Hospital New York-Newark-Jersey City, NY-NJ

Mount Sinai Behavioral Health Center

Mount Sinai Behavioral Health Center in New York, NY publishes cash prices for 457 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the New York median for 8 of 10 procedures and below it for 1. Select a procedure to compare it with other hospitals nearby.

45 Rivington Street, New York, NY 10002 Collected Oct 4, 2026 Source price file Check a bill from this hospital

Some prices here are not compared

Mount Sinai Behavioral Health Center is a psychiatric hospital. Its price file also lists scans, lab tests and procedures, but these are generally provided to its own inpatients, not booked by outside patients, so they are not compared with other hospitals here. Only its psychiatric evaluation and therapy prices are compared.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs New York	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT Abdomen W&WO Contrast	$2,160.00	$2,400.00	—	—	10%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abdomen W&WO Contrast	$2,160.00	$2,400.00	—	—	10%
Abdominal X-ray, 2 views CPT 74019 HC X-Ray Exam Abdomen 2 Views	$495.00	$550.00	—	—	10%
Abdominal X-ray, 2 views inpatient CPT 74019 HC X-Ray Exam Abdomen 2 Views	$495.00	$550.00	—	—	10%
Ankle X-ray, complete, 3 or more views CPT 73610 HC Xray Ankle Complete 3+ Views	$540.00	$600.00	—	—	10%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC Xray Ankle Complete 3+ Views	$540.00	$600.00	—	—	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 N-Invas Physiologic Std Upr/Lxtr Art 1 Lvl Bi - 93922	$1,309.50	$1,455.00	—	—	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC Extremity Study Sngl Lvi Bi	$1,309.50	$1,455.00	—	—	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC Non-Invas Physiologic Std Extremity Art 2 Level	$1,309.50	$1,455.00	—	—	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC Extremity Study Sngl Lvi Bi	$1,309.50	$1,455.00	—	—	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 N-Invas Physiologic Std Upr/Lxtr Art 1 Lvl Bi - 93922	$1,309.50	$1,455.00	—	—	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC Non-Invas Physiologic Std Extremity Art 2 Level	$1,309.50	$1,455.00	—	—	10%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT Upper Extremity WO Contrast	$1,440.00	$1,600.00	—	—	10%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT Upper Extremity WO Contrast	$1,440.00	$1,600.00	—	—	10%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC Single Contrast Exam - Esophagus	$868.50	$965.00	—	—	10%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC Single Contrast Exam - Esophagus	$868.50	$965.00	—	—	10%
Bone scan, whole body (nuclear medicine) CPT 78306 HC Bone and or Joint Imaging Whole Body	$2,520.00	$2,800.00	—	—	10%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC Bone and or Joint Imaging Whole Body	$2,520.00	$2,800.00	—	—	10%
Breast ultrasound, complete, one breast one side CPT 76641 HC US Breast Unilateral W/Image Complete	$666.00	$740.00	—	—	10%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 HC US Breast Unilateral W/Image Complete	$666.00	$740.00	—	—	10%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC US Breast Unilateral W/Image Limited	$450.00	$500.00	—	—	10%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HC US Breast Unilateral W/Image Limited	$450.00	$500.00	—	—	10%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CT Angio Abd&Pelv W/O&W/ Contrast	$4,950.00	$5,500.00	—	—	10%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CT Angio Abd&Pelv W/O&W/ Contrast	$4,950.00	$5,500.00	—	—	10%
CT angiography (CTA) of the head CPT 70496 HC Cta Head W&WO Contrast	$3,555.00	$3,950.00	—	—	10%
CT angiography (CTA) of the head inpatient CPT 70496 HC Cta Head W&WO Contrast	$3,555.00	$3,950.00	—	—	10%
CT angiography (CTA) of the neck CPT 70498 HC Cta Neck W W/O Contrast	$3,555.00	$3,950.00	—	—	10%
CT angiography (CTA) of the neck inpatient CPT 70498 HC Cta Neck W W/O Contrast	$3,555.00	$3,950.00	—	—	10%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC Cta Chest Noncornr W W/O Contrast	$3,330.00	$3,700.00	—	—	10%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC Cta Chest Noncornr W W/O Contrast	$3,330.00	$3,700.00	—	—	10%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CT Angio Heart W/3d Image	$2,308.50	$2,565.00	—	—	10%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CT Angio Heart W/3d Image	$2,308.50	$2,565.00	—	—	10%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT Heart W/O Quant Eval Calc	$1,116.00	$1,240.00	—	—	10%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT Heart W/O Quant Eval Calc	$1,116.00	$1,240.00	—	—	10%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT Abdomen Pelvis W/O Contrast	$2,970.00	$3,300.00	—	—	10%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT Abdomen Pelvis W/O Contrast	$2,970.00	$3,300.00	—	—	10%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abdomen Pelvis W Contrast	$3,960.00	$4,400.00	—	—	10%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abdomen Pelvis W Contrast	$3,960.00	$4,400.00	—	—	10%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Abdmn Pelvis WO & W Contrast	$5,040.00	$5,600.00	—	—	10%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Abdmn Pelvis WO & W Contrast	$5,040.00	$5,600.00	—	—	10%
CT scan of the abdomen with contrast CPT 74160 HC CT Abdomen W/Contrast	$1,890.00	$2,100.00	—	—	10%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT Abdomen W/Contrast	$1,890.00	$2,100.00	—	—	10%
CT scan of the abdomen without contrast CPT 74150 HC CT Abdomen W/O Contrast	$1,620.00	$1,800.00	—	—	10%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT Abdomen W/O Contrast	$1,620.00	$1,800.00	—	—	10%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT Maxillofacial WO Contrast	$1,908.00	$2,120.00	—	—	10%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT Maxillofacial WO Contrast	$1,908.00	$2,120.00	—	—	10%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain WO Dye	$1,620.00	$1,800.00	—	—	10%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT- Head W/O Contrast	$1,620.00	$1,800.00	—	—	10%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head/Brain WO Dye	$1,620.00	$1,800.00	—	—	10%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT- Head W/O Contrast	$1,620.00	$1,800.00	—	—	10%
CT scan of the head with contrast CPT 70460 HC CT Head W/ Contrast	$1,800.00	$2,000.00	—	—	10%
CT scan of the head with contrast inpatient CPT 70460 HC CT Head W/ Contrast	$1,800.00	$2,000.00	—	—	10%
CT scan of the head without and with contrast CPT 70470 HC CT Head W W/O Contrast	$1,980.00	$2,200.00	—	—	10%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT Head W W/O Contrast	$1,980.00	$2,200.00	—	—	10%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT Lumbar Spine WO Contrast	$1,530.00	$1,700.00	—	—	10%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT Lumbar Spine WO Contrast	$1,530.00	$1,700.00	—	—	10%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT Cervical Spine W/O Contrast	$1,530.00	$1,700.00	—	—	10%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT Cervical Spine W/O Contrast	$1,530.00	$1,700.00	—	—	10%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/ Contrast	$2,340.00	$2,600.00	—	—	10%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/ Contrast	$2,340.00	$2,600.00	—	—	10%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC Dplx Scn Excran Art Comp Bilat	$1,944.00	$2,160.00	—	—	10%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Dup-Scan Xtrc Art Compl Bi Std - 93880	$1,944.00	$2,160.00	—	—	10%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 HC Extracranial	$1,944.00	$2,160.00	—	—	10%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Dup-Scan Xtrc Art Compl Bi Std - 93880	$1,944.00	$2,160.00	—	—	10%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC Dplx Scn Excran Art Comp Bilat	$1,944.00	$2,160.00	—	—	10%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 HC Extracranial	$1,944.00	$2,160.00	—	—	10%
Chest CT scan without and with contrast CPT 71270 HC CT Thorax W&WO Contrast	$2,902.50	$3,225.00	—	—	10%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT Thorax W&WO Contrast	$2,902.50	$3,225.00	—	—	10%
Chest X-ray, 2 views CPT 71046 HC X-Ray Exam Chest 2 Views	$477.00	$530.00	—	—	10%
Chest X-ray, 2 views inpatient CPT 71046 HC X-Ray Exam Chest 2 Views	$477.00	$530.00	—	—	10%
Chest X-ray, single view CPT 71045 HC X-Ray Exam Chest 1 View	$382.50	$425.00	—	—	10%
Chest X-ray, single view inpatient CPT 71045 HC X-Ray Exam Chest 1 View	$382.50	$425.00	—	—	10%
Collarbone (clavicle) X-ray, complete CPT 73000 HC Xray Clavicle Complete	$454.50	$505.00	—	—	10%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC Xray Clavicle Complete	$454.50	$505.00	—	—	10%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US Exam Abdo Back Wall Complete	$1,215.00	$1,350.00	—	—	10%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Rpr B-Scan&/R-T Img Compl - 76770	$1,215.00	$1,350.00	—	—	10%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Rpr B-Scan&/R-T Img Compl - 76770	$1,215.00	$1,350.00	—	—	10%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US Exam Abdo Back Wall Complete	$1,215.00	$1,350.00	—	—	10%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC Dexa 1+ Sites Axial Skeleton	$922.50	$1,025.00	—	—	10%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC Dexa 1+ Sites Axial Skeleton	$922.50	$1,025.00	—	—	10%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC Dexa 1+ Sites Appendic Skeleton	$549.00	$610.00	—	—	10%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC Dexa 1+ Sites Appendic Skeleton	$549.00	$610.00	—	—	10%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC Obstetric US Detailed Sngl Fetus	$1,314.00	$1,460.00	—	—	10%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC Obstetric US Detailed Sngl Fetus	$1,314.00	$1,460.00	—	—	10%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Thorax WO Contrast	$1,800.00	$2,000.00	—	—	10%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT Thorax WO Contrast	$1,800.00	$2,000.00	—	—	10%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT Thorax W/ Contrast	$2,596.50	$2,885.00	—	—	10%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT Thorax W/ Contrast	$2,596.50	$2,885.00	—	—	10%
Diagnostic mammogram, both breasts both sides CPT 77066 HC Dx Mammo Incl Cad Bilateral	$855.00	$950.00	—	—	10%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Dx Mammo Incl Cad Bilateral	$855.00	$950.00	—	—	10%
Diagnostic mammogram, one breast one side CPT 77065 HC Dx Mammo Incl Cad Unilateral	$652.50	$725.00	—	—	10%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Dx Mammo Incl Cad Unilateral	$652.50	$725.00	—	—	10%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC Lwr Ext Art Duplex Comp Bilat	$2,070.00	$2,300.00	—	—	10%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Std - 93925	$2,070.00	$2,300.00	—	—	10%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Std - 93925	$2,070.00	$2,300.00	—	—	10%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC Lwr Ext Art Duplex Comp Bilat	$2,070.00	$2,300.00	—	—	10%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC Duplex Extrem Veins Compl Bilat	$2,160.00	$2,400.00	—	—	10%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Dup-Scan Xtr Veins Compl Bi Std - 93970	$2,160.00	$2,400.00	—	—	10%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Dup-Scan Xtr Veins Compl Bi Std - 93970	$2,160.00	$2,400.00	—	—	10%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC Duplex Extrem Veins Compl Bilat	$2,160.00	$2,400.00	—	—	10%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC Echo 2d Transthoracic W Doppler Complete	$3,280.50	$3,645.00	—	—	10%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC Echo 2d Transthoracic W Doppler Complete	$3,280.50	$3,645.00	—	—	10%
Elbow X-ray, 2 views CPT 73070 HC Xray Elbow 2 Views	$360.00	$400.00	—	—	10%
Elbow X-ray, 2 views inpatient CPT 73070 HC Xray Elbow 2 Views	$360.00	$400.00	—	—	10%
Elbow X-ray, complete, 3 or more views CPT 73080 HC X-Ray Elbows Minimum 3 Views	$495.00	$550.00	—	—	10%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC X-Ray Elbows Minimum 3 Views	$495.00	$550.00	—	—	10%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT Orb/Sella/Fossa/Ear WO Contrast	$2,070.00	$2,300.00	—	—	10%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT Orb/Sella/Fossa/Ear WO Contrast	$2,070.00	$2,300.00	—	—	10%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC Complete X-Ray of Facial Bones, Minimum of 3 Views	$540.00	$600.00	—	—	10%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC Xray Facial Bones Compl Min 3	$540.00	$600.00	—	—	10%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC Xray Facial Bones Compl Min 3	$540.00	$600.00	—	—	10%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC Complete X-Ray of Facial Bones, Minimum of 3 Views	$540.00	$600.00	—	—	10%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC Xray Forearm 2 Views	$450.00	$500.00	—	—	10%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC Xray Forearm 2 Views	$450.00	$500.00	—	—	10%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC Hepatobiliary Syst Imaging Including Gallbladder	$2,025.00	$2,250.00	—	—	10%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC Hepatobiliary Syst Imaging Including Gallbladder	$2,025.00	$2,250.00	—	—	10%
Hand X-ray, 2 views CPT 73120 HC Xray Hand 2 Views	$531.00	$590.00	—	—	10%
Hand X-ray, 2 views inpatient CPT 73120 HC Xray Hand 2 Views	$531.00	$590.00	—	—	10%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC Xray Calcaneus Min 2 Views	$432.00	$480.00	—	—	10%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC Xray Calcaneus Min 2 Views	$432.00	$480.00	—	—	10%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC Sleep Std Airflow Hrt Rate&O2 Sat Effort Unatt	$6,660.00	$7,400.00	—	—	10%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC Sleep Std Airflow Hrt Rate&O2 Sat Effort Unatt	$6,660.00	$7,400.00	—	—	10%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC Polysmnogrphy,Slp W/4+Par,Cpap	$9,571.50	$10,635.00	—	—	10%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC Polysmnogrphy,Slp W/4+Par,Cpap	$9,571.50	$10,635.00	—	—	10%
Knee X-ray, 3 views CPT 73562 HC Xray Knee 3 Views	$540.00	$600.00	—	—	10%
Knee X-ray, 3 views inpatient CPT 73562 HC Xray Knee 3 Views	$540.00	$600.00	—	—	10%
Knee X-ray, complete, 4 or more views CPT 73564 HC Xray Knee 4+Views	$972.00	$1,080.00	—	—	10%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC Xray Knee 4+Views	$972.00	$1,080.00	—	—	10%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT Lower Extreminty WO Contrast	$1,300.50	$1,445.00	—	—	10%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT Lower Extreminty WO Contrast	$1,300.50	$1,445.00	—	—	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US Abdominal W/Image Limited	$900.00	$1,000.00	—	—	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdl B-Scan&/R-T Img Lmtd - 76705	$900.00	$1,000.00	—	—	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdl B-Scan&/R-T Img Lmtd - 76705	$900.00	$1,000.00	—	—	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US Abdominal W/Image Limited	$900.00	$1,000.00	—	—	10%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US Extremity Non-Vasc Real-Time Img Lmtd - 76882	$486.00	$540.00	—	—	10%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US Extrem Non Vascul Limited	$486.00	$540.00	—	—	10%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US Extrem Non Vascul Limited	$486.00	$540.00	—	—	10%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US Extremity Non-Vasc Real-Time Img Lmtd - 76882	$486.00	$540.00	—	—	10%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC Ldct Lung Cancer Screening	$2,115.00	$2,350.00	—	—	10%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC Ldct Lung Cancer Screening	$2,115.00	$2,350.00	—	—	10%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC Xray Tibia Fibula 2 Views	$661.50	$735.00	—	—	10%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC Xray Tibia Fibula 2 Views	$661.50	$735.00	—	—	10%
MR angiography (MRA) of the head without contrast CPT 70544 HC Mra Head W/O Contrast	$3,330.00	$3,700.00	—	—	10%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC Mra Head W/O Contrast	$3,330.00	$3,700.00	—	—	10%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Any Joint Lower Extrem W/O Contrast	$3,159.00	$3,510.00	—	—	10%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Any Joint Lower Extrem W/O Contrast	$3,159.00	$3,510.00	—	—	10%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI Any Jt Lower Extrem W/O & W/Contrast	$4,140.00	$4,600.00	—	—	10%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI Any Jt Lower Extrem W/O & W/Contrast	$4,140.00	$4,600.00	—	—	10%
MRI of the abdomen without contrast CPT 74181 HC MRI Abdomen W/O Contrast	$2,461.50	$2,735.00	—	—	10%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI Abdomen W/O Contrast	$2,461.50	$2,735.00	—	—	10%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI Abdomen W/O & W/Contrast	$5,224.50	$5,805.00	—	—	10%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI Abdomen W/O & W/Contrast	$5,224.50	$5,805.00	—	—	10%
MRI of the brain, no contrast dye CPT 70551 HC MRI Brain Brain Stem W/O Contrast	$4,860.00	$5,400.00	—	—	10%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain Brain Stem W/O Contrast	$4,860.00	$5,400.00	—	—	10%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI Brain Brain Stem W/O W/Contrast	$8,176.50	$9,085.00	—	—	10%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Brain Brain Stem W/O W/Contrast	$8,176.50	$9,085.00	—	—	10%
MRI of the lower back, no contrast dye CPT 72148 HC MRI Spinal Canal Lumbar W/O Contrast	$3,523.50	$3,915.00	—	—	10%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Spinal Canal Lumbar W/O Contrast	$3,523.50	$3,915.00	—	—	10%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI Spinal Canal Lumbar W/O & W/Contrast	$5,400.00	$6,000.00	—	—	10%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI Spinal Canal Lumbar W/O & W/Contrast	$5,400.00	$6,000.00	—	—	10%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI Spinal Canal Thoracic W/O Contrast	$3,505.50	$3,895.00	—	—	10%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI Spinal Canal Thoracic W/O Contrast	$3,505.50	$3,895.00	—	—	10%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI Spinal Canal Cervical W/O & W/Contrast	$5,400.00	$6,000.00	—	—	10%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI Spinal Canal Cervical W/O & W/Contrast	$5,400.00	$6,000.00	—	—	10%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI Cervical Spine WO Contrast	$3,514.50	$3,905.00	—	—	10%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI Cervical Spine WO Contrast	$3,514.50	$3,905.00	—	—	10%
MRI of the pelvis without and with contrast CPT 72197 HC MRI Pelvis W/O & W/Contrast	$5,589.00	$6,210.00	—	—	10%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI Pelvis W/O & W/Contrast	$5,589.00	$6,210.00	—	—	10%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI Pelvis W/O Contrast	$3,402.00	$3,780.00	—	—	10%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI Pelvis W/O Contrast	$3,402.00	$3,780.00	—	—	10%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI Any Joint Upper Extremity W/O Contrast	$3,159.00	$3,510.00	—	—	10%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI Any Joint Upper Extremity W/O Contrast	$3,159.00	$3,510.00	—	—	10%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC Xray Spine Cervical 4-5 Views	$1,093.50	$1,215.00	—	—	10%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC Xray Spine Cervical 4-5 Views	$1,093.50	$1,215.00	—	—	10%
Neck soft tissue CT scan with contrast CPT 70491 HC CT Neck Soft Tissue W Contrast	$2,070.00	$2,300.00	—	—	10%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT Neck Soft Tissue W Contrast	$2,070.00	$2,300.00	—	—	10%
Neck soft tissue CT scan without contrast CPT 70490 HC CT Neck Soft Tissue WO Contrast	$1,620.00	$1,800.00	—	—	10%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT Neck Soft Tissue WO Contrast	$1,620.00	$1,800.00	—	—	10%
Neck soft tissue X-ray CPT 70360 HC Xray Neck Soft Tissue	$364.50	$405.00	—	—	10%
Neck soft tissue X-ray inpatient CPT 70360 HC Xray Neck Soft Tissue	$364.50	$405.00	—	—	10%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC Myocardial Spect Multiple Studies	$5,287.50	$5,875.00	—	—	10%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC Myocardial Spect Multiple Studies	$5,287.50	$5,875.00	—	—	10%
OCT scan of the retina (optical coherence tomography) CPT 92134 HC Cptr Ophth Dx Img Post Segmt	$306.00	$340.00	—	—	10%
OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 HC Cptr Ophth Dx Img Post Segmt	$306.00	$340.00	—	—	10%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC Pet Imaging CT Attenuation Skull Base Mid-Thigh	$7,290.00	$8,100.00	—	—	10%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC Pet Imaging CT Attenuation Skull Base Mid-Thigh	$7,290.00	$8,100.00	—	—	10%
Pelvic CT scan without contrast CPT 72192 HC CT Pelvis WO Contrast	$1,800.00	$2,000.00	—	—	10%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT Pelvis WO Contrast	$1,800.00	$2,000.00	—	—	10%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pel Nonob B-Scan&/R-T Img Lmtd/F-Up+C97 - 76857	$526.50	$585.00	—	—	10%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US Pelvic Non OB Limited	$526.50	$585.00	—	—	10%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pel Nonob B-Scan&/R-T Img Lmtd/F-Up+C97 - 76857	$526.50	$585.00	—	—	10%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US Pelvic Non OB Limited	$526.50	$585.00	—	—	10%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC Pelvic US Bscan Complete	$1,336.50	$1,485.00	—	—	10%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US Exam of Pelvis	$1,336.50	$1,485.00	—	—	10%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC Pelvic US Bscan Complete	$1,336.50	$1,485.00	—	—	10%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US Exam of Pelvis	$1,336.50	$1,485.00	—	—	10%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pg Uter F&Mat After 1st Tri 1/1st Gestation - 76805	$688.50	$765.00	—	—	10%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US Pregnt Uterus >14weeks Sng	$688.50	$765.00	—	—	10%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US Pregnt Uterus >14weeks Sng	$688.50	$765.00	—	—	10%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pg Uter F&Mat After 1st Tri 1/1st Gestation - 76805	$688.50	$765.00	—	—	10%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US Pregn Uterus <14 Week Sngl	$720.00	$800.00	—	—	10%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Pg Uter Img F&Mat 14 Wk Tabdl 1/1st Gestation - 76801	$720.00	$800.00	—	—	10%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US Pregn Uterus <14 Week Sngl	$720.00	$800.00	—	—	10%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Pg Uter Img F&Mat 14 Wk Tabdl 1/1st Gestation - 76801	$720.00	$800.00	—	—	10%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pg Uter R-T Img Lmtd 1+ Fetuses - 76815	$729.00	$810.00	—	—	10%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US Pregnant Uterus Limited	$729.00	$810.00	—	—	10%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US Pregnant Uterus Limited	$729.00	$810.00	—	—	10%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Pg Uter R-T Img Lmtd 1+ Fetuses - 76815	$729.00	$810.00	—	—	10%
Rib X-ray, one side, 2 views one side CPT 71100 HC Xray Ribs Unilateral 2 Views	$396.00	$440.00	—	—	10%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC Xray Ribs Unilateral 2 Views	$396.00	$440.00	—	—	10%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC Xray Ribs Uni W/Posteroant Ch Min 3 Views	$477.00	$530.00	—	—	10%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC Xray Ribs W/Chest-1 View	$477.00	$530.00	—	—	10%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC Xray Ribs Uni W/Posteroant Ch Min 3 Views	$477.00	$530.00	—	—	10%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC Xray Ribs W/Chest-1 View	$477.00	$530.00	—	—	10%
Screening mammogram, both breasts both sides CPT 77067 HC Screen Mammo W Cad Bilateral	$720.00	$800.00	—	—	10%
Screening mammogram, both breasts inpatient both sides CPT 77067 HC Screen Mammo W Cad Bilateral	$720.00	$800.00	—	—	10%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC Xray Shoulder Comp Min 2 View	$576.00	$640.00	—	—	10%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC Xray Shoulder Comp Minimum 2 Views	$576.00	$640.00	—	—	10%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC Xray Shoulder Comp Minimum 2 Views	$576.00	$640.00	—	—	10%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC Xray Shoulder Comp Min 2 View	$576.00	$640.00	—	—	10%
Sinus X-ray, complete, 3 or more views CPT 70220 HC Xray Sinuses Parans Minimum 3 Views	$396.00	$440.00	—	—	10%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC Xray Sinuses Parans Minimum 3 Views	$396.00	$440.00	—	—	10%
Skull X-ray, fewer than 4 views CPT 70250 HC Xray Skull Less Than 4 Views	$490.50	$545.00	—	—	10%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC Xray Skull Less Than 4 Views	$490.50	$545.00	—	—	10%
Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnogrphy,Slp W/4+Paramet Stg	$9,378.00	$10,420.00	—	—	10%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnogrphy,Slp W/4+Paramet Stg	$9,378.00	$10,420.00	—	—	10%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC Stress Tte Complete	$3,375.00	$3,750.00	—	—	10%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC Stress Tte 2d W Ecg Recording	$3,375.00	$3,750.00	—	—	10%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC Stress Tte 2d W Ecg Recording	$3,375.00	$3,750.00	—	—	10%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC Stress Tte Complete	$3,375.00	$3,750.00	—	—	10%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC Xr Swallow Study W Cine and Contrast	$783.00	$870.00	—	—	10%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC Xr Swallow Study W Cine and Contrast	$783.00	$870.00	—	—	10%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC Xray Femur Min 2 Views	$360.00	$400.00	—	—	10%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC Xray Femur Min 2 Views	$360.00	$400.00	—	—	10%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT Thoracic Spine WO Contrast	$1,530.00	$1,700.00	—	—	10%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT Thoracic Spine WO Contrast	$1,530.00	$1,700.00	—	—	10%
Toe X-ray, 2 or more views CPT 73660 HC Xray Toes Min 2 Views	$540.00	$600.00	—	—	10%
Toe X-ray, 2 or more views inpatient CPT 73660 HC Xray Toes Min 2 Views	$540.00	$600.00	—	—	10%
Transvaginal pelvic ultrasound CPT 76830 US Trvg - 76830	$1,336.50	$1,485.00	—	—	10%
Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal Nonobstetric	$1,336.50	$1,485.00	—	—	10%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Trvg - 76830	$1,336.50	$1,485.00	—	—	10%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal Nonobstetric	$1,336.50	$1,485.00	—	—	10%
Transvaginal ultrasound during pregnancy CPT 76817 HC US Pregn Uterus Transvaginal	$720.00	$800.00	—	—	10%
Transvaginal ultrasound during pregnancy CPT 76817 US Pg Uter R-T Img Trvg - 76817	$720.00	$800.00	—	—	10%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Pg Uter R-T Img Trvg - 76817	$720.00	$800.00	—	—	10%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US Pregn Uterus Transvaginal	$720.00	$800.00	—	—	10%
Ultrasound of the abdomen, complete CPT 76700 HC US Exam of Abdomen Complete	$1,260.00	$1,400.00	—	—	10%
Ultrasound of the abdomen, complete CPT 76700 US Abdl B-Scan&/R-T Img Compl - 76700	$1,260.00	$1,400.00	—	—	10%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Exam of Abdomen Complete	$1,260.00	$1,400.00	—	—	10%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdl B-Scan&/R-T Img Compl - 76700	$1,260.00	$1,400.00	—	—	10%
Ultrasound of the scrotum and testicles CPT 76870 HC US Exam of Scrotum	$1,336.50	$1,485.00	—	—	10%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US Exam of Scrotum	$1,336.50	$1,485.00	—	—	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US Soft Tissue Head & Neck Real Time Imge Docm	$1,449.00	$1,610.00	—	—	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Soft Tiss Head&Nck B-Scan&/R-T Img - 76536	$1,449.00	$1,610.00	—	—	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US Soft Tissue Head & Neck Real Time Imge Docm	$1,449.00	$1,610.00	—	—	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Soft Tiss Head&Nck B-Scan&/R-T Img - 76536	$1,449.00	$1,610.00	—	—	10%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC X-Ray Exam Upper GI Tract Single Contrast	$1,260.00	$1,400.00	—	—	10%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC X-Ray Exam Upper GI Tract Single Contrast	$1,260.00	$1,400.00	—	—	10%
Upper arm X-ray (humerus), 2 views CPT 73060 HC Xray Humerus Min 2 Views	$409.50	$455.00	—	—	10%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC Xray Humerus Min 2 Views	$409.50	$455.00	—	—	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Dup-Scan Xtr Veins Uni/Lmtd Std - 93971	$1,350.00	$1,500.00	—	—	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC Duplex Extrem Vein Unilat Ltd	$1,350.00	$1,500.00	—	—	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Dup-Scan Xtr Veins Uni/Lmtd Std - 93971	$1,350.00	$1,500.00	—	—	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC Duplex Extrem Vein Unilat Ltd	$1,350.00	$1,500.00	—	—	10%
Wrist X-ray, 2 views CPT 73100 HC Xray Wrist 2 Views	$432.00	$480.00	—	—	10%
Wrist X-ray, 2 views inpatient CPT 73100 HC Xray Wrist 2 Views	$432.00	$480.00	—	—	10%
Wrist X-ray, complete, 3 or more views CPT 73110 HC Xray Wrist Complete 3+Views	$585.00	$650.00	—	—	10%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC Xray Wrist Complete 3+Views	$585.00	$650.00	—	—	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC X-Ray Hip Unilateral 2-3 Views	$391.50	$435.00	—	—	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC X-Ray Hip Unilateral 2-3 View	$391.50	$435.00	—	—	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC X-Ray Hip Unilateral 2-3 Views	$391.50	$435.00	—	—	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC X-Ray Hip Unilateral 2-3 View	$391.50	$435.00	—	—	10%
X-ray of the abdomen, 1 view CPT 74018 HC X-Ray Exam Abdomen 1 View	$405.00	$450.00	—	—	10%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC X-Ray Exam Abdomen 1 View	$405.00	$450.00	—	—	10%
X-ray of the ankle, 2 views CPT 73600 HC Xray Ankle 2 Views	$441.00	$490.00	—	—	10%
X-ray of the ankle, 2 views inpatient CPT 73600 HC Xray Ankle 2 Views	$441.00	$490.00	—	—	10%
X-ray of the finger(s), 2 or more views CPT 73140 HC Xray Fingers Minimum 2 Views	$418.50	$465.00	—	—	10%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC Xray Fingers Minimum 2 Views	$418.50	$465.00	—	—	10%
X-ray of the foot, 2 views CPT 73620 HC Xray Foot 2 Views	$432.00	$480.00	—	—	10%
X-ray of the foot, 2 views inpatient CPT 73620 HC Xray Foot 2 Views	$432.00	$480.00	—	—	10%
X-ray of the foot, complete, 3 or more views CPT 73630 HC Xray Foot 3 + Views	$585.00	$650.00	—	—	10%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC Xray Foot 3 + Views	$585.00	$650.00	—	—	10%
X-ray of the hand, 3 or more views CPT 73130 HC Xray Hand 3 Views	$630.00	$700.00	—	—	10%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC Xray Hand 3 Views	$630.00	$700.00	—	—	10%
X-ray of the knee, 1 or 2 views CPT 73560 HC Xray Knee 1-2 Views	$427.50	$475.00	—	—	10%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC Xray Knee 1-2 Views	$427.50	$475.00	—	—	10%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC Xray Lumbosacral 2-3 Views	$580.50	$645.00	—	—	10%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC Xray Lumbosacral 2-3 Views	$580.50	$645.00	—	—	10%
X-ray of the lower back, 4 or more views CPT 72110 HC Xray Spine Lumbosacral Min 4 Views	$873.00	$970.00	—	—	10%
X-ray of the lower back, 4 or more views CPT 72110 HC Xray Spine Lumbosc Min 4 View	$873.00	$970.00	—	—	10%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Xray Spine Lumbosc Min 4 View	$873.00	$970.00	—	—	10%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Xray Spine Lumbosacral Min 4 Views	$873.00	$970.00	—	—	10%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC Xray Spine Thoracic 2 Views	$558.00	$620.00	—	—	10%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC Xray Spine Thoracic 2 Views	$558.00	$620.00	—	—	10%
X-ray of the nasal bones, 3 or more views CPT 70160 HC Xray Nasal Bones Min 3 Views	$400.50	$445.00	—	—	10%
X-ray of the nasal bones, 3 or more views CPT 70160 HC Complete X-Ray of Nasal Bones, Minimum of 3 Views	$400.50	$445.00	—	—	10%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC Xray Nasal Bones Min 3 Views	$400.50	$445.00	—	—	10%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC Complete X-Ray of Nasal Bones, Minimum of 3 Views	$400.50	$445.00	—	—	10%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC Xray Spine Cervical 2-3 Views	$486.00	$540.00	—	—	10%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC Xray Spine Cervical 2-3 Views	$486.00	$540.00	—	—	10%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC Xray Pelvis 1-2 Views	$477.00	$530.00	—	—	10%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC Xray Pelvis 1-2 Views	$477.00	$530.00	—	—	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC Myelography Cervical	$405.00	$450.00	—	—	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC Xray Sacrum and Coccyx Min 2 View	$405.00	$450.00	—	—	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC Myelography Cervical	$405.00	$450.00	—	—	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC Xray Sacrum and Coccyx Min 2 View	$405.00	$450.00	—	—	10%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs New York	Off list
ACTH blood test CPT 82024 HC Acth	$162.00	$180.00	—	—	10%
ACTH blood test CPT 82024 HC Adrenocorticotropic Hormone Acth	$220.50	$245.00	—	—	10%
ACTH blood test CPT 82024 HC Adrenocorticotropic Horm	$360.90	$401.00	—	—	10%
ACTH blood test inpatient CPT 82024 HC Acth	$162.00	$180.00	—	—	10%
ACTH blood test inpatient CPT 82024 HC Adrenocorticotropic Hormone Acth	$220.50	$245.00	—	—	10%
ACTH blood test inpatient CPT 82024 HC Adrenocorticotropic Horm	$360.90	$401.00	—	—	10%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC Alt (Sgpt)	$22.50	$25.00	—	—	10%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC Transferase Alanine Alt Sgpt	$63.00	$70.00	—	—	10%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC Alt (Sgpt)	$22.50	$25.00	—	—	10%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC Transferase Alanine Alt Sgpt	$63.00	$70.00	—	—	10%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC Transferase Ast Sgot	$63.00	$70.00	—	—	10%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC Transferase Ast Sgot	$63.00	$70.00	—	—	10%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC Acute Hepatitis Panel	$265.50	$295.00	—	—	10%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC Acute Hepatitis Panel	$265.50	$295.00	—	—	10%
Albumin blood test CPT 82040 HC Albumin, Serum	$45.00	$50.00	—	—	10%
Albumin blood test CPT 82040 HC Albumin, Serum Plasma Whole Blood	$45.00	$50.00	—	—	10%
Albumin blood test inpatient CPT 82040 HC Albumin, Serum Plasma Whole Blood	$45.00	$50.00	—	—	10%
Albumin blood test inpatient CPT 82040 HC Albumin, Serum	$45.00	$50.00	—	—	10%
Aldosterone blood test CPT 82088 HC Aldosterone	$144.00	$160.00	—	—	10%
Aldosterone blood test inpatient CPT 82088 HC Aldosterone	$144.00	$160.00	—	—	10%
Alkaline phosphatase (ALP) blood test CPT 84075 HC Assay Alkaline Phosphatase	$54.00	$60.00	—	—	10%
Alkaline phosphatase (ALP) blood test CPT 84075 HC Phosphatase Alkaline	$54.00	$60.00	—	—	10%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC Assay Alkaline Phosphatase	$54.00	$60.00	—	—	10%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC Phosphatase Alkaline	$54.00	$60.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC F87 Muskmelon	$9.00	$10.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Rat Epithelium Igg	$12.60	$14.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC F112 Chestnut Food	$12.60	$14.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Formaldehyde Ige	$31.50	$35.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Insulin Porcine Ige	$31.50	$35.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Insulin Bovine Ige	$31.50	$35.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Insulin Human Ige	$31.50	$35.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Allergen Ped Allergy Pan 1	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Other	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Specific Ige Ea Qnt	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Tree	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Beans/Nuts/Seeds	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Allergen Drug Penicilli V Min	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Allergen Drugs Amoxicillin	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Allergen Drugs Ampicillin	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Shellfish/Seafood	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Food	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Mold/Fungi	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Insect	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Weeds	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Pollen	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Animal Dander	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Animal Droppings	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Cockroach 16 Allergen	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Animal Epithelia	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Dust	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Mold Profile	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Animal Urine	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Pencillin G-C1	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC F87 Muskmelon	$9.00	$10.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC F112 Chestnut Food	$12.60	$14.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Rat Epithelium Igg	$12.60	$14.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Insulin Porcine Ige	$31.50	$35.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Insulin Human Ige	$31.50	$35.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Insulin Bovine Ige	$31.50	$35.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Formaldehyde Ige	$31.50	$35.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Allergen Ped Allergy Pan 1	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Insect	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Weeds	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Pollen	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Animal Dander	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Animal Droppings	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Cockroach 16 Allergen	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Animal Urine	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Food	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Mold/Fungi	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Other	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Pencillin G-C1	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Specific Ige Ea Qnt	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Animal Epithelia	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Tree	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Beans/Nuts/Seeds	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Dust	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Allergen Drug Penicilli V Min	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Allergen Drugs Amoxicillin	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Mold Profile	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Allergen Drugs Ampicillin	$63.00	$70.00	—	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each Shellfish/Seafood	$63.00	$70.00	—	—	10%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC Alphafetoprotein Serum	$261.00	$290.00	—	—	10%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC Alphafetoprotein Serum	$261.00	$290.00	—	—	10%
Ammonia blood test CPT 82140 HC Ammonia	$72.00	$80.00	—	—	10%
Ammonia blood test inpatient CPT 82140 HC Ammonia	$72.00	$80.00	—	—	10%
Amylase blood test CPT 82150 HC Amylase	$63.00	$70.00	—	—	10%
Amylase blood test CPT 82150 HC Urine-Amylase Random	$72.00	$80.00	—	—	10%
Amylase blood test CPT 82150 HC Fluid-Amylase	$72.00	$80.00	—	—	10%
Amylase blood test CPT 82150 HC Urine-Amylase Timed	$72.00	$80.00	—	—	10%
Amylase blood test inpatient CPT 82150 HC Amylase	$63.00	$70.00	—	—	10%
Amylase blood test inpatient CPT 82150 HC Urine-Amylase Timed	$72.00	$80.00	—	—	10%
Amylase blood test inpatient CPT 82150 HC Fluid-Amylase	$72.00	$80.00	—	—	10%
Amylase blood test inpatient CPT 82150 HC Urine-Amylase Random	$72.00	$80.00	—	—	10%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC Cyclic Citrullinated Peptide Antibody	$90.00	$100.00	—	—	10%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC Cyclic Citrullinated Peptide Antibody	$90.00	$100.00	—	—	10%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC Centromere B Antibody	$33.30	$37.00	—	—	10%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC Ana W/Reflex	$34.20	$38.00	—	—	10%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC Antinuclear Antibodies Ana	$207.00	$230.00	—	—	10%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC Centromere B Antibody	$33.30	$37.00	—	—	10%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC Ana W/Reflex	$34.20	$38.00	—	—	10%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC Antinuclear Antibodies Ana	$207.00	$230.00	—	—	10%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC Natriuretic Peptide	$229.50	$255.00	—	—	10%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC Natriuretic Peptide	$229.50	$255.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Bact Culture Other Legionella Pneumophila Ag	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Bact Culture Other	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Bact Culture Other Catheter Tip Cult	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Bact Culture Other Upper Resp	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Bact Culture Other Genitalia	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Bact Culture Other Wound	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Bact Culture Other Body Fluids	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Bact Culture Other Tissue	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Bact Culture Other Eye	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Bact Culture Other Sputum	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Bact Culture Other Upper Resp	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Bact Culture Other Tissue	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Bact Culture Other Body Fluids	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Bact Culture Other Wound	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Bact Culture Other	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Bact Culture Other Genitalia	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Bact Culture Other Catheter Tip Cult	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Bact Culture Other Eye	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Bact Culture Other Legionella Pneumophila Ag	$162.00	$180.00	—	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Bact Culture Other Sputum	$162.00	$180.00	—	—	10%
Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel Total Ca	$117.00	$130.00	—	—	10%
Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel Total Ca POCT	$121.50	$135.00	—	—	10%
Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel Total Ca	$117.00	$130.00	—	—	10%
Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel Total Ca POCT	$121.50	$135.00	—	—	10%
Bilirubin blood test, total CPT 82247 HC Bilirubin Direct	$22.50	$25.00	—	—	10%
Bilirubin blood test, total CPT 82247 HC Bilirubin Total	$72.00	$80.00	—	—	10%
Bilirubin blood test, total inpatient CPT 82247 HC Bilirubin Direct	$22.50	$25.00	—	—	10%
Bilirubin blood test, total inpatient CPT 82247 HC Bilirubin Total	$72.00	$80.00	—	—	10%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC Level IV Surg Pathology Gross&Microscopic Exam	$360.00	$400.00	—	—	10%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC Level IV Surg Pathology Gross&Microscopic Exam	$360.00	$400.00	—	—	10%
Blood culture for bacteria CPT 87040 HC Culture Bacterial Blood Aerobic W/ID Isolates	$153.00	$170.00	—	—	10%
Blood culture for bacteria inpatient CPT 87040 HC Culture Bacterial Blood Aerobic W/ID Isolates	$153.00	$170.00	—	—	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Routine Venipuncture	$63.00	$70.00	—	—	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Venipuncture	$63.00	$70.00	—	—	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Collj Ven Bld Vnpnxr - 36415	$63.00	$70.00	—	—	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Routine Venipuncture	$63.00	$70.00	—	—	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Venipuncture	$63.00	$70.00	—	—	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Collj Ven Bld Vnpnxr - 36415	$63.00	$70.00	—	—	10%
Blood glucose (sugar) test CPT 82947 HC Blood Glucose Gtt Fasting	$18.00	$20.00	—	—	10%
Blood glucose (sugar) test CPT 82947 HC Blood Glucose 2hr Post Pran	$18.00	$20.00	—	—	10%
Blood glucose (sugar) test CPT 82947 HC Blood Glucose	$18.00	$20.00	—	—	10%
Blood glucose (sugar) test CPT 82947 HC Blood Glucose Pres	$27.00	$30.00	—	—	10%
Blood glucose (sugar) test CPT 82947 HC Assay Glucose Blood Quant	$27.00	$30.00	—	—	10%
Blood glucose (sugar) test CPT 82947 HC Blood Glucose POCT	$27.00	$30.00	—	—	10%
Blood glucose (sugar) test inpatient CPT 82947 HC Blood Glucose 2hr Post Pran	$18.00	$20.00	—	—	10%
Blood glucose (sugar) test inpatient CPT 82947 HC Blood Glucose Gtt Fasting	$18.00	$20.00	—	—	10%
Blood glucose (sugar) test inpatient CPT 82947 HC Blood Glucose	$18.00	$20.00	—	—	10%
Blood glucose (sugar) test inpatient CPT 82947 HC Blood Glucose POCT	$27.00	$30.00	—	—	10%
Blood glucose (sugar) test inpatient CPT 82947 HC Blood Glucose Pres	$27.00	$30.00	—	—	10%
Blood glucose (sugar) test inpatient CPT 82947 HC Assay Glucose Blood Quant	$27.00	$30.00	—	—	10%
Blood lead test CPT 83655 HC Assay of Lead	$49.50	$55.00	—	—	10%
Blood lead test CPT 83655 HC Blood Lead	$49.50	$55.00	—	—	10%
Blood lead test CPT 83655 HC Blood Lead POCT	$49.50	$55.00	—	—	10%
Blood lead test inpatient CPT 83655 HC Blood Lead POCT	$49.50	$55.00	—	—	10%
Blood lead test inpatient CPT 83655 HC Blood Lead	$49.50	$55.00	—	—	10%
Blood lead test inpatient CPT 83655 HC Assay of Lead	$49.50	$55.00	—	—	10%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC Gonadotropin Chorionic Qual	$90.00	$100.00	—	—	10%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC Hcg-Qual.	$90.00	$100.00	—	—	10%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC Pregnancy Urine Gonadotropin	$90.00	$100.00	—	—	10%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC Hcg-Qual.	$90.00	$100.00	—	—	10%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC Pregnancy Urine Gonadotropin	$90.00	$100.00	—	—	10%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC Gonadotropin Chorionic Qual	$90.00	$100.00	—	—	10%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC Blood Typing Abo	$216.00	$240.00	—	—	10%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC Blood Typing Serologic Abo	$216.00	$240.00	—	—	10%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC Blood Typing Serologic Abo	$216.00	$240.00	—	—	10%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC Blood Typing Abo	$216.00	$240.00	—	—	10%
Blood urea nitrogen (BUN) test CPT 84520 HC Urea Nitrogen POCT	$31.50	$35.00	—	—	10%
Blood urea nitrogen (BUN) test CPT 84520 HC Urea Nitrogen (Bun)	$31.50	$35.00	—	—	10%
Blood urea nitrogen (BUN) test CPT 84520 HC Urea Nitrogen (Bun) POCT	$31.50	$35.00	—	—	10%
Blood urea nitrogen (BUN) test CPT 84520 HC Assay of Urea Nitrogen Quant	$31.50	$35.00	—	—	10%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Assay of Urea Nitrogen Quant	$31.50	$35.00	—	—	10%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Urea Nitrogen (Bun) POCT	$31.50	$35.00	—	—	10%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Urea Nitrogen POCT	$31.50	$35.00	—	—	10%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Urea Nitrogen (Bun)	$31.50	$35.00	—	—	10%
C-peptide blood test CPT 84681 HC Cpeptide	$117.00	$130.00	—	—	10%
C-peptide blood test inpatient CPT 84681 HC Cpeptide	$117.00	$130.00	—	—	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C Reactive Protein	$153.00	$170.00	—	—	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C Reactive Protein	$153.00	$170.00	—	—	10%
C. difficile toxin gene test (stool PCR) CPT 87493 HC Inf Agent Det Nucleic Acid Clostridium Amp Probe	$324.00	$360.00	—	—	10%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC Inf Agent Det Nucleic Acid Clostridium Amp Probe	$324.00	$360.00	—	—	10%
CA 19-9 blood test (tumor marker) CPT 86301 HC Immunoassay Tumor Antigen Quant Ca 19-9 Plerual Fl	$37.80	$42.00	—	—	10%
CA 19-9 blood test (tumor marker) CPT 86301 HC Immunoassay Tumor Antigen Quant Ca 19-9 Fluid	$279.00	$310.00	—	—	10%
CA 19-9 blood test (tumor marker) CPT 86301 HC Immunoassay Tumor Antigen Quant Ca 19-9	$279.00	$310.00	—	—	10%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC Immunoassay Tumor Antigen Quant Ca 19-9 Plerual Fl	$37.80	$42.00	—	—	10%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC Immunoassay Tumor Antigen Quant Ca 19-9 Fluid	$279.00	$310.00	—	—	10%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC Immunoassay Tumor Antigen Quant Ca 19-9	$279.00	$310.00	—	—	10%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC Tumor Ag Quant Ca 125	$279.00	$310.00	—	—	10%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC Tumor Ag Quant Ca 125	$279.00	$310.00	—	—	10%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC Sarscov2 Naa Coronavirus	$171.00	$190.00	—	—	10%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC Sarscov2 Naa Coronavirus	$171.00	$190.00	—	—	10%
Calcium blood test, total CPT 82310 HC Calcium Total	$40.50	$45.00	—	—	10%
Calcium blood test, total CPT 82310 HC Calcium Total Blood Chem Lab	$40.50	$45.00	—	—	10%
Calcium blood test, total inpatient CPT 82310 HC Calcium Total	$40.50	$45.00	—	—	10%
Calcium blood test, total inpatient CPT 82310 HC Calcium Total Blood Chem Lab	$40.50	$45.00	—	—	10%
Carcinoembryonic antigen (CEA) test CPT 82378 HC Carcinoembryonic Ag (Cea)	$220.50	$245.00	—	—	10%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC Carcinoembryonic Ag (Cea)	$220.50	$245.00	—	—	10%
Chickenpox (varicella) immunity blood test CPT 86787 HC Antibody Varicella-Zoster	$121.50	$135.00	—	—	10%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC Antibody Varicella-Zoster	$121.50	$135.00	—	—	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC Iadna Chlamydia Trachomatis Amplified Probe Tq	$193.50	$215.00	—	—	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC Iadna Chlamydia Trachomatis Amplified Probe Tq	$193.50	$215.00	—	—	10%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Coronary Risk Profile	$103.50	$115.00	—	—	10%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel POCT	$117.00	$130.00	—	—	10%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel	$121.50	$135.00	—	—	10%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Coronary Risk Profile	$103.50	$115.00	—	—	10%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel POCT	$117.00	$130.00	—	—	10%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel	$121.50	$135.00	—	—	10%
Complete blood count (CBC) with differential CPT 85025 HC Blood Count Complete Auto&Auto Difrntl Wbc	$83.70	$93.00	—	—	10%
Complete blood count (CBC) with differential CPT 85025 HC Cbc Automat W Autom Diff	$83.70	$93.00	—	—	10%
Complete blood count (CBC) with differential inpatient CPT 85025 HC Blood Count Complete Auto&Auto Difrntl Wbc	$83.70	$93.00	—	—	10%
Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc Automat W Autom Diff	$83.70	$93.00	—	—	10%
Complete blood count (CBC), no differential CPT 85027 HC Blood Count Complete Automated	$72.00	$80.00	—	—	10%
Complete blood count (CBC), no differential CPT 85027 HC Cbc Plus Platelet	$72.00	$80.00	—	—	10%
Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc Plus Platelet	$72.00	$80.00	—	—	10%
Complete blood count (CBC), no differential inpatient CPT 85027 HC Blood Count Complete Automated	$72.00	$80.00	—	—	10%
Comprehensive metabolic panel (blood test) CPT 80053 HC Comp Metabolic Panel POCT	$171.00	$190.00	—	—	10%
Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel	$189.00	$210.00	—	—	10%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comp Metabolic Panel POCT	$171.00	$190.00	—	—	10%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel	$189.00	$210.00	—	—	10%
Cortisol blood test, total CPT 82533 HC Collagen Cross Links	$36.00	$40.00	—	—	10%
Cortisol blood test, total CPT 82533 HC Cortisol Saliva	$49.50	$55.00	—	—	10%
Cortisol blood test, total CPT 82533 HC Cortisol	$67.50	$75.00	—	—	10%
Cortisol blood test, total CPT 82533 HC Cortisol Timed	$76.50	$85.00	—	—	10%
Cortisol blood test, total CPT 82533 HC Cortisol Total	$76.50	$85.00	—	—	10%
Cortisol blood test, total CPT 82533 HC Cortisol Total Am	$90.00	$100.00	—	—	10%
Cortisol blood test, total CPT 82533 HC Cortisol Timed 30 Min POCT	$90.00	$100.00	—	—	10%
Cortisol blood test, total CPT 82533 HC Cortisol, Serum Pm	$90.00	$100.00	—	—	10%
Cortisol blood test, total inpatient CPT 82533 HC Collagen Cross Links	$36.00	$40.00	—	—	10%
Cortisol blood test, total inpatient CPT 82533 HC Cortisol Saliva	$49.50	$55.00	—	—	10%
Cortisol blood test, total inpatient CPT 82533 HC Cortisol	$67.50	$75.00	—	—	10%
Cortisol blood test, total inpatient CPT 82533 HC Cortisol Timed	$76.50	$85.00	—	—	10%
Cortisol blood test, total inpatient CPT 82533 HC Cortisol Total	$76.50	$85.00	—	—	10%
Cortisol blood test, total inpatient CPT 82533 HC Cortisol Total Am	$90.00	$100.00	—	—	10%
Cortisol blood test, total inpatient CPT 82533 HC Cortisol Timed 30 Min POCT	$90.00	$100.00	—	—	10%
Cortisol blood test, total inpatient CPT 82533 HC Cortisol, Serum Pm	$90.00	$100.00	—	—	10%
Creatine kinase (CK) blood test, total CPT 82550 HC Creatine Kinase CK (Cpk) Total	$67.50	$75.00	—	—	10%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC Creatine Kinase CK (Cpk) Total	$67.50	$75.00	—	—	10%
Creatinine blood test CPT 82565 HC Creatinine Blood Chem Lab	$85.50	$95.00	—	—	10%
Creatinine blood test CPT 82565 HC Creatinine Blood POCT	$85.50	$95.00	—	—	10%
Creatinine blood test CPT 82565 HC Creatinine Blood	$85.50	$95.00	—	—	10%
Creatinine blood test inpatient CPT 82565 HC Creatinine Blood POCT	$85.50	$95.00	—	—	10%
Creatinine blood test inpatient CPT 82565 HC Creatinine Blood	$85.50	$95.00	—	—	10%
Creatinine blood test inpatient CPT 82565 HC Creatinine Blood Chem Lab	$85.50	$95.00	—	—	10%
Cytomegalovirus (CMV) antibody test CPT 86644 HC Antibody Cytomegalovirus Cmv	$225.00	$250.00	—	—	10%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC Antibody Cytomegalovirus Cmv	$225.00	$250.00	—	—	10%
D-dimer blood test (blood clot marker) CPT 85379 HC Ddimer Quant	$22.50	$25.00	—	—	10%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC Ddimer Quant	$22.50	$25.00	—	—	10%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC Dhea Sulfate	$144.00	$160.00	—	—	10%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC Dhea Sulfate	$144.00	$160.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Lsd, Urine	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Blood-Etoh Screen	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Monitor Scr 14 Drug Class Prf	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Amphetamine Conf UR	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Ethyl Glucuronide Urine	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Monitor Scr 10 Drug Class Prf	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Oxycodone Scr UR	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Screen Urine Alcohols	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Synthetic Cannab Met Scr UR	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Flunitrazepam Metabol Urine	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Psy Emergency UR Tox	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Drug of Abuse Scr Stim Amines	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Flunitrazepam Rohypnol S/P	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Drug Test Prsmv Chem Anlyzr	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Ethyl Glucuronide Urine	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Oxycodone Scr UR	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Psy Emergency UR Tox	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Synthetic Cannab Met Scr UR	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Drug of Abuse Scr Stim Amines	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Screen Urine Alcohols	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Flunitrazepam Metabol Urine	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Flunitrazepam Rohypnol S/P	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Blood-Etoh Screen	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Drug Test Prsmv Chem Anlyzr	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Amphetamine Conf UR	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Monitor Scr 10 Drug Class Prf	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Monitor Scr 14 Drug Class Prf	$261.00	$290.00	—	—	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Lsd, Urine	$261.00	$290.00	—	—	10%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC Electrolytes Panel POCT	$81.00	$90.00	—	—	10%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC Electrolytes Panel	$81.00	$90.00	—	—	10%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC Electrolytes Panel POCT	$81.00	$90.00	—	—	10%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC Electrolytes Panel	$81.00	$90.00	—	—	10%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC Antibody Epstein-Barr Eb Virus Viral Capsid Vca	$283.50	$315.00	—	—	10%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC Antibody Epstein-Barr Eb Virus Viral Capsid Vca	$283.50	$315.00	—	—	10%
Estradiol blood test CPT 82670 HC Estradiol Total	$427.50	$475.00	—	—	10%
Estradiol blood test inpatient CPT 82670 HC Estradiol Total	$427.50	$475.00	—	—	10%
FSH (follicle-stimulating hormone) test CPT 83001 HC Ped. Fsh	$31.50	$35.00	—	—	10%
FSH (follicle-stimulating hormone) test CPT 83001 HC Fsh	$211.50	$235.00	—	—	10%
FSH (follicle-stimulating hormone) test CPT 83001 HC Follicle Stimulating Hormone	$211.50	$235.00	—	—	10%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC Ped. Fsh	$31.50	$35.00	—	—	10%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC Follicle Stimulating Hormone	$211.50	$235.00	—	—	10%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC Fsh	$211.50	$235.00	—	—	10%
Fecal calprotectin (stool inflammation test) CPT 83993 HC Calprotectin Stool	$162.00	$180.00	—	—	10%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC Calprotectin Stool	$162.00	$180.00	—	—	10%
Ferritin blood test (iron stores) CPT 82728 HC Ferritin	$184.50	$205.00	—	—	10%
Ferritin blood test (iron stores) CPT 82728 HC Assay of Ferritin	$184.50	$205.00	—	—	10%
Ferritin blood test (iron stores) inpatient CPT 82728 HC Ferritin	$184.50	$205.00	—	—	10%
Ferritin blood test (iron stores) inpatient CPT 82728 HC Assay of Ferritin	$184.50	$205.00	—	—	10%
Fibrinogen blood test CPT 85384 HC Fibrinogen Activity	$126.00	$140.00	—	—	10%
Fibrinogen blood test inpatient CPT 85384 HC Fibrinogen Activity	$126.00	$140.00	—	—	10%
Folate (folic acid) blood test CPT 82746 HC Blood Folic Acid	$108.00	$120.00	—	—	10%
Folate (folic acid) blood test CPT 82746 HC Assay Folic Acid Serum Blood	$108.00	$120.00	—	—	10%
Folate (folic acid) blood test inpatient CPT 82746 HC Blood Folic Acid	$108.00	$120.00	—	—	10%
Folate (folic acid) blood test inpatient CPT 82746 HC Assay Folic Acid Serum Blood	$108.00	$120.00	—	—	10%
Free T3 thyroid hormone test CPT 84481 HC T3 Free	$117.00	$130.00	—	—	10%
Free T3 thyroid hormone test inpatient CPT 84481 HC T3 Free	$117.00	$130.00	—	—	10%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC Thyroxine (T4) Free	$108.00	$120.00	—	—	10%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC Thyroxine (T4) Free	$108.00	$120.00	—	—	10%
Free testosterone test CPT 84402 HC Testosterone Free	$108.00	$120.00	—	—	10%
Free testosterone test inpatient CPT 84402 HC Testosterone Free	$108.00	$120.00	—	—	10%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC Glutamyltransferase Gamma	$81.00	$90.00	—	—	10%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC Ggt Glutamyltransferase Gamma	$81.00	$90.00	—	—	10%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC Glutamyltransferase Gamma	$81.00	$90.00	—	—	10%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC Ggt Glutamyltransferase Gamma	$81.00	$90.00	—	—	10%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC General Health Panel	$378.00	$420.00	—	—	10%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC General Health Panel	$378.00	$420.00	—	—	10%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC Glucose Post Glucose Dose	$45.00	$50.00	—	—	10%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC Glucose Post Glucose Dose	$45.00	$50.00	—	—	10%
Glucose tolerance test, 3 samples CPT 82951 HC Glucose Toler Test Gtt 3 Spec	$81.00	$90.00	—	—	10%
Glucose tolerance test, 3 samples CPT 82951 HC Glucose Tolerance 3 Specimens	$81.00	$90.00	—	—	10%
Glucose tolerance test, 3 samples CPT 82951 HC Gtt W/Stimulation	$81.00	$90.00	—	—	10%
Glucose tolerance test, 3 samples CPT 82951 HC Gluc Tolerance	$81.00	$90.00	—	—	10%
Glucose tolerance test, 3 samples CPT 82951 HC Gluc Tt Prenatal	$81.00	$90.00	—	—	10%
Glucose tolerance test, 3 samples CPT 82951 HC Gtt-3 Specs Include Glucose	$81.00	$90.00	—	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC Glucose Toler Test Gtt 3 Spec	$81.00	$90.00	—	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC Gtt-3 Specs Include Glucose	$81.00	$90.00	—	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC Glucose Tolerance 3 Specimens	$81.00	$90.00	—	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC Gtt W/Stimulation	$81.00	$90.00	—	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC Gluc Tolerance	$81.00	$90.00	—	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC Gluc Tt Prenatal	$81.00	$90.00	—	—	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC Iadna Neisseria Gonorrhoeae Amplified Probe Tq	$135.00	$150.00	—	—	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC Iadna Neisseria Gonorrhoeae Amplified Probe Tq	$135.00	$150.00	—	—	10%
H. pylori antibody blood test CPT 86677 HC Antibody Helicobacter Pylori	$85.50	$95.00	—	—	10%
H. pylori antibody blood test inpatient CPT 86677 HC Antibody Helicobacter Pylori	$85.50	$95.00	—	—	10%
H. pylori stool antigen test CPT 87338 HC Iaad Ia Hpylori Stool	$85.50	$95.00	—	—	10%
H. pylori stool antigen test inpatient CPT 87338 HC Iaad Ia Hpylori Stool	$85.50	$95.00	—	—	10%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC Quantrna Pcr	$180.00	$200.00	—	—	10%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC Hiv-1 Quant Incld Reverse Transcription	$427.50	$475.00	—	—	10%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC Quantrna Pcr	$180.00	$200.00	—	—	10%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC Hiv-1 Quant Incld Reverse Transcription	$427.50	$475.00	—	—	10%
HIV-1 and HIV-2 antibody test CPT 86703 HC Rapid Hiv Test 1/2 Antibody	$162.00	$180.00	—	—	10%
HIV-1 and HIV-2 antibody test CPT 86703 Antb Hiv-1&Hiv-2 1 Assay - 86703	$162.00	$180.00	—	—	10%
HIV-1 and HIV-2 antibody test CPT 86703 HC Hiv-1/ Hiv-2 Ab Single Result POCT	$162.00	$180.00	—	—	10%
HIV-1 and HIV-2 antibody test CPT 86703 HC Hiv-1/ Hiv-2 Ab Single Result	$162.00	$180.00	—	—	10%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Antb Hiv-1&Hiv-2 1 Assay - 86703	$162.00	$180.00	—	—	10%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC Hiv-1/ Hiv-2 Ab Single Result	$162.00	$180.00	—	—	10%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC Rapid Hiv Test 1/2 Antibody	$162.00	$180.00	—	—	10%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC Hiv-1/ Hiv-2 Ab Single Result POCT	$162.00	$180.00	—	—	10%
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	$85.50	$95.00	—	—	10%
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	$85.50	$95.00	—	—	10%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC Hpv Nucl Acid Amp Probe Hi Rsk Cervix	$109.80	$122.00	—	—	10%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC Hpv Nucl Acid Amp Probe Hi Rsk	$265.50	$295.00	—	—	10%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC Hpv Nucl Acid Amp Probe Hi Rsk Cervix	$109.80	$122.00	—	—	10%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC Hpv Nucl Acid Amp Probe Hi Rsk	$265.50	$295.00	—	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC Hemoglobin Glycated A1c POCT	$171.00	$190.00	—	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC Hemoglobin Glycated A1c	$171.00	$190.00	—	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC Glycosylated Hemoglobin Test	$171.00	$190.00	—	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC Hemoglobin Glycated A1c POCT	$171.00	$190.00	—	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC Hemoglobin Glycated A1c	$171.00	$190.00	—	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC Glycosylated Hemoglobin Test	$171.00	$190.00	—	—	10%
Hemoglobin blood test CPT 85018 HC Hemoglobin Blood Count	$31.50	$35.00	—	—	10%
Hemoglobin blood test CPT 85018 HC Hemoglobin Blood Count Hgb	$31.50	$35.00	—	—	10%
Hemoglobin blood test CPT 85018 HC Blood Count Hemoglobin	$31.50	$35.00	—	—	10%
Hemoglobin blood test CPT 85018 HC Blood Count Hemoglobin POCT	$31.50	$35.00	—	—	10%
Hemoglobin blood test inpatient CPT 85018 HC Hemoglobin Blood Count Hgb	$31.50	$35.00	—	—	10%
Hemoglobin blood test inpatient CPT 85018 HC Blood Count Hemoglobin POCT	$31.50	$35.00	—	—	10%
Hemoglobin blood test inpatient CPT 85018 HC Hemoglobin Blood Count	$31.50	$35.00	—	—	10%
Hemoglobin blood test inpatient CPT 85018 HC Blood Count Hemoglobin	$31.50	$35.00	—	—	10%
Hepatitis B core antibody test (total) CPT 86704 HC Hep B Core Ab (Hbcab) Total	$99.00	$110.00	—	—	10%
Hepatitis B core antibody test (total) CPT 86704 HC Hep B Core Anitbody	$99.00	$110.00	—	—	10%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC Hep B Core Anitbody	$99.00	$110.00	—	—	10%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC Hep B Core Ab (Hbcab) Total	$99.00	$110.00	—	—	10%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC Hep B Surface Antibody	$117.00	$130.00	—	—	10%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC Hepatitis B Surf Antibody Hbsab	$117.00	$130.00	—	—	10%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC Hepatitis B Surf Antibody Hbsab	$117.00	$130.00	—	—	10%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC Hep B Surface Antibody	$117.00	$130.00	—	—	10%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC Hepatitis B Surface Ag Eia	$108.00	$120.00	—	—	10%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC Iaad Ia Hepatitis B Surface Antigen	$108.00	$120.00	—	—	10%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC Hepatitis B Surface Ag Eia	$108.00	$120.00	—	—	10%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC Iaad Ia Hepatitis B Surface Antigen	$108.00	$120.00	—	—	10%
Hepatitis C antibody blood test (screening) CPT 86803 HC Hepatitis C Antibody	$90.00	$100.00	—	—	10%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC Hepatitis C Antibody	$90.00	$100.00	—	—	10%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC Hepatitis C Quantification	$175.50	$195.00	—	—	10%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC Hep Rna Qnt Genotype	$225.00	$250.00	—	—	10%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC Hcv Rna Quant Pcr	$225.00	$250.00	—	—	10%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC Hepatitis C Quant	$306.00	$340.00	—	—	10%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC Hepatitis C Quantif Incl Reverse Trascription	$306.00	$340.00	—	—	10%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC Hepatitis C Quant Genotype	$306.00	$340.00	—	—	10%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC Hepatitis C Quantification	$175.50	$195.00	—	—	10%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC Hep Rna Qnt Genotype	$225.00	$250.00	—	—	10%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC Hcv Rna Quant Pcr	$225.00	$250.00	—	—	10%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC Hepatitis C Quant Genotype	$306.00	$340.00	—	—	10%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC Hepatitis C Quant	$306.00	$340.00	—	—	10%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC Hepatitis C Quantif Incl Reverse Trascription	$306.00	$340.00	—	—	10%
Herpes blood test, HSV-1 antibody CPT 86695 HC Hsv 1/2 Ab Screen Igg CSF	$61.20	$68.00	—	—	10%
Herpes blood test, HSV-1 antibody CPT 86695 HC Antibody Herpes Smplx Type 1	$135.00	$150.00	—	—	10%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC Hsv 1/2 Ab Screen Igg CSF	$61.20	$68.00	—	—	10%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC Antibody Herpes Smplx Type 1	$135.00	$150.00	—	—	10%
Herpes blood test, HSV-2 antibody CPT 86696 HC Hsv 1/2 Ab Igm CSF	$61.20	$68.00	—	—	10%
Herpes blood test, HSV-2 antibody CPT 86696 HC Antibody Herpes Smplx Type 2	$153.00	$170.00	—	—	10%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC Hsv 1/2 Ab Igm CSF	$61.20	$68.00	—	—	10%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC Antibody Herpes Smplx Type 2	$153.00	$170.00	—	—	10%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C Reactive Protein High Sensitivity	$220.50	$245.00	—	—	10%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C Reactive Protein High Sensitivity	$220.50	$245.00	—	—	10%
Homocysteine blood test CPT 83090 HC Homocystine	$234.00	$260.00	—	—	10%
Homocysteine blood test inpatient CPT 83090 HC Homocystine	$234.00	$260.00	—	—	10%
Insulin blood test CPT 83525 HC Insulin Total	$117.00	$130.00	—	—	10%
Insulin blood test inpatient CPT 83525 HC Insulin Total	$117.00	$130.00	—	—	10%
Iron blood test (serum iron) CPT 83540 HC Assay of Iron	$72.00	$80.00	—	—	10%
Iron blood test (serum iron) CPT 83540 HC Iron	$72.00	$80.00	—	—	10%
Iron blood test (serum iron) inpatient CPT 83540 HC Iron	$72.00	$80.00	—	—	10%
Iron blood test (serum iron) inpatient CPT 83540 HC Assay of Iron	$72.00	$80.00	—	—	10%
Iron-binding capacity (TIBC) test CPT 83550 HC Iron Binding Capacity	$117.00	$130.00	—	—	10%
Iron-binding capacity (TIBC) test CPT 83550 HC Iron Binding Capacity Test	$117.00	$130.00	—	—	10%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC Iron Binding Capacity Test	$117.00	$130.00	—	—	10%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC Iron Binding Capacity	$117.00	$130.00	—	—	10%
Kidney function blood test panel CPT 80069 HC Renal Function Panel	$67.50	$75.00	—	—	10%
Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel	$67.50	$75.00	—	—	10%
LH (luteinizing hormone) test CPT 83002 HC Luteinizing Hormone	$207.00	$230.00	—	—	10%
LH (luteinizing hormone) test inpatient CPT 83002 HC Luteinizing Hormone	$207.00	$230.00	—	—	10%
Lactate (lactic acid) blood test CPT 83605 HC Lactic Acid	$99.00	$110.00	—	—	10%
Lactate (lactic acid) blood test CPT 83605 HC Whole Blood Lactate POCT	$99.00	$110.00	—	—	10%
Lactate (lactic acid) blood test CPT 83605 HC Whole Blood Lactate Stat	$117.00	$130.00	—	—	10%
Lactate (lactic acid) blood test CPT 83605 HC Venous Lactic Acid Only POCT	$117.00	$130.00	—	—	10%
Lactate (lactic acid) blood test CPT 83605 HC Arterial Lactic Acid Only POCT	$117.00	$130.00	—	—	10%
Lactate (lactic acid) blood test inpatient CPT 83605 HC Whole Blood Lactate POCT	$99.00	$110.00	—	—	10%
Lactate (lactic acid) blood test inpatient CPT 83605 HC Lactic Acid	$99.00	$110.00	—	—	10%
Lactate (lactic acid) blood test inpatient CPT 83605 HC Whole Blood Lactate Stat	$117.00	$130.00	—	—	10%
Lactate (lactic acid) blood test inpatient CPT 83605 HC Venous Lactic Acid Only POCT	$117.00	$130.00	—	—	10%
Lactate (lactic acid) blood test inpatient CPT 83605 HC Arterial Lactic Acid Only POCT	$117.00	$130.00	—	—	10%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC Ldh Lactate Dehydrogenase	$99.00	$110.00	—	—	10%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC Ldh Lactate Dehydrogenase	$99.00	$110.00	—	—	10%
Lipase blood test (pancreas enzyme) CPT 83690 HC Lipase	$99.00	$110.00	—	—	10%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC Lipase	$99.00	$110.00	—	—	10%
Liver function blood test panel CPT 80076 HC Hepatic Function Panel	$139.50	$155.00	—	—	10%
Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel	$139.50	$155.00	—	—	10%
Lyme disease antibody test CPT 86618 HC Lyme Ab/Western Blot Reflex	$31.50	$35.00	—	—	10%
Lyme disease antibody test CPT 86618 HC B Burgdorferi Ab CSF	$73.80	$82.00	—	—	10%
Lyme disease antibody test CPT 86618 HC Lyme Igm Early Test	$144.00	$160.00	—	—	10%
Lyme disease antibody test CPT 86618 HC Antibody Borrelia Burgdorferi Lyme Disease	$184.50	$205.00	—	—	10%
Lyme disease antibody test CPT 86618 HC Borrelia Burgdorferi Lyme	$184.50	$205.00	—	—	10%
Lyme disease antibody test inpatient CPT 86618 HC Lyme Ab/Western Blot Reflex	$31.50	$35.00	—	—	10%
Lyme disease antibody test inpatient CPT 86618 HC B Burgdorferi Ab CSF	$73.80	$82.00	—	—	10%
Lyme disease antibody test inpatient CPT 86618 HC Lyme Igm Early Test	$144.00	$160.00	—	—	10%
Lyme disease antibody test inpatient CPT 86618 HC Borrelia Burgdorferi Lyme	$184.50	$205.00	—	—	10%
Lyme disease antibody test inpatient CPT 86618 HC Antibody Borrelia Burgdorferi Lyme Disease	$184.50	$205.00	—	—	10%
Magnesium blood test CPT 83735 HC Magnesium Urine	$45.00	$50.00	—	—	10%
Magnesium blood test CPT 83735 HC Magnesium Fecal	$54.00	$60.00	—	—	10%
Magnesium blood test CPT 83735 HC Magnesium	$67.50	$75.00	—	—	10%
Magnesium blood test CPT 83735 HC Assay of Magnesium	$72.00	$80.00	—	—	10%
Magnesium blood test inpatient CPT 83735 HC Magnesium Urine	$45.00	$50.00	—	—	10%
Magnesium blood test inpatient CPT 83735 HC Magnesium Fecal	$54.00	$60.00	—	—	10%
Magnesium blood test inpatient CPT 83735 HC Magnesium	$67.50	$75.00	—	—	10%
Magnesium blood test inpatient CPT 83735 HC Assay of Magnesium	$72.00	$80.00	—	—	10%
Measles (rubeola) antibody test CPT 86765 HC Antibody Rubeola	$99.00	$110.00	—	—	10%
Measles (rubeola) antibody test inpatient CPT 86765 HC Antibody Rubeola	$99.00	$110.00	—	—	10%
Mono test (heterophile antibody, Monospot) CPT 86308 HC Rapid Monospot Heterophile	$81.00	$90.00	—	—	10%
Mono test (heterophile antibody, Monospot) CPT 86308 HC Heterophile Antibody Screen	$81.00	$90.00	—	—	10%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC Heterophile Antibody Screen	$81.00	$90.00	—	—	10%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC Rapid Monospot Heterophile	$81.00	$90.00	—	—	10%
Mumps immunity blood test CPT 86735 HC Antibody Mumps	$135.00	$150.00	—	—	10%
Mumps immunity blood test inpatient CPT 86735 HC Antibody Mumps	$135.00	$150.00	—	—	10%
Obstetric blood test panel CPT 80055 HC Obstetric Panel	$49.50	$55.00	—	—	10%
Obstetric blood test panel inpatient CPT 80055 HC Obstetric Panel	$49.50	$55.00	—	—	10%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC Prostate Specf Ag Free	$153.00	$170.00	—	—	10%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Prostate Specf Ag Free	$153.00	$170.00	—	—	10%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC Prostate Specf Antigen Total	$220.50	$245.00	—	—	10%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Prostate Specf Antigen Total	$220.50	$245.00	—	—	10%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen	$171.00	$190.00	—	—	10%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen	$171.00	$190.00	—	—	10%
Parathyroid hormone (PTH) blood test CPT 83970 HC Assay of Parathormone	$256.50	$285.00	—	—	10%
Parathyroid hormone (PTH) blood test CPT 83970 HC Parathyroid Hormone	$256.50	$285.00	—	—	10%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC Assay of Parathormone	$256.50	$285.00	—	—	10%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC Parathyroid Hormone	$256.50	$285.00	—	—	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ptt/ Aptt	$78.30	$87.00	—	—	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC Aptt Stat	$81.00	$90.00	—	—	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ptt Plasma or Whole Blood	$99.00	$110.00	—	—	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ptt Plasma or Whole Blood Timed	$108.00	$120.00	—	—	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC Fingerstick Ptt POCT	$108.00	$120.00	—	—	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC Aptt Actin F.S.	$108.00	$120.00	—	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Ptt/ Aptt	$78.30	$87.00	—	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Aptt Stat	$81.00	$90.00	—	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Ptt Plasma or Whole Blood	$99.00	$110.00	—	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Ptt Plasma or Whole Blood Timed	$108.00	$120.00	—	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Aptt Actin F.S.	$108.00	$120.00	—	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Fingerstick Ptt POCT	$108.00	$120.00	—	—	10%
Phosphorus (phosphate) blood test CPT 84100 HC Phosphate	$49.50	$55.00	—	—	10%
Phosphorus (phosphate) blood test CPT 84100 HC Assay of Phosphorus	$49.50	$55.00	—	—	10%
Phosphorus (phosphate) blood test CPT 84100 HC Peri. Fluid Phosphorus	$54.00	$60.00	—	—	10%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC Phosphate	$49.50	$55.00	—	—	10%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC Assay of Phosphorus	$49.50	$55.00	—	—	10%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC Peri. Fluid Phosphorus	$54.00	$60.00	—	—	10%
Potassium blood test CPT 84132 HC Blood Potassium Art POCT	$49.50	$55.00	—	—	10%
Potassium blood test CPT 84132 HC Blood Potassium Cap POCT	$49.50	$55.00	—	—	10%
Potassium blood test CPT 84132 HC Blood Potassium Ven POCT	$49.50	$55.00	—	—	10%
Potassium blood test CPT 84132 HC Blood Potassium POCT	$49.50	$55.00	—	—	10%
Potassium blood test CPT 84132 HC Blood Potassium	$49.50	$55.00	—	—	10%
Potassium blood test CPT 84132 HC Serum Potassium Plsm Whol Bld	$49.50	$55.00	—	—	10%
Potassium blood test inpatient CPT 84132 HC Blood Potassium Ven POCT	$49.50	$55.00	—	—	10%
Potassium blood test inpatient CPT 84132 HC Blood Potassium	$49.50	$55.00	—	—	10%
Potassium blood test inpatient CPT 84132 HC Serum Potassium Plsm Whol Bld	$49.50	$55.00	—	—	10%
Potassium blood test inpatient CPT 84132 HC Blood Potassium Art POCT	$49.50	$55.00	—	—	10%
Potassium blood test inpatient CPT 84132 HC Blood Potassium Cap POCT	$49.50	$55.00	—	—	10%
Potassium blood test inpatient CPT 84132 HC Blood Potassium POCT	$49.50	$55.00	—	—	10%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC Genomic Sequencing Fetal Chrm	$477.00	$530.00	—	—	10%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC Genomic Sequencing Fetal Chrm	$477.00	$530.00	—	—	10%
Progesterone blood test CPT 84144 HC Progesterone	$117.00	$130.00	—	—	10%
Progesterone blood test inpatient CPT 84144 HC Progesterone	$117.00	$130.00	—	—	10%
Prolactin blood test CPT 84146 HC Prolactin	$184.50	$205.00	—	—	10%
Prolactin blood test inpatient CPT 84146 HC Prolactin	$184.50	$205.00	—	—	10%
Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time POCT	$76.50	$85.00	—	—	10%
Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time	$76.50	$85.00	—	—	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time POCT	$76.50	$85.00	—	—	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time	$76.50	$85.00	—	—	10%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Drug Test Prsmv Dir Opt Obs	$175.50	$195.00	—	—	10%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Drug Test Prsmv Dir Opt Obs	$175.50	$195.00	—	—	10%
Rapid flu test (influenza antigen) CPT 87804 HC Influenza Assay W/Optic	$139.50	$155.00	—	—	10%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC Influenza Assay W/Optic	$139.50	$155.00	—	—	10%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC Strep a Assay W/Optic	$85.50	$95.00	—	—	10%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC Strep-a Rapid Stat	$85.50	$95.00	—	—	10%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC Iaadiadoo Streptococcus Group A	$85.50	$95.00	—	—	10%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC Strep a POCT	$85.50	$95.00	—	—	10%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC Strep-a Rapid POCT	$85.50	$95.00	—	—	10%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC Strep-a Rapid Stat	$85.50	$95.00	—	—	10%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC Strep-a Rapid POCT	$85.50	$95.00	—	—	10%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC Strep a Assay W/Optic	$85.50	$95.00	—	—	10%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC Iaadiadoo Streptococcus Group A	$85.50	$95.00	—	—	10%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC Strep a POCT	$85.50	$95.00	—	—	10%
Renin blood test CPT 84244 HC Renin	$121.50	$135.00	—	—	10%
Renin blood test CPT 84244 HC Renin Activity	$121.50	$135.00	—	—	10%
Renin blood test inpatient CPT 84244 HC Renin	$121.50	$135.00	—	—	10%
Renin blood test inpatient CPT 84244 HC Renin Activity	$121.50	$135.00	—	—	10%
Rh blood typing CPT 86901 HC Blood Typing Rh(D)	$198.00	$220.00	—	—	10%
Rh blood typing CPT 86901 HC Blood Typing Serologic Rh (D)	$198.00	$220.00	—	—	10%
Rh blood typing inpatient CPT 86901 HC Blood Typing Serologic Rh (D)	$198.00	$220.00	—	—	10%
Rh blood typing inpatient CPT 86901 HC Blood Typing Rh(D)	$198.00	$220.00	—	—	10%
Rheumatoid factor (RF) test CPT 86431 HC Rheumatoid Factor Quant	$126.00	$140.00	—	—	10%
Rheumatoid factor (RF) test inpatient CPT 86431 HC Rheumatoid Factor Quant	$126.00	$140.00	—	—	10%
Rubella antibody test (immunity check) CPT 86762 HC Antibody Rubella	$90.00	$100.00	—	—	10%
Rubella antibody test (immunity check) inpatient CPT 86762 HC Antibody Rubella	$90.00	$100.00	—	—	10%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC Sedimentation Rate Automated	$175.50	$195.00	—	—	10%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC Sedimentation Rate Automated	$175.50	$195.00	—	—	10%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC Semen Analysis Complete	$22.50	$25.00	—	—	10%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC Semen Analysis Complete	$22.50	$25.00	—	—	10%
Sodium blood test CPT 84295 HC Blood Sodium Art POCT	$40.50	$45.00	—	—	10%
Sodium blood test CPT 84295 HC Blood Sodium Cap POCT	$40.50	$45.00	—	—	10%
Sodium blood test CPT 84295 HC Blood Sodium Ven POCT	$40.50	$45.00	—	—	10%
Sodium blood test CPT 84295 HC Assay Serum Sodium POCT	$40.50	$45.00	—	—	10%
Sodium blood test CPT 84295 HC Blood Sodium POCT	$40.50	$45.00	—	—	10%
Sodium blood test CPT 84295 HC Blood Sodium	$40.50	$45.00	—	—	10%
Sodium blood test inpatient CPT 84295 HC Blood Sodium	$40.50	$45.00	—	—	10%
Sodium blood test inpatient CPT 84295 HC Blood Sodium POCT	$40.50	$45.00	—	—	10%
Sodium blood test inpatient CPT 84295 HC Assay Serum Sodium POCT	$40.50	$45.00	—	—	10%
Sodium blood test inpatient CPT 84295 HC Blood Sodium Cap POCT	$40.50	$45.00	—	—	10%
Sodium blood test inpatient CPT 84295 HC Blood Sodium Art POCT	$40.50	$45.00	—	—	10%
Sodium blood test inpatient CPT 84295 HC Blood Sodium Ven POCT	$40.50	$45.00	—	—	10%
Stool ova and parasites exam CPT 87177 HC Ova and Parasite Direct Smear	$91.58	$101.75	—	—	10%
Stool ova and parasites exam CPT 87177 HC Ova and Parasite Smear Conc and ID Tick	$157.50	$175.00	—	—	10%
Stool ova and parasites exam CPT 87177 HC Ova and Parasite Smear Conc and ID Malaria	$157.50	$175.00	—	—	10%
Stool ova and parasites exam CPT 87177 HC Ova and Parasite Smear Conc and ID	$157.50	$175.00	—	—	10%
Stool ova and parasites exam inpatient CPT 87177 HC Ova and Parasite Direct Smear	$91.58	$101.75	—	—	10%
Stool ova and parasites exam inpatient CPT 87177 HC Ova and Parasite Smear Conc and ID	$157.50	$175.00	—	—	10%
Stool ova and parasites exam inpatient CPT 87177 HC Ova and Parasite Smear Conc and ID Tick	$157.50	$175.00	—	—	10%
Stool ova and parasites exam inpatient CPT 87177 HC Ova and Parasite Smear Conc and ID Malaria	$157.50	$175.00	—	—	10%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC Blood Occult Fecal Qualt Scrn POCT	$31.50	$35.00	—	—	10%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Bld Oclt Proxidase Actv Qual Feces 1 Deter - 82270	$31.50	$35.00	—	—	10%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC Blood Occult Fecal Qual Scrn	$31.50	$35.00	—	—	10%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC Blood Occult Fecal Qualt Scrn POCT	$31.50	$35.00	—	—	10%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC Blood Occult Fecal Qual Scrn	$31.50	$35.00	—	—	10%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Bld Oclt Proxidase Actv Qual Feces 1 Deter - 82270	$31.50	$35.00	—	—	10%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC Occ Bld Fec Hgb Immunoassay Dx	$40.50	$45.00	—	—	10%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC Occ Bld Fec Hgb Immunoassay Dx	$40.50	$45.00	—	—	10%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC Fluorescent Treponema Ab CSF	$42.30	$47.00	—	—	10%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC Neurosyphilis Test	$112.50	$125.00	—	—	10%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC Antibody Treponema Pallidum	$153.00	$170.00	—	—	10%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC Fluorescent Treponema Ab CSF	$42.30	$47.00	—	—	10%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC Neurosyphilis Test	$112.50	$125.00	—	—	10%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC Antibody Treponema Pallidum	$153.00	$170.00	—	—	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC Syph Test Nontreponem Ab Qual	$99.00	$110.00	—	—	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC Rpr Syphilis Test Non-Treponemal Antibody Qual	$99.00	$110.00	—	—	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC Syph Test Nontreponem Ab Qual	$99.00	$110.00	—	—	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC Rpr Syphilis Test Non-Treponemal Antibody Qual	$99.00	$110.00	—	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC Quantiferon-TB Immunity Ag Response	$54.00	$60.00	—	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC Qft-TB Plus Client Incubated	$72.00	$80.00	—	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB Test Cell Immun Measure	$94.50	$105.00	—	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC Quantiferon-TB Gold	$220.50	$245.00	—	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB Test, Cell Immun Measure POCT	$220.50	$245.00	—	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC Quantiferon-TB Immunity Ag Response	$54.00	$60.00	—	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC Qft-TB Plus Client Incubated	$72.00	$80.00	—	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB Test Cell Immun Measure	$94.50	$105.00	—	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC Quantiferon-TB Gold	$220.50	$245.00	—	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB Test, Cell Immun Measure POCT	$220.50	$245.00	—	—	10%
Testosterone blood test, total (not free testosterone) CPT 84403 HC Testosterone Adult Male	$112.50	$125.00	—	—	10%
Testosterone blood test, total (not free testosterone) CPT 84403 HC Testosterone Total	$274.50	$305.00	—	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC Testosterone Adult Male	$112.50	$125.00	—	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC Testosterone Total	$274.50	$305.00	—	—	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC Liver Cytosol Autoabs	$135.00	$150.00	—	—	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC Lk Microsomal Ab	$184.50	$205.00	—	—	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC Anti Tpo Thyroid Antibody	$184.50	$205.00	—	—	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC Anti Microsomal Antibody	$184.50	$205.00	—	—	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC Microsomal Antibodies Each	$184.50	$205.00	—	—	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Liver Cytosol Autoabs	$135.00	$150.00	—	—	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Anti Microsomal Antibody	$184.50	$205.00	—	—	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Anti Tpo Thyroid Antibody	$184.50	$205.00	—	—	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Microsomal Antibodies Each	$184.50	$205.00	—	—	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Lk Microsomal Ab	$184.50	$205.00	—	—	10%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone	$193.50	$215.00	—	—	10%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Assay Thyroid Stimulating Hormone Tsh	$193.50	$215.00	—	—	10%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Assay Thyroid Stimulating Hormone Tsh	$193.50	$215.00	—	—	10%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone	$193.50	$215.00	—	—	10%
Total IgE blood test CPT 82785 HC Gammaglobulin Ige	$135.00	$150.00	—	—	10%
Total IgE blood test inpatient CPT 82785 HC Gammaglobulin Ige	$135.00	$150.00	—	—	10%
Total cholesterol blood test CPT 82465 HC Bld/Serum Cholesterol Total	$40.50	$45.00	—	—	10%
Total cholesterol blood test CPT 82465 HC Cholesterol Total	$40.50	$45.00	—	—	10%
Total cholesterol blood test inpatient CPT 82465 HC Cholesterol Total	$40.50	$45.00	—	—	10%
Total cholesterol blood test inpatient CPT 82465 HC Bld/Serum Cholesterol Total	$40.50	$45.00	—	—	10%
Total thyroxine (T4) blood test CPT 84436 HC Thyroxine (T4) Total	$103.50	$115.00	—	—	10%
Total thyroxine (T4) blood test inpatient CPT 84436 HC Thyroxine (T4) Total	$103.50	$115.00	—	—	10%
Total triiodothyronine (T3) blood test CPT 84480 HC T3 Total	$117.00	$130.00	—	—	10%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC T3 Total	$117.00	$130.00	—	—	10%
Transferrin blood test CPT 84466 HC Transferrin	$81.00	$90.00	—	—	10%
Transferrin blood test inpatient CPT 84466 HC Transferrin	$81.00	$90.00	—	—	10%
Trichomonas test (NAAT) CPT 87661 HC Trichom Vaginlis Amp Probe Tech	$265.50	$295.00	—	—	10%
Trichomonas test (NAAT) inpatient CPT 87661 HC Trichom Vaginlis Amp Probe Tech	$265.50	$295.00	—	—	10%
Triglycerides blood test CPT 84478 HC Assay of Triglycerides	$54.00	$60.00	—	—	10%
Triglycerides blood test CPT 84478 HC Triglycerides	$54.00	$60.00	—	—	10%
Triglycerides blood test inpatient CPT 84478 HC Triglycerides	$54.00	$60.00	—	—	10%
Triglycerides blood test inpatient CPT 84478 HC Assay of Triglycerides	$54.00	$60.00	—	—	10%
Troponin test, quantitative CPT 84484 HC Troponin Quant	$117.00	$130.00	—	—	10%
Troponin test, quantitative CPT 84484 HC Troponin Quant POCT	$130.50	$145.00	—	—	10%
Troponin test, quantitative CPT 84484 Troponin Quan - 84484	$130.50	$145.00	—	—	10%
Troponin test, quantitative inpatient CPT 84484 HC Troponin Quant	$117.00	$130.00	—	—	10%
Troponin test, quantitative inpatient CPT 84484 HC Troponin Quant POCT	$130.50	$145.00	—	—	10%
Troponin test, quantitative inpatient CPT 84484 Troponin Quan - 84484	$130.50	$145.00	—	—	10%
Uric acid blood test CPT 84550 HC Assay of Blood/Uric Acid	$63.00	$70.00	—	—	10%
Uric acid blood test CPT 84550 HC Blood Uric Acid	$63.00	$70.00	—	—	10%
Uric acid blood test inpatient CPT 84550 HC Blood Uric Acid	$63.00	$70.00	—	—	10%
Uric acid blood test inpatient CPT 84550 HC Assay of Blood/Uric Acid	$63.00	$70.00	—	—	10%
Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis Auto W Scope	$54.00	$60.00	—	—	10%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis Auto W Scope	$54.00	$60.00	—	—	10%
Urinalysis with microscope exam, manual CPT 81000 HC Urinalysis Nonauto W Scope POCT	$49.50	$55.00	—	—	10%
Urinalysis with microscope exam, manual CPT 81000 HC Urinalysis Nonauto W Scope	$49.50	$55.00	—	—	10%
Urinalysis with microscope exam, manual inpatient CPT 81000 HC Urinalysis Nonauto W Scope POCT	$49.50	$55.00	—	—	10%
Urinalysis with microscope exam, manual inpatient CPT 81000 HC Urinalysis Nonauto W Scope	$49.50	$55.00	—	—	10%
Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Auto W/O Scope	$67.50	$75.00	—	—	10%
Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Auto W/O Scope POCT	$67.50	$75.00	—	—	10%
Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Rutt	$67.50	$75.00	—	—	10%
Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Auto W/O Micro	$72.00	$80.00	—	—	10%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis Rutt	$67.50	$75.00	—	—	10%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis Auto W/O Scope	$67.50	$75.00	—	—	10%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis Auto W/O Scope POCT	$67.50	$75.00	—	—	10%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis Auto W/O Micro	$72.00	$80.00	—	—	10%
Urinalysis without microscope exam, manual CPT 81002 HC Urinalysis Nonauto W/O Scope POCT	$36.00	$40.00	—	—	10%
Urinalysis without microscope exam, manual CPT 81002 Urnls Dip Stick/Tablet Rgnt Non-Auto W/O Mic - 81002	$36.00	$40.00	—	—	10%
Urinalysis without microscope exam, manual CPT 81002 HC Urinalysis Nonauto W/O Scope	$36.00	$40.00	—	—	10%
Urinalysis without microscope exam, manual CPT 81002 Urine-Dipstick (POCT)	$36.00	$40.00	—	—	10%
Urinalysis without microscope exam, manual CPT 81002 HC Urine-Dipstick (POCT)	$36.00	$40.00	—	—	10%
Urinalysis without microscope exam, manual CPT 81002 HC Urinalys Nonauto W/O Scope	$36.00	$40.00	—	—	10%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urinalysis Nonauto W/O Scope	$36.00	$40.00	—	—	10%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urine-Dipstick (POCT)	$36.00	$40.00	—	—	10%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urinalysis Nonauto W/O Scope POCT	$36.00	$40.00	—	—	10%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urine-Dipstick (POCT)	$36.00	$40.00	—	—	10%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urinalys Nonauto W/O Scope	$36.00	$40.00	—	—	10%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urnls Dip Stick/Tablet Rgnt Non-Auto W/O Mic - 81002	$36.00	$40.00	—	—	10%
Urine culture for bacteria, with colony count CPT 87086 HC Culture Bacterial Quanttative Colony Count Urine	$130.50	$145.00	—	—	10%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC Culture Bacterial Quanttative Colony Count Urine	$130.50	$145.00	—	—	10%
Urine microalbumin (albumin) test CPT 82043 HC Albumin Urine Microalbumin Quant Timed	$81.00	$90.00	—	—	10%
Urine microalbumin (albumin) test CPT 82043 HC Albumin Urine Microalbumin Quant	$81.00	$90.00	—	—	10%
Urine microalbumin (albumin) test CPT 82043 HC Albumin Urine Microalbumin Quant POCT	$81.00	$90.00	—	—	10%
Urine microalbumin (albumin) test CPT 82043 HC Albumin Urine Microalbumin Quant Random	$81.00	$90.00	—	—	10%
Urine microalbumin (albumin) test inpatient CPT 82043 HC Albumin Urine Microalbumin Quant	$81.00	$90.00	—	—	10%
Urine microalbumin (albumin) test inpatient CPT 82043 HC Albumin Urine Microalbumin Quant Timed	$81.00	$90.00	—	—	10%
Urine microalbumin (albumin) test inpatient CPT 82043 HC Albumin Urine Microalbumin Quant POCT	$81.00	$90.00	—	—	10%
Urine microalbumin (albumin) test inpatient CPT 82043 HC Albumin Urine Microalbumin Quant Random	$81.00	$90.00	—	—	10%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Tst Vis Color Cmprsn Meths - 81025	$72.00	$80.00	—	—	10%
Urine pregnancy test, read by color change CPT 81025 HC Pregnancy, Urine, Qualitative	$72.00	$80.00	—	—	10%
Urine pregnancy test, read by color change CPT 81025 HC Urine Pregnancy Test POCT	$72.00	$80.00	—	—	10%
Urine pregnancy test, read by color change CPT 81025 HC Urine Pregnancy Test	$81.00	$90.00	—	—	10%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test	$81.00	$90.00	—	—	10%
Urine pregnancy test, read by color change inpatient CPT 81025 HC Urine Pregnancy Test POCT	$72.00	$80.00	—	—	10%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Tst Vis Color Cmprsn Meths - 81025	$72.00	$80.00	—	—	10%
Urine pregnancy test, read by color change inpatient CPT 81025 HC Pregnancy, Urine, Qualitative	$72.00	$80.00	—	—	10%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Test	$81.00	$90.00	—	—	10%
Urine pregnancy test, read by color change inpatient CPT 81025 HC Urine Pregnancy Test	$81.00	$90.00	—	—	10%
Vitamin B12 (cobalamin) blood test CPT 82607 HC Vitamin B12	$108.00	$120.00	—	—	10%
Vitamin B12 (cobalamin) blood test CPT 82607 HC Vitamin B12 Cyanocobalamin	$108.00	$120.00	—	—	10%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC Vitamin B12	$108.00	$120.00	—	—	10%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC Vitamin B12 Cyanocobalamin	$108.00	$120.00	—	—	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC Vitamin D 25-Hydroxy	$40.50	$45.00	—	—	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC Vitamin D 25oh Incl Fractions	$144.00	$160.00	—	—	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC Vitamin D 25-Hydroxy	$40.50	$45.00	—	—	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC Vitamin D 25oh Incl Fractions	$144.00	$160.00	—	—	10%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC Vitamin D 1 25 Dihydroxy Fractn(S)	$90.00	$100.00	—	—	10%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC Vitamin D 1 25 Dihydroxy Fractn(S)	$90.00	$100.00	—	—	10%
Zinc blood test CPT 84630 HC Zinc Random Urine	$40.50	$45.00	—	—	10%
Zinc blood test CPT 84630 HC Zinc	$108.00	$120.00	—	—	10%
Zinc blood test inpatient CPT 84630 HC Zinc Random Urine	$40.50	$45.00	—	—	10%
Zinc blood test inpatient CPT 84630 HC Zinc	$108.00	$120.00	—	—	10%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Chorionic Gonadotropin	$90.00	$100.00	—	—	10%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Gonadotropin Chorionic Quant	$157.50	$175.00	—	—	10%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Chorionic Gonadotropin	$90.00	$100.00	—	—	10%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Gonadotropin Chorionic Quant	$157.50	$175.00	—	—	10%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs New York	Off list
Balloon dilation of the maxillary sinus opening, one side CPT 31295 HC Sinus Endo W/Balloon Dil Max	$7,740.00	$8,600.00	—	—	10%
Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 HC Sinus Endo W/Balloon Dil Max	$7,740.00	$8,600.00	—	—	10%
Botox injections for chronic migraine both sides CPT 64615 HC Chemodenerv Mus Fac/Neck Bilat	$2,610.00	$2,900.00	—	—	10%
Botox injections for chronic migraine inpatient both sides CPT 64615 HC Chemodenerv Mus Fac/Neck Bilat	$2,610.00	$2,900.00	—	—	10%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC Bx Breast 1st Lesion Stereotc	$4,581.00	$5,090.00	—	—	10%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC Bx Breast 1st Lesion Stereotc	$4,581.00	$5,090.00	—	—	10%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Cltx Dstl Fibular Fx Lat Malls W/O Mnpj - 27786	$1,093.50	$1,215.00	—	—	10%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC Cltx Dstl Fibular Fx Lat Malls W/O Manj	$1,093.50	$1,215.00	—	—	10%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC Cltx Dstl Fibular Fx Lat Malls W/O Manj	$1,093.50	$1,215.00	—	—	10%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Cltx Dstl Fibular Fx Lat Malls W/O Mnpj - 27786	$1,093.50	$1,215.00	—	—	10%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Cltx Metar Fx W/O Mnpj - 28470	$850.50	$945.00	—	—	10%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC Cls Tx Metatarsal Fx WO Man	$850.50	$945.00	—	—	10%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC Cls Tx Metatarsal Fx WO Man	$850.50	$945.00	—	—	10%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Cltx Metar Fx W/O Mnpj - 28470	$850.50	$945.00	—	—	10%
Cardiac catheterization with coronary angiogram one side CPT 93458 HC Cath Placement Angiog Lt Cath	$8,100.00	$9,000.00	—	—	10%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 HC Cath Placement Angiog Lt Cath	$8,100.00	$9,000.00	—	—	10%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC Cardioversion	$3,420.00	$3,800.00	—	—	10%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Elective Arrhyt Xtrnl - 92960	$3,420.00	$3,800.00	—	—	10%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC Cardioversion Elective Extern	$3,420.00	$3,800.00	—	—	10%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Elective Arrhyt Xtrnl - 92960	$3,420.00	$3,800.00	—	—	10%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC Cardioversion	$3,420.00	$3,800.00	—	—	10%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC Cardioversion Elective Extern	$3,420.00	$3,800.00	—	—	10%
Catheter ablation for atrial fibrillation CPT 93656 HC Comp Ep Eval W Tx Atr Fib Abl	$27,000.00	$30,000.00	—	—	10%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC Comp Ep Eval W Tx Atr Fib Abl	$27,000.00	$30,000.00	—	—	10%
Cervical biopsy CPT 57500 HC Bx Cerv Sng/Mlt or Loc Exc.	$1,620.00	$1,800.00	—	—	10%
Cervical biopsy inpatient CPT 57500 HC Bx Cerv Sng/Mlt or Loc Exc.	$1,620.00	$1,800.00	—	—	10%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC Circumcision Age >28 Days	$4,770.00	$5,300.00	—	—	10%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 HC Circumcision Age >28 Days	$4,770.00	$5,300.00	—	—	10%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC Circumcision W/Clamp/Oth Dev W/Block	$2,610.00	$2,900.00	—	—	10%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC Circumcision W/Clamp/Oth Dev W/Block	$2,610.00	$2,900.00	—	—	10%
Circumcision, surgical, older than a newborn CPT 54160 HC Circumcision Neonate	$2,070.00	$2,300.00	—	—	10%
Circumcision, surgical, older than a newborn inpatient CPT 54160 HC Circumcision Neonate	$2,070.00	$2,300.00	—	—	10%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC Cls Tx Dist Radial Fx WO Manip	$1,215.00	$1,350.00	—	—	10%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Cltx Dstl Rdl Fx/Epiphysl Sep +-Mnpj - 25600	$1,215.00	$1,350.00	—	—	10%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC Cls Tx Dist Radial Fx WO Man	$1,215.00	$1,350.00	—	—	10%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC Cls Tx Dist Radial Fx WO Man	$1,215.00	$1,350.00	—	—	10%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC Cls Tx Dist Radial Fx WO Manip	$1,215.00	$1,350.00	—	—	10%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Cltx Dstl Rdl Fx/Epiphysl Sep +-Mnpj - 25600	$1,215.00	$1,350.00	—	—	10%
Colonoscopy, diagnostic CPT 45378 HC Colonoscopy, Flexible; Diagnostic, Including Collection of Specimen(S) by Brushing or Washing, When Performed (Separate Procedure)	$3,060.00	$3,400.00	—	—	10%
Colonoscopy, diagnostic inpatient CPT 45378 HC Colonoscopy, Flexible; Diagnostic, Including Collection of Specimen(S) by Brushing or Washing, When Performed (Separate Procedure)	$3,060.00	$3,400.00	—	—	10%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC Colposcopy W/Loop Cervix Bx	$3,780.00	$4,200.00	—	—	10%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HC Colposcopy W/Loop Cervix Bx	$3,780.00	$4,200.00	—	—	10%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC Colp W Cerv Bx/Endocerv Curet	$1,080.00	$1,200.00	—	—	10%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC Colp W Cerv Bx/Endocerv Curet	$1,080.00	$1,200.00	—	—	10%
Coronary stent placement, one artery CPT 92928 HC Prq Tcth Plc Stnt W Angio Sin	$13,950.00	$15,500.00	—	—	10%
Coronary stent placement, one artery inpatient CPT 92928 HC Prq Tcth Plc Stnt W Angio Sin	$13,950.00	$15,500.00	—	—	10%
Cystoscopy with ureteral stent placement CPT 52332 HC Cysto W/Insert Ureteral Stent	$4,770.00	$5,300.00	—	—	10%
Cystoscopy with ureteral stent placement inpatient CPT 52332 HC Cysto W/Insert Ureteral Stent	$4,770.00	$5,300.00	—	—	10%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC Cystourethroscopy	$3,240.00	$3,600.00	—	—	10%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC Cystourethroscopy	$3,240.00	$3,600.00	—	—	10%
D&C (dilation and curettage), not related to pregnancy CPT 58120 HC Dilation and Curettage Diag/Th	$5,310.00	$5,900.00	—	—	10%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC Dilation and Curettage Diag/Th	$5,310.00	$5,900.00	—	—	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC Destruction Premalignant Lesion 1st	$630.00	$700.00	—	—	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC Destruction Premalignant Lesion 1st	$630.00	$700.00	—	—	10%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 HC Tympanostomy Local Anesth	$1,080.00	$1,200.00	—	—	10%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 Tmpst Local/Topical Anes - 69433	$1,080.00	$1,200.00	—	—	10%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 Tmpst Local/Topical Anes - 69433	$1,080.00	$1,200.00	—	—	10%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 HC Tympanostomy Local Anesth	$1,080.00	$1,200.00	—	—	10%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC Remove Impacted Ear Wax Uni	$198.00	$220.00	—	—	10%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC Removal Impacted Cerumen Irrigat/Lvg Unilat	$198.00	$220.00	—	—	10%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC Remove Impacted Ear Wax Uni	$198.00	$220.00	—	—	10%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 HC Removal Impacted Cerumen Irrigat/Lvg Unilat	$198.00	$220.00	—	—	10%
Earwax removal with instruments, one ear one side CPT 69210 Removal Impacted Cerumen Instrumentation Unilat - 69210	$211.50	$235.00	—	—	10%
Earwax removal with instruments, one ear one side CPT 69210 HC Removal Impacted Cerumen Instrumentation Unilat	$211.50	$235.00	—	—	10%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HC Removal Impacted Cerumen Instrumentation Unilat	$211.50	$235.00	—	—	10%
Earwax removal with instruments, one ear inpatient one side CPT 69210 Removal Impacted Cerumen Instrumentation Unilat - 69210	$211.50	$235.00	—	—	10%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC Endomet Bx W/WO Endocerv Samp	$1,944.00	$2,160.00	—	—	10%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC Endomet Bx W/WO Endocerv Samp	$1,944.00	$2,160.00	—	—	10%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 HC Nsl/Sins Ndsc Frnt Tiss Rmvl	$7,740.00	$8,600.00	—	—	10%
Endoscopic sinus surgery: opening the frontal sinus inpatient CPT 31276 HC Nsl/Sins Ndsc Frnt Tiss Rmvl	$7,740.00	$8,600.00	—	—	10%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 HC Exploration Maxillary Sinus	$4,500.00	$5,000.00	—	—	10%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 HC Exploration Maxillary Sinus	$4,500.00	$5,000.00	—	—	10%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 HC Nasal Endo Maxilla Arthrostomy	$7,740.00	$8,600.00	—	—	10%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 HC Nasal Endo Maxilla Arthrostomy	$7,740.00	$8,600.00	—	—	10%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC Inj Dx/Ther Sbst Intrl W/Img	$2,700.00	$3,000.00	—	—	10%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC Inj Dx/Ther Sbst Intrl W/Img	$2,700.00	$3,000.00	—	—	10%
Eye injection into the vitreous (intravitreal injection) CPT 67028 HC Intravitreal Inj Pharm Agent	$720.00	$800.00	—	—	10%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HC Intravitreal Inj Pharm Agent	$720.00	$800.00	—	—	10%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC Inj Paravert F Jnt L/S 1 Lev	$2,160.00	$2,400.00	—	—	10%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC Inj Paravert F Jnt L/S 1 Lev	$2,160.00	$2,400.00	—	—	10%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC Sigmoidoscopy Flx Dx W/Collj	$3,240.00	$3,600.00	—	—	10%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sgmdsc Flx Dx +-Collj Spec Br/Wa Spx - 45330	$3,240.00	$3,600.00	—	—	10%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC Sigmoidoscopy Flx Dx W/Collj	$3,240.00	$3,600.00	—	—	10%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Sgmdsc Flx Dx +-Collj Spec Br/Wa Spx - 45330	$3,240.00	$3,600.00	—	—	10%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC Simple Ligation Hemorrhoid	$2,070.00	$2,300.00	—	—	10%
Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoidectomy Smpl Ligature - 46221	$2,070.00	$2,300.00	—	—	10%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 Hemorrhoidectomy Smpl Ligature - 46221	$2,070.00	$2,300.00	—	—	10%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC Simple Ligation Hemorrhoid	$2,070.00	$2,300.00	—	—	10%
Hemorrhoidectomy (internal and external), one area CPT 46255 Hrhc Smpl - 46255	$4,860.00	$5,400.00	—	—	10%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 Hrhc Smpl - 46255	$4,860.00	$5,400.00	—	—	10%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC Cathteriz Saline Contrast Sis	$751.50	$835.00	—	—	10%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC Cathteriz Saline Contrast Sis	$751.50	$835.00	—	—	10%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HC Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$6,210.00	$6,900.00	—	—	10%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HC Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$6,210.00	$6,900.00	—	—	10%
IUD insertion (the device itself billed separately) CPT 58300 HC Insert Intrauterine Device	$607.50	$675.00	—	—	10%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC Insert Intrauterine Device	$607.50	$675.00	—	—	10%
Incision and drainage of a simple or single skin abscess CPT 10060 HC Incision & Drainage Abscess Simple/Single	$742.50	$825.00	—	—	10%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Absc Smpl/1 - 10060	$742.50	$825.00	—	—	10%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Absc Smpl/1 - 10060	$742.50	$825.00	—	—	10%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC Incision & Drainage Abscess Simple/Single	$742.50	$825.00	—	—	10%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Njx 1 Tdn Shth/Ligm Aponeurosis - 20550	$675.00	$750.00	—	—	10%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC Inj Single Tendon or Ligament	$675.00	$750.00	—	—	10%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Njx 1 Tdn Shth/Ligm Aponeurosis - 20550	$675.00	$750.00	—	—	10%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC Inj Single Tendon or Ligament	$675.00	$750.00	—	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Arthrocentesis Major Jt WO US	$1,080.00	$1,200.00	—	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocnts Aspir&/Njx Major Jt/Bursa - 20610	$1,080.00	$1,200.00	—	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocnts Aspir&/Njx Major Jt/Bursa - 20610	$1,080.00	$1,200.00	—	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC Arthrocentesis Major Jt WO US	$1,080.00	$1,200.00	—	—	10%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC Insert Drug Implant Device	$720.00	$800.00	—	—	10%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC Insert Drug Implant Device	$720.00	$800.00	—	—	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC Arthrocentes Med Joint WO US	$1,080.00	$1,200.00	—	—	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocnts Aspir&/Njx Intrm Jt/Bursa - 20605	$1,080.00	$1,200.00	—	—	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocnts Aspir&/Njx Intrm Jt/Bursa - 20605	$1,080.00	$1,200.00	—	—	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC Arthrocentes Med Joint WO US	$1,080.00	$1,200.00	—	—	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocnts Aspir&/Njx Sm Jt/Bursa - 20600	$913.50	$1,015.00	—	—	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC Arthrocentesis Sm Joint WO US	$913.50	$1,015.00	—	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC Arthrocentesis Sm Joint WO US	$913.50	$1,015.00	—	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocnts Aspir&/Njx Sm Jt/Bursa - 20600	$913.50	$1,015.00	—	—	10%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 HC After Cataract Laser Surgery	$1,386.00	$1,540.00	—	—	10%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 HC After Cataract Laser Surgery	$1,386.00	$1,540.00	—	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC Repair Interm Wound <2.5 S A	$1,458.00	$1,620.00	—	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC Repair Intermediate S/a/T/E 2.5 Cm/<	$1,458.00	$1,620.00	—	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs one side CPT 12031 Lyr Clsr S/a/T/E 2.5 Cm/Lt - 12031	$1,458.00	$1,620.00	—	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC Repair Intermediate S/a/T/E 2.5 Cm/<	$1,458.00	$1,620.00	—	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC Repair Interm Wound <2.5 S A	$1,458.00	$1,620.00	—	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient one side CPT 12031 Lyr Clsr S/a/T/E 2.5 Cm/Lt - 12031	$1,458.00	$1,620.00	—	—	10%
Left heart catheterization, diagnostic one side CPT 93452 HC Lt Heart Cath W/Inj Lt Ventr	$9,900.00	$11,000.00	—	—	10%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC Lt Heart Cath W/Inj Lt Ventr	$9,900.00	$11,000.00	—	—	10%
Lower-back epidural injection, with imaging guidance CPT 62323 HC Inj Dx/Ther Sbst Lmbr/Sac W/Img	$2,970.00	$3,300.00	—	—	10%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Inj Dx/Ther Sbst Lmbr/Sac W/Img	$2,970.00	$3,300.00	—	—	10%
Lower-back epidural injection, without imaging guidance CPT 62322 HC Inj Dx/Ther Sbst Intrw/O Img	$2,700.00	$3,000.00	—	—	10%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC Inj Dx/Ther Sbst Intrw/O Img	$2,700.00	$3,000.00	—	—	10%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Inj Foramen W CT/Fluoro Lumber/Sacral 1 Level	$2,610.00	$2,900.00	—	—	10%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC Inj Foramen W CT/Fluoro Lumber/Sacral 1 Level	$2,610.00	$2,900.00	—	—	10%
Miscarriage treatment with D&C, first trimester CPT 59820 HC Tx Missed Abortion First Trimester Surgical	$5,310.00	$5,900.00	—	—	10%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC Tx Missed Abortion First Trimester Surgical	$5,310.00	$5,900.00	—	—	10%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 HC Mohs 1 Stage H/N/Hf/G	$2,700.00	$3,000.00	—	—	10%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 HC Mohs 1 Stage H/N/Hf/G	$2,700.00	$3,000.00	—	—	10%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC Benign Excise <0.5 Cm T a L	$1,080.00	$1,200.00	—	—	10%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC Benign Excise <0.5 Cm T a L	$1,080.00	$1,200.00	—	—	10%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC Benign Excise <0.5cm F E E N	$1,980.00	$2,200.00	—	—	10%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC Benign Excise <0.5cm F E E N	$1,980.00	$2,200.00	—	—	10%
Nail removal (partial or complete), one nail CPT 11730 Avlsn Nail Plate Prtl/Compl Smpl 1 - 11730	$540.00	$600.00	—	—	10%
Nail removal (partial or complete), one nail CPT 11730 HC Avulsion Nail Plate Partial/Complete Simple 1	$540.00	$600.00	—	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avlsn Nail Plate Prtl/Compl Smpl 1 - 11730	$540.00	$600.00	—	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC Avulsion Nail Plate Partial/Complete Simple 1	$540.00	$600.00	—	—	10%
Occipital nerve block (injection for headaches) CPT 64405 HC Inj Anesth Occipital Nerve	$2,520.00	$2,800.00	—	—	10%
Occipital nerve block (injection for headaches) CPT 64405 Njx Anes Grter Occipital Nrv - 64405	$2,520.00	$2,800.00	—	—	10%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC Inj Anesth Occipital Nerve	$2,520.00	$2,800.00	—	—	10%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Njx Anes Grter Occipital Nrv - 64405	$2,520.00	$2,800.00	—	—	10%
Pacemaker implant (dual chamber) CPT 33208 HC Insert Replc Heart Pm Atr Ven	$17,100.00	$19,000.00	—	—	10%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC Insert Replc Heart Pm Atr Ven	$17,100.00	$19,000.00	—	—	10%
Paracentesis with imaging guidance CPT 49083 HC Paracentesis Abdomen W Image	$4,500.00	$5,000.00	—	—	10%
Paracentesis with imaging guidance CPT 49083 Abdom Paracentesis Dx/Ther W Imaging Guidance - 49083	$4,500.00	$5,000.00	—	—	10%
Paracentesis with imaging guidance inpatient CPT 49083 HC Paracentesis Abdomen W Image	$4,500.00	$5,000.00	—	—	10%
Paracentesis with imaging guidance inpatient CPT 49083 Abdom Paracentesis Dx/Ther W Imaging Guidance - 49083	$4,500.00	$5,000.00	—	—	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC Removal of Nail Bed	$1,458.00	$1,620.00	—	—	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Exc Nail Matrix Prm Rmvl - 11750	$1,458.00	$1,620.00	—	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC Removal of Nail Bed	$1,458.00	$1,620.00	—	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Exc Nail Matrix Prm Rmvl - 11750	$1,458.00	$1,620.00	—	—	10%
Prostate biopsy CPT 55700 HC Prostatic Needle Biopsy	$4,050.00	$4,500.00	—	—	10%
Prostate biopsy inpatient CPT 55700 HC Prostatic Needle Biopsy	$4,050.00	$4,500.00	—	—	10%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC Destroy Lumb/Sac Sngl Facet Jnt	$3,420.00	$3,800.00	—	—	10%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC Destroy Lumb/Sac Sngl Facet Jnt	$3,420.00	$3,800.00	—	—	10%
Removal of a breast lump, open surgery CPT 19120 HC Removal Breast Lesion	$5,467.50	$6,075.00	—	—	10%
Removal of a breast lump, open surgery inpatient CPT 19120 HC Removal Breast Lesion	$5,467.50	$6,075.00	—	—	10%
Removal of a foreign object under the skin, simple CPT 10120 HC Incision & Removal Foreign Body Subq Tiss Simple	$810.00	$900.00	—	—	10%
Removal of a foreign object under the skin, simple CPT 10120 Inc&Rmvl FB Subq Tiss Smpl - 10120	$810.00	$900.00	—	—	10%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC Incision & Removal Foreign Body Subq Tiss Simple	$810.00	$900.00	—	—	10%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Inc&Rmvl FB Subq Tiss Smpl - 10120	$810.00	$900.00	—	—	10%
Short arm cast (elbow to hand) CPT 29075 Appl Cst Elbw Fngr Short Arm - 29075	$517.50	$575.00	—	—	10%
Short arm cast (elbow to hand) CPT 29075 HC Application Cast Elbow to Finger (Short Arm)	$517.50	$575.00	—	—	10%
Short arm cast (elbow to hand) inpatient CPT 29075 HC Application Cast Elbow to Finger (Short Arm)	$517.50	$575.00	—	—	10%
Short arm cast (elbow to hand) inpatient CPT 29075 Appl Cst Elbw Fngr Short Arm - 29075	$517.50	$575.00	—	—	10%
Short arm splint (forearm and hand) CPT 29125 Appl Shor Arm Splnt Static - 29125	$517.50	$575.00	—	—	10%
Short arm splint (forearm and hand) CPT 29125 Appl Short Arm Splnt F/Arm-Hand Static - 29125	$517.50	$575.00	—	—	10%
Short arm splint (forearm and hand) CPT 29125 HC Apply Short Arm Splint Static	$517.50	$575.00	—	—	10%
Short arm splint (forearm and hand) inpatient CPT 29125 Appl Shor Arm Splnt Static - 29125	$517.50	$575.00	—	—	10%
Short arm splint (forearm and hand) inpatient CPT 29125 Appl Short Arm Splnt F/Arm-Hand Static - 29125	$517.50	$575.00	—	—	10%
Short arm splint (forearm and hand) inpatient CPT 29125 HC Apply Short Arm Splint Static	$517.50	$575.00	—	—	10%
Short leg cast (below the knee) CPT 29405 Appl Short Leg Cst Belw Kne-Toe - 29405	$522.00	$580.00	—	—	10%
Short leg cast (below the knee) CPT 29405 HC Application of Short Leg Cast	$522.00	$580.00	—	—	10%
Short leg cast (below the knee) inpatient CPT 29405 HC Application of Short Leg Cast	$522.00	$580.00	—	—	10%
Short leg cast (below the knee) inpatient CPT 29405 Appl Short Leg Cst Belw Kne-Toe - 29405	$522.00	$580.00	—	—	10%
Short leg splint (calf to foot) CPT 29515 Appl Short Leg Splnt Calf Foot - 29515	$535.50	$595.00	—	—	10%
Short leg splint (calf to foot) CPT 29515 Application Short Leg Splint - 29515	$535.50	$595.00	—	—	10%
Short leg splint (calf to foot) CPT 29515 HC Application Short Leg Splint	$535.50	$595.00	—	—	10%
Short leg splint (calf to foot) inpatient CPT 29515 Appl Short Leg Splnt Calf Foot - 29515	$535.50	$595.00	—	—	10%
Short leg splint (calf to foot) inpatient CPT 29515 Application Short Leg Splint - 29515	$535.50	$595.00	—	—	10%
Short leg splint (calf to foot) inpatient CPT 29515 HC Application Short Leg Splint	$535.50	$595.00	—	—	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5cm/<	$607.50	$675.00	—	—	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs one side CPT 12001 Smpl Rpr Supfc S/N/Ax/G/T 2.5cm/Lt - 12001	$607.50	$675.00	—	—	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5cm/<	$607.50	$675.00	—	—	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient one side CPT 12001 Smpl Rpr Supfc S/N/Ax/G/T 2.5cm/Lt - 12001	$607.50	$675.00	—	—	10%
Skin biopsy, punch, one lesion CPT 11104 HC Punch Bx Skin Single Lesion	$972.00	$1,080.00	—	—	10%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC Punch Bx Skin Single Lesion	$972.00	$1,080.00	—	—	10%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC Excision Mal Lesion Trunk/Arm/Leg 0.5 Cm/<	$1,485.00	$1,650.00	—	—	10%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC Excision Mal Lesion Trunk/Arm/Leg 0.5 Cm/<	$1,485.00	$1,650.00	—	—	10%
Skin tag removal, up to 15 tags CPT 11200 HC Removal Skin Tag(S) Up to 15	$540.00	$600.00	—	—	10%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC Removal Skin Tag(S) Up to 15	$540.00	$600.00	—	—	10%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Spinal Puncture Lumbar Diagnostic	$3,330.00	$3,700.00	—	—	10%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Spinal Puncture,Lumbar,Diagnostic	$3,330.00	$3,700.00	—	—	10%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spi Pnxr Lmbr Dx - 62270	$3,330.00	$3,700.00	—	—	10%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spi Pnxr Lmbr Dx - 62270	$3,330.00	$3,700.00	—	—	10%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC Spinal Puncture,Lumbar,Diagnostic	$3,330.00	$3,700.00	—	—	10%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC Spinal Puncture Lumbar Diagnostic	$3,330.00	$3,700.00	—	—	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5cm	$729.00	$810.00	—	—	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Smpl Rpr Supfc S/N/Ax/G/T 2.6cm-7.5cm - 12002	$729.00	$810.00	—	—	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Smpl Rpr Supfc S/N/Ax/G/T 2.6cm-7.5cm - 12002	$729.00	$810.00	—	—	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5cm	$729.00	$810.00	—	—	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC Simple Repair F/E/E/N/L/M 2.5cm/<	$607.50	$675.00	—	—	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair one side CPT 12011 Smpl Rpr Supfc F/E/E/N/L/M 2.5cm/Lt - 12011	$607.50	$675.00	—	—	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC Simple Repair F/E/E/N/L/M 2.5cm/<	$607.50	$675.00	—	—	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient one side CPT 12011 Smpl Rpr Supfc F/E/E/N/L/M 2.5cm/Lt - 12011	$607.50	$675.00	—	—	10%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC Tangntl Bx Skin Single Les	$765.00	$850.00	—	—	10%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC Tangntl Bx Skin Single Les	$765.00	$850.00	—	—	10%
Thoracentesis with imaging guidance CPT 32555 HC Thoracentesis Pleural W/Imag	$1,980.00	$2,200.00	—	—	10%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis Needle/Cath Pleura W/Imaging - 32555	$1,980.00	$2,200.00	—	—	10%
Thoracentesis with imaging guidance CPT 32555 HC Thoracentesis W/ Imaging	$1,980.00	$2,200.00	—	—	10%
Thoracentesis with imaging guidance inpatient CPT 32555 HC Thoracentesis Pleural W/Imag	$1,980.00	$2,200.00	—	—	10%
Thoracentesis with imaging guidance inpatient CPT 32555 HC Thoracentesis W/ Imaging	$1,980.00	$2,200.00	—	—	10%
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis Needle/Cath Pleura W/Imaging - 32555	$1,980.00	$2,200.00	—	—	10%
Trigger finger release surgery CPT 26055 HC Tendon Sheath Incision	$2,610.00	$2,900.00	—	—	10%
Trigger finger release surgery inpatient CPT 26055 HC Tendon Sheath Incision	$2,610.00	$2,900.00	—	—	10%
Trigger point injections, 1 or 2 muscles CPT 20552 HC Injection Single/Mlt Trigger Point 1/2 Muscles	$792.00	$880.00	—	—	10%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC Injection Single/Mlt Trigger Point 1/2 Muscles	$792.00	$880.00	—	—	10%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC Bx Breast 1st Lesion US Imag	$4,036.50	$4,485.00	—	—	10%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC Bx Breast 1st Lesion US Imag	$4,036.50	$4,485.00	—	—	10%
Upper endoscopy (EGD) with biopsy CPT 43239 HC Egd Transoral Biopsy Single/Multiple	$2,187.00	$2,430.00	—	—	10%
Upper endoscopy (EGD) with biopsy CPT 43239 Egd Transoral Biopsy Single/Multiple - 43239	$2,673.00	$2,970.00	—	—	10%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC Egd Transoral Biopsy Single/Multiple	$2,187.00	$2,430.00	—	—	10%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Egd Transoral Biopsy Single/Multiple - 43239	$2,673.00	$2,970.00	—	—	10%
Upper endoscopy (EGD), diagnostic CPT 43235 HC Egd Flex Transoral Dx W Colle	$2,187.00	$2,430.00	—	—	10%
Upper endoscopy (EGD), diagnostic CPT 43235 Esophagogastroduodenoscopy Transoral Diagnostic - 43235	$2,187.00	$2,430.00	—	—	10%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Esophagogastroduodenoscopy Transoral Diagnostic - 43235	$2,187.00	$2,430.00	—	—	10%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC Egd Flex Transoral Dx W Colle	$2,187.00	$2,430.00	—	—	10%
Vaginal delivery, including prenatal and postpartum care CPT 59400 HC Routine Obstetric Care W/Deliv	$3,150.00	$3,500.00	—	—	10%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 HC Routine Obstetric Care W/Deliv	$3,150.00	$3,500.00	—	—	10%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 HC Vasectomy Uni/Bi W/Semen Exam	$4,320.00	$4,800.00	—	—	10%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 HC Vasectomy Uni/Bi W/Semen Exam	$4,320.00	$4,800.00	—	—	10%
Vein ablation, radiofrequency, first vein CPT 36475 HC Endovenous Rf 1st Vein	$5,130.00	$5,700.00	—	—	10%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC Endovenous Rf 1st Vein	$5,130.00	$5,700.00	—	—	10%
Wart removal, up to 14 warts CPT 17110 HC Destruct Benign Lesions 1-14	$540.00	$600.00	—	—	10%
Wart removal, up to 14 warts inpatient CPT 17110 HC Destruct Benign Lesions 1-14	$540.00	$600.00	—	—	10%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Debridement Sq Tiss <20 Sq Cm	$720.00	$800.00	—	—	10%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Dbrdmt Skn&Subq Tiss - 11042	$720.00	$800.00	—	—	10%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Dbrdmt Skn&Subq Tiss - 11042	$720.00	$800.00	—	—	10%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC Debridement Sq Tiss <20 Sq Cm	$720.00	$800.00	—	—	10%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs New York	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC Transfusion Observation 3-6 Hr	$3,645.00	$4,050.00	—	—	10%
Blood transfusion (giving blood or blood components) CPT 36430 HC Transfusion Observation 0-3 Hr	$3,645.00	$4,050.00	—	—	10%
Blood transfusion (giving blood or blood components) CPT 36430 HC Transfusion Blood/Components	$3,645.00	$4,050.00	—	—	10%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Bld/Bld Components - 36430	$3,645.00	$4,050.00	—	—	10%
Blood transfusion (giving blood or blood components) CPT 36430 HC Transfusion Observation 6-12 H	$3,645.00	$4,050.00	—	—	10%
Blood transfusion (giving blood or blood components) CPT 36430 HC Blood Transfusion	$3,645.00	$4,050.00	—	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC Transfusion Blood/Components	$3,645.00	$4,050.00	—	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC Blood Transfusion	$3,645.00	$4,050.00	—	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC Transfusion Observation 6-12 H	$3,645.00	$4,050.00	—	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Bld/Bld Components - 36430	$3,645.00	$4,050.00	—	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC Transfusion Observation 0-3 Hr	$3,645.00	$4,050.00	—	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC Transfusion Observation 3-6 Hr	$3,645.00	$4,050.00	—	—	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Pulmonary Diagnostic Testing	$432.00	$480.00	—	—	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Induced Sputum	$432.00	$480.00	—	—	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Press/N-Press Inhlj Tx F/Aao/Sptm Indctj - 94640	$432.00	$480.00	—	—	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Inhalation Tx Airway Acut Obs	$432.00	$480.00	—	—	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Press/N-Press Inhlj Tx F/Aao/Sptm Indctj - 94640	$432.00	$480.00	—	—	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Pulmonary Diagnostic Testing	$432.00	$480.00	—	—	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Induced Sputum	$432.00	$480.00	—	—	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Inhalation Tx Airway Acut Obs	$432.00	$480.00	—	—	10%
Chemotherapy IV infusion, first hour CPT 96413 HC Chemotx Admn IV Nfs Tq Up 1 Hr 1/1st Sbst/Drug	$2,790.00	$3,100.00	—	—	10%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC Chemotx Admn IV Nfs Tq Up 1 Hr 1/1st Sbst/Drug	$2,790.00	$3,100.00	—	—	10%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 HC Ophthalm Exam New Pt Compreh	$630.00	$700.00	—	—	10%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 HC Ophthalm Exam New Pt Compreh	$630.00	$700.00	—	—	10%
Comprehensive eye exam, returning patient CPT 92014 HC Ophthal Exam Est Pt Comprh	$630.00	$700.00	—	—	10%
Comprehensive eye exam, returning patient inpatient CPT 92014 HC Ophthal Exam Est Pt Comprh	$630.00	$700.00	—	—	10%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC Comprh Audiom Threshld Eval W Spch Recogntn	$580.50	$645.00	—	—	10%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC Comprh Audiom Threshld Eval W Spch Recogntn	$580.50	$645.00	—	—	10%
Critical care, first 30 to 74 minutes CPT 99291 Cc E/M Critically Ill/Injured 1st 30-74 Min - 99291	$2,655.00	$2,950.00	—	—	10%
Critical care, first 30 to 74 minutes CPT 99291 HC Part Activt No Prenotf Cc	$6,750.00	$7,500.00	—	—	10%
Critical care, first 30 to 74 minutes CPT 99291 HC Full Activt No Prenotf Cc	$8,865.00	$9,850.00	—	—	10%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Cc E/M Critically Ill/Injured 1st 30-74 Min - 99291	$2,655.00	$2,950.00	—	—	10%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC Part Activt No Prenotf Cc	$6,750.00	$7,500.00	—	—	10%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC Full Activt No Prenotf Cc	$8,865.00	$9,850.00	—	—	10%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC Eeg Awake and Drowsy	$2,160.00	$2,400.00	—	—	10%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC Eeg Awake and Drowsy	$2,160.00	$2,400.00	—	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC Ekg Tracing W Min 12 Leads	$355.50	$395.00	—	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ecg Routine Ecg W/Least 12 Lds Trcg Only W/O I&R - 93005	$355.50	$395.00	—	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC Electrocardiogram Report	$355.50	$395.00	—	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC Electrocardiogram Report	$355.50	$395.00	—	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Ecg Routine Ecg W/Least 12 Lds Trcg Only W/O I&R - 93005	$355.50	$395.00	—	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC Ekg Tracing W Min 12 Leads	$355.50	$395.00	—	—	10%
Electroconvulsive therapy (ECT), one session CPT 90870 Strtctc Loclzj Insj Cath/Prb Plmt Radj Src	$1,800.00	$2,000.00	—	109% above	10%
Electroconvulsive therapy (ECT), one session CPT 90870 Electroconvulsive Ther - 90870	$2,430.00	$2,700.00	—	182% above	10%
Electroconvulsive therapy (ECT), one session CPT 90870 HC Electroconvulsive Therapy Ect	$2,430.00	$2,700.00	—	182% above	10%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 Strtctc Loclzj Insj Cath/Prb Plmt Radj Src	$1,800.00	$2,000.00	—	—	10%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC Electroconvulsive Therapy Ect	$2,430.00	$2,700.00	—	—	10%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 Electroconvulsive Ther - 90870	$2,430.00	$2,700.00	—	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emer Dept Self Limited/Minor - 99281	$1,395.00	$1,550.00	—	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED Visit Level 1 Pa	$1,395.00	$1,550.00	—	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC Psych ED Visit Level 1	$1,395.00	$1,550.00	—	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED Visit Level 1 Pa	$1,395.00	$1,550.00	—	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC Psych ED Visit Level 1	$1,395.00	$1,550.00	—	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emer Dept Self Limited/Minor - 99281	$1,395.00	$1,550.00	—	—	10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emer Dept Low to Moderate Severity - 99282	$1,620.00	$1,800.00	—	—	10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED Visit Level 2 Pa	$1,620.00	$1,800.00	—	—	10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC Psych ED Visit Level 2	$1,620.00	$1,800.00	—	—	10%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED Visit Level 2 Pa	$1,620.00	$1,800.00	—	—	10%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC Psych ED Visit Level 2	$1,620.00	$1,800.00	—	—	10%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emer Dept Low to Moderate Severity - 99282	$1,620.00	$1,800.00	—	—	10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED Visit Level 3 Pa	$1,935.00	$2,150.00	—	—	10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emer Dept Moderate Severity - 99283	$1,935.00	$2,150.00	—	—	10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC Psych ED Visit Level 3	$1,935.00	$2,150.00	—	—	10%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED Visit Level 3 Pa	$1,935.00	$2,150.00	—	—	10%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC Psych ED Visit Level 3	$1,935.00	$2,150.00	—	—	10%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emer Dept Moderate Severity - 99283	$1,935.00	$2,150.00	—	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC Psych ED Visit Level 4	$2,160.00	$2,400.00	—	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emer Dept Hi Severity&Urgent Eval - 99284	$2,160.00	$2,400.00	—	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC Trauma Actv Part W/O Cc Lv4	$6,426.00	$7,140.00	—	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC Trauma Actv Full W/O Cc Lv4	$8,793.00	$9,770.00	—	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC Psych ED Visit Level 4	$2,160.00	$2,400.00	—	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emer Dept Hi Severity&Urgent Eval - 99284	$2,160.00	$2,400.00	—	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC Trauma Actv Part W/O Cc Lv4	$6,426.00	$7,140.00	—	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC Trauma Actv Full W/O Cc Lv4	$8,793.00	$9,770.00	—	—	10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emer Dept High Severity&Threat Funcj - 99285	$2,340.00	$2,600.00	—	—	10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC Psych ED Visit Level 5	$2,340.00	$2,600.00	—	—	10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC Trauma Actv Part W/O Cc Lv5	$6,615.00	$7,350.00	—	—	10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC Trauma Actv Full W/O Cc Lv5	$8,982.00	$9,980.00	—	—	10%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emer Dept High Severity&Threat Funcj - 99285	$2,340.00	$2,600.00	—	—	10%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC Psych ED Visit Level 5	$2,340.00	$2,600.00	—	—	10%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC Trauma Actv Part W/O Cc Lv5	$6,615.00	$7,350.00	—	—	10%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC Trauma Actv Full W/O Cc Lv5	$8,982.00	$9,980.00	—	—	10%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC Cardiovascular Stress Test W/ Ecg	$1,530.00	$1,700.00	—	—	10%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC Cardiovasc Stress Test W/ Ecg	$1,530.00	$1,700.00	—	—	10%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC Cardiovasc Stress Test W/ Ecg	$1,530.00	$1,700.00	—	—	10%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC Cardiovascular Stress Test W/ Ecg	$1,530.00	$1,700.00	—	—	10%
Eye exam, returning patient, intermediate CPT 92012 HC Opthm Services;Interm;Est	$540.00	$600.00	—	—	10%
Eye exam, returning patient, intermediate CPT 92012 HC Ophthal Exam Estab Pt Intermd	$540.00	$600.00	—	—	10%
Eye exam, returning patient, intermediate inpatient CPT 92012 HC Opthm Services;Interm;Est	$540.00	$600.00	—	—	10%
Eye exam, returning patient, intermediate inpatient CPT 92012 HC Ophthal Exam Estab Pt Intermd	$540.00	$600.00	—	—	10%
Family therapy with the patient, 50 minutes CPT 90847 HC Family Psy W/ Pat Collateral	$517.50	$575.00	—	85% above	10%
Family therapy with the patient, 50 minutes CPT 90847 HC Family Psy W/ Pat Crisis	$517.50	$575.00	—	85% above	10%
Family therapy with the patient, 50 minutes CPT 90847 Fam Psyctx W/Pt Present - 90847	$517.50	$575.00	—	85% above	10%
Family therapy with the patient, 50 minutes CPT 90847 HC Family Psytx W/Patient 30min	$517.50	$575.00	—	85% above	10%
Family therapy with the patient, 50 minutes CPT 90847 HC Family Psytx W/Patient 50min	$517.50	$575.00	—	85% above	10%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Psy W/ Pat Collateral	$517.50	$575.00	—	—	10%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Psy W/ Pat Crisis	$517.50	$575.00	—	—	10%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Fam Psyctx W/Pt Present - 90847	$517.50	$575.00	—	—	10%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Psytx W/Patient 30min	$517.50	$575.00	—	—	10%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Psytx W/Patient 50min	$517.50	$575.00	—	—	10%
Family therapy without the patient, 50 minutes CPT 90846 HC Family Psytx WO Patient 50min	$270.00	$300.00	—	2% above	10%
Family therapy without the patient, 50 minutes CPT 90846 HC Fam/Collat Serv W/O Pat 30min	$486.00	$540.00	—	84% above	10%
Family therapy without the patient, 50 minutes CPT 90846 HC Fam/Collat Ser W/O Pat 30min	$486.00	$540.00	—	84% above	10%
Family therapy without the patient, 50 minutes CPT 90846 Fam Psyctx W/O Pt Present - 90846	$486.00	$540.00	—	84% above	10%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Family Psytx WO Patient 50min	$270.00	$300.00	—	—	10%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Fam/Collat Ser W/O Pat 30min	$486.00	$540.00	—	—	10%
Family therapy without the patient, 50 minutes inpatient CPT 90846 Fam Psyctx W/O Pt Present - 90846	$486.00	$540.00	—	—	10%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Fam/Collat Serv W/O Pat 30min	$486.00	$540.00	—	—	10%
Group psychotherapy session CPT 90853 HC Alcohol/Drug Group Counseling	$198.00	$220.00	—	56% above	10%
Group psychotherapy session CPT 90853 HC Group Psychotx	$270.00	$300.00	—	113% above	10%
Group psychotherapy session CPT 90853 HC Group Counseling 60 Min	$270.00	$300.00	—	113% above	10%
Group psychotherapy session CPT 90853 HC Sbhc Group Psychotx< 60min	$270.00	$300.00	—	113% above	10%
Group psychotherapy session CPT 90853 HC Group Psychotx- CRS	$270.00	$300.00	—	113% above	10%
Group psychotherapy session CPT 90853 Grp Psyctx - 90853	$270.00	$300.00	—	113% above	10%
Group psychotherapy session inpatient CPT 90853 HC Alcohol/Drug Group Counseling	$198.00	$220.00	—	—	10%
Group psychotherapy session inpatient CPT 90853 HC Sbhc Group Psychotx< 60min	$270.00	$300.00	—	—	10%
Group psychotherapy session inpatient CPT 90853 HC Group Counseling 60 Min	$270.00	$300.00	—	—	10%
Group psychotherapy session inpatient CPT 90853 Grp Psyctx - 90853	$270.00	$300.00	—	—	10%
Group psychotherapy session inpatient CPT 90853 HC Group Psychotx	$270.00	$300.00	—	—	10%
Group psychotherapy session inpatient CPT 90853 HC Group Psychotx- CRS	$270.00	$300.00	—	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV Infus Hydration 31-60 Min	$1,575.00	$1,750.00	—	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 110	$1,575.00	$1,750.00	—	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Infusion Hydration Initial 31 Min-1 Hour - 96360	$1,575.00	$1,750.00	—	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV Infusion Hydration Initial 31 Min-1 Hour	$1,575.00	$1,750.00	—	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV Infus Hydration 31-60 Min	$1,575.00	$1,750.00	—	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV Infusion Hydration Initial 31 Min-1 Hour	$1,575.00	$1,750.00	—	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 110	$1,575.00	$1,750.00	—	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Infusion Hydration Initial 31 Min-1 Hour - 96360	$1,575.00	$1,750.00	—	—	10%
IV infusion of a medicine, first hour CPT 96365 HC Ther/Proph/Diag IV Inf <1hr	$2,736.00	$3,040.00	—	—	10%
IV infusion of a medicine, first hour CPT 96365 HC IV Infusion Therapy/Prophylaxis /Dx 1st to 1 Hr	$2,736.00	$3,040.00	—	—	10%
IV infusion of a medicine, first hour CPT 96365 Prophylactic and Injections	$2,736.00	$3,040.00	—	—	10%
IV infusion of a medicine, first hour CPT 96365 IV Infusion Therapy/Prophylaxis /Dx 1st Gt1 Hour - 96365	$2,736.00	$3,040.00	—	—	10%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Infusion Therapy/Prophylaxis /Dx 1st Gt1 Hour - 96365	$2,736.00	$3,040.00	—	—	10%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV Infusion Therapy/Prophylaxis /Dx 1st to 1 Hr	$2,736.00	$3,040.00	—	—	10%
IV infusion of a medicine, first hour inpatient CPT 96365 HC Ther/Proph/Diag IV Inf <1hr	$2,736.00	$3,040.00	—	—	10%
IV infusion of a medicine, first hour inpatient CPT 96365 Prophylactic and Injections	$2,736.00	$3,040.00	—	—	10%
IV push of a medicine, first drug CPT 96374 Ther Proph/Dx Njx IV Push Single/1st Sbst/Drug - 96374	$855.00	$950.00	—	—	10%
IV push of a medicine, first drug CPT 96374 Prophylactic and Injections	$855.00	$950.00	—	—	10%
IV push of a medicine, first drug CPT 96374 HC Ther Proph/Dx Njx IV Push Single/1st Sbst/Drug	$855.00	$950.00	—	—	10%
IV push of a medicine, first drug inpatient CPT 96374 Ther Proph/Dx Njx IV Push Single/1st Sbst/Drug - 96374	$855.00	$950.00	—	—	10%
IV push of a medicine, first drug inpatient CPT 96374 HC Ther Proph/Dx Njx IV Push Single/1st Sbst/Drug	$855.00	$950.00	—	—	10%
IV push of a medicine, first drug inpatient CPT 96374 Prophylactic and Injections	$855.00	$950.00	—	—	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC Ther/Proph/Diag Inj Subq Im	$22.59	$25.10	—	—	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic Prophylactic/Dx Injection Subq/Im - 96372	$675.00	$750.00	—	—	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC Therapeutic Prophylactic/Dx Injection Subq/Im	$675.00	$750.00	—	—	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC Therapeutic Injection Subcutaneous or Intramuscular	$675.00	$750.00	—	—	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC Ther/Proph/Diag Inj Sc/Im	$1,620.00	$1,800.00	—	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC Ther/Proph/Diag Inj Subq Im	$22.59	$25.10	—	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC Therapeutic Injection Subcutaneous or Intramuscular	$675.00	$750.00	—	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapeutic Prophylactic/Dx Injection Subq/Im - 96372	$675.00	$750.00	—	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC Therapeutic Prophylactic/Dx Injection Subq/Im	$675.00	$750.00	—	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC Ther/Proph/Diag Inj Sc/Im	$1,620.00	$1,800.00	—	—	10%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Olp Licensed Evaluation	$99.00	$110.00	—	61% below	10%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Extended Assess 75 Minimum	$405.00	$450.00	—	59% above	10%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Psych Diagnostic Evaluation	$657.00	$730.00	—	159% above	10%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Assessment Extended 75 Min	$657.00	$730.00	—	159% above	10%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psyc Dx Evaluation - 90791	$657.00	$730.00	—	159% above	10%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Olp Licensed Evaluation	$99.00	$110.00	—	—	10%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Extended Assess 75 Minimum	$405.00	$450.00	—	—	10%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psyc Dx Evaluation - 90791	$657.00	$730.00	—	—	10%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Assessment Extended 75 Min	$657.00	$730.00	—	—	10%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Psych Diagnostic Evaluation	$657.00	$730.00	—	—	10%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC Nerve Conduction Study 7-8	$1,575.00	$1,750.00	—	—	10%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC Nerve Conduction 7-8 Studies	$1,575.00	$1,750.00	—	—	10%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC Nerve Conduction Studies 7-8	$1,575.00	$1,750.00	—	—	10%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC Nerve Conduction Study 7-8	$1,575.00	$1,750.00	—	—	10%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC Nerve Conduction Studies 7-8	$1,575.00	$1,750.00	—	—	10%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC Nerve Conduction 7-8 Studies	$1,575.00	$1,750.00	—	—	10%
Neuromuscular re-education, 15 minutes CPT 97112 HC Neuromuscular Reeducation 15m	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes CPT 97112 HC Pt Neuromuscular Re-Education Each 15 Min	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation 15m - 97112	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes CPT 97112 HC Ot Neuromuscular Re-Education Each 15 Min	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes CPT 97112 Ther Px 1+ Areas Ea 15 Min Neuromusc Reeducaj - 97112	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation 15 Min - 97112	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes CPT 97112 HC Vest.Rehab-Neuromusc Re-ED 15m	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC Pt Neuromuscular Re-Education Each 15 Min	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Ther Px 1+ Areas Ea 15 Min Neuromusc Reeducaj - 97112	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC Vest.Rehab-Neuromusc Re-ED 15m	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Reeducation 15 Min - 97112	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC Neuromuscular Reeducation 15m	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Reeducation 15m - 97112	$315.00	$350.00	—	—	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC Ot Neuromuscular Re-Education Each 15 Min	$315.00	$350.00	—	—	10%
New patient office visit, about 30 minutes CPT 99203 HC Cosmetic Surgery Consult	$205.24	$228.04	—	—	10%
New patient office visit, about 30 minutes CPT 99203 HC New Patient E/M Visit Lvl 3	$531.00	$590.00	—	—	10%
New patient office visit, about 30 minutes CPT 99203 HC Psych Assess New Pt. Lvl 3	$531.00	$590.00	—	—	10%
New patient office visit, about 30 minutes CPT 99203 HC Office Visit New Pat- Detailed Exam- Lvl3	$531.00	$590.00	—	—	10%
New patient office visit, about 30 minutes CPT 99203 HC Office Visit New Detailed Low	$531.00	$590.00	—	—	10%
New patient office visit, about 30 minutes inpatient CPT 99203 HC Cosmetic Surgery Consult	$205.24	$228.04	—	—	10%
New patient office visit, about 30 minutes inpatient CPT 99203 HC Office Visit New Detailed Low	$531.00	$590.00	—	—	10%
New patient office visit, about 30 minutes inpatient CPT 99203 HC Psych Assess New Pt. Lvl 3	$531.00	$590.00	—	—	10%
New patient office visit, about 30 minutes inpatient CPT 99203 HC Office Visit New Pat- Detailed Exam- Lvl3	$531.00	$590.00	—	—	10%
New patient office visit, about 30 minutes inpatient CPT 99203 HC New Patient E/M Visit Lvl 3	$531.00	$590.00	—	—	10%
New patient office visit, about 45 minutes CPT 99204 HC Psych Assess New Pt. Lvl 4	$558.00	$620.00	—	—	10%
New patient office visit, about 45 minutes CPT 99204 HC Office Visit New Comprh Mod	$558.00	$620.00	—	—	10%
New patient office visit, about 45 minutes CPT 99204 HC Office Visit New Pat- Mod Complexity-Lvl4	$558.00	$620.00	—	—	10%
New patient office visit, about 45 minutes CPT 99204 HC New Patient E/M Visit Lvl 4	$558.00	$620.00	—	—	10%
New patient office visit, about 45 minutes CPT 99204 HC Post-OP Office Visit	$810.00	$900.00	—	—	10%
New patient office visit, about 45 minutes inpatient CPT 99204 HC Office Visit New Comprh Mod	$558.00	$620.00	—	—	10%
New patient office visit, about 45 minutes inpatient CPT 99204 HC New Patient E/M Visit Lvl 4	$558.00	$620.00	—	—	10%
New patient office visit, about 45 minutes inpatient CPT 99204 HC Psych Assess New Pt. Lvl 4	$558.00	$620.00	—	—	10%
New patient office visit, about 45 minutes inpatient CPT 99204 HC Office Visit New Pat- Mod Complexity-Lvl4	$558.00	$620.00	—	—	10%
New patient office visit, about 45 minutes inpatient CPT 99204 HC Post-OP Office Visit	$810.00	$900.00	—	—	10%
New patient office visit, about 60 minutes CPT 99205 HC Psych Assess New Pt. Lvl 5	$585.00	$650.00	—	—	10%
New patient office visit, about 60 minutes CPT 99205 HC Office Visit New Comprh High	$585.00	$650.00	—	—	10%
New patient office visit, about 60 minutes CPT 99205 HC Office Visit New Pat- Comprehensive-Lvl5	$585.00	$650.00	—	—	10%
New patient office visit, about 60 minutes CPT 99205 HC New Patient E/M Visit Lvl 5	$585.00	$650.00	—	—	10%
New patient office visit, about 60 minutes inpatient CPT 99205 HC New Patient E/M Visit Lvl 5	$585.00	$650.00	—	—	10%
New patient office visit, about 60 minutes inpatient CPT 99205 HC Office Visit New Comprh High	$585.00	$650.00	—	—	10%
New patient office visit, about 60 minutes inpatient CPT 99205 HC Office Visit New Pat- Comprehensive-Lvl5	$585.00	$650.00	—	—	10%
New patient office visit, about 60 minutes inpatient CPT 99205 HC Psych Assess New Pt. Lvl 5	$585.00	$650.00	—	—	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC Office Visit New Pat-Expanded Prblm Focus- Lvl2	$504.00	$560.00	—	—	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC New Patient E/M Visit Lvl 2	$504.00	$560.00	—	—	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC Psych Assess New Pt. Lvl 2	$504.00	$560.00	—	—	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC Office Visit New Expanded	$504.00	$560.00	—	—	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC Psych Assess New Pt. Lvl 1	$504.00	$560.00	—	—	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC Office Visit New Pat-Expanded Prblm Focus- Lvl2	$504.00	$560.00	—	—	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC Office Visit New Expanded	$504.00	$560.00	—	—	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC Psych Assess New Pt. Lvl 1	$504.00	$560.00	—	—	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC Psych Assess New Pt. Lvl 2	$504.00	$560.00	—	—	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC New Patient E/M Visit Lvl 2	$504.00	$560.00	—	—	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC Init Med Nutrtn Ther Ea 15min	$139.50	$155.00	—	—	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC Init Med Nutrtn Ther Ea 15min	$139.50	$155.00	—	—	10%
Occupational therapy evaluation, low complexity CPT 97165 HC Ot Eval Low Complex 30 Min	$558.00	$620.00	—	—	10%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC Ot Eval Low Complex 30 Min	$558.00	$620.00	—	—	10%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC Pt Eval High Complex 45 Min	$850.50	$945.00	—	—	10%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC Pt Eval High Complex 45 Min	$850.50	$945.00	—	—	10%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC Pt Eval Low Complex 20 Min	$531.00	$590.00	—	—	10%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC Pt Eval Low Complex 20 Min	$531.00	$590.00	—	—	10%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC Pt Eval Mod Complex 30 Min	$670.50	$745.00	—	—	10%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC Pt Eval Mod Complex 30 Min	$670.50	$745.00	—	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Manual Therapy per 15 Min	$252.00	$280.00	—	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Ot Manual Therapy 15 Min	$252.00	$280.00	—	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy 15 Min - 97140	$252.00	$280.00	—	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Mnl Ther Tqs 1+ Regions Ea 15 Min - 97140	$252.00	$280.00	—	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy - 97140	$252.00	$280.00	—	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Pt Manual Therapy 15 Min	$252.00	$280.00	—	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy - 97140	$252.00	$280.00	—	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Mnl Ther Tqs 1+ Regions Ea 15 Min - 97140	$252.00	$280.00	—	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC Pt Manual Therapy 15 Min	$252.00	$280.00	—	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC Ot Manual Therapy 15 Min	$252.00	$280.00	—	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC Manual Therapy per 15 Min	$252.00	$280.00	—	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy 15 Min - 97140	$252.00	$280.00	—	—	10%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Therapeutic Exercises 15 Min 1 or More Area	$252.00	$280.00	—	—	10%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Therapeutic Exercises Each 15 Min 1 or More Area	$252.00	$280.00	—	—	10%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercises - 97110	$252.00	$280.00	—	—	10%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ther Px 1+ Areas Ea 15 Min Ther Xerss - 97110	$252.00	$280.00	—	—	10%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercises 15 Min - 97110	$252.00	$280.00	—	—	10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Therapeutic Exercises 15 Min 1 or More Area	$252.00	$280.00	—	—	10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Therapeutic Exercises Each 15 Min 1 or More Area	$252.00	$280.00	—	—	10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercises - 97110	$252.00	$280.00	—	—	10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercises 15 Min - 97110	$252.00	$280.00	—	—	10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Ther Px 1+ Areas Ea 15 Min Ther Xerss - 97110	$252.00	$280.00	—	—	10%
Preventive checkup, new patient aged 18–39 CPT 99385 HC Preventive Visit New 18-39 Y	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 18–39 CPT 99385 HC Initial Preventive Medicine New Pt Age 18-39yrs	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 18–39 CPT 99385 HC Physical Exam New 19-39 Yrs	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC Preventive Visit New 18-39 Y	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC Initial Preventive Medicine New Pt Age 18-39yrs	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC Physical Exam New 19-39 Yrs	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 40–64 CPT 99386 HC Preventive Visit New 40-64 Y	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 40–64 CPT 99386 HC Physical Exam New 40-64 Yrs	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 40–64 CPT 99386 HC Initial Preventive Medicine New Patient 40-64yrs	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC Preventive Visit New 40-64 Y	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC Physical Exam New 40-64 Yrs	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC Initial Preventive Medicine New Patient 40-64yrs	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 65 or older CPT 99387 HC Preventive Visit New 65+ Year	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 65 or older CPT 99387 HC Physical Exam New 65+ Yrs	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 65 or older CPT 99387 HC Initial Preventive Medicine New Patient 65yrs&>	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC Initial Preventive Medicine New Patient 65yrs&>	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC Physical Exam New 65+ Yrs	$391.50	$435.00	—	—	10%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC Preventive Visit New 65+ Year	$391.50	$435.00	—	—	10%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC Periodic Preventive Med Est Patient 18-39 Yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC Prevent Visit Est Pt 18-39 Y	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 18–39 CPT 99395 HC Physical Exam Est 19-39 Yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC Periodic Preventive Med Est Patient 18-39 Yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC Prevent Visit Est Pt 18-39 Y	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC Physical Exam Est 19-39 Yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC Prev Visit Est Pt 40-64 Yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC Physical Exam Est 40-64 Yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC Periodic Preventive Med Est Patient 40-64yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC Physical Exam Est 40-64 Yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC Periodic Preventive Med Est Patient 40-64yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC Prev Visit Est Pt 40-64 Yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC Prev Visit Est Pt 65+ Yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC Physical Exam Est 65+. Yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC Periodic Preventive Med Est Patient 65yrs& Older	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC Physical Exam Est 65+. Yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC Prev Visit Est Pt 65+ Yrs	$364.50	$405.00	—	—	10%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC Periodic Preventive Med Est Patient 65yrs& Older	$364.50	$405.00	—	—	10%
Psychiatric evaluation with medical services CPT 90792 HC Initial Assesment W/Med Serv	$729.00	$810.00	—	145% above	10%
Psychiatric evaluation with medical services CPT 90792 HC Psych Diag Eval W/Med Srvcs	$765.00	$850.00	—	157% above	10%
Psychiatric evaluation with medical services inpatient CPT 90792 HC Initial Assesment W/Med Serv	$729.00	$810.00	—	—	10%
Psychiatric evaluation with medical services inpatient CPT 90792 HC Psych Diag Eval W/Med Srvcs	$765.00	$850.00	—	—	10%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 Psycl Tst Eval Phys/Qhp 1st (96130)	$540.00	$600.00	—	—	10%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HC Psycl Tst Eval Phys/Qhp 1st Hr	$540.00	$600.00	—	—	10%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 Psycl Tst Eval Phys/Qhp 1st (96130)	$540.00	$600.00	—	—	10%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 HC Psycl Tst Eval Phys/Qhp 1st Hr	$540.00	$600.00	—	—	10%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC Crisis Intervention per Hour	$630.00	$700.00	—	136% above	10%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC Psytx Crisis Initial 60 Min	$630.00	$700.00	—	136% above	10%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC Crisis Intervention per Hour	$630.00	$700.00	—	—	10%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC Psytx Crisis Initial 60 Min	$630.00	$700.00	—	—	10%
Psychotherapy session, 30 minutes CPT 90832 HC Psychotherapy W/Patient 30 Min	$198.00	$220.00	—	at median	10%
Psychotherapy session, 30 minutes CPT 90832 HC Psychoterapy W/Patient 30min	$198.00	$220.00	—	at median	10%
Psychotherapy session, 30 minutes CPT 90832 HC Procedure Music Thrpy 30 Mins	$360.00	$400.00	—	82% above	10%
Psychotherapy session, 30 minutes CPT 90832 HC Individ Therapy Brief 25 Min	$360.00	$400.00	—	82% above	10%
Psychotherapy session, 30 minutes CPT 90832 HC Psychotherapy W/Patient 30min	$360.00	$400.00	—	82% above	10%
Psychotherapy session, 30 minutes CPT 90832 Psychotherapy W/Patient 30min - 90832	$360.00	$400.00	—	82% above	10%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC Psychotherapy W/Patient 30 Min	$198.00	$220.00	—	—	10%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC Psychoterapy W/Patient 30min	$198.00	$220.00	—	—	10%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC Individ Therapy Brief 25 Min	$360.00	$400.00	—	—	10%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC Procedure Music Thrpy 30 Mins	$360.00	$400.00	—	—	10%
Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy W/Patient 30min - 90832	$360.00	$400.00	—	—	10%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC Psychotherapy W/Patient 30min	$360.00	$400.00	—	—	10%
Psychotherapy session, 45 minutes CPT 90834 HC Psychotherapy 45min W/Patient	$387.00	$430.00	—	48% above	10%
Psychotherapy session, 45 minutes CPT 90834 HC Indiv Therapy Normative 45min	$486.00	$540.00	—	86% above	10%
Psychotherapy session, 45 minutes CPT 90834 Psychotherapy 45min W/Patient - 90834	$486.00	$540.00	—	86% above	10%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC Psychotherapy 45min W/Patient	$387.00	$430.00	—	—	10%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC Indiv Therapy Normative 45min	$486.00	$540.00	—	—	10%
Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy 45min W/Patient - 90834	$486.00	$540.00	—	—	10%
Psychotherapy session, 60 minutes CPT 90837 Psychotherapy 60 Min W/Pat - 90837	$562.50	$625.00	—	88% above	10%
Psychotherapy session, 60 minutes CPT 90837 HC Psychotherapy 60 Min W/Pat	$562.50	$625.00	—	88% above	10%
Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy 60 Min W/Pat - 90837	$562.50	$625.00	—	—	10%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC Psychotherapy 60 Min W/Pat	$562.50	$625.00	—	—	10%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco Use Cessation Intermediate 3-10 Minutes - 99406	$85.50	$95.00	—	—	10%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC Smoking Cessat Counsel 3-10m	$85.50	$95.00	—	—	10%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco Use Cessation Intermediate 3-10 Minutes - 99406	$85.50	$95.00	—	—	10%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC Smoking Cessat Counsel 3-10m	$85.50	$95.00	—	—	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Office Visit Est Pat- High Complx Lvl5	$558.00	$620.00	—	—	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Office Visit Estb Comprh High	$558.00	$620.00	—	—	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Office Visit Est Pat- High Complx-Lvl5	$558.00	$620.00	—	—	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Office Visit Est Comprh High	$558.00	$620.00	—	—	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Est Patient E/M Visit Lvl 5	$558.00	$620.00	—	—	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Psych Assess Est Pt Lvl 5	$558.00	$620.00	—	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Est Patient E/M Visit Lvl 5	$558.00	$620.00	—	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Office Visit Est Pat- High Complx Lvl5	$558.00	$620.00	—	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Office Visit Est Comprh High	$558.00	$620.00	—	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Office Visit Est Pat- High Complx-Lvl5	$558.00	$620.00	—	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Office Visit Estb Comprh High	$558.00	$620.00	—	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Psych Assess Est Pt Lvl 5	$558.00	$620.00	—	—	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Office Visit Est Detailed Low	$504.00	$560.00	—	—	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Office Visit Estb Detailed Lo	$504.00	$560.00	—	—	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Psych Assess Est Pt Lvl 3	$504.00	$560.00	—	—	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Est Patient E/M Visit Lvl 3	$504.00	$560.00	—	—	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Office Visit Est Pat- Expanded Prob Focus-Lvl3	$504.00	$560.00	—	—	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Office Visit Est Expanded	$504.00	$560.00	—	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Psych Assess Est Pt Lvl 3	$504.00	$560.00	—	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Office Visit Estb Detailed Lo	$504.00	$560.00	—	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Est Patient E/M Visit Lvl 3	$504.00	$560.00	—	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Office Visit Est Pat- Expanded Prob Focus-Lvl3	$504.00	$560.00	—	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Office Visit Est Expanded	$504.00	$560.00	—	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Office Visit Est Detailed Low	$504.00	$560.00	—	—	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Psych Assess Est Pt Lvl 4	$531.00	$590.00	—	—	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Est Patient E/M Visit Lvl 4	$531.00	$590.00	—	—	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Office Visit Estb Comprh Mod	$531.00	$590.00	—	—	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Office Visit Est Detailed Mod	$531.00	$590.00	—	—	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Office Visit Est Pat- Mod Complx-Lvl4	$531.00	$590.00	—	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Psych Assess Est Pt Lvl 4	$531.00	$590.00	—	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Office Visit Est Detailed Mod	$531.00	$590.00	—	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Office Visit Est Pat- Mod Complx-Lvl4	$531.00	$590.00	—	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Office Visit Estb Comprh Mod	$531.00	$590.00	—	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Est Patient E/M Visit Lvl 4	$531.00	$590.00	—	—	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Psych Assess Est Pt Lvl 2	$423.00	$470.00	—	—	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Office Visit Est Focused	$423.00	$470.00	—	—	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Office Visit Estb Expanded	$423.00	$470.00	—	—	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Office Visit Est Pat- Prob Focus-Lvl2	$423.00	$470.00	—	—	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Est Patient E/M Visit Lvl 2	$423.00	$470.00	—	—	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Office Visit Est Pat- High Complx Lvl2	$423.00	$470.00	—	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Psych Assess Est Pt Lvl 2	$423.00	$470.00	—	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Office Visit Est Pat- High Complx Lvl2	$423.00	$470.00	—	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Office Visit Est Focused	$423.00	$470.00	—	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Office Visit Est Pat- Prob Focus-Lvl2	$423.00	$470.00	—	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Est Patient E/M Visit Lvl 2	$423.00	$470.00	—	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Office Visit Estb Expanded	$423.00	$470.00	—	—	10%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HC Office Consultation Detailed L	$472.50	$525.00	—	—	10%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HC Office Consult	$472.50	$525.00	—	—	10%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC Office Consult	$472.50	$525.00	—	—	10%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC Office Consultation Detailed L	$472.50	$525.00	—	—	10%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC Office Consult	$517.50	$575.00	—	—	10%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HC Office Consult	$517.50	$575.00	—	—	10%
Speech and language evaluation CPT 92523 HC Eval Speech Sound Lang Comprhn	$729.00	$810.00	—	—	10%
Speech and language evaluation inpatient CPT 92523 HC Eval Speech Sound Lang Comprhn	$729.00	$810.00	—	—	10%
Speech therapy session, individual CPT 92507 Tx Sp Lang Comunicaj Pcx Disorder Indiv - 92507	$522.00	$580.00	—	—	10%
Speech therapy session, individual CPT 92507 HC Speech/Hear/Voice Tx Individu (15min)	$522.00	$580.00	—	—	10%
Speech therapy session, individual CPT 92507 HC Speech/Hearing Ther (30 Min)	$549.00	$610.00	—	—	10%
Speech therapy session, individual CPT 92507 HC Speech/Hear/Voice Tx Individu	$576.00	$640.00	—	—	10%
Speech therapy session, individual CPT 92507 HC Speech/Hearing Ther (45 Min)	$576.00	$640.00	—	—	10%
Speech therapy session, individual CPT 92507 HC Speech/Hearing Ther (60 Min)	$603.00	$670.00	—	—	10%
Speech therapy session, individual inpatient CPT 92507 HC Speech/Hear/Voice Tx Individu (15min)	$522.00	$580.00	—	—	10%
Speech therapy session, individual inpatient CPT 92507 Tx Sp Lang Comunicaj Pcx Disorder Indiv - 92507	$522.00	$580.00	—	—	10%
Speech therapy session, individual inpatient CPT 92507 HC Speech/Hearing Ther (30 Min)	$549.00	$610.00	—	—	10%
Speech therapy session, individual inpatient CPT 92507 HC Speech/Hear/Voice Tx Individu	$576.00	$640.00	—	—	10%
Speech therapy session, individual inpatient CPT 92507 HC Speech/Hearing Ther (45 Min)	$576.00	$640.00	—	—	10%
Speech therapy session, individual inpatient CPT 92507 HC Speech/Hearing Ther (60 Min)	$603.00	$670.00	—	—	10%
Spirometry (breathing test) CPT 94010 Spmtry W/Vc Expiratory Flo +-Mxml Vol Vntj - 94010	$796.50	$885.00	—	—	10%
Spirometry (breathing test) CPT 94010 HC Spirometry W/Vc Expiratory Flow Rate W/WO Max Voluntary Ventilation	$796.50	$885.00	—	—	10%
Spirometry (breathing test) CPT 94010 HC Spirometry	$796.50	$885.00	—	—	10%
Spirometry (breathing test) inpatient CPT 94010 HC Spirometry W/Vc Expiratory Flow Rate W/WO Max Voluntary Ventilation	$796.50	$885.00	—	—	10%
Spirometry (breathing test) inpatient CPT 94010 Spmtry W/Vc Expiratory Flo +-Mxml Vol Vntj - 94010	$796.50	$885.00	—	—	10%
Spirometry (breathing test) inpatient CPT 94010 HC Spirometry	$796.50	$885.00	—	—	10%
Spirometry before and after a bronchodilator CPT 94060 HC Evaluation of Wheezing	$990.00	$1,100.00	—	—	10%
Spirometry before and after a bronchodilator CPT 94060 HC Brnchodilation Response Spirometry Pre&Post-Brncdilat Admn	$990.00	$1,100.00	—	—	10%
Spirometry before and after a bronchodilator CPT 94060 Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn - 94060	$990.00	$1,100.00	—	—	10%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC Brnchodilation Response Spirometry Pre&Post-Brncdilat Admn	$990.00	$1,100.00	—	—	10%
Spirometry before and after a bronchodilator inpatient CPT 94060 Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn - 94060	$990.00	$1,100.00	—	—	10%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC Evaluation of Wheezing	$990.00	$1,100.00	—	—	10%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC Pt Therapeutic Activities Each 15 Min	$252.00	$280.00	—	—	10%
Therapeutic activities (functional training), 15 minutes CPT 97530 Ther Actv Dir Pt Contact by Provider Ea 15 Min - 97530	$252.00	$280.00	—	—	10%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC Ot Therapeutic Activities 15 Min Each	$252.00	$280.00	—	—	10%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities 15 Min - 97530	$252.00	$280.00	—	—	10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities 15 Min - 97530	$252.00	$280.00	—	—	10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC Ot Therapeutic Activities 15 Min Each	$252.00	$280.00	—	—	10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC Pt Therapeutic Activities Each 15 Min	$252.00	$280.00	—	—	10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Ther Actv Dir Pt Contact by Provider Ea 15 Min - 97530	$252.00	$280.00	—	—	10%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy Ther Spx - 99195	$1,350.00	$1,500.00	—	—	10%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC Phlebotomy Therapeutic	$1,350.00	$1,500.00	—	—	10%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy Ther Spx - 99195	$1,350.00	$1,500.00	—	—	10%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC Phlebotomy Therapeutic	$1,350.00	$1,500.00	—	—	10%
Visual field test, extended CPT 92083 HC Visual Field Exam Extended	$670.50	$745.00	—	—	10%
Visual field test, extended CPT 92083 Ophthalmology, Special Services	$670.50	$745.00	—	—	10%
Visual field test, extended inpatient CPT 92083 Ophthalmology, Special Services	$670.50	$745.00	—	—	10%
Visual field test, extended inpatient CPT 92083 HC Visual Field Exam Extended	$670.50	$745.00	—	—	10%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs New York	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 influenza vaccine 2024-25 (65YR UP) syringe 0.5 mL Syringe	$260.10	$289.00	—	—	10%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 influenza vaccine 2024-25 (65YR UP) syringe 0.5 mL Syringe	$260.10	$289.00	—	—	10%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COVID vaccine 2024-25 (12 years+)(PF) 30 mcg/0.3 mL syringe 0.3 mL Syringe	$499.68	$555.20	—	—	10%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COVID vaccine 2024-25 (12 years+)(PF) 30 mcg/0.3 mL syringe 0.3 mL Syringe	$499.68	$555.20	—	—	10%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 varicella virus vaccine (live) 1,350 unit/0.5 mL suspension for reconstitution 1 each Vial	$616.41	$684.90	—	—	10%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 varicella virus vaccine (live) 1,350 unit/0.5 mL suspension for reconstitution 1 each Vial	$616.41	$684.90	—	—	10%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 diphtheria, tetanus, acellular pertussis (DTaP) 25-58-10 Lf-mcg-Lf/0.5mL syringe 0.5 mL Syringe	$75.73	$84.14	—	—	10%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 diphtheria, tetanus, acellular pertussis (DTaP) 25-58-10 Lf-mcg-Lf/0.5mL syringe 0.5 mL Syringe	$75.73	$84.14	—	—	10%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 hep B-DP(Acell)T-polio vac-PF 10 mcg-25Lf-25 mcg-10Lf/0.5 mL syringe 0.5 mL Syringe	$223.97	$248.86	—	—	10%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 hep B-DP(Acell)T-polio vac-PF 10 mcg-25Lf-25 mcg-10Lf/0.5 mL syringe 0.5 mL Syringe	$223.97	$248.86	—	—	10%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 dp(A)T-polio-hib conj-Tet (PF) 15 Lf unit-20 mcg-5 Lf/0.5 mL kit 1 each KIT	$342.15	$380.17	—	—	10%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 dp(A)T-polio-hib conj-Tet (PF) 15 Lf unit-20 mcg-5 Lf/0.5 mL kit 1 each KIT	$342.15	$380.17	—	—	10%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza vaccine 2024-25 (6 MONTHS+) (PF) 45 mcg/0.5 mL syringe 0.5 mL Syringe	$72.09	$80.10	—	—	10%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza vaccine 2024-25 (6 MONTHS+) (PF) 45 mcg/0.5 mL syringe 0.5 mL Syringe	$72.09	$80.10	—	—	10%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 papillomavirus vaccine (9-valent) 0.5 mL syringe 0.5 mL Syringe	$1,090.35	$1,211.50	—	—	10%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 papillomavirus vaccine (9-valent) 0.5 mL syringe 0.5 mL Syringe	$1,090.35	$1,211.50	—	—	10%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 hepatitis A & B vaccine (PF) 720 ELISA unit- 20 mcg/mL syringe 1 mL Syringe	$336.90	$374.33	—	—	10%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 hepatitis A & B vaccine (PF) 720 ELISA unit- 20 mcg/mL syringe 1 mL Syringe	$336.90	$374.33	—	—	10%
Hepatitis A vaccine, adult dose CPT 90632 hepatitis A virus vaccine (PF) 1,440 ELISA unit/mL syringe 1 mL Syringe	$231.85	$257.61	—	—	10%
Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A virus vaccine (PF) 1,440 ELISA unit/mL syringe 1 mL Syringe	$231.85	$257.61	—	—	10%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Hepatitis A Virus Vaccine (PF) 720 ELISA unit/0.5 mL syringe 0.5 mL Syringe	$98.86	$109.85	—	—	10%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Hepatitis A Virus Vaccine (PF) 720 ELISA unit/0.5 mL syringe 0.5 mL Syringe	$98.86	$109.85	—	—	10%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B Virus Vaccine (PF) 20 mcg/mL suspension 1 mL Vial	$154.84	$172.05	—	—	10%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B virus vacc.rec(PF) 20 mcg/mL syringe 1 mL Syringe	$154.84	$172.05	—	—	10%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepatitis B Virus Vaccine (PF) 20 mcg/mL suspension 1 mL Vial	$154.84	$172.05	—	—	10%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B virus vacc.rec(PF) 20 mcg/mL syringe 1 mL Syringe	$154.84	$172.05	—	—	10%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 hepatitis B vacc-CpG 1018 (PF) 20 mcg/0.5 mL syringe 0.5 mL Syringe	$441.09	$490.10	—	—	10%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 hepatitis B vacc-CpG 1018 (PF) 20 mcg/0.5 mL syringe 0.5 mL Syringe	$441.09	$490.10	—	—	10%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 hepatitis B virus vacc.rec(PF) 5 mcg/0.5 mL suspension 0.5 mL Vial	$75.63	$84.03	—	—	10%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 hepatitis B virus vacc.rec(PF) 5 mcg/0.5 mL suspension 0.5 mL Vial	$75.63	$84.03	—	—	10%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 haemophilus b polysac conj-meningitidis 7.5 mcg/0.5 mL solution 0.5 mL Vial	$103.18	$114.64	—	—	10%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 haemophilus b polysac conj-meningitidis 7.5 mcg/0.5 mL solution 0.5 mL Vial	$103.18	$114.64	—	—	10%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 influenza vaccine 2024-25 (65YR UP) syringe 0.5 mL Syringe	$268.06	$297.85	—	—	10%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 influenza vaccine 2024-25 (65YR UP) syringe 0.5 mL Syringe	$268.06	$297.85	—	—	10%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles, mumps and rubella vaccine 1,000-12,500 TCID50/0.5 mL recon soln 10 each Vial	$321.20	$356.89	—	—	10%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles, mumps and rubella vaccine 1,000-12,500 TCID50/0.5 mL recon soln 1 each Vial	$321.20	$356.89	—	—	10%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles, mumps and rubella vaccine 1,000-12,500 TCID50/0.5 mL recon soln 1 each Vial	$321.20	$356.89	—	—	10%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles, mumps and rubella vaccine 1,000-12,500 TCID50/0.5 mL recon soln 10 each Vial	$321.20	$356.89	—	—	10%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 menin C,Y,W-135 vac,1 of 2(PF) 5 mcg recon soln 0.5 mL Vial	$183.16	$203.51	—	—	10%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal conj-diphteria 15 mcg kit 1 each KIT	$373.63	$415.14	—	—	10%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 mening A conj vacc,2 of 2 (PF) 10 mcg recon soln 1 each Vial	$373.63	$415.14	—	—	10%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal conj-diphteria 4 mcg/0.5 mL solution 0.5 mL Vial	$498.27	$553.63	—	—	10%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 menin C,Y,W-135 vac,1 of 2(PF) 5 mcg recon soln 0.5 mL Vial	$183.16	$203.51	—	—	10%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 meningococcal conj-diphteria 15 mcg kit 1 each KIT	$373.63	$415.14	—	—	10%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 mening A conj vacc,2 of 2 (PF) 10 mcg recon soln 1 each Vial	$373.63	$415.14	—	—	10%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 meningococcal conj-diphteria 4 mcg/0.5 mL solution 0.5 mL Vial	$498.27	$553.63	—	—	10%
Meningococcal B vaccine (Trumenba) CPT 90621 meningococcal group B 120 mcg/0.5 mL syringe 0.5 mL Syringe	$520.68	$578.53	—	—	10%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 meningococcal group B 120 mcg/0.5 mL syringe 0.5 mL Syringe	$520.68	$578.53	—	—	10%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 pneumoc 13-val conj-dip cr(PF) 0.5 mL syringe 0.5 mL Syringe	$762.15	$846.83	—	—	10%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 pneumoc 13-val conj-dip cr(PF) 0.5 mL syringe 0.5 mL Syringe	$762.15	$846.83	—	—	10%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 pneumoc 15-val conj-dip cr(PF) 0.5 mL syringe 0.5 mL Syringe	$812.44	$902.71	—	—	10%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 pneumoc 15-val conj-dip cr(PF) 0.5 mL syringe 0.5 mL Syringe	$812.44	$902.71	—	—	10%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumoc 20-val conj-dip cr(PF) 0.5 mL syringe 0.5 mL Syringe	$910.43	$1,011.59	—	—	10%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumoc 20-val conj-dip cr(PF) 0.5 mL syringe 0.5 mL Syringe	$910.43	$1,011.59	—	—	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 pneumococcal 23-val vaccine 25 mcg/0.5 mL solution 0.5 mL Vial	$414.96	$461.07	—	—	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 pneumococcal 23-val vaccine 25 mcg/0.5 mL syringe 0.5 mL Syringe	$414.96	$461.07	—	—	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 pneumococcal 23-val vaccine 25 mcg/0.5 mL syringe 0.5 mL Syringe	$414.96	$461.07	—	—	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 pneumococcal 23-val vaccine 25 mcg/0.5 mL solution 0.5 mL Vial	$414.96	$461.07	—	—	10%
Polio vaccine, inactivated (IPV) CPT 90713 poliovirus vaccine, IPV 40-8-32 unit/0.5 mL suspension 5 mL Vial	$143.53	$159.48	—	—	10%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 poliovirus vaccine, IPV 40-8-32 unit/0.5 mL suspension 5 mL Vial	$143.53	$159.48	—	—	10%
Rabies vaccine, one dose CPT 90675 rabies vaccine, PCEC 2.5 unit suspension for reconstitution 1 each KIT	$1,198.51	$1,331.68	—	—	10%
Rabies vaccine, one dose CPT 90675 rabies vaccine, PCEC 2.5 unit suspension for reconstitution 1 each Vial	$1,198.51	$1,331.68	—	—	10%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, PCEC 2.5 unit suspension for reconstitution 1 each KIT	$1,198.51	$1,331.68	—	—	10%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, PCEC 2.5 unit suspension for reconstitution 1 each Vial	$1,198.51	$1,331.68	—	—	10%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 varicella-zoster 50 mcg/0.5 mL suspension for reconstitution 1 each KIT	$533.38	$592.64	—	—	10%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 varicella-zoster gE vac,2 of 2 50 mcg suspension for reconstitution 1 each Vial	$627.65	$697.39	—	—	10%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 varicella-zoster 50 mcg/0.5 mL suspension for reconstitution 1 each KIT	$533.38	$592.64	—	—	10%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 varicella-zoster gE vac,2 of 2 50 mcg suspension for reconstitution 1 each Vial	$627.65	$697.39	—	—	10%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 diptheria-tetanus toxoids 2-2 Lf unit/0.5 mL suspension 0.5 mL Vial	$96.99	$107.77	—	—	10%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus and diphtheria 5-2 Lf unit/0.5 mL syringe 0.5 mL Syringe	$136.39	$151.54	—	—	10%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 diptheria-tetanus toxoids 2-2 Lf unit/0.5 mL suspension 0.5 mL Vial	$96.99	$107.77	—	—	10%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus and diphtheria 5-2 Lf unit/0.5 mL syringe 0.5 mL Syringe	$136.39	$151.54	—	—	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus, diphtheria, acellular pertussis (Tdap) 2.5-8-5 Lf-mcg-Lf/0.5mL syringe 0.5 mL Syringe	$126.91	$141.01	—	—	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus, diphtheria, acellular pertussis (Tdap) 2.5-8-5 Lf-mcg-Lf/0.5mL suspension 0.5 mL Vial	$160.13	$177.92	—	—	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus, diphtheria, acellular pertussis (Tdap) 2.5-8-5 Lf-mcg-Lf/0.5mL syringe 0.5 mL Syringe	$126.91	$141.01	—	—	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus, diphtheria, acellular pertussis (Tdap) 2.5-8-5 Lf-mcg-Lf/0.5mL suspension 0.5 mL Vial	$160.13	$177.92	—	—	10%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Typhoid VI Polysacch Vaccine 25 mcg/0.5 mL syringe 0.5 mL Syringe	$494.53	$549.48	—	—	10%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 Typhoid VI Polysacch Vaccine 25 mcg/0.5 mL syringe 0.5 mL Syringe	$494.53	$549.48	—	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Monkeypox Vaccine Administration	$126.00	$140.00	—	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Monkeypox Vax Admin	$157.50	$175.00	—	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Imadm Prq ID Subq/Im Njxs 1 Vacc - 90471	$157.50	$175.00	—	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Monkeypox Vac Admin	$157.50	$175.00	—	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Vaccine Administration 1 Vacc	$157.50	$175.00	—	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Administration Part D Vaccine	$157.50	$175.00	—	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC Monkeypox Vaccine Administration	$126.00	$140.00	—	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC Vaccine Administration 1 Vacc	$157.50	$175.00	—	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC Monkeypox Vax Admin	$157.50	$175.00	—	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC Administration Part D Vaccine	$157.50	$175.00	—	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Imadm Prq ID Subq/Im Njxs 1 Vacc - 90471	$157.50	$175.00	—	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC Monkeypox Vac Admin	$157.50	$175.00	—	—	10%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC Vaccine Admin Each Add	$90.00	$100.00	—	—	10%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Imadm Prq ID Subq/Im Njxs Ea Vacc - 90472	$90.00	$100.00	—	—	10%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Imadm Prq ID Subq/Im Njxs Ea Vacc - 90472	$90.00	$100.00	—	—	10%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC Vaccine Admin Each Add	$90.00	$100.00	—	—	10%

Dental

Procedure	Cash price	List price	Insurers pay	vs New York	Off list
Deep cleaning (scaling and root planing), 4 or more teeth in one quadrant CDT D4341 HC Scaling/Root Plain per Quad	$1,080.00	$1,200.00	—	—	10%
Deep cleaning (scaling and root planing), 4 or more teeth in one quadrant inpatient CDT D4341 HC Scaling/Root Plain per Quad	$1,080.00	$1,200.00	—	—	10%
Dental implant, surgical placement CDT D6010 HC Odontics Endosteal Implant	$1,215.00	$1,350.00	—	—	10%
Dental implant, surgical placement inpatient CDT D6010 HC Odontics Endosteal Implant	$1,215.00	$1,350.00	—	—	10%
Porcelain crown CDT D2740 HC Crown Porcelain Ceramic	$1,080.00	$1,200.00	—	—	10%
Porcelain crown inpatient CDT D2740 HC Crown Porcelain Ceramic	$1,080.00	$1,200.00	—	—	10%
Removal of an impacted tooth fully covered by bone, often a wisdom tooth CDT D7240 HC Impacted Full Bony	$810.00	$900.00	—	—	10%
Removal of an impacted tooth fully covered by bone, often a wisdom tooth inpatient CDT D7240 HC Impacted Full Bony	$810.00	$900.00	—	—	10%
Root canal treatment on a molar (back tooth), not including the final crown CDT D3330 HC Permanent Molar	$1,080.00	$1,200.00	—	—	10%
Root canal treatment on a molar (back tooth), not including the final crown inpatient CDT D3330 HC Permanent Molar	$1,080.00	$1,200.00	—	—	10%
Routine teeth cleaning (prophylaxis), adult or teen CDT D1110 HC Prophylaxis Adult	$225.00	$250.00	—	—	10%
Routine teeth cleaning (prophylaxis), adult or teen inpatient CDT D1110 HC Prophylaxis Adult	$225.00	$250.00	—	—	10%
Simple extraction of a tooth or exposed root that is above the gum CDT D7140 HC Extract Erupted Tooth/Ex Root	$315.00	$350.00	—	—	10%
Simple extraction of a tooth or exposed root that is above the gum inpatient CDT D7140 HC Extract Erupted Tooth/Ex Root	$315.00	$350.00	—	—	10%

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.mountsinai.org/files/mrf/135564934_mount-sinai-behavioral-health-center_standardcharges.json