Ascension Saint Thomas Hickman
TN
Prices last published by the hospital: —
What these numbers mean.
Cash price is what the hospital lists for patients paying out of pocket.
Negotiated median is the middle of what insurance companies actually agreed to pay.
Gross charge is the sticker price — almost nobody pays it.
What you will actually pay is usually different from both numbers:
with insurance, your deductible, copay, or coinsurance decides what you owe —
the negotiated rate is what the insurer pays, not your bill.
A single line item may not be the whole cost: physician, anesthesia, pathology,
and facility fees can be billed separately.
Prices vary by hospital and change over time; always confirm with the hospital before you go.
Can't afford a bill from Ascension Saint Thomas Hickman?
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Financial assistance: see income limits & how to applyPrices at this hospital (466 procedures)
| Procedure | Cash price | Where it sits | Insurance pays (typical) | Gross charge |
|---|---|---|---|---|
| Abdominal ultrasound | —Insurance typically pays $179Sticker price — | — | $179 | — |
| Ablation for supraventricular tachycardia | —Insurance typically pays $11,069Sticker price — | — | $11,069 | — |
| Achilles tendon repair, primary | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION | —Insurance typically pays $11,792Sticker price — | — | $11,792 | — |
| Amino acid analysis, quantitative, each specimen | —Insurance typically pays $32Sticker price — | — | $32 | — |
| Analysis for antibody to Herpes simplex virus | —Insurance typically pays $20Sticker price — | — | $20 | — |
| Ankle-brachial index (ABI), complete | —Insurance typically pays $242Sticker price — | — | $242 | — |
| Ankle-brachial index (ABI), limited | —Insurance typically pays $159Sticker price — | — | $159 | — |
| Ankle fracture repair, open | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Appendix removal, laparoscopic | —Insurance typically pays $1,974Sticker price — | — | $1,974 | — |
| Application of long leg cast | —Insurance typically pays $164Sticker price — | — | $164 | — |
| Application of short arm cast | —Insurance typically pays $179Sticker price — | — | $179 | — |
| Application of short leg cast | —Insurance typically pays $170Sticker price — | — | $170 | — |
| Application of short leg splint | —Insurance typically pays $149Sticker price — | — | $149 | — |
| Arterial line placement | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Arterial puncture for blood draw | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Arteriovenous fistula creation for dialysis | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Arthroscopic ACL reconstruction | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Arthroscopic rotator cuff repair | —Insurance typically pays $2,286Sticker price — | — | $2,286 | — |
| Aspiration of fluid from chest cavity | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Aspiration or injection of ganglion cyst | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Basic metabolic blood panel | —Insurance typically pays $12Sticker price — | — | $12 | — |
| Benign skin growth removal | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Biceps tenodesis (tendon repair) | —Insurance typically pays $1,974Sticker price — | — | $1,974 | — |
| Bladder catheter placement | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Blood count (CBC) | —Insurance typically pays $9Sticker price — | — | $9 | — |
| Blood count with differential | —Insurance typically pays $11Sticker price — | — | $11 | — |
| Blood draw | —Insurance typically pays $5Sticker price — | — | $5 | — |
| Blood sugar test | —Insurance typically pays $6Sticker price — | — | $6 | — |
| Bone biopsy, deep | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Bone biopsy, superficial | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Bowel adhesion removal, laparoscopic | —Insurance typically pays $2,286Sticker price — | — | $2,286 | — |
| Breast biopsy, open | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Breast biopsy with stereotactic guidance | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Bunionectomy | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| BUN kidney test | —Insurance typically pays $6Sticker price — | — | $6 | — |
| Capillary blood draw (finger stick) | —Insurance typically pays $3Sticker price — | — | $3 | — |
| Cardiac stress test | —Insurance typically pays $149Sticker price — | — | $149 | — |
| Carotid endarterectomy | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Carpal tunnel release | —Insurance typically pays $6,089Sticker price — | — | $6,089 | — |
| Cataract surgery, complex | —Insurance typically pays $2,916Sticker price — | — | $2,916 | — |
| Cataract surgery with lens implant | —Insurance typically pays $2,916Sticker price — | — | $2,916 | — |
| Cervical spinal fusion, anterior | —Insurance typically pays $6,089Sticker price — | — | $6,089 | — |
| Cesarean delivery only | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Cesarean delivery with routine obstetric care | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Chemotherapy infusion, additional hour | —Insurance typically pays $54Sticker price — | — | $54 | — |
| Chemotherapy infusion, first hour | —Insurance typically pays $253Sticker price — | — | $253 | — |
| Chemotherapy injection under skin or into muscle | —Insurance typically pays $140Sticker price — | — | $140 | — |
| Cholesterol panel | —Insurance typically pays $19Sticker price — | — | $19 | — |
| Closed treatment of broken middle or upper end of outside lower leg bone | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Clotting factor VII (proconvertin, stable factor) | —Insurance typically pays $25Sticker price — | — | $25 | — |
| Cold knife conization of cervix | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Colectomy with colostomy | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Colonoscopy | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Colonoscopy with ablation of lesion | —Insurance typically pays $1,974Sticker price — | — | $1,974 | — |
| Colonoscopy with biopsy | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Colonoscopy with polyp removal | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Colonoscopy with submucosal injection | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Coronary angiography | —Insurance typically pays $10,362Sticker price — | — | $10,362 | — |
| Coronary angioplasty (balloon), single vessel | —Insurance typically pays $14,281Sticker price — | — | $14,281 | — |
| Creatinine test | —Insurance typically pays $7Sticker price — | — | $7 | — |
| Critical care, additional 30 minutes | —Insurance typically pays $904Sticker price — | — | $904 | — |
| Critical care, first hour | —Insurance typically pays $1,124Sticker price — | — | $1,124 | — |
| C-section delivery | —Insurance typically pays $11,398Sticker price — | — | $11,398 | — |
| CT abdomen and pelvis with contrast | —Insurance typically pays $611Sticker price — | — | $611 | — |
| CT head without contrast | —Insurance typically pays $179Sticker price — | — | $179 | — |
| Debridement of skin, muscle or fascia | —Insurance typically pays $490Sticker price — | — | $490 | — |
| Defibrillator interrogation in office | —Insurance typically pays $36Sticker price — | — | $36 | — |
| DEPRESSIVE NEUROSES | —Insurance typically pays $11,792Sticker price — | — | $11,792 | — |
| Detailed obstetric ultrasound | —Insurance typically pays $194Sticker price — | — | $194 | — |
| Detection test by immunoassay technique for rotavirus | —Insurance typically pays $17Sticker price — | — | $17 | — |
| Diagnostic exam of bladder and urethra using an endoscope | —Insurance typically pays $1,236Sticker price — | — | $1,236 | — |
| Diagnostic exam of lower portion of large bowel using a flexible endoscope | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Dilation and curettage (D&C), diagnostic | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| DISORDERS OF PERSONALITY AND IMPULSE CONTROL | —Insurance typically pays $14,128Sticker price — | — | $14,128 | — |
| Distal radius fracture repair, open | —Insurance typically pays $2,286Sticker price — | — | $2,286 | — |
| Doctor office visit (established patient) | —Insurance typically pays $47Sticker price — | — | $47 | — |
| Doctor visit, established patient | —Insurance typically pays $72Sticker price — | — | $72 | — |
| Doctor visit, established patient, complex | —Insurance typically pays $101Sticker price — | — | $101 | — |
| Doctor visit, established patient, quick | —Insurance typically pays $23Sticker price — | — | $23 | — |
| Doctor visit, new patient | —Insurance typically pays $69Sticker price — | — | $69 | — |
| Doctor visit, new patient | —Insurance typically pays $118Sticker price — | — | $118 | — |
| Doctor visit, new patient, complex | —Insurance typically pays $153Sticker price — | — | $153 | — |
| Doctor visit, new patient, quick | —Insurance typically pays $46Sticker price — | — | $46 | — |
| Duplex ultrasound of aorta and iliac arteries | —Insurance typically pays $357Sticker price — | — | $357 | — |
| Duplex ultrasound of dialysis access | —Insurance typically pays $338Sticker price — | — | $338 | — |
| Duplex ultrasound of lower extremity arteries, bilateral | —Insurance typically pays $427Sticker price — | — | $427 | — |
| Ear wax removal | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| EEG, awake and asleep | —Insurance typically pays $656Sticker price — | — | $656 | — |
| EEG, awake and drowsy | —Insurance typically pays $560Sticker price — | — | $560 | — |
| EKG | —Insurance typically pays $33Sticker price — | — | $33 | — |
| Electrophysiology study, comprehensive | —Insurance typically pays $669Sticker price — | — | $669 | — |
| Emergency room visit, high complexity | —Insurance typically pays $2,380Sticker price — | — | $2,380 | — |
| Emergency room visit (high severity) | —Insurance typically pays $2,380Sticker price — | — | $2,380 | — |
| Emergency room visit, low complexity | —Insurance typically pays $1,243Sticker price — | — | $1,243 | — |
| Emergency room visit, minor | —Insurance typically pays $923Sticker price — | — | $923 | — |
| Emergency room visit, moderate | —Insurance typically pays $1,269Sticker price — | — | $1,269 | — |
| Endoscopic lumbar decompression | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Epidural injection, cervical or thoracic | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Epidural steroid shot, lower back | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Esophagus stretching | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Excision of breast lesion with radiologic marker | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Eye exam | —Insurance typically pays $170Sticker price — | — | $170 | — |
| Eye exam, established patient | —Insurance typically pays $247Sticker price — | — | $247 | — |
| Eye exam, new patient | —Insurance typically pays $162Sticker price — | — | $162 | — |
| Eye exam, new patient, comprehensive | —Insurance typically pays $297Sticker price — | — | $297 | — |
| Eye injection | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Eyelid bump removal | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Facet joint injection, cervical or thoracic | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Facet joint injection, lumbar or sacral | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Femoral/popliteal artery stent placement | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Femoral-popliteal bypass graft | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Femur shaft fracture repair with plate or screws | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Ferritin test | —Insurance typically pays $19Sticker price — | — | $19 | — |
| Fetal non-stress test | —Insurance typically pays $2,220Sticker price — | — | $2,220 | — |
| Flu shot | —Insurance typically pays $29Sticker price — | — | $29 | — |
| Flu shot | —Insurance typically pays $127Sticker price — | — | $127 | — |
| Gallbladder removal (laparoscopic) | —Insurance typically pays $3,142Sticker price — | — | $3,142 | — |
| Gastric bypass (Roux-en-Y), open | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Glaucoma laser treatment | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Glaucoma laser treatment | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Hammertoe correction | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| HCHG ACTH PLASMA LC | —Insurance typically pays $54Sticker price — | — | $54 | — |
| HCHG AFB CONCENTRATION | —Insurance typically pays $9Sticker price — | — | $9 | — |
| HCHG ALDOLASE LC | —Insurance typically pays $14Sticker price — | — | $14 | — |
| HCHG ALK PHOSPHATASE | —Insurance typically pays $7Sticker price — | — | $7 | — |
| HCHG ALPHA-1-ANTITRYPSIN SERUM LC | —Insurance typically pays $19Sticker price — | — | $19 | — |
| HCHG AMINO ACIDEMIAS (PKU) | —Insurance typically pays $34Sticker price — | — | $34 | — |
| HCHG AMPA RECEPTOR ABY TITER SPINAL FLUID | —Insurance typically pays $17Sticker price — | — | $17 | — |
| HCHG ANA | —Insurance typically pays $17Sticker price — | — | $17 | — |
| HCHG ANAEROBIC CULTURE | —Insurance typically pays $13Sticker price — | — | $13 | — |
| HCHG ANTI-DNASE B STREP ANTIBODIES LC | —Insurance typically pays $19Sticker price — | — | $19 | — |
| HCHG ANTISTREPTOLYSIN O AB LC | —Insurance typically pays $10Sticker price — | — | $10 | — |
| HCHG ANTITHROMBIN III | —Insurance typically pays $17Sticker price — | — | $17 | — |
| HCHG ARC-ABY ID EACH SELECTED REAGENT CELL | —Insurance typically pays $8Sticker price — | — | $8 | — |
| HCHG ARTHROCENT/ASPIR/INJ SMALL JOINT/BURSA WO US | —Insurance typically pays $998Sticker price — | — | $998 | — |
| HCHG BLOOD/BLOOD PRODUCT ADMIN PER UNIT | —Insurance typically pays $70Sticker price — | — | $70 | — |
| HCHG CA15.3 | —Insurance typically pays $29Sticker price — | — | $29 | — |
| HCHG CARBAMAZEPINE | —Insurance typically pays $20Sticker price — | — | $20 | — |
| HCHG CATECHOLAMINESURFREE24 HR LC | —Insurance typically pays $35Sticker price — | — | $35 | — |
| HCHG CF SCREEN | —Insurance typically pays $16Sticker price — | — | $16 | — |
| HCHG CHROMIUM BLOOD | —Insurance typically pays $28Sticker price — | — | $28 | — |
| HCHG CHROMOGRANIN A | —Insurance typically pays $29Sticker price — | — | $29 | — |
| HCHG CMV IGM ABY | —Insurance typically pays $24Sticker price — | — | $24 | — |
| HCHG CMV QUANT DNA PCR (PLASMA) LC | —Insurance typically pays $60Sticker price — | — | $60 | — |
| HCHG COMPREHENSIVE METABOLIC PANE | —Insurance typically pays $15Sticker price — | — | $15 | — |
| HCHG COVID 19 NAA LC | —Insurance typically pays $51Sticker price — | — | $51 | — |
| HCHG C-PEPTIDE SERUM | —Insurance typically pays $29Sticker price — | — | $29 | — |
| HCHG CREATININE URINE | —Insurance typically pays $7Sticker price — | — | $7 | — |
| HCHG CROSSMATCH IS | —Insurance typically pays $111Sticker price — | — | $111 | — |
| HCHG CRYOGLOBULIN QUAL WITH REFLEX | —Insurance typically pays $9Sticker price — | — | $9 | — |
| HCHG CRYPTOCOCCAL AG LATEX SCREEN W/REFL TITER QUE | —Insurance typically pays $16Sticker price — | — | $16 | — |
| HCHG CT CHEST TUBE PLACEMENT AND PLEURAL DRAINAGE | —Insurance typically pays $998Sticker price — | — | $998 | — |
| HCHG CT SOFT TISSUE NECK W CONTRAST | —Insurance typically pays $301Sticker price — | — | $301 | — |
| HCHG CT THORACENTESIS PLEURAL ASPIRATION | —Insurance typically pays $998Sticker price — | — | $998 | — |
| HCHG DEBRIDE SQ TISSUE FIRST 20 SQ CM | —Insurance typically pays $247Sticker price — | — | $247 | — |
| HCHG DHEA SERUM LC | —Insurance typically pays $35Sticker price — | — | $35 | — |
| HCHG DIPTHERIA TOXOID IGG ABY | —Insurance typically pays $21Sticker price — | — | $21 | — |
| HCHG DIRECT ANTIGLOBULIN TEST | —Insurance typically pays $8Sticker price — | — | $8 | — |
| HCHG EBV NA | —Insurance typically pays $21Sticker price — | — | $21 | — |
| HCHG EBV VCA IGG | —Insurance typically pays $25Sticker price — | — | $25 | — |
| HCHG ECHO 2D F-U OR LTD STUDY W BUBBLE | —Insurance typically pays $185Sticker price — | — | $185 | — |
| HCHG FACTOR 2 GENE MUTATION | —Insurance typically pays $92Sticker price — | — | $92 | — |
| HCHG FACTOR 8 ASSAY | —Insurance typically pays $25Sticker price — | — | $25 | — |
| HCHG FACTOR IX ACTIVITY LC | —Insurance typically pays $27Sticker price — | — | $27 | — |
| HCHG FLUORO < 1 HOUR | —Insurance typically pays $88Sticker price — | — | $88 | — |
| HCHG FOLIC ACID | —Insurance typically pays $21Sticker price — | — | $21 | — |
| HCHG FSH-SERUM | —Insurance typically pays $26Sticker price — | — | $26 | — |
| HCHG GENERAL LAB 8007400 | —Insurance typically pays $67Sticker price — | — | $67 | — |
| HCHG GENERAL LAB 8663103 LC | —Insurance typically pays $17Sticker price — | — | $17 | — |
| HCHG GENERAL LAB 8670600 | —Insurance typically pays $15Sticker price — | — | $15 | — |
| HCHG GENERAL LAB 8680300 | —Insurance typically pays $20Sticker price — | — | $20 | — |
| HCHG GENERAL LAB 8738900 | —Insurance typically pays $34Sticker price — | — | $34 | — |
| HCHG GENERAL LAB 8748602 LC | —Insurance typically pays $49Sticker price — | — | $49 | — |
| HCHG GENERAL LAB 8749100 | —Insurance typically pays $49Sticker price — | — | $49 | — |
| HCHG GENERAL LAB 87522 LCC | —Insurance typically pays $60Sticker price — | — | $60 | — |
| HCHG GENTAMICIN KINETICS | —Insurance typically pays $23Sticker price — | — | $23 | — |
| HCHG GRAM STAIN | —Insurance typically pays $6Sticker price — | — | $6 | — |
| HCHG HEMOGLOBINOPATHIES | —Insurance typically pays $18Sticker price — | — | $18 | — |
| HCHG H HEMACHROMATOSIS | —Insurance typically pays $92Sticker price — | — | $92 | — |
| HCHG H. PYLORI ANTIGEN STOOL | —Insurance typically pays $20Sticker price — | — | $20 | — |
| HCHG ICU MD RETROPERITONEAL LIMITED | —Insurance typically pays $66Sticker price — | — | $66 | — |
| HCHG I D ABSCESS/CARB/CYST SINGLE SIMPLE | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| HCHG I D HEMATOMA/SEROMA FLUID COLL | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| HCHG IHC STAIN ADDL | —Insurance typically pays $67Sticker price — | — | $67 | — |
| HCHG IHC STAIN FIRST | —Insurance typically pays $129Sticker price — | — | $129 | — |
| HCHG INJ EPIDURAL BLOOD/CLOT PATCH TX | —Insurance typically pays $998Sticker price — | — | $998 | — |
| HCHG INSERT PICC WO SUBQ PORT/PUMP WO GUIDANCE >5 | —Insurance typically pays $998Sticker price — | — | $998 | — |
| HCHG INTRINSIC FACTOR ABS SERUM LC | —Insurance typically pays $21Sticker price — | — | $21 | — |
| HCHG INTUBATION ENDOTRACHEAL EMERGENCY | —Insurance typically pays $998Sticker price — | — | $998 | — |
| HCHG IR INJ CHOLANGIOGRAPHY PERC W GUIDE EXISTING | —Insurance typically pays $998Sticker price — | — | $998 | — |
| HCHG IRON | —Insurance typically pays $9Sticker price — | — | $9 | — |
| HCHG JAK2 MUTATION DETECTION | —Insurance typically pays $128Sticker price — | — | $128 | — |
| HCHG LEAD FILTER PAPER | —Insurance typically pays $17Sticker price — | — | $17 | — |
| HCHG LUTEINIZING HORMONE | —Insurance typically pays $26Sticker price — | — | $26 | — |
| HCHG MEAS POST VOID RES US NON-IMAGING | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| HCHG N METHYLHISTAMINE URINE | —Insurance typically pays $34Sticker price — | — | $34 | — |
| HCHG OCCULT BLOOD IFOBT | —Insurance typically pays $22Sticker price — | — | $22 | — |
| HCHG OT APPLICATION LONG ARM CAST | —Insurance typically pays $198Sticker price — | — | $198 | — |
| HCHG OT EVAL HIGH COMPLEXITY | —Insurance typically pays $137Sticker price — | — | $137 | — |
| HCHG OT EVAL LOW COMPLEXITY | —Insurance typically pays $137Sticker price — | — | $137 | — |
| HCHG OT EVAL MOD COMPLEXITY | —Insurance typically pays $137Sticker price — | — | $137 | — |
| HCHG OT RE-EVALUATION | —Insurance typically pays $90Sticker price — | — | $90 | — |
| HCHG OT THER INTERVENT COGNITIVE FUNCT 1 1 EA ADDL | —Insurance typically pays $31Sticker price — | — | $31 | — |
| HCHG OT THER INTERVENT COGNITIVE FUNCT 1 1 INIT 15 | —Insurance typically pays $32Sticker price — | — | $32 | — |
| HCHG PARACENTESIS ABD WO IMAGING | —Insurance typically pays $998Sticker price — | — | $998 | — |
| HCHG PFT C0 MEMBRANE DIFFUSE CAPACITY | —Insurance typically pays $85Sticker price — | — | $85 | — |
| HCHG PHENOBARBITAL | —Insurance typically pays $21Sticker price — | — | $21 | — |
| HCHG PLCMT NEPHROSTOMY CATHETER WWO NEPHRO/URETERO | —Insurance typically pays $2,965Sticker price — | — | $2,965 | — |
| HCHG POTASSIUM | —Insurance typically pays $7Sticker price — | — | $7 | — |
| HCHG PROCALCITONIN | —Insurance typically pays $38Sticker price — | — | $38 | — |
| HCHG PROTEIN TOTAL | —Insurance typically pays $5Sticker price — | — | $5 | — |
| HCHG PROTHOMBIN TIME | —Insurance typically pays $6Sticker price — | — | $6 | — |
| HCHG PT APPLICATION LONG ARM SPLINT | —Insurance typically pays $182Sticker price — | — | $182 | — |
| HCHG PT E-STIM-ATTENDED 15MIN | —Insurance typically pays $21Sticker price — | — | $21 | — |
| HCHG PT EVAL HIGH COMPLEXITY | —Insurance typically pays $141Sticker price — | — | $141 | — |
| HCHG PT EVAL LOW COMPLEXITY | —Insurance typically pays $141Sticker price — | — | $141 | — |
| HCHG PT EVAL MOD COMPLEXITY | —Insurance typically pays $141Sticker price — | — | $141 | — |
| HCHG PT FLUIDOTHERAPY | —Insurance typically pays $22Sticker price — | — | $22 | — |
| HCHG PT GAIT TRAINING 15MIN | —Insurance typically pays $42Sticker price — | — | $42 | — |
| HCHG PT GROUP THERAPY | —Insurance typically pays $25Sticker price — | — | $25 | — |
| HCHG PT IONTOPHORESIS 15MIN | —Insurance typically pays $27Sticker price — | — | $27 | — |
| HCHG PT MANUAL THERAPY 15MIN | —Insurance typically pays $40Sticker price — | — | $40 | — |
| HCHG PT MASSAGE 15 MIN | —Insurance typically pays $43Sticker price — | — | $43 | — |
| HCHG PT MECHANICAL TRACTION | —Insurance typically pays $21Sticker price — | — | $21 | — |
| HCHG PT NEUROMUSCULAR RE-ED 15MIN | —Insurance typically pays $47Sticker price — | — | $47 | — |
| HCHG PT ORTHO/PROSTHETIC TRAIN UPR/LWR EXT TRUNK S | —Insurance typically pays $71Sticker price — | — | $71 | — |
| HCHG PT ORTHOTIC FIT/TRAIN UPR/LWR EXT TRUNK INITI | —Insurance typically pays $66Sticker price — | — | $66 | — |
| HCHG PT PHONOPHORESIS 15MIN | —Insurance typically pays $20Sticker price — | — | $20 | — |
| HCHG PT PROSTHETIC TRAIN UPR/LWR EXT INITIAL ENC E | —Insurance typically pays $58Sticker price — | — | $58 | — |
| HCHG PT RE-EVALUATION | —Insurance typically pays $95Sticker price — | — | $95 | — |
| HCHG PT SELFCARE/HOME MNGMNT 15MIN | —Insurance typically pays $46Sticker price — | — | $46 | — |
| HCHG PT STRAPPING ANKLE | —Insurance typically pays $78Sticker price — | — | $78 | — |
| HCHG PT THERAPEUTIC ACTIVITY 15MIN | —Insurance typically pays $50Sticker price — | — | $50 | — |
| HCHG PT THERAPEUTIC EXERCISE 15MIN | —Insurance typically pays $42Sticker price — | — | $42 | — |
| HCHG RAD CT ANGIO CHEST | —Insurance typically pays $469Sticker price — | — | $469 | — |
| HCHG RAD CT ANGIO HEART CORONARY ARTERIES | —Insurance typically pays $511Sticker price — | — | $511 | — |
| HCHG RAD CT ANGIO LOWER EXTREMITY | —Insurance typically pays $470Sticker price — | — | $470 | — |
| HCHG RAD CT ANGIO NECK W CONTRAST | —Insurance typically pays $578Sticker price — | — | $578 | — |
| HCHG RAD CT GUIDED NEEDLE PLACEMENT | —Insurance typically pays $125Sticker price — | — | $125 | — |
| HCHG RAD CT HEAD BRAIN WWO | —Insurance typically pays $292Sticker price — | — | $292 | — |
| HCHG RAD CT LIMITED OR LOCALIZED FOLLOW UP | —Insurance typically pays $174Sticker price — | — | $174 | — |
| HCHG RAD CT LOWER EXTREMITY WO | —Insurance typically pays $237Sticker price — | — | $237 | — |
| HCHG RAD ECHO STRESS TRANSTHORACIC 2D EXERCISE OR | —Insurance typically pays $321Sticker price — | — | $321 | — |
| HCHG RAD MRI ANGIO HEAD BRAIN WWO | —Insurance typically pays $878Sticker price — | — | $878 | — |
| HCHG RAD MRI ANGIO HEAD WO | —Insurance typically pays $584Sticker price — | — | $584 | — |
| HCHG RAD MRI ANGIO NECK WO | —Insurance typically pays $586Sticker price — | — | $586 | — |
| HCHG RAD MRI ANGIO NECK WWO | —Insurance typically pays $885Sticker price — | — | $885 | — |
| HCHG RAD MRI JOINT LOWER EXTREMITY WO | —Insurance typically pays $373Sticker price — | — | $373 | — |
| HCHG RAD MRI SPINE CERVICAL WO | —Insurance typically pays $373Sticker price — | — | $373 | — |
| HCHG RAD MRI SPINE THORACIC WO | —Insurance typically pays $373Sticker price — | — | $373 | — |
| HCHG RAD NM BONE SCAN WHOLE BODY | —Insurance typically pays $589Sticker price — | — | $589 | — |
| HCHG RAD NM LUNG PERFUSION SCAN | —Insurance typically pays $476Sticker price — | — | $476 | — |
| HCHG RAD NM LUNG VENTILATION AND PERFUSION QUANTIT | —Insurance typically pays $621Sticker price — | — | $621 | — |
| HCHG RAD NM RADIOPHARM ORAL THERAPY | —Insurance typically pays $112Sticker price — | — | $112 | — |
| HCHG RAD US ARTERIAL UPPER EXTREMITY BILATERAL COM | —Insurance typically pays $390Sticker price — | — | $390 | — |
| HCHG RAD XRAY ABDOMEN ACUTE W CHEST 1 VIEW | —Insurance typically pays $66Sticker price — | — | $66 | — |
| HCHG RAD XRAY CHEST FRONTAL 1 VIEW | —Insurance typically pays $26Sticker price — | — | $26 | — |
| HCHG RAD XRAY FEMUR 1 VIEW UNILATERAL | —Insurance typically pays $44Sticker price — | — | $44 | — |
| HCHG RAD XRAY FOOT 2 VIEWS | —Insurance typically pays $41Sticker price — | — | $41 | — |
| HCHG RAD XRAY KNEE 3 VIEWS | —Insurance typically pays $60Sticker price — | — | $60 | — |
| HCHG RAD XRAY KNEES STANDING BILATERAL | —Insurance typically pays $62Sticker price — | — | $62 | — |
| HCHG RAD XRAY MANDIBLE MINIMUM OF FOUR VIEWS | —Insurance typically pays $59Sticker price — | — | $59 | — |
| HCHG RAD XRAY RIBS 3 VIEWS BILATERAL | —Insurance typically pays $58Sticker price — | — | $58 | — |
| HCHG REPLACE CATH ONLY CVAD W SQ PORT/PUMP | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| HCHG REPOSITIONING PREV PLC CV CATH FLUOR GUID | —Insurance typically pays $998Sticker price — | — | $998 | — |
| HCHG RESPIRATORY DISEASE MULTIPLEX PCR PANEL | —Insurance typically pays $583Sticker price — | — | $583 | — |
| HCHG REVERSE T3 SERUM LC | —Insurance typically pays $22Sticker price — | — | $22 | — |
| HCHG RN APPL MULTLAY COMPRS LWR LEG UNILATERAL | —Insurance typically pays $127Sticker price — | — | $127 | — |
| HCHG SCHISTOSOMA IGG ABY | —Insurance typically pays $18Sticker price — | — | $18 | — |
| HCHG SELENIUM SERUM/PLASMA LC | —Insurance typically pays $36Sticker price — | — | $36 | — |
| HCHG SLP EVAL ORAL/PHAR SWALLOWING | —Insurance typically pays $121Sticker price — | — | $121 | — |
| HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP | —Insurance typically pays $327Sticker price — | — | $327 | — |
| HCHG SLP INDIV TX COMMUNICATION | —Insurance typically pays $110Sticker price — | — | $110 | — |
| HCHG SODIUM URINE | —Insurance typically pays $7Sticker price — | — | $7 | — |
| HCHG SP STAIN 1 ORG | —Insurance typically pays $98Sticker price — | — | $98 | — |
| HCHG STONE ANALYSIS LC | —Insurance typically pays $18Sticker price — | — | $18 | — |
| HCHG STOOL CULTURE AEROBIC BACTERIA LC | —Insurance typically pays $13Sticker price — | — | $13 | — |
| HCHG T3 FREE | —Insurance typically pays $24Sticker price — | — | $24 | — |
| HCHG T4 FREE | —Insurance typically pays $13Sticker price — | — | $13 | — |
| HCHG TACROLIMUS AHL | —Insurance typically pays $19Sticker price — | — | $19 | — |
| HCHG TESTOSTERONE FREE EQUILIBRIUM ULTRAFILTRATION | —Insurance typically pays $36Sticker price — | — | $36 | — |
| HCHG THER APHERESIS PLASMA PHERESIS | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| HCHG THY PEROXIDASE ABY | —Insurance typically pays $20Sticker price — | — | $20 | — |
| HCHG THYROGLOBULIN ABY LC | —Insurance typically pays $22Sticker price — | — | $22 | — |
| HCHG THYROGLOBULIN TUMOR MARKER FNA ASP BX NEEDLE | —Insurance typically pays $22Sticker price — | — | $22 | — |
| HCHG TISSUE LEVEL 2 | —Insurance typically pays $31Sticker price — | — | $31 | — |
| HCHG TOTAL T CELLS | —Insurance typically pays $53Sticker price — | — | $53 | — |
| HCHG URIC ACID URINE | —Insurance typically pays $7Sticker price — | — | $7 | — |
| HCHG US ABDOMEN LIMITED | —Insurance typically pays $141Sticker price — | — | $141 | — |
| HCHG VALPROIC ACID | —Insurance typically pays $19Sticker price — | — | $19 | — |
| HCHG VANILLYLMANDELIC ACID 24-HR U LC | —Insurance typically pays $22Sticker price — | — | $22 | — |
| HCHG VEDOLIZUMAB QUANT LC | —Insurance typically pays $54Sticker price — | — | $54 | — |
| HCHG VENOUS MECH THROMBECTOMY | —Insurance typically pays $3,142Sticker price — | — | $3,142 | — |
| HCHG VITAMIN A SERUM LC | —Insurance typically pays $16Sticker price — | — | $16 | — |
| HCHG VITAMIN B6 PLASMA LC | —Insurance typically pays $39Sticker price — | — | $39 | — |
| Heart catheterization | —Insurance typically pays $9,492Sticker price — | — | $9,492 | — |
| Heart catheterization with bypass graft angiography | —Insurance typically pays $9,492Sticker price — | — | $9,492 | — |
| Heart stent placement | —Insurance typically pays $14,281Sticker price — | — | $14,281 | — |
| Heart ultrasound | —Insurance typically pays $312Sticker price — | — | $312 | — |
| Hemorrhoid banding | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Hemorrhoid removal | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Hernia repair (inguinal) | —Insurance typically pays $1,974Sticker price — | — | $1,974 | — |
| Hernia repair, laparoscopic | —Insurance typically pays $1,974Sticker price — | — | $1,974 | — |
| Hernia repair, open | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Hip fracture repair with pins or screws | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Hip fracture repair with plate and screws | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Hip replacement (total) | —Insurance typically pays $21,555Sticker price — | — | $21,555 | — |
| Hormonal chemotherapy injection | —Insurance typically pays $62Sticker price — | — | $62 | — |
| Hospital admission visit | —Insurance typically pays $125Sticker price — | — | $125 | — |
| Hospital admission visit | —Insurance typically pays $185Sticker price — | — | $185 | — |
| Hospital discharge visit | —Insurance typically pays $66Sticker price — | — | $66 | — |
| Hospital discharge visit, extended | —Insurance typically pays $97Sticker price — | — | $97 | — |
| Hospital follow-up visit | —Insurance typically pays $66Sticker price — | — | $66 | — |
| Hospital follow-up visit, complex | —Insurance typically pays $95Sticker price — | — | $95 | — |
| Hysterectomy (laparoscopic) | —Insurance typically pays $3,142Sticker price — | — | $3,142 | — |
| Hysteroscopy with biopsy | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Hysteroscopy with endometrial ablation | —Insurance typically pays $3,142Sticker price — | — | $3,142 | — |
| Iliac artery stent placement | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Inguinal hernia repair, incarcerated, open | —Insurance typically pays $3,142Sticker price — | — | $3,142 | — |
| Insertion of tube in bypass graft for diagnosis with review by radiologist | —Insurance typically pays $10,362Sticker price — | — | $10,362 | — |
| Insertion of tube in right heart chambers for measurement | —Insurance typically pays $9,772Sticker price — | — | $9,772 | — |
| Iron test | —Insurance typically pays $12Sticker price — | — | $12 | — |
| Irrigation of implanted venous access (port flush) | —Insurance typically pays $47Sticker price — | — | $47 | — |
| IV hydration infusion, additional hour | —Insurance typically pays $55Sticker price — | — | $55 | — |
| IV hydration infusion, first hour | —Insurance typically pays $249Sticker price — | — | $249 | — |
| IV infusion, additional drug or sequence | —Insurance typically pays $87Sticker price — | — | $87 | — |
| IV infusion, additional hour | —Insurance typically pays $87Sticker price — | — | $87 | — |
| IV infusion, first hour | —Insurance typically pays $87Sticker price — | — | $87 | — |
| IV placement (needle into vein) | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| IV push injection | —Insurance typically pays $87Sticker price — | — | $87 | — |
| Joint injection, large joint | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Joint injection, medium joint | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Joint injection with ultrasound | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Kidney function panel | —Insurance typically pays $12Sticker price — | — | $12 | — |
| Knee arthroscopy | —Insurance typically pays $1,974Sticker price — | — | $1,974 | — |
| Knee arthroscopy, meniscectomy medial and lateral | —Insurance typically pays $1,974Sticker price — | — | $1,974 | — |
| Knee arthroscopy with debridement | —Insurance typically pays $1,974Sticker price — | — | $1,974 | — |
| Knee arthroscopy with meniscus repair | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Knee replacement (total) | —Insurance typically pays $21,670Sticker price — | — | $21,670 | — |
| Kyphoplasty (vertebral augmentation) | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Laparoscopic colectomy with anastomosis | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Laparoscopic gastric bypass | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Laparoscopic incisional hernia repair | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Laparoscopic inguinal hernia repair, incarcerated | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Laparoscopic partial colectomy | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Laparoscopic removal of ovary | —Insurance typically pays $2,286Sticker price — | — | $2,286 | — |
| Laparoscopic sleeve gastrectomy | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Laparoscopic ventral hernia repair | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Laser treatment after cataract surgery | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| LDH test | —Insurance typically pays $8Sticker price — | — | $8 | — |
| LEEP conization of cervix | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Left heart catheterization with coronary angiography | —Insurance typically pays $9,492Sticker price — | — | $9,492 | — |
| Leg vein ultrasound | —Insurance typically pays $316Sticker price — | — | $316 | — |
| Liver biopsy | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Liver function panel | —Insurance typically pays $11Sticker price — | — | $11 | — |
| Lumbar laminectomy with discectomy | —Insurance typically pays $6,089Sticker price — | — | $6,089 | — |
| Lumbar laminectomy with facetectomy | —Insurance typically pays $6,089Sticker price — | — | $6,089 | — |
| Lumbar spinal fusion, posterior | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Lumpectomy (partial mastectomy) | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Lysis of bowel adhesions, open | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Manipulation of knee under anesthesia | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Mastectomy, modified radical | —Insurance typically pays $3,142Sticker price — | — | $3,142 | — |
| Mastectomy, simple | —Insurance typically pays $1,974Sticker price — | — | $1,974 | — |
| Mohs skin cancer surgery | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Molecular pathology procedure level 6 genetic analysis | —Insurance typically pays $422Sticker price — | — | $422 | — |
| Molecular pathology procedure level 7 genetic analysis | —Insurance typically pays $396Sticker price — | — | $396 | — |
| Molecular pathology procedure level 9 genetic analysis | —Insurance typically pays $2,800Sticker price — | — | $2,800 | — |
| MRI brain with and without contrast | —Insurance typically pays $611Sticker price — | — | $611 | — |
| MRI brain without contrast | —Insurance typically pays $373Sticker price — | — | $373 | — |
| MRI lower back with and without contrast | —Insurance typically pays $611Sticker price — | — | $611 | — |
| MRI lower back without contrast | —Insurance typically pays $373Sticker price — | — | $373 | — |
| Nail avulsion, additional nail | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Nail avulsion (ingrown nail removal) | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Nail bed removal | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Nail trimming, 6 or more nails | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Nebulizer treatment | —Insurance typically pays $34Sticker price — | — | $34 | — |
| Neck artery ultrasound | —Insurance typically pays $333Sticker price — | — | $333 | — |
| Needle EMG, one extremity | —Insurance typically pays $138Sticker price — | — | $138 | — |
| Needle EMG, two extremities | —Insurance typically pays $178Sticker price — | — | $178 | — |
| Nerve conduction study, 1-2 nerves | —Insurance typically pays $78Sticker price — | — | $78 | — |
| Nerve conduction study, 3-4 nerves | —Insurance typically pays $95Sticker price — | — | $95 | — |
| Nerve conduction study, 5-6 nerves | —Insurance typically pays $115Sticker price — | — | $115 | — |
| Nuclear heart stress test | —Insurance typically pays $931Sticker price — | — | $931 | — |
| Nursing home visit | —Insurance typically pays $62Sticker price — | — | $62 | — |
| Nursing home visit, complex | —Insurance typically pays $82Sticker price — | — | $82 | — |
| Obstetric ultrasound | —Insurance typically pays $179Sticker price — | — | $179 | — |
| Occipital nerve block | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Occlusion of growths or obstructed vessels with review by radiologist | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Osteotomy of foot bone | —Insurance typically pays $1,974Sticker price — | — | $1,974 | — |
| OTHER CARDIOTHORACIC PROCEDURES WITH MCC | —Insurance typically pays $19,131Sticker price — | — | $19,131 | — |
| OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC | —Insurance typically pays $15,974Sticker price — | — | $15,974 | — |
| OTHER HEART ASSIST SYSTEM IMPLANT | —Insurance typically pays $19,970Sticker price — | — | $19,970 | — |
| Pacemaker insertion, single chamber | —Insurance typically pays $6,936Sticker price — | — | $6,936 | — |
| Pacemaker interrogation in office | —Insurance typically pays $30Sticker price — | — | $30 | — |
| Panniculectomy (excess abdominal skin removal) | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Parathyroidectomy | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Partial colectomy | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Partial excision of foot bone | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC | —Insurance typically pays $15,974Sticker price — | — | $15,974 | — |
| Peripheral nerve block | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Peritoneal dialysis with single evaluation | —Insurance typically pays $288Sticker price — | — | $288 | — |
| Posterior spinal instrumentation | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Precancerous skin spot removal | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Precancerous skin spots removal, 15+ | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Precancerous skin spots removal, 2-14 | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Radiofrequency ablation, lumbar/sacral facet nerve | —Insurance typically pays $2,286Sticker price — | — | $2,286 | — |
| Radiofrequency ablation of facet joint nerve | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Removal of abdominal cavity tube | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Rhythm ECG interpretation | —Insurance typically pays $25Sticker price — | — | $25 | — |
| Sacroiliac joint injection | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Salpingo-oophorectomy (tube and ovary removal) | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Screening mammogram (3D) | —Insurance typically pays $160Sticker price — | — | $160 | — |
| Shot in muscle or under skin | —Insurance typically pays $87Sticker price — | — | $87 | — |
| Shoulder arthroscopy with distal clavicle excision | —Insurance typically pays $2,286Sticker price — | — | $2,286 | — |
| Shoulder arthroscopy with subacromial decompression | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Sigmoidoscopy | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Sigmoidoscopy with biopsy | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Simple drainage of abscess of finger | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Skin biopsy | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Skin biopsy, shave | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Skin cancer removal | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Skin substitute graft | —Insurance typically pays $326Sticker price — | — | $326 | — |
| Sleep study (polysomnography) | —Insurance typically pays $233Sticker price — | — | $233 | — |
| Sleep study with CPAP initiation | —Insurance typically pays $233Sticker price — | — | $233 | — |
| Small bowel resection | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Spinal nerve injection, lower back | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Spirometry before and after bronchodilator | —Insurance typically pays $90Sticker price — | — | $90 | — |
| Spirometry (lung function test) | —Insurance typically pays $52Sticker price — | — | $52 | — |
| Stool blood test | —Insurance typically pays $6Sticker price — | — | $6 | — |
| Tdap vaccine | —Insurance typically pays $73Sticker price — | — | $73 | — |
| Tendon insertion injection | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Tendon sheath injection | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Therapy session, 60 minutes | —Insurance typically pays $92Sticker price — | — | $92 | — |
| Thyroid biopsy, open | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Thyroid (TSH) test | —Insurance typically pays $24Sticker price — | — | $24 | — |
| Tilt table test | —Insurance typically pays $118Sticker price — | — | $118 | — |
| Tissue lab exam (pathology) | —Insurance typically pays $46Sticker price — | — | $46 | — |
| Tonsillectomy | —Insurance typically pays $1,974Sticker price — | — | $1,974 | — |
| Total abdominal hysterectomy | —Insurance typically pays $2,226Sticker price — | — | $2,226 | — |
| Total shoulder replacement (arthroplasty) | —Insurance typically pays $19,804Sticker price — | — | $19,804 | — |
| Total thyroidectomy | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Total thyroidectomy with neck dissection | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Transforaminal epidural, additional level | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Trigger finger release | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Trigger point injection | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Trigger point injections, multiple | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Unattended home sleep study | —Insurance typically pays $206Sticker price — | — | $206 | — |
| Upper endoscopy | —Insurance typically pays $998Sticker price — | — | $998 | — |
| Upper endoscopy (EGD) | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Upper endoscopy with ablation | —Insurance typically pays $2,286Sticker price — | — | $2,286 | — |
| Upper endoscopy with control of bleeding | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Upper endoscopy with fine needle biopsy | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Upper endoscopy with guide wire placement | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Upper endoscopy with limited ultrasound | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Upper endoscopy with submucosal injection | —Insurance typically pays $1,239Sticker price — | — | $1,239 | — |
| Upper endoscopy with ultrasound | —Insurance typically pays $1,535Sticker price — | — | $1,535 | — |
| Urinalysis | —Insurance typically pays $4Sticker price — | — | $4 | — |
| Vaginal delivery only | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC | —Insurance typically pays $9,656Sticker price — | — | $9,656 | — |
| Vaginal delivery with routine obstetric care | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Vertebroplasty | —Insurance typically pays $3,142Sticker price — | — | $3,142 | — |
| Visual field test | —Insurance typically pays $68Sticker price — | — | $68 | — |
| Voice box scope | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
| Wound repair, layered stitches | —Insurance typically pays $2,215Sticker price — | — | $2,215 | — |
Source: this hospital's own published price file. Original file · Methodology