estradiol blood test CPT 82670 HC So Estradiol	$240.00	$400.00	—	96% above	40%
Estradiol blood test inpatient CPT 82670 HC Assay of Total Estradiol	$113.40	$189.00	—	—	40%
Estradiol blood test inpatient CPT 82670 HC So Estradiol	$240.00	$400.00	—	—	40%
FSH (follicle-stimulating hormone) test CPT 83001 HC Gonadotropin Follicle Stimulating Hormone	$142.80	$238.00	—	35% above	40%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC Gonadotropin Follicle Stimulating Hormone	$154.80	$258.00	—	—	40%
Fecal calprotectin (stool inflammation test) CPT 83993 HC So Calprotectin Fecal	$301.80	$503.00	—	148% above	40%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC So Calprotectin Fecal	$340.80	$568.00	—	—	40%
Ferritin blood test (iron stores) CPT 82728 HC Assay of Ferritin	$178.80	$298.00	—	39% above	40%
Ferritin blood test (iron stores) inpatient CPT 82728 HC Assay of Ferritin	$138.60	$231.00	—	—	40%
Fibrinogen blood test CPT 85384 HC So Fibrinogen	$38.40	$64.00	—	54% below	40%
Fibrinogen blood test CPT 85384 HC Fibrinogen Activity	$78.60	$131.00	—	6% below	40%
Fibrinogen blood test inpatient CPT 85384 HC So Fibrinogen	$38.40	$64.00	—	—	40%
Fibrinogen blood test inpatient CPT 85384 HC Fibrinogen Activity	$183.00	$305.00	—	—	40%
Folate (folic acid) blood test CPT 82746 HC So1 Folic Acid Serum	$46.80	$78.00	—	57% below	40%
Folate (folic acid) blood test CPT 82746 HC Assay of Folic Acid Serum	$84.60	$141.00	—	22% below	40%
Folate (folic acid) blood test CPT 82746 HC So Folic Acid, Serum	$84.60	$141.00	—	22% below	40%
Folate (folic acid) blood test inpatient CPT 82746 HC So1 Folic Acid Serum	$46.80	$78.00	—	—	40%
Folate (folic acid) blood test inpatient CPT 82746 HC So Folic Acid, Serum	$84.60	$141.00	—	—	40%
Folate (folic acid) blood test inpatient CPT 82746 HC Assay of Folic Acid Serum	$84.60	$141.00	—	—	40%
Free T3 thyroid hormone test CPT 84481 HC So Triiodothyronine T-3, Free	$91.20	$152.00	—	11% below	40%
Free T3 thyroid hormone test CPT 84481 HC Assay of Triiodothyronine T3 Free	$96.00	$160.00	—	7% below	40%
Free T3 thyroid hormone test inpatient CPT 84481 HC So Triiodothyronine T-3, Free	$100.20	$167.00	—	—	40%
Free T3 thyroid hormone test inpatient CPT 84481 HC Assay of Triiodothyronine T3 Free	$205.20	$342.00	—	—	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC So T4 Free	$54.00	$90.00	—	30% below	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC Assay of Free Thyroxine	$76.80	$128.00	—	1% below	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC So T4 Free	$64.20	$107.00	—	—	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC Assay of Free Thyroxine	$85.20	$142.00	—	—	40%
Free testosterone test CPT 84402 HC So Testosterone Free	$147.00	$245.00	—	20% below	40%
Free testosterone test inpatient CPT 84402 HC So Testosterone Free	$147.00	$245.00	—	—	40%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC So Ggtp	$41.40	$69.00	—	3% below	40%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC Assay of Glutamyltrase Gamma	$44.40	$74.00	—	4% above	40%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC So Ggtp	$41.40	$69.00	—	—	40%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC Assay of Glutamyltrase Gamma	$112.80	$188.00	—	—	40%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC Glucose Post Glucose Dose	$45.00	$75.00	—	10% above	40%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC Glucose Post Glucose Dose	$45.00	$75.00	—	—	40%
Glucose tolerance test, 3 samples CPT 82951 HC Glucose Tolerance Test	$69.60	$116.00	—	15% below	40%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC Glucose Tolerance Test	$69.60	$116.00	—	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.Gonorrhea, Dna, Amp Probe	$185.40	$309.00	—	70% above	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC So N Gonorrhoeae Dna Amp Prob	$189.00	$315.00	—	74% above	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC So N Gonorrhoeae Dna Amp Prob	$189.00	$315.00	—	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N.Gonorrhea, Dna, Amp Probe	$190.20	$317.00	—	—	40%
H. pylori antibody blood test CPT 86677 HC So H.Pylori. Serum	$89.40	$149.00	—	21% above	40%
H. pylori antibody blood test inpatient CPT 86677 HC So H.Pylori. Serum	$89.40	$149.00	—	—	40%
H. pylori stool antigen test CPT 87338 HC So H.Pylori Stool Antigen	$93.60	$156.00	—	13% below	40%
H. pylori stool antigen test inpatient CPT 87338 HC So H.Pylori Stool Antigen	$170.40	$284.00	—	—	40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC So Hiv-1, Quantification	$445.80	$743.00	—	49% above	40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC So Hiv-1, Quantification	$480.00	$800.00	—	—	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$148.20	$247.00	—	32% above	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$156.60	$261.00	—	—	40%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC Iadna Human Papillomavirus Hi-Rsk Typ Poold Rslt	$121.80	$203.00	—	6% above	40%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC Iadna Human Papillomavirus Hi-Rsk Typ Poold Rslt	$121.80	$203.00	—	—	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC Hemoglobin Glycosylated A1c	$61.80	$103.00	—	43% below	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC Hemoglobin Glycosylated A1c	$117.00	$195.00	—	—	40%
Hemoglobin blood test CPT 85018 HC Blood Count Hemoglobin	$18.00	$30.00	—	at median	40%
Hemoglobin blood test inpatient CPT 85018 HC Blood Count Hemoglobin	$57.60	$96.00	—	—	40%
Hepatitis B core antibody test (total) CPT 86704 HC So Hepatitis B Core Antibody	$50.40	$84.00	—	24% below	40%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC So Hepatitis B Core Antibody	$50.40	$84.00	—	—	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC So Anti-Hbs	$133.80	$223.00	—	60% above	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC Hepatitis B Surf Antibody Hbsab	$140.40	$234.00	—	68% above	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC So Anti-Hbs	$135.60	$226.00	—	—	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC Hepatitis B Surf Antibody Hbsab	$142.20	$237.00	—	—	40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC So Hepatitis B Surface Ag	$38.40	$64.00	—	39% below	40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC Iaad Ia Hepatitis B Surface Antigen	$64.20	$107.00	—	2% above	40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC M94 Hepb Surface Antigen Hbsag - Bmt	$136.20	$227.00	—	116% above	40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC So Hepatitis B Surface Ag	$38.40	$64.00	—	—	40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC Iaad Ia Hepatitis B Surface Antigen	$64.20	$107.00	—	—	40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC M94 Hepb Surface Antigen Hbsag - Bmt	$148.20	$247.00	—	—	40%
Hepatitis C antibody blood test (screening) CPT 86803 HC Hepatitis C Antibody	$55.20	$92.00	—	30% below	40%
Hepatitis C antibody blood test (screening) CPT 86803 HC So Hepatitis C Virus Antibody	$61.20	$102.00	—	22% below	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC Hepatitis C Antibody	$55.20	$92.00	—	—	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC So Hepatitis C Virus Antibody	$61.20	$102.00	—	—	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC So Hcv Ultraquant	$259.80	$433.00	—	3% above	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC So Hcv Ultraquant	$501.00	$835.00	—	—	40%
Herpes blood test, HSV-1 antibody CPT 86695 HC So Herpes Simplex, Type 1	$105.60	$176.00	—	26% above	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC So Herpes Simplex, Type 1	$120.60	$201.00	—	—	40%
Herpes blood test, HSV-2 antibody CPT 86696 HC So Herpes Simplex, Type 2	$83.40	$139.00	—	9% below	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC So Herpes Simplex, Type 2	$83.40	$139.00	—	—	40%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-Reactive Protein High Sensitivity	$101.40	$169.00	—	88% above	40%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-Reactive Protein High Sensitivity	$101.40	$169.00	—	—	40%
Homocysteine blood test CPT 83090 HC Assay of Homocysteine	$93.60	$156.00	—	16% below	40%
Homocysteine blood test inpatient CPT 83090 HC Assay of Homocysteine	$93.60	$156.00	—	—	40%
Insulin blood test CPT 83525 HC So Insulin	$75.00	$125.00	—	8% above	40%
Insulin blood test inpatient CPT 83525 HC So Insulin	$87.60	$146.00	—	—	40%
Iron blood test (serum iron) CPT 83540 HC Assay of Iron	$114.60	$191.00	—	46% above	40%
Iron blood test (serum iron) inpatient CPT 83540 HC Assay of Iron	$36.00	$60.00	—	—	40%
Iron-binding capacity (TIBC) test CPT 83550 HC So Iron Binding Capacity	$53.40	$89.00	—	20% below	40%
Iron-binding capacity (TIBC) test CPT 83550 HC Iron Binding Capacity	$69.60	$116.00	—	4% above	40%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC So Iron Binding Capacity	$53.40	$89.00	—	—	40%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC Iron Binding Capacity	$78.00	$130.00	—	—	40%
Kidney function blood test panel CPT 80069 HC Renal Function Panel	$50.40	$84.00	—	53% below	40%
Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel	$233.40	$389.00	—	—	40%
LH (luteinizing hormone) test CPT 83002 HC Gonadotropin Luteinizing Hormone	$134.40	$224.00	—	at median	40%
LH (luteinizing hormone) test inpatient CPT 83002 HC Gonadotropin Luteinizing Hormone	$147.00	$245.00	—	—	40%
Lactate (lactic acid) blood test CPT 83605 HC So Lactic Acid	$39.00	$65.00	—	56% below	40%
Lactate (lactic acid) blood test CPT 83605 HC Assay of Lactate	$64.20	$107.00	—	28% below	40%
Lactate (lactic acid) blood test CPT 83605 HC So1 Assay of Lactic Acid	$82.80	$138.00	—	8% below	40%
Lactate (lactic acid) blood test inpatient CPT 83605 HC So Lactic Acid	$39.00	$65.00	—	—	40%
Lactate (lactic acid) blood test inpatient CPT 83605 HC So1 Assay of Lactic Acid	$82.80	$138.00	—	—	40%
Lactate (lactic acid) blood test inpatient CPT 83605 HC Assay of Lactate	$161.40	$269.00	—	—	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC So Ldh	$39.00	$65.00	—	28% below	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC Lactate Dehydrogenase Ldh	$109.80	$183.00	—	104% above	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC So Ldh	$39.00	$65.00	—	—	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC Lactate Dehydrogenase Ldh	$219.60	$366.00	—	—	40%
Lipase blood test (pancreas enzyme) CPT 83690 HC Assay of Lipase	$48.60	$81.00	—	55% below	40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC Assay of Lipase	$228.00	$380.00	—	—	40%
Liver function blood test panel CPT 80076 HC So Hepatic Function Panel	$28.80	$48.00	—	65% below	40%
Liver function blood test panel CPT 80076 HC Hepatic Function Panel	$79.20	$132.00	—	5% below	40%
Liver function blood test panel inpatient CPT 80076 HC So Hepatic Function Panel	$28.80	$48.00	—	—	40%
Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel	$208.20	$347.00	—	—	40%
Lyme disease antibody test CPT 86618 HC So Lyme Disease Total Anitbodies	$93.60	$156.00	—	7% above	40%
Lyme disease antibody test inpatient CPT 86618 HC So Lyme Disease Total Anitbodies	$172.20	$287.00	—	—	40%
Magnesium blood test CPT 83735 HC So2 Magnesium	$21.60	$36.00	—	61% below	40%
Magnesium blood test CPT 83735 HC Assay of Magnesium	$51.60	$86.00	—	6% below	40%
Magnesium blood test CPT 83735 HC So Magnesium	$121.20	$202.00	—	121% above	40%
Magnesium blood test inpatient CPT 83735 HC So2 Magnesium	$21.60	$36.00	—	—	40%
Magnesium blood test inpatient CPT 83735 HC Assay of Magnesium	$88.80	$148.00	—	—	40%
Magnesium blood test inpatient CPT 83735 HC So Magnesium	$126.00	$210.00	—	—	40%
Measles (rubeola) antibody test CPT 86765 HC So Rubeola Igg / Igm	$101.40	$169.00	—	35% above	40%
Measles (rubeola) antibody test CPT 86765 HC So1 Rubeola Igg / Igm	$156.00	$260.00	—	108% above	40%
Measles (rubeola) antibody test inpatient CPT 86765 HC So Rubeola Igg / Igm	$111.00	$185.00	—	—	40%
Measles (rubeola) antibody test inpatient CPT 86765 HC So1 Rubeola Igg / Igm	$156.00	$260.00	—	—	40%
Mono test (heterophile antibody, Monospot) CPT 86308 HC Mono Spot Test,Agglutination	$57.00	$95.00	—	36% below	40%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC Mono Spot Test,Agglutination	$255.00	$425.00	—	—	40%
Mumps immunity blood test CPT 86735 HC So Antibody; Mumps	$88.80	$148.00	—	27% above	40%
Mumps immunity blood test inpatient CPT 86735 HC So Antibody; Mumps	$88.80	$148.00	—	—	40%
Obstetric blood test panel CPT 80055 HC Obstetric Panel	$180.60	$301.00	—	4% below	40%
Obstetric blood test panel inpatient CPT 80055 HC Obstetric Panel	$188.40	$314.00	—	—	40%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC So Prostate Specific Antigen/Free	$108.00	$180.00	—	at median	40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC So Prostate Specific Antigen/Free	$116.40	$194.00	—	—	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC Assay of Prostate Specific Antigen Total	$102.00	$170.00	—	3% above	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC So Assay of Psa Total	$121.20	$202.00	—	23% above	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC So Assay of Psa Total	$124.80	$208.00	—	—	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Assay of Prostate Specific Antigen Total	$166.80	$278.00	—	—	40%
Pap test (liquid-based, automated screening with review) CPT 88175 HC Cytp C/V Auto Thin Lyr Prepj Scr Mnl Rescr Phys	$92.40	$154.00	—	6% below	40%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC Cytp C/V Auto Thin Lyr Prepj Scr Mnl Rescr Phys	$92.40	$154.00	—	—	40%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen	$67.80	$113.00	—	at median	40%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen	$67.80	$113.00	—	—	40%
Parathyroid hormone (PTH) blood test CPT 83970 HC Assay of Parathormone	$232.20	$387.00	—	1% above	40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC Assay of Parathormone	$180.60	$301.00	—	—	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ptt	$43.20	$72.00	—	27% below	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC So Ptt	$49.20	$82.00	—	17% below	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC So Ptt	$52.80	$88.00	—	—	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Ptt	$213.00	$355.00	—	—	40%
Phosphorus (phosphate) blood test CPT 84100 HC Assay of Phosphorus Inorganic	$52.80	$88.00	—	10% above	40%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC Assay of Phosphorus Inorganic	$96.60	$161.00	—	—	40%
Potassium blood test CPT 84132 HC Potassium Serum Plasma/Whole Blood	$39.00	$65.00	—	at median	40%
Potassium blood test inpatient CPT 84132 HC Potassium Serum Plasma/Whole Blood	$41.40	$69.00	—	—	40%
Progesterone blood test CPT 84144 HC So Progesterone	$133.20	$222.00	—	26% below	40%
Progesterone blood test inpatient CPT 84144 HC So Progesterone	$133.20	$222.00	—	—	40%
Prolactin blood test CPT 84146 HC Assay of Prolactin	$142.80	$238.00	—	21% above	40%
Prolactin blood test inpatient CPT 84146 HC Assay of Prolactin	$166.80	$278.00	—	—	40%
Prothrombin time (PT/INR) clotting test CPT 85610 HC So Prothrombin Time	$25.20	$42.00	—	3% below	40%
Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time	$30.00	$50.00	—	16% above	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC So Prothrombin Time	$25.20	$42.00	—	—	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time	$58.20	$97.00	—	—	40%
Rapid flu test (influenza antigen) CPT 87804 HC Iaadiadoo Influenza	$66.00	$110.00	—	22% below	40%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC Iaadiadoo Influenza	$142.80	$238.00	—	—	40%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC Iaadiadoo Streptococcus Group A	$127.20	$212.00	—	42% above	40%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC Iaadiadoo Streptococcus Group A	$124.80	$208.00	—	—	40%
Renin blood test CPT 84244 HC So Renin	$111.00	$185.00	—	16% below	40%
Renin blood test inpatient CPT 84244 HC So Renin	$111.00	$185.00	—	—	40%
Rh blood typing CPT 86901 HC Blood Typing, Rh(D)	$64.80	$108.00	—	5% above	40%
Rh blood typing inpatient CPT 86901 HC Blood Typing, Rh(D)	$124.20	$207.00	—	—	40%
Rheumatoid factor (RF) test CPT 86431 HC So Ra Titer, Quantitative	$36.00	$60.00	—	at median	40%
Rheumatoid factor (RF) test CPT 86431 HC Rheumatoid Factor Quantitative	$88.20	$147.00	—	145% above	40%
Rheumatoid factor (RF) test inpatient CPT 86431 HC So Ra Titer, Quantitative	$36.60	$61.00	—	—	40%
Rheumatoid factor (RF) test inpatient CPT 86431 HC Rheumatoid Factor Quantitative	$88.20	$147.00	—	—	40%
Rubella antibody test (immunity check) CPT 86762 HC So Rubella Latex Test	$97.20	$162.00	—	at median	40%
Rubella antibody test (immunity check) CPT 86762 HC Antibody Rubella	$117.00	$195.00	—	20% above	40%
Rubella antibody test (immunity check) inpatient CPT 86762 HC So Rubella Latex Test	$99.60	$166.00	—	—	40%
Rubella antibody test (immunity check) inpatient CPT 86762 HC Antibody Rubella	$134.40	$224.00	—	—	40%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC Sed Rate	$18.00	$30.00	—	69% below	40%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC Sed Rate	$21.60	$36.00	—	—	40%
Sodium blood test CPT 84295 HC Sodium Serum Plasma or Whole Blood	$37.80	$63.00	—	25% below	40%
Sodium blood test inpatient CPT 84295 HC Sodium Serum Plasma or Whole Blood	$42.60	$71.00	—	—	40%
Stool ova and parasites exam CPT 87177 HC So Ova and Parasites	$54.00	$90.00	—	at median	40%
Stool ova and parasites exam inpatient CPT 87177 HC So Ova and Parasites	$130.20	$217.00	—	—	40%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC Blood Occult Peroxidase Actv Qual Feces 1 Deter	$60.60	$101.00	—	163% above	40%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC Blood Occult Peroxidase Actv Qual Feces 1 Deter	$60.60	$101.00	—	—	40%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC Antibody Treponema Pallidum	$70.80	$118.00	—	at median	40%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC So Fta-Abs	$95.40	$159.00	—	35% above	40%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC Antibody Treponema Pallidum	$70.80	$118.00	—	—	40%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC So Fta-Abs	$95.40	$159.00	—	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC Syphilis Test Non-Treponemal Antibody Qual	$42.60	$71.00	—	69% above	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC So Vdrl / Rpr	$70.20	$117.00	—	179% above	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC Syphilis Test Non-Treponemal Antibody Qual	$28.20	$47.00	—	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC So Vdrl / Rpr	$83.40	$139.00	—	—	40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC So TB Test, Cell Immun Measure	$322.20	$537.00	—	46% above	40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC So TB Test, Cell Immun Measure	$322.20	$537.00	—	—	40%
Testosterone blood test, total (not free testosterone) CPT 84403 HC So Testosterone Total	$144.00	$240.00	—	4% below	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC So Testosterone Total	$147.60	$246.00	—	—	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC So Microsomal Antibody	$80.40	$134.00	—	8% above	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC So Microsomal Antibody	$141.00	$235.00	—	—	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone	$93.60	$156.00	—	4% below	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC So Tsh 3rd Generation	$101.40	$169.00	—	4% above	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC So Tsh 3rd Generation	$102.00	$170.00	—	—	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone	$250.20	$417.00	—	—	40%
Total IgE blood test CPT 82785 HC So Immunoglobulin,Ige	$88.80	$148.00	—	at median	40%
Total IgE blood test inpatient CPT 82785 HC So Immunoglobulin,Ige	$164.40	$274.00	—	—	40%
Total cholesterol blood test CPT 82465 HC So Cholesterol	$15.60	$26.00	—	71% below	40%
Total cholesterol blood test CPT 82465 HC Cholesterol Serum/Whole Blood Total	$32.40	$54.00	—	40% below	40%
Total cholesterol blood test inpatient CPT 82465 HC So Cholesterol	$15.60	$26.00	—	—	40%
Total cholesterol blood test inpatient CPT 82465 HC Cholesterol Serum/Whole Blood Total	$32.40	$54.00	—	—	40%
Total thyroxine (T4) blood test CPT 84436 HC Assay of Thyroxine Total	$39.60	$66.00	—	18% below	40%
Total thyroxine (T4) blood test CPT 84436 HC So Thyroxine Total	$42.00	$70.00	—	13% below	40%
Total thyroxine (T4) blood test inpatient CPT 84436 HC Assay of Thyroxine Total	$37.80	$63.00	—	—	40%
Total thyroxine (T4) blood test inpatient CPT 84436 HC So Thyroxine Total	$42.00	$70.00	—	—	40%
Total triiodothyronine (T3) blood test CPT 84480 HC So T-3 by Ria,Total	$99.60	$166.00	—	2% below	40%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC So T-3 by Ria,Total	$99.60	$166.00	—	—	40%
Transferrin blood test CPT 84466 HC So Transferrin	$80.40	$134.00	—	5% above	40%
Transferrin blood test inpatient CPT 84466 HC So Transferrin	$94.80	$158.00	—	—	40%
Trichomonas test (NAAT) CPT 87661 HC So1 Trichomonas Vaginalis Amplif	$110.40	$184.00	—	at median	40%
Trichomonas test (NAAT) CPT 87661 HC Iadna Trichomonas Vaginalis Amplified Probe Tech	$128.40	$214.00	—	16% above	40%
Trichomonas test (NAAT) CPT 87661 HC So Trichomonas Vaginalis Amplif	$183.00	$305.00	—	66% above	40%
Trichomonas test (NAAT) inpatient CPT 87661 HC So1 Trichomonas Vaginalis Amplif	$110.40	$184.00	—	—	40%
Trichomonas test (NAAT) inpatient CPT 87661 HC Iadna Trichomonas Vaginalis Amplified Probe Tech	$128.40	$214.00	—	—	40%
Trichomonas test (NAAT) inpatient CPT 87661 HC So Trichomonas Vaginalis Amplif	$183.00	$305.00	—	—	40%
Triglycerides blood test CPT 84478 HC So Triglycerides	$53.40	$89.00	—	1% below	40%
Triglycerides blood test inpatient CPT 84478 HC So Triglycerides	$53.40	$89.00	—	—	40%
Troponin test, quantitative CPT 84484 HC Assay of Troponin Quantitative	$51.00	$85.00	—	50% below	40%
Troponin test, quantitative inpatient CPT 84484 HC Assay of Troponin Quantitative	$74.40	$124.00	—	—	40%
Uric acid blood test CPT 84550 HC Assay of Blood/Uric Acid	$40.80	$68.00	—	42% below	40%
Uric acid blood test inpatient CPT 84550 HC Assay of Blood/Uric Acid	$41.40	$69.00	—	—	40%
Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis W/ Microscopy	$78.60	$131.00	—	77% above	40%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis W/ Microscopy	$163.20	$272.00	—	—	40%
Urinalysis with microscope exam, manual CPT 81000 HC Urinls Dip Stick/Tablet Reagnt Non-Auto Micrscpy	$13.80	$23.00	—	36% above	40%
Urinalysis with microscope exam, manual inpatient CPT 81000 HC Urinls Dip Stick/Tablet Reagnt Non-Auto Micrscpy	$13.80	$23.00	—	—	40%
Urinalysis without microscope exam, automated CPT 81003 HC So Urinalysis Routine	$13.20	$22.00	—	60% below	40%
Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis, Auto, W/O Scope	$34.20	$57.00	—	4% above	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC So Urinalysis Routine	$13.20	$22.00	—	—	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis, Auto, W/O Scope	$67.80	$113.00	—	—	40%
Urinalysis without microscope exam, manual CPT 81002 HC Non-Auto,Urine W/O Microscopy	$51.00	$85.00	—	149% above	40%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC Non-Auto,Urine W/O Microscopy	$37.20	$62.00	—	—	40%
Urine culture for bacteria, with colony count CPT 87086 HC Urine Cult./Colony Count	$120.00	$200.00	—	55% above	40%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC Urine Cult./Colony Count	$156.00	$260.00	—	—	40%
Urine microalbumin (albumin) test CPT 82043 HC Urine,Microalbumin,Quantitativ	$39.00	$65.00	—	34% below	40%
Urine microalbumin (albumin) test inpatient CPT 82043 HC Urine,Microalbumin,Quantitativ	$118.20	$197.00	—	—	40%
Urine pregnancy test, read by color change CPT 81025 HC Hcg (Urine) Pregnancy Test	$91.80	$153.00	—	at median	40%
Urine pregnancy test, read by color change inpatient CPT 81025 HC Hcg (Urine) Pregnancy Test	$124.80	$208.00	—	—	40%
Vitamin B12 (cobalamin) blood test CPT 82607 HC Cyanocobalamin Vitamin B-12	$84.00	$140.00	—	at median	40%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC Cyanocobalamin Vitamin B-12	$61.20	$102.00	—	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 Hydroxy Includes Fractions if Performed	$277.80	$463.00	—	97% above	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 Hydroxy Includes Fractions if Performed	$188.40	$314.00	—	—	40%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC So Dihydroxyvitamin D, 1 25	$193.20	$322.00	—	11% below	40%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC So Dihydroxyvitamin D, 1 25	$193.20	$322.00	—	—	40%
Zinc blood test CPT 84630 HC So Zinc, Serum	$98.40	$164.00	—	54% above	40%
Zinc blood test inpatient CPT 84630 HC So Zinc, Serum	$120.00	$200.00	—	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC So Hcg Quantitative	$98.40	$164.00	—	27% below	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Hcg Quantitative	$197.40	$329.00	—	46% above	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC So Hcg Quantitative	$98.40	$164.00	—	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Hcg Quantitative	$222.60	$371.00	—	—	40%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 Arthrd Ant Interbody Decompress Cervical Belw C2	$64,501.17	$107,501.95	$12,880.66	52% above	40%
Arthroscopic ACL reconstruction or repair of the knee one side CPT 29888 Arthrs Aided Ant Cruciate Ligm Rpr/Agmntj/Rcnstj\|LEFT SIDE	$42,299.29	$70,498.82	$7,279.94–$7,425.54	31% above	40%
Arthroscopic ACL reconstruction or repair of the knee one side CPT 29888 Arthrs Aided Ant Cruciate Ligm Rpr/Agmntj/Rcnstj\|RIGHT SIDE	$43,377.36	$72,295.60	$7,279.94–$7,425.54	35% above	40%
Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 Surgical Arthroscopy Shoulder W/Rotator Cuff Rpr\|RIGHT SIDE	$33,220.12	$55,366.87	$7,279.94–$7,425.54	20% above	40%
Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 Surgical Arthroscopy Shoulder W/Rotator Cuff Rpr\|LEFT SIDE	$35,060.80	$58,434.67	$7,279.94–$7,425.54	26% above	40%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC Bx Breast 1st Lesion Strtctc	$5,809.20	$9,682.00	—	114% above	40%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC Bx Breast 1st Lesion Strtctc	$5,700.60	$9,501.00	—	—	40%
Bunion correction with a bone cut near the head of the first metatarsal one side CPT 28296 Corrj Hallux Valgus W/Sesmdc W/Dist Metar Osteot\|LEFT SIDE	$29,698.97	$49,498.28	$7,279.94–$7,425.54	61% above	40%
Bunion correction with a bone cut near the head of the first metatarsal one side CPT 28296 Corrj Hallux Valgus W/Sesmdc W/Dist Metar Osteot\|RIGHT SIDE	$74,357.86	$123,929.77	$7,279.94–$7,425.54	304% above	40%
Cardiac catheterization with coronary angiogram CPT 93458 HC L Heart W Lv & Coronary	$18,770.40	$31,284.00	—	94% above	40%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 HC L Heart W Lv & Coronary	$14,923.80	$24,873.00	—	—	40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC Cardioversion	$1,616.40	$2,694.00	—	35% above	40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC Cardioversion	$1,616.40	$2,694.00	—	—	40%
Carpal tunnel release, open surgery one side CPT 64721 Neuroplasty &/Transpos Median Nrv Carpal Tunne\|RIGHT SIDE	$7,426.28	$12,377.13	$1,959.11–$1,998.29	1% above	40%
Carpal tunnel release, open surgery one side CPT 64721 Neuroplasty &/Transpos Median Nrv Carpal Tunne\|LEFT SIDE	$7,938.81	$13,231.35	$1,959.11–$1,998.29	8% above	40%
Cataract surgery with lens implant CPT 66984 Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp	$12,633.88	$21,056.47	$2,315.37	94% above	40%
Cataract surgery with lens implant one side CPT 66984 Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp\|LEFT SIDE	$11,134.80	$18,558.00	$2,315.37–$2,361.68	71% above	40%
Cataract surgery with lens implant one side CPT 66984 Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp\|RIGHT SIDE	$11,441.25	$19,068.75	$2,315.37–$2,361.68	75% above	40%
Catheter ablation for atrial fibrillation CPT 93656 HC Ep Tx Atrial Fib Pul Vn Isolat	$24,316.20	$40,527.00	—	13% above	40%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC Ep Tx Atrial Fib Pul Vn Isolat	$27,578.40	$45,964.00	—	—	40%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC Circum 28 Days or Older	$1,546.20	$2,577.00	—	3% below	40%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 HC Circum 28 Days or Older	$1,546.20	$2,577.00	—	—	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC Circumcision W/Clamp/Oth Dev W/Block	$1,290.00	$2,150.00	—	15% below	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC Circumcision W/Clamp/Oth Dev W/Block	$1,290.00	$2,150.00	—	—	40%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC Treat Radius/Ulna Fx	$172.80	$288.00	—	49% below	40%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC Treat Radius/Ulna Fx	$172.80	$288.00	—	—	40%
Colonoscopy with polyp removal CPT 45385 Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$5,872.17	$9,786.95	$1,200.55–$1,224.56	52% above	40%
Colonoscopy with tissue sample CPT 45380 Colonoscopy W/Biopsy Single/Multiple	$5,287.16	$8,811.93	$1,200.55–$1,224.56	202% above	40%
Colonoscopy, diagnostic CPT 45378 Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$4,723.20	$7,872.00	$933.00–$951.66	234% above	40%
Complex cataract surgery with lens implant one side CPT 66982 Xcapsl Ctrc Rmvl Insj Io Lens Prosth Cplx WO Ecp\|LEFT SIDE	$13,587.68	$22,646.13	$2,315.37–$2,361.68	67% above	40%
Complex cataract surgery with lens implant one side CPT 66982 Xcapsl Ctrc Rmvl Insj Io Lens Prosth Cplx WO Ecp\|RIGHT SIDE	$13,754.00	$22,923.33	$2,315.37–$2,361.68	69% above	40%
Coronary stent placement, one artery CPT 92928 HC Perq Tcat Plmt Ntrac St 1 Les 1+C Segments	$13,057.80	$21,763.00	—	25% above	40%
Coronary stent placement, one artery inpatient CPT 92928 HC Perq Tcat Plmt Ntrac St 1 Les 1+C Segments	$13,057.80	$21,763.00	—	—	40%
Cystoscopy with ureteral stent placement one side CPT 52332 Cysto W/Insert Ureteral Stent\|LEFT SIDE	$15,998.08	$26,663.47	$3,536.51–$3,607.24	273% above	40%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC Cystourethroscopy (Separate Procedure)	$521.40	$869.00	—	40% below	40%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC Cystourethroscopy (Separate Procedure)	$521.40	$869.00	—	—	40%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC Destruct Benign Lesion 1st	$376.20	$627.00	—	214% above	40%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC Destruct Benign Lesion 1st	$376.20	$627.00	—	—	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC Remov Imp Ear Wax 1 Ear	$45.60	$76.00	—	53% below	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC Rem Impact Cerumen Irrigat Uni	$48.00	$80.00	—	51% below	40%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC Remov Imp Ear Wax 1 Ear	$45.60	$76.00	—	—	40%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC Rem Impact Cerumen Irrigat Uni	$48.00	$80.00	—	—	40%
Earwax removal with instruments, one ear CPT 69210 HC Remove Impacted Cerumen	$194.40	$324.00	—	13% above	40%
Earwax removal with instruments, one ear one side CPT 69210 HC Removal Impacted Cerumen Unilateral	$143.40	$239.00	—	17% below	40%
Earwax removal with instruments, one ear inpatient CPT 69210 HC Remove Impacted Cerumen	$194.40	$324.00	—	—	40%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HC Removal Impacted Cerumen Unilateral	$137.40	$229.00	—	—	40%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC Endometrial Biopsy	$8,342.90	$13,904.83	$202.83–$206.89	2640% above	40%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn	$3,284.40	$5,474.00	—	144% above	40%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn	$3,284.40	$5,474.00	—	—	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC N Block Paravert Lumbar 1st	$1,279.20	$2,132.00	—	9% below	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC Inj Anes/Steroid L/S Facet Sg	$1,809.60	$3,016.00	—	29% above	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC Facet Jnt, L/S, Single	$3,746.66	$6,244.43	$887.36–$905.11	167% above	40%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 HC Facet Jnt, L/S, Single\|RIGHT SIDE	$2,233.46	$3,722.43	$887.36–$905.11	59% above	40%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 HC Facet Jnt, L/S, Single\|LEFT SIDE	$3,925.85	$6,543.08	$887.36–$905.11	179% above	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC N Block Paravert Lumbar 1st	$1,279.20	$2,132.00	—	—	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC Inj Anes/Steroid L/S Facet Sg	$1,809.60	$3,016.00	—	—	40%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Rpr Aa Hernia 1st 3-10 Cm Reducible	$17,277.10	$28,795.17	$6,494.99–$6,624.89	14% above	40%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 Rpr Aa Hernia 1st > 10 Cm Reducible	$28,009.91	$46,683.18	$6,494.99–$6,624.89	1% above	40%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Rpr Aa Hernia 1st < 3 Cm Reducible	$14,873.94	$24,789.90	$3,592.11–$3,663.95	11% above	40%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy Flx Dx W/Collj Spec Br/Wa if Pfrmd	$3,922.58	$6,537.63	$933.00–$951.66	247% above	40%
Gallbladder removal, laparoscopic CPT 47562 Laparoscopy Surg Cholecystectomy	$18,308.89	$30,514.82	$6,065.29–$6,186.60	8% above	40%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Laps Surg Cholecystectomy W/Cholangiography	$20,113.03	$33,521.72	$6,065.29–$6,186.60	2% below	40%
Hammertoe correction surgery CPT 28285 Correction Hammertoe	$45,825.13	$76,375.22	$3,282.70–$3,348.35	742% above	40%
Hammertoe correction surgery one side CPT 28285 Correction Hammertoe\|RIGHT SIDE	$46,204.48	$77,007.47	$3,282.70–$3,348.35	749% above	40%
Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorrhoidectomy Ntrnl & Xtrnl 1 Column/Group	$17,876.81	$29,794.68	$2,784.74–$2,840.43	426% above	40%
Hysterectomy through an abdominal incision (total) CPT 58150 Total Abdominal Hysterect W/WO Rmvl Tube Ovary	$106,343.48	$177,239.13	$3,167.80	339% above	40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC Cath/Intro Sal Cont Hyst	$1,478.40	$2,464.00	—	182% above	40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC Cath/Intro Sal Cont Hyst	$1,105.20	$1,842.00	—	—	40%
Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy Endometrial Ablation	$18,495.61	$30,826.02	$5,018.81–$5,119.18	27% above	40%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$14,790.28	$24,650.47	$3,247.71–$3,312.66	117% above	40%
IUD insertion (the device itself billed separately) CPT 58300 HC Insert Intrauterine Device	$14,894.51	$24,824.18	$3,247.71–$3,312.66	6362% above	40%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I & D Subcutaneous Abscess-Simple	$387.00	$645.00	—	at median	40%
Incision and drainage of a simple or single skin abscess CPT 10060 HC Incision & Drainage-Simple	$406.20	$677.00	—	5% above	40%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D Simple	$466.20	$777.00	—	20% above	40%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I & D Simple	$675.00	$1,125.00	$201.29	74% above	40%
Incision and drainage of a simple or single skin abscess one side CPT 10060 HC I & D Simple\|RIGHT SIDE	$522.00	$870.00	$201.29–$205.32	35% above	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I & D Subcutaneous Abscess-Simple	$387.00	$645.00	—	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D Simple	$466.20	$777.00	—	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC Incision & Drainage-Simple	$466.20	$777.00	—	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I & D Simple	$675.00	$1,125.00	—	—	40%
Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible\|RIGHT SIDE	$10,778.39	$17,963.98	$3,592.11–$3,663.95	20% below	40%
Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible\|LEFT SIDE	$12,812.60	$21,354.33	$3,592.11–$3,663.95	5% below	40%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC Inject Tendon Sheath Ligament	$947.40	$1,579.00	—	158% above	40%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC Inject Tendon Sheath Ligament	$947.40	$1,579.00	—	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Asp Injection Major Joint	$262.20	$437.00	—	32% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Joint Injection/Aspir Large WO US	$471.00	$785.00	—	22% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Arthrocent/Aspiration Maj Jnt	$603.60	$1,006.00	$307.96–$314.11	56% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC Arthrocent/Aspiration Maj Jnt\|RIGHT SIDE	$1,742.45	$2,904.08	$307.96–$314.11	350% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC Arthrocent/Aspiration Maj Jnt\|LEFT SIDE	$1,817.30	$3,028.83	$307.96–$314.11	369% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC Asp Injection Major Joint	$262.20	$437.00	—	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC Joint Injection/Aspir Large WO US	$471.00	$785.00	—	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC Arthrocent/Aspiration Maj Jnt	$3,031.20	$5,052.00	—	—	40%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC Insert Drug Implant Device	$23,930.31	$39,883.85	$8,200.11–$8,364.11	4139% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC Asp Inj Intermediate Joint	$262.20	$437.00	—	38% below	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC Joint Injection/Aspir Medium WO US	$494.40	$824.00	—	17% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 HC Joint Injection/Aspir Medium WO US\|RIGHT SIDE	$6,872.55	$11,454.25	$1,959.11–$1,998.29	1530% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 HC Joint Injection/Aspir Medium WO US\|LEFT SIDE	$7,097.10	$11,828.50	$1,959.11–$1,998.29	1584% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC Asp Inj Intermediate Joint	$262.20	$437.00	—	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC Joint Injection/Aspir Medium WO US	$494.40	$824.00	—	—	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC Drain/Inject Joint/Bursa	$262.20	$437.00	—	28% below	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC Joint Injection/Aspir Small WO US	$494.40	$824.00	—	35% above	40%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 HC Injection Small Joint/Bursa\|LEFT SIDE	$7,166.95	$11,944.92	$1,959.11–$1,998.29	1856% above	40%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 HC Injection Small Joint/Bursa\|RIGHT SIDE	$7,172.89	$11,954.82	$1,959.11–$1,998.29	1857% above	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC Drain/Inject Joint/Bursa	$262.20	$437.00	—	—	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC Joint Injection/Aspir Small WO US	$494.40	$824.00	—	—	40%
Knee arthroscopy with meniscus repair (one side of the knee) one side CPT 29882 Arthroscopy Knee W/Meniscus Rpr Medial/Lateral\|RIGHT SIDE	$27,263.89	$45,439.82	$3,282.70–$3,348.35	6% above	40%
Knee arthroscopy with meniscus repair (one side of the knee) one side CPT 29882 Arthroscopy Knee W/Meniscus Rpr Medial/Lateral\|LEFT SIDE	$57,260.59	$95,434.32	$12,880.66–$13,138.27	122% above	40%
Knee arthroscopy with meniscus trim one side CPT 29881 Arthrs Kne Surg W/Meniscectomy Med/Lat W/Shvg\|LEFT SIDE	$13,758.98	$22,931.63	$3,282.70–$3,348.35	19% above	40%
Knee arthroscopy with meniscus trim one side CPT 29881 Arthrs Kne Surg W/Meniscectomy Med/Lat W/Shvg\|RIGHT SIDE	$14,125.60	$23,542.67	$3,282.70–$3,348.35	22% above	40%
Knee arthroscopy with removal of both torn meniscus parts one side CPT 29880 Arthrs Knee W/Meniscectomy Med&Lat W/Shaving\|LEFT SIDE	$13,870.36	$23,117.27	$3,282.70–$3,348.35	at median	40%
Knee arthroscopy with removal of both torn meniscus parts one side CPT 29880 Arthrs Knee W/Meniscectomy Med&Lat W/Shaving\|RIGHT SIDE	$14,906.86	$24,844.77	$3,282.70–$3,348.35	8% above	40%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) one side CPT 29877 Arthrs Knee Debridement/Shaving Artclr Crtlg\|RIGHT SIDE	$13,800.35	$23,000.58	$3,282.70–$3,348.35	3% below	40%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) one side CPT 29877 Arthrs Knee Debridement/Shaving Artclr Crtlg\|LEFT SIDE	$15,607.83	$26,013.05	$3,282.70–$3,348.35	9% above	40%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Laparoscopic Appendectomy	$20,009.97	$33,349.95	$6,065.29–$6,186.60	14% above	40%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 Laparoscopy W Total Hysterectomy Uterus 250 Gm/<	$27,944.37	$46,573.95	$10,664.59–$10,877.88	16% above	40%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 Laps Total Hysterect 250 Gm/< W/Rmvl Tube/Ovary	$30,910.99	$51,518.32	$10,664.59	21% above	40%
Laparoscopic inguinal (groin) hernia repair, first repair on that side one side CPT 49650 Laparoscopy Surg Rpr Initial Inguinal Hernia\|LEFT SIDE	$15,176.57	$25,294.28	$6,065.29–$6,186.60	2% above	40%
Laparoscopic inguinal (groin) hernia repair, first repair on that side one side CPT 49650 Laparoscopy Surg Rpr Initial Inguinal Hernia\|RIGHT SIDE	$16,110.42	$26,850.70	$6,065.29–$6,186.60	8% above	40%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia one side CPT 49651 Laps Surg Rpr Recurrent Inguinal Hernia\|RIGHT SIDE	$16,114.03	$26,856.72	$6,065.29–$6,186.60	10% above	40%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia one side CPT 49651 Laps Surg Rpr Recurrent Inguinal Hernia\|LEFT SIDE	$16,652.79	$27,754.65	$6,065.29–$6,186.60	13% above	40%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy W/Rmvl Adnexal Structures	$24,959.86	$41,599.77	$6,065.29–$6,186.60	43% above	40%
Laparoscopic removal of fallopian tubes and/or ovaries one side CPT 58661 Laparoscopy W/Rmvl Adnexal Structures\|LEFT SIDE	$17,712.31	$29,520.52	$6,065.29–$6,186.60	1% above	40%
Laparoscopic removal of fallopian tubes and/or ovaries one side CPT 58661 Laparoscopy W/Rmvl Adnexal Structures\|RIGHT SIDE	$23,726.29	$39,543.82	$6,065.29–$6,186.60	36% above	40%
Laser treatment of clouding after cataract surgery (YAG) one side CPT 66821 HC Laser Capsulotomy\|LEFT SIDE	$2,694.28	$4,490.47	$551.80–$562.83	150% above	40%
Laser treatment of clouding after cataract surgery (YAG) one side CPT 66821 HC Laser Capsulotomy\|RIGHT SIDE	$2,694.28	$4,490.47	$551.80–$562.83	150% above	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC Lyr Clos Sc Tk Ext <2.5 Cm	$1,108.80	$1,848.00	—	115% above	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC Lyr Clos Sc Tk Ext <2.5 Cm	$9,105.15	$15,175.25	$407.84	1661% above	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC Lyr Clos Sc Tk Ext <2.5 Cm	$1,108.80	$1,848.00	—	—	40%
Left heart catheterization, diagnostic CPT 93452 HC L Heart W Lvgram	$14,047.20	$23,412.00	—	113% above	40%
Left heart catheterization, diagnostic inpatient CPT 93452 HC L Heart W Lvgram	$7,031.40	$11,719.00	—	—	40%
Lower-back epidural injection, with imaging guidance CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$2,089.20	$3,482.00	—	24% above	40%
Lower-back epidural injection, with imaging guidance CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$3,530.40	$5,884.00	$708.19–$722.35	110% above	40%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$2,089.20	$3,482.00	—	—	40%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$2,448.60	$4,081.00	—	—	40%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Inj a/S Transforam Lumbar	$2,544.60	$4,241.00	$887.36–$905.11	69% above	40%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC Inj a/S Transforam Lumbar\|RIGHT SIDE	$3,755.49	$6,259.15	$887.36–$905.11	149% above	40%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC Inj a/S Transforam Lumbar\|LEFT SIDE	$4,066.49	$6,777.48	$887.36–$905.11	170% above	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC Inj a/S Transforam Lumbar	$1,837.20	$3,062.00	—	—	40%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 Lamnotmy Incl W/Dcmprsn Nrv Root 1 Intrspc Lumbr	$28,872.37	$48,120.62	$7,279.94–$7,425.54	10% above	40%
Lumbar discectomy or laminotomy to free a nerve root, one level one side CPT 63030 Lamnotmy Incl W/Dcmprsn Nrv Root 1 Intrspc Lumbr\|RIGHT SIDE	$26,354.77	$43,924.62	$7,279.94–$7,425.54	at median	40%
Lumbar discectomy or laminotomy to free a nerve root, one level one side CPT 63030 Lamnotmy Incl W/Dcmprsn Nrv Root 1 Intrspc Lumbr\|LEFT SIDE	$26,835.49	$44,725.82	$7,279.94–$7,425.54	2% above	40%
Lumbar fusion with interbody cage and posterolateral graft (TLIF), one level CPT 22633 Arthrodesis Combined Tq 1ntrspc Lumbar	$103,617.13	$172,695.22	$27,222.74–$27,767.19	at median	40%
Lumbar interbody fusion (PLIF or TLIF), one level CPT 22630 Arthrodesis Posterior Interbody 1 Ntrspc Lumbar	$100,882.90	$168,138.17	$27,222.74–$27,767.19	4% above	40%
Lumbar laminectomy (spinal decompression), one level CPT 63047 Laminec/Facetect/Foramin,Lumbar	$34,040.02	$56,733.37	$7,279.94–$7,425.54	at median	40%
Lumbar spinal fusion (posterior), one level CPT 22612 Arthrodesis Posterior/Pstlat Tq 1ntrspc Lumbar	$70,573.75	$117,622.92	$17,591.15	9% below	40%
Lumpectomy (partial mastectomy) one side CPT 19301 Mastectomy Partial\|LEFT SIDE	$19,231.58	$32,052.63	$6,661.88–$6,795.12	75% above	40%
Lumpectomy (partial mastectomy) one side CPT 19301 Mastectomy Partial\|RIGHT SIDE	$20,277.06	$33,795.10	$6,661.88–$6,795.12	85% above	40%
Mastectomy (total removal of the breast) CPT 19303 Mastectomy Simple Complete	$42,630.65	$71,051.08	$6,661.88	107% above	40%
Mastectomy (total removal of the breast) one side CPT 19303 Mastectomy Simple Complete\|LEFT SIDE	$21,951.61	$36,586.02	$6,661.88	6% above	40%
Mastectomy (total removal of the breast) one side CPT 19303 Mastectomy Simple Complete\|RIGHT SIDE	$23,096.77	$38,494.62	—	12% above	40%
Miscarriage treatment with D&C, first trimester CPT 59820 HC Tx Missed Abortion First Trimester Surgical	$2,356.80	$3,928.00	—	at median	40%
Miscarriage treatment with D&C, first trimester CPT 59820 Tx Missed Abortion First Trimester Surgical	$8,115.04	$13,525.07	$3,247.71–$3,312.66	244% above	40%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC Tx Missed Abortion First Trimester Surgical	$2,356.80	$3,928.00	—	—	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC Exc Tr-Ext B9+Marg 0.5 Cm<	$541.20	$902.00	—	4% below	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC Exc Tr-Ext B9+Marg 0.5 Cm<	$541.20	$902.00	—	—	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC Exc Face-Mm B9+Marg 0.5 Cm/<	$541.20	$902.00	—	55% below	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC Exc Face-Mm B9+Marg 0.5 Cm/<	$541.20	$902.00	—	—	40%
Nail removal (partial or complete), one nail CPT 11730 HC Avulsion Nail Plate Single	$296.40	$494.00	—	39% above	40%
Nail removal (partial or complete), one nail CPT 11730 HC ED Avulsion Nail Plate Single	$420.60	$701.00	—	97% above	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC Avulsion Nail Plate Single	$150.00	$250.00	—	—	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC ED Avulsion Nail Plate Single	$420.60	$701.00	—	—	40%
Occipital nerve block (injection for headaches) CPT 64405 HC Inj Aa&/Strd Greater Occipital Nerve	$1,188.00	$1,980.00	—	116% above	40%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC Inj Aa&/Strd Greater Occipital Nerve	$1,188.00	$1,980.00	—	—	40%
Pacemaker implant (dual chamber) CPT 33208 HC Ins/Repl of Dual Cham Ppm Lead	$20,640.60	$34,401.00	$10,486.17–$10,695.89	77% above	40%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC Ins/Repl of Dual Cham Ppm Lead	$16,881.60	$28,136.00	—	—	40%
Paracentesis with imaging guidance CPT 49083 HC Abdom Paracentesis Dx/Ther W Imaging Guidance	$688.80	$1,148.00	—	41% below	40%
Paracentesis with imaging guidance CPT 49083 HC Abd Paracentesis W Guide	$3,315.00	$5,525.00	—	185% above	40%
Paracentesis with imaging guidance inpatient CPT 49083 HC Abdom Paracentesis Dx/Ther W Imaging Guidance	$688.80	$1,148.00	—	—	40%
Paracentesis with imaging guidance inpatient CPT 49083 HC Abd Paracentesis W Guide	$2,444.40	$4,074.00	—	—	40%
Partial knee replacement (one compartment) one side CPT 27446 Arthrp Knee Condyle&Plateau Medial/Lat Cmprt\|RIGHT SIDE	$41,812.18	$69,686.97	$12,880.66–$13,138.27	2% below	40%
Partial knee replacement (one compartment) one side CPT 27446 Arthrp Knee Condyle&Plateau Medial/Lat Cmprt\|LEFT SIDE	$46,295.75	$77,159.58	$12,880.66–$13,138.27	8% above	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC Excis Nail Matrix Perm Rmvl	$311.40	$519.00	—	48% below	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC Removal of Nail Bed	$7,443.40	$12,405.67	—	1135% above	40%
Permanent removal of a nail and nail root (partial or complete) one side CPT 11750 HC Removal of Nail Bed\|RIGHT SIDE	$11,022.21	$18,370.35	$407.84–$416.00	1729% above	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC Excis Nail Matrix Perm Rmvl	$311.40	$519.00	—	—	40%
Prostate biopsy CPT 55700 HC Biopsy Prostate Needle or Punc	$4,957.90	$8,263.17	$122.17–$124.61	95% above	40%
Prostate removal (prostatectomy), laparoscopic CPT 55866 Laps Surg Prst8ect Rpbic Rad W/Nrv Sparing Robot	$33,343.98	$55,573.30	$10,664.59–$10,877.88	at median	40%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC Rf Destruct Lum Single	$5,113.51	$8,522.52	$1,959.11–$1,998.29	86% above	40%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 HC Rf Destruct Lum Single\|RIGHT SIDE	$3,814.70	$6,357.83	$1,959.11–$1,998.29	39% above	40%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 HC Rf Destruct Lum Single\|LEFT SIDE	$6,037.20	$10,062.00	$1,959.11–$1,998.29	120% above	40%
Removal of a breast lump, open surgery one side CPT 19120 Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion\|RIGHT SIDE	$8,013.93	$13,356.55	$3,928.24–$4,006.80	37% above	40%
Removal of a breast lump, open surgery one side CPT 19120 Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion\|LEFT SIDE	$9,884.71	$16,474.52	$3,928.24–$4,006.80	69% above	40%
Removal of a foreign object under the skin, simple CPT 10120 HC Removal FB Skin	$777.60	$1,296.00	—	38% above	40%
Removal of a foreign object under the skin, simple CPT 10120 HC Removal FB Skin	$5,852.70	$9,754.50	$407.84	942% above	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC Removal FB Skin	$777.60	$1,296.00	—	—	40%
Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 Total Thyroid Lobectomy Uni W/WO Isthmusectomy\|RIGHT SIDE	$23,124.69	$38,541.15	$6,065.29–$6,186.60	5% below	40%
Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 Total Thyroid Lobectomy Uni W/WO Isthmusectomy\|LEFT SIDE	$31,817.21	$53,028.68	$6,065.29–$6,186.60	30% above	40%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colon Ca Scrn Not Hi Rsk Ind	$3,704.46	$6,174.10	$933.00–$951.66	18% above	40%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal Scrn; Hi Risk Ind	$3,690.71	$6,151.18	$933.00–$951.66	27% above	40%
Short arm cast (elbow to hand) CPT 29075 HC Cast - Short Arm	$237.00	$395.00	—	13% below	40%
Short arm cast (elbow to hand) inpatient CPT 29075 HC Cast - Short Arm	$237.00	$395.00	—	—	40%
Short arm splint (forearm and hand) CPT 29125 HC Splint App Short Arm Stat	$477.60	$796.00	—	97% above	40%
Short arm splint (forearm and hand) inpatient CPT 29125 HC Splint App Short Arm Stat	$477.60	$796.00	—	—	40%
Short leg cast (below the knee) CPT 29405 HC Cast Short Leg	$237.00	$395.00	—	25% below	40%
Short leg cast (below the knee) inpatient CPT 29405 HC Cast Short Leg	$237.00	$395.00	—	—	40%
Short leg splint (calf to foot) CPT 29515 HC Splint App/Short Leg	$477.60	$796.00	—	106% above	40%
Short leg splint (calf to foot) inpatient CPT 29515 HC Splint App/Short Leg	$477.60	$796.00	—	—	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) one side CPT 29824 Surgical Arthroscopy Shoulder Dstl Claviculc\|RIGHT SIDE	$31,490.56	$52,484.27	$7,279.94–$7,425.54	42% above	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) one side CPT 29824 Surgical Arthroscopy Shoulder Dstl Claviculc\|LEFT SIDE	$36,005.47	$60,009.12	$7,279.94–$7,425.54	62% above	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls\|RIGHT SIDE	$27,564.79	$45,941.32	$7,279.94–$7,425.54	16% above	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls\|LEFT SIDE	$36,001.21	$60,002.02	$7,279.94–$7,425.54	52% above	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC Rep Lac Smp Not Face <2.5cm	$800.40	$1,334.00	—	120% above	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC Rep Lac Smp Not Face <2.5cm	$941.40	$1,569.00	—	159% above	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC Rep Lac Smp Not Face <2.5cm	$800.40	$1,334.00	—	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC Rep Lac Smp Not Face <2.5cm	$941.40	$1,569.00	—	—	40%
Skin biopsy, punch, one lesion CPT 11104 HC Punch Biopsy Skin Single Lesion	$311.40	$519.00	—	at median	40%
Skin biopsy, punch, one lesion CPT 11104 HC Punch Biopsy Skin Single Lesion	$452.40	$754.00	—	45% above	40%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC Punch Biopsy Skin Single Lesion	$311.40	$519.00	—	—	40%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC Punch Biopsy Skin Single Lesion	$452.40	$754.00	—	—	40%
Skin tag removal, up to 15 tags CPT 11200 HC Excision Up to 15 Skin Tags	$150.60	$251.00	—	40% below	40%
Skin tag removal, up to 15 tags CPT 11200 HC Excision Up to 15 Skin Tags	$264.00	$440.00	$201.29	6% above	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC Excision Up to 15 Skin Tags	$150.60	$251.00	—	—	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC Excision Up to 15 Skin Tags	$227.40	$379.00	—	—	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Spinal Puncture, Lumbar, Diagnostic	$1,168.80	$1,948.00	—	36% above	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Spinal Puncture Lumbar Diagnos	$2,581.20	$4,302.00	—	200% above	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC Spinal Puncture, Lumbar, Diagnostic	$2,268.00	$3,780.00	—	—	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC Spinal Puncture Lumbar Diagnos	$2,581.20	$4,302.00	—	—	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC Repr Smp Not Face 2.6-7.5cm	$941.40	$1,569.00	—	123% above	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC Rpr Lac Smp Scalp 2.6-7.5	$941.40	$1,569.00	—	123% above	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC Repr Smp Not Face 2.6-7.5cm	$941.40	$1,569.00	—	—	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC Rpr Lac Smp Scalp 2.6-7.5	$941.40	$1,569.00	—	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC Simple Rep Wnd Face <2.5 Cm	$941.40	$1,569.00	—	150% above	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC Simple Rep Wnd Face <2.5 Cm	$941.40	$1,569.00	—	—	40%
TURP (transurethral resection of the prostate) CPT 52601 Trurl Electrosurg Rescj Prostate Bleed Complete	$13,081.88	$21,803.13	$5,379.33–$5,486.91	28% below	40%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC Tangential Biopsy Skin Single Lesion	$150.60	$251.00	—	40% below	40%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC Tangential Biopsy Skin Single Lesion	$150.60	$251.00	—	—	40%
Thoracentesis with imaging guidance CPT 32555 HC Sp Thora for Aspiration	$1,321.80	$2,203.00	—	at median	40%
Thoracentesis with imaging guidance inpatient CPT 32555 HC Sp Thora for Aspiration	$1,321.80	$2,203.00	—	—	40%
Total hip replacement one side CPT 27130 Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft\|LEFT SIDE	$52,031.95	$86,719.92	$12,880.66	60% above	40%
Total hip replacement one side CPT 27130 Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft\|RIGHT SIDE	$52,842.74	$88,071.23	$12,880.66–$13,138.27	63% above	40%
Total knee replacement CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments	$51,895.27	$86,492.12	$12,880.66–$13,138.27	42% above	40%
Total knee replacement one side CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments\|LEFT SIDE	$49,953.31	$83,255.52	$12,880.66–$13,138.27	36% above	40%
Total knee replacement one side CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments\|RIGHT SIDE	$51,057.28	$85,095.47	$12,880.66–$13,138.27	39% above	40%
Total shoulder replacement CPT 23472 Arthroplasty Glenohumeral Joint Total Shoulder	$76,145.17	$126,908.62	$17,591.15–$17,942.97	37% above	40%
Total shoulder replacement one side CPT 23472 Arthroplasty Glenohumeral Joint Total Shoulder\|RIGHT SIDE	$68,084.53	$113,474.22	$17,591.15	23% above	40%
Total shoulder replacement one side CPT 23472 Arthroplasty Glenohumeral Joint Total Shoulder\|LEFT SIDE	$68,258.69	$113,764.48	$17,591.15–$17,942.97	23% above	40%
Total thyroid removal (thyroidectomy) CPT 60240 Thyroidectomy Total/Complete	$28,166.24	$46,943.73	$6,065.29–$6,186.60	9% below	40%
Trigger finger release surgery CPT 26055 HC Incise Finger Tendon Sheath	$1,195.80	$1,993.00	—	62% below	40%
Trigger finger release surgery inpatient CPT 26055 HC Incise Finger Tendon Sheath	$1,195.80	$1,993.00	—	—	40%
Trigger point injections, 1 or 2 muscles CPT 20552 HC Inj Trigger Points 1-2 Musc	$226.80	$378.00	—	38% below	40%
Trigger point injections, 1 or 2 muscles CPT 20552 HC Inj Trigger Pt 1-2 Musc Grps	$528.00	$880.00	—	44% above	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC Inj Trigger Points 1-2 Musc	$226.80	$378.00	—	—	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC Inj Trigger Pt 1-2 Musc Grps	$516.60	$861.00	—	—	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC Bx Breast 1st Lesion US Img	$2,988.60	$4,981.00	—	49% above	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC Bx Breast 1st Lesion US Img	$2,988.60	$4,981.00	—	—	40%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Egd Balloon Dilation Esophagus <30 Mm Diam	$5,961.65	$9,936.08	$1,925.18–$1,963.69	153% above	40%
Upper endoscopy (EGD) with biopsy CPT 43239 Egd Transoral Biopsy Single/Multiple	$5,020.88	$8,368.13	$909.95–$928.15	238% above	40%
Upper endoscopy (EGD) with injection into the lining CPT 43236 Esophagogastroduodenoscopy Submucosal Injection	$7,938.34	$13,230.57	$909.95–$928.15	377% above	40%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Egd Removal Tumor Polyp/Other Lesion Snare Tech	$8,915.83	$14,859.72	$1,925.18–$1,963.69	142% above	40%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Egd Insert Guide Wire Dilator Passage Esophagus	$4,759.31	$7,932.18	$909.95–$928.15	241% above	40%
Upper endoscopy (EGD), diagnostic CPT 43235 HC Egd Diagnostic Brush Wash	$1,720.80	$2,868.00	—	16% above	40%
Upper endoscopy (EGD), diagnostic CPT 43235 HC Egd Diagnostic Brush Wash	$3,886.90	$6,478.17	$909.95–$928.15	162% above	40%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC Egd Diagnostic Brush Wash	$1,720.80	$2,868.00	—	—	40%
Ureteroscopy with laser stone breaking (lithotripsy) one side CPT 52353 Cysto W/Ureteroscopy W/Lithotripsy\|RIGHT SIDE	$17,733.35	$29,555.58	$5,379.33–$5,486.91	21% above	40%
Ureteroscopy with laser stone breaking and stent placement one side CPT 52356 Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt\|RIGHT SIDE	$24,079.97	$40,133.28	$5,379.33–$5,486.91	43% above	40%
Ureteroscopy with laser stone breaking and stent placement one side CPT 52356 Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt\|LEFT SIDE	$27,308.19	$45,513.65	$5,379.33–$5,486.91	63% above	40%
Wart removal, up to 14 warts CPT 17110 HC Destruct B9 Lesion 1-14	$150.60	$251.00	—	10% above	40%
Wart removal, up to 14 warts inpatient CPT 17110 HC Destruct B9 Lesion 1-14	$150.60	$251.00	—	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Debride Skin and Subcu	$295.20	$492.00	—	51% below	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Debride Subq First 20 Sq Cm	$1,531.80	$2,553.00	$407.84–$416.00	156% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm one side CPT 11042 HC Debride Subq First 20 Sq Cm\|RIGHT SIDE	$1,531.80	$2,553.00	$407.84–$416.00	156% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm one side CPT 11042 HC Debride Subq First 20 Sq Cm\|LEFT SIDE	$1,531.80	$2,553.00	$407.84–$416.00	156% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC Debride Skin and Subcu	$295.20	$492.00	—	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC Debride Subq First 20 Sq Cm	$1,554.60	$2,591.00	—	—	40%
Wrist fracture surgery (plate and screws), distal radius one side CPT 25607 Optx Dstl Radl X-Artic Fx/Epiphysl Sep\|RIGHT SIDE	$31,334.81	$52,224.68	$7,279.94–$7,425.54	47% above	40%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC Blood Administration	$1,612.80	$2,688.00	—	89% above	40%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC Blood Administration	$1,989.00	$3,315.00	—	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Aerosol, Hhn, Mdi, Ippb	$157.80	$263.00	—	at median	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Sputum Induction	$157.80	$263.00	—	at median	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Sputum Induction	$163.80	$273.00	—	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Aerosol, Hhn, Mdi, Ippb	$172.20	$287.00	—	—	40%
Chemotherapy IV infusion, first hour CPT 96413 HC Chemo Infusion 1st Hour Chemo	$817.20	$1,362.00	—	7% above	40%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC Chemo Infusion 1st Hour Chemo	$817.20	$1,362.00	—	—	40%
Critical care, first 30 to 74 minutes CPT 99291 HC E/M Crit Care,ER, 1st 30-74min	$5,729.40	$9,549.00	—	126% above	40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC E/M Crit Care,ER, 1st 30-74min	$5,729.40	$9,549.00	—	—	40%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC Eeg Awake & Drowsy	$2,401.80	$4,003.00	—	325% above	40%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC Eeg Awake & Drowsy	$1,041.00	$1,735.00	—	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC >= 12 Lead Ekg	$226.20	$377.00	—	8% above	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC >= 12 Lead Ekg	$202.20	$337.00	—	—	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC OB ER Level 1	$360.00	$600.00	—	91% above	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ER Level 1	$387.00	$645.00	—	106% above	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC OB ER Level 1	$360.00	$600.00	—	—	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ER Level 1	$387.00	$645.00	—	—	40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ER Level 2	$883.80	$1,473.00	—	166% above	40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC OB ER Level 2	$1,398.00	$2,330.00	—	320% above	40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ER Level 2	$883.80	$1,473.00	—	—	40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC OB ER Level 2	$1,398.00	$2,330.00	—	—	40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ER Level 3	$1,386.60	$2,311.00	—	176% above	40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC OB ER Level 3	$2,173.80	$3,623.00	—	332% above	40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ER Level 3	$1,386.60	$2,311.00	—	—	40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC OB ER Level 3	$2,173.80	$3,623.00	—	—	40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ER Level 4	$1,929.60	$3,216.00	—	112% above	40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC OB ER Level 4	$2,848.20	$4,747.00	—	213% above	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ER Level 4	$1,929.60	$3,216.00	—	—	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC OB ER Level 4	$2,848.20	$4,747.00	—	—	40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ER Level 5	$2,770.20	$4,617.00	—	93% above	40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC OB ER Level 5	$3,909.00	$6,515.00	—	173% above	40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ER Level 5	$2,770.20	$4,617.00	—	—	40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC OB ER Level 5	$3,909.00	$6,515.00	—	—	40%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC Cardiac Stress Test	$1,669.80	$2,783.00	—	122% above	40%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC Cardiac Stress Test	$462.60	$771.00	—	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC Inf 1st Hour Hyd	$642.00	$1,070.00	—	91% above	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC Inf 1st Hour Hyd	$454.80	$758.00	—	—	40%
IV infusion of a medicine, first hour CPT 96365 HC IV 1st Hour Init Drug	$503.40	$839.00	—	38% above	40%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV 1st Hour Init Drug	$676.20	$1,127.00	—	—	40%
IV push of a medicine, first drug CPT 96374 HC IV Push Initial Drug	$288.00	$480.00	—	6% above	40%
IV push of a medicine, first drug inpatient CPT 96374 HC IV Push Initial Drug	$396.00	$660.00	—	—	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC Injection Im Sub Q	$148.20	$247.00	—	36% above	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC Injection Im Sub Q	$57.60	$96.00	—	—	40%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Psych Evaluation	$293.40	$489.00	—	6% below	40%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Php Psych Evaluation	$594.60	$991.00	—	91% above	40%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Psych Evaluation	$293.40	$489.00	—	—	40%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Php Psych Evaluation	$594.60	$991.00	—	—	40%
Neuromuscular re-education, 15 minutes CPT 97112 HC Neuromuscular Re-Education, Ot	$124.80	$208.00	—	14% above	40%
Neuromuscular re-education, 15 minutes CPT 97112 HC Pt Neuro Facilitation Ea 15 Min	$285.00	$475.00	—	161% above	40%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC Neuromuscular Re-Education, Ot	$124.80	$208.00	—	—	40%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC Pt Neuro Facilitation Ea 15 Min	$124.80	$208.00	—	—	40%
New patient office visit, about 30 minutes CPT 99203 HC New Pt, Outpt Visit Level 3	$122.40	$204.00	—	36% below	40%
New patient office visit, about 30 minutes CPT 99203 HC New Pt, E/M Level 3	$122.40	$204.00	—	36% below	40%
New patient office visit, about 30 minutes inpatient CPT 99203 HC New Pt, E/M Level 3	$122.40	$204.00	—	—	40%
New patient office visit, about 30 minutes inpatient CPT 99203 HC New Pt, Outpt Visit Level 3	$280.20	$467.00	—	—	40%
New patient office visit, about 45 minutes CPT 99204 HC New Pt, E/M Level 4	$145.80	$243.00	—	10% below	40%
New patient office visit, about 45 minutes CPT 99204 HC New Pt, Outpt Visit Level 4	$145.80	$243.00	—	10% below	40%
New patient office visit, about 45 minutes inpatient CPT 99204 HC New Pt, E/M Level 4	$294.00	$490.00	—	—	40%
New patient office visit, about 45 minutes inpatient CPT 99204 HC New Pt, Outpt Visit Level 4	$309.00	$515.00	—	—	40%
New patient office visit, about 60 minutes CPT 99205 HC New Pt, Outpt Visit Level 5	$165.60	$276.00	—	29% below	40%
New patient office visit, about 60 minutes CPT 99205 HC New Pt, E/M Level 5	$165.60	$276.00	—	29% below	40%
New patient office visit, about 60 minutes inpatient CPT 99205 HC New Pt, E/M Level 5	$165.60	$276.00	—	—	40%
New patient office visit, about 60 minutes inpatient CPT 99205 HC New Pt, Outpt Visit Level 5	$408.60	$681.00	—	—	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC New Pt, Outpt Visit Level 2	$105.60	$176.00	—	at median	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC New Pt, E/M Level 2	$105.60	$176.00	—	at median	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC New Pt, E/M Level 2 W/ Procedure	$105.60	$176.00	—	at median	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC New Pt, E/M Level 2 W/ Procedure	$105.60	$176.00	—	—	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC New Pt, E/M Level 2	$105.60	$176.00	—	—	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC New Pt, Outpt Visit Level 2	$255.00	$425.00	—	—	40%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC Med Nut Therapy Ind Init 15 Min	$126.60	$211.00	—	387% above	40%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC Med Nut Therapy Ind Init 15 Min	$126.60	$211.00	—	—	40%
Occupational therapy evaluation, low complexity CPT 97165 HC Ot Eval Low Complex	$356.40	$594.00	—	67% above	40%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC Ot Eval Low Complex	$92.40	$154.00	—	—	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC Pt Eval High Complex	$364.80	$608.00	—	47% above	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC Pt Eval High Complex	$107.40	$179.00	—	—	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC Pt Eval Low Complex	$303.60	$506.00	—	41% above	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC Pt Eval Low Complex	$88.80	$148.00	—	—	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC Pt Eval Mod Complex	$366.00	$610.00	—	59% above	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC Pt Eval Mod Complex	$106.20	$177.00	—	—	40%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Pt Manual Therapy Ea 15	$141.00	$235.00	—	60% above	40%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC Pt Manual Therapy Ea 15	$137.40	$229.00	—	—	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Ther Ex per 15 Min	$148.80	$248.00	—	61% above	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Exercise,Ea 15 Min	$210.00	$350.00	—	127% above	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Ther Ex per 15 Min	$107.40	$179.00	—	—	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Exercise,Ea 15 Min	$114.60	$191.00	—	—	40%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC Prev Visit Est Age 40-64	$213.60	$356.00	—	at median	40%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC Prev Visit Est Age 40-64	$213.60	$356.00	—	—	40%
Psychotherapy session, 30 minutes CPT 90832 HC OP Psych Tx 30 Min	$216.60	$361.00	—	44% above	40%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC OP Psych Tx 30 Min	$216.60	$361.00	—	—	40%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC Smoke/Tobac Counsel 3-10	$58.80	$98.00	—	23% above	40%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC Smoke/Tobac Counsel 3-10	$58.80	$98.00	—	—	40%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Est Pt, E/M Level 5	$159.00	$265.00	—	35% below	40%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Est Pt, Outpt Visit Level 5	$159.00	$265.00	—	35% below	40%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Est Pt, E/M Level 5	$389.40	$649.00	—	—	40%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Est Pt, Outpt Visit Level 5	$408.60	$681.00	—	—	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Est Pt, Outpt Visit Level 3	$115.80	$193.00	—	24% below	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Est Pt, E/M Level 3	$121.80	$203.00	—	20% below	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Est Pt, E/M Level 3	$255.60	$426.00	—	—	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Est Pt, Outpt Visit Level 3	$268.20	$447.00	—	—	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Est Pt, E/M Level 4	$139.20	$232.00	—	at median	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Est Pt, Outpt Visit Level 4	$139.20	$232.00	—	at median	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Est Pt, Outpt Visit Level 4	$294.00	$490.00	—	—	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Est Pt, E/M Level 4	$294.00	$490.00	—	—	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Est Pt, Outpt Visit Level 2	$99.60	$166.00	—	18% below	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Est Pt, E/M Level 2	$99.60	$166.00	—	18% below	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Est Pt, E/M Level 2	$99.60	$166.00	—	—	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Est Pt, Outpt Visit Level 2	$229.80	$383.00	—	—	40%
Speech and language evaluation CPT 92523 HC Eval Speech Sound Lang Comprhension	$275.40	$459.00	—	16% below	40%
Speech and language evaluation inpatient CPT 92523 HC Eval Speech Sound Lang Comprhension	$275.40	$459.00	—	—	40%
Speech therapy session, individual CPT 92507 HC Speech/Language Therapy	$174.00	$290.00	—	1% below	40%
Speech therapy session, individual inpatient CPT 92507 HC Speech/Language Therapy	$231.60	$386.00	—	—	40%
Spirometry (breathing test) CPT 94010 HC Pif (Copd Assessment)	$374.40	$624.00	—	44% above	40%
Spirometry (breathing test) CPT 94010 HC Spirometry / Tvc / Mvv	$698.40	$1,164.00	—	168% above	40%
Spirometry (breathing test) inpatient CPT 94010 HC Pif (Copd Assessment)	$374.40	$624.00	—	—	40%
Spirometry (breathing test) inpatient CPT 94010 HC Spirometry / Tvc / Mvv	$374.40	$624.00	—	—	40%
Spirometry before and after a bronchodilator CPT 94060 HC Before / After Bronchodilator	$819.60	$1,366.00	—	100% above	40%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC Before / After Bronchodilator	$743.40	$1,239.00	—	—	40%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC Ot Therapeutic Activities 15 Min	$162.60	$271.00	—	59% above	40%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC Pt Therapeutic Activities 15 Min	$168.60	$281.00	—	64% above	40%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC Ot Therapeutic Activities 15 Min	$89.40	$149.00	—	—	40%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC Pt Therapeutic Activities 15 Min	$115.80	$193.00	—	—	40%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Virginia	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 HC Iiv Adjuvanted Vaccine for Intramuscular Use	$67.80	$113.00	—	167% above	40%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 HC Iiv Adjuvanted Vaccine for Intramuscular Use	$67.80	$113.00	—	—	40%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 HC Var Vaccine Live for Subcutaneous Use	$128.40	$214.00	—	68% below	40%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 HC Var Vaccine Live for Subcutaneous Use	$128.40	$214.00	—	—	40%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 HC Dtap-Ipv Vaccine Child 4-6 Yrs for Im Use	$61.80	$103.00	—	36% above	40%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 HC Dtap-Ipv Vaccine Child 4-6 Yrs for Im Use	$61.80	$103.00	—	—	40%
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	$110.97	$184.95	—	36% above	40%
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	$110.97	$184.95	—	—	40%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 HC Dtap-Ipv-Hib-Hepb Vaccine Im	$145.20	$242.00	—	30% above	40%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 HC Dtap-Ipv-Hib-Hepb Vaccine Im	$145.20	$242.00	—	—	40%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HC Hepa/Hepb Vaccine Adult Im	$87.60	$146.00	—	51% below	40%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HC Hepa/Hepb Vaccine Adult Im	$87.60	$146.00	—	—	40%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HC Hepa Vaccine 2 Dose Schedule Ped/Adolesc Im Use	$47.40	$79.00	—	35% below	40%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HC Hepa Vaccine 2 Dose Schedule Ped/Adolesc Im Use	$47.40	$79.00	—	—	40%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC Hepatitis B Vaccine	$97.20	$162.00	—	52% below	40%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HC Hepatitis B Vaccine	$97.20	$162.00	—	—	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HC Hepb Vaccine Ped/Adolesc 3 Dose Schedule Im	$54.00	$90.00	—	42% below	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY	$98.76	$164.60	—	5% above	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HC Hepb Vaccine Ped/Adolesc 3 Dose Schedule Im	$54.00	$90.00	—	—	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY	$98.76	$164.60	—	—	40%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP	$118.03	$196.71	—	at median	40%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP	$118.03	$196.71	—	—	40%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR	$50.27	$83.79	—	80% above	40%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR	$50.27	$83.79	—	—	40%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC Iiv Vaccine Preserv Free Increased Ag Count Im	$65.40	$109.00	—	59% below	40%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 HC Iiv Vaccine Preserv Free Increased Ag Count Im	$65.40	$109.00	—	—	40%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$367.46	$612.44	—	8% above	40%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$367.46	$612.44	—	—	40%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 HC Meningococcal Conj Vaccine Quadravalent Im	$156.00	$260.00	—	41% below	40%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR	$625.31	$1,042.18	—	135% above	40%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 HC Meningococcal Conj Vaccine Quadravalent Im	$156.00	$260.00	—	—	40%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR	$625.31	$1,042.18	—	—	40%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 HC Menb 4c Vacc 2 Dose Im	$328.20	$547.00	—	at median	40%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY	$889.22	$1,482.04	—	171% above	40%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 HC Menb 4c Vacc 2 Dose Im	$328.20	$547.00	—	—	40%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY	$889.22	$1,482.04	—	—	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 HC Pcv20 Vaccine Im	$159.00	$265.00	—	52% below	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY	$1,029.76	$1,716.26	—	213% above	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 HC Pcv20 Vaccine Im	$159.00	$265.00	—	—	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY	$1,029.76	$1,716.26	—	—	40%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 HC Pneumococcal Conjugate Vaccine, 21 Valent (Pcv21), for Im	$582.60	$971.00	—	at median	40%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 HC Pneumococcal Conjugate Vaccine, 21 Valent (Pcv21), for Im	$582.60	$971.00	—	—	40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC Pneumococcal Vaccine	$147.00	$245.00	—	23% below	40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HC Pneumococcal Vaccine	$147.00	$245.00	—	—	40%
Polio vaccine, inactivated (IPV) CPT 90713 HC Poliomyelitis Immunizatn,Inactv,Sub-Q	$42.00	$70.00	—	4% above	40%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 HC Poliomyelitis Immunizatn,Inactv,Sub-Q	$42.00	$70.00	—	—	40%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 HC Rsv Vaccine Syncytial Monoclonal 1ml Dose for Im	$327.60	$546.00	—	53% below	40%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 HC Rsv Vaccine Syncytial Monoclonal 1ml Dose for Im	$327.60	$546.00	—	—	40%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 HC Rsv Vaccine Syncytial Monoclonal 0.5ml Dose for Im	$163.80	$273.00	—	86% below	40%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 HC Rsv Vaccine Syncytial Monoclonal 0.5ml Dose for Im	$163.80	$273.00	—	—	40%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 HC Rsv Vaccine Pref Subunit Bivalent for Im Use	$211.80	$353.00	—	38% below	40%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 HC Rsv Vaccine Pref Subunit Bivalent for Im Use	$211.80	$353.00	—	—	40%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 HC Rsv Vaccine Pref Recombinant Subunit Adjvtd for Im Use	$195.60	$326.00	—	at median	40%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 HC Rsv Vaccine Pref Recombinant Subunit Adjvtd for Im Use	$195.60	$326.00	—	—	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP	$158.42	$264.04	—	22% above	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP	$158.42	$264.04	—	—	40%
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	$182.80	$304.67	—	69% above	40%
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	$182.80	$304.67	—	—	40%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 HC Typhoid Vaccine, Im	$129.60	$216.00	—	27% below	40%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 HC Typhoid Vaccine, Im	$129.60	$216.00	—	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Immunization Administration	$52.80	$88.00	—	6% below	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC Immunization Administration	$57.60	$96.00	—	—	40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC Subsequent Immun Admin	$34.20	$57.00	—	17% below	40%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC Subsequent Immun Admin	$37.20	$62.00	—	—	40%

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.bonsecours.com/-/media/bon-secours/patients-and-visitors/corporate/pricing/541744931_bon-secours-memorial-regional-medical-center-llc_standardcharges.ashx