Hospital St. Louis, MO-IL

Mercy Hospital Washington

Listed in its price file as “Mercy Hospitals East Communities dba Mercy Hospital Washington”.

Mercy Hospital Washington in Washington, MO publishes cash prices for 440 common procedures listed here, from its own machine-readable price file updated Jun 10, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Missouri median for 235 of 435 procedures and below it for 190. By typical cash price it ranks #38 of 67 Missouri hospitals and #8 of 17 hospitals in the St. Louis, MO area, cheapest first. Select a procedure to compare it with other hospitals nearby.

851 E 5th Street 160 Washington MO 63090 Collected Sep 23, 2026 Source price file Check a bill from this hospital (636) 239-8000

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 260052 · CMS hospital register NPI 1285664177

Financial assistance

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

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

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

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen W/WO Cont	$1,275.95	$1,963.00	$151.76–$519.27	34% below	35%
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen W/WO Cont Ltd	$1,457.30	$2,242.00	$151.76–$519.27	25% below	35%
Abdominal X-ray, 2 views CPT 74019 Xr Abdomen 2 Views	$365.95	$563.00	$176.00–$201.00	24% above	35%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 Xr Ankle Complete Min 3v Bi	$490.10	$754.00	$85.51–$108.96	—	35%
Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Ankle Complete Min 3v Rt	$326.30	$502.00	$176.00–$201.00	13% above	35%
Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Ankle Complete Min 3v Lt	$326.30	$502.00	$32.63–$451.80	13% above	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Art Non Invas Extr Bi Sngl Level	$703.30	$1,082.00	$130.73–$166.58	—	35%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Extremity Upper WO Cont Bi	$1,586.65	$2,441.00	$90.66–$283.47	—	35%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Extremity Upper WO Cont Rt	$1,004.90	$1,546.00	$100.49–$1,391.40	16% below	35%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Extremity Upper WO Cont Lt	$1,004.90	$1,546.00	$102.72–$130.89	16% below	35%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Xr Esophagus/Barium Swallow	$283.40	$436.00	$176.00–$201.00	33% below	35%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone and or Jnt Imag Whol Body	$3,380.97	$5,201.50	$187.49–$1,069.98	138% above	35%
Breast ultrasound, complete, one breast both sides CPT 76641 Breast Ultrasound Complete Bilat	$543.40	$836.00	$54.34–$752.40	—	35%
Breast ultrasound, complete, one breast one side CPT 76641 Breast Ultrasound Complete Lt	$362.70	$558.00	$36.27–$502.20	14% below	35%
Breast ultrasound, complete, one breast one side CPT 76641 Breast Ultrasound Complete Rt	$362.70	$558.00	$64.54–$313.71	14% below	35%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 Breast Ultrasound Limited Bilat	$522.60	$804.00	$85.51–$108.96	—	35%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Breast Ultrasound Limited Lt	$349.05	$537.00	$49.45–$240.96	at median	35%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Breast Ultrasound Limited Rt	$349.05	$537.00	$49.45–$240.96	at median	35%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 Cta Abd Pelvis Wwo Contrast	$2,140.45	$3,293.00	$342.80–$436.80	14% below	35%
CT angiography (CTA) of the head CPT 70496 Cta Head W/WO Cont	$1,366.30	$2,102.00	$525.00	30% below	35%
CT angiography (CTA) of the neck CPT 70498 Cta Neck W and/or WO Contrast	$1,318.85	$2,029.00	$151.76–$526.15	34% below	35%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Cta Chest W and/or WO Cont	$1,613.30	$2,482.00	$261.00–$464.00	17% below	35%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Cta Heart W Contr W 3d	$1,270.10	$1,954.00	$525.00	at median	35%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Heart WO Cont Eval Coron Calc	$84.50	$130.00	$61.95–$155.02	9% above	35%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd Pelvis Without Contrast	$2,327.65	$3,581.00	$261.00–$464.00	8% above	35%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abd Pelvis With Contrast	$2,717.65	$4,181.00	$342.80–$436.80	3% above	35%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abd Pelvis WO Cont Then W Cont	$3,914.95	$6,023.00	$525.00	22% above	35%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen W Cont	$1,069.90	$1,646.00	$151.76–$395.55	37% below	35%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen WO Cont	$853.45	$1,313.00	$261.00–$464.00	27% below	35%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial WO Cont Limited	$862.55	$1,327.00	$261.00–$464.00	24% below	35%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial Area WO Cont	$971.10	$1,494.00	$261.00–$464.00	14% below	35%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head/Brain WO Cont	$1,132.30	$1,742.00	$261.00–$464.00	10% below	35%
CT scan of the head with contrast CPT 70460 CT Head/Brain W Cont	$1,222.65	$1,881.00	$261.00–$464.00	15% below	35%
CT scan of the head without and with contrast CPT 70470 CT Head/Brain W/WO Cont	$1,542.45	$2,373.00	$154.25–$2,135.70	13% below	35%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Lumbar Spine WO Cont	$924.30	$1,422.00	$90.66–$289.28	35% below	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Cervical Spine WO Cont	$1,725.75	$2,655.00	$102.72–$130.89	10% above	35%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis W Cont	$1,548.30	$2,382.00	$172.35–$219.61	5% below	35%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Carotid Duplex Scan Bilat	$2,483.65	$3,821.00	$128.98–$1,069.71	—	35%
Chest CT scan without and with contrast CPT 71270 CT Chest Diag W/WO Cont	$1,480.70	$2,278.00	$151.76–$452.13	20% below	35%
Chest X-ray, 2 views CPT 71046 Xr Chest 2 Views	$282.10	$434.00	$176.00–$201.00	14% above	35%
Chest X-ray, single view CPT 71045 Xr Chest 1 View	$224.25	$345.00	$176.00–$201.00	17% above	35%
Collarbone (clavicle) X-ray, complete both sides CPT 73000 Xr Clavicle Complete Bi	$254.15	$391.00	$36.95–$123.85	—	35%
Collarbone (clavicle) X-ray, complete one side CPT 73000 Xr Clavicle Complete Rt	$169.65	$261.00	$85.51–$108.96	30% below	35%
Collarbone (clavicle) X-ray, complete one side CPT 73000 Xr Clavicle Complete Lt	$169.65	$261.00	$176.00–$201.00	30% below	35%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneum Complete	$559.00	$860.00	$102.72–$130.89	9% below	35%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Xr DXA Bone Density Axial	$224.90	$346.00	$43.54–$217.04	30% below	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Xr DXA Bone Density Appendicular	$146.90	$226.00	$85.51–$108.96	21% below	35%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US Preg Uter W Detl Fetl	$579.80	$892.00	$131.10–$392.45	13% below	35%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US Preg Uter W Detl Fetl W/Counsel	$971.75	$1,495.00	$234.45–$298.73	47% above	35%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest Diag WO Cont	$1,036.10	$1,594.00	$102.72–$130.89	20% below	35%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest Diag W Cont	$1,364.35	$2,099.00	$172.35–$219.61	17% below	35%
Diagnostic mammogram, both breasts both sides CPT 77066 Mamm Diagnostic Bilat W Cad	$386.10	$594.00	$94.03–$506.22	—	35%
Diagnostic mammogram, one breast one side CPT 77065 Mamm Diagnostic Unilat Rt W Cad	$257.40	$396.00	$73.27–$397.09	10% above	35%
Diagnostic mammogram, one breast one side CPT 77065 Mamm Diagnostic Unilat Lt W Cad	$257.40	$396.00	$25.74–$356.40	10% above	35%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Art Lwr Extr Duplex Graft Comp Bi	$1,763.45	$2,713.00	$206.06–$1,418.59	—	35%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Venous Duplex Lower Ext Comp Bi	$2,256.80	$3,472.00	$234.45–$298.73	—	35%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Venous Duplex Upper Ext Comp Bi	$2,256.80	$3,472.00	$206.06–$1,085.94	—	35%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echo 2d W/M-Mode & Dopp Comp	$4,692.35	$7,219.00	$469.24–$6,497.10	163% above	35%
Elbow X-ray, 2 views both sides CPT 73070 Xr Elbow 2 Views Bi	$297.05	$457.00	$32.40–$123.85	—	35%
Elbow X-ray, 2 views one side CPT 73070 Xr Elbow 1 View Rt	$178.75	$275.00	$32.40–$123.85	15% below	35%
Elbow X-ray, 2 views one side CPT 73070 Xr Elbow 1 View Lt	$178.75	$275.00	$176.00–$201.00	15% below	35%
Elbow X-ray, 2 views one side CPT 73070 Xr Elbow 2 Views Rt	$197.60	$304.00	$176.00–$201.00	6% below	35%
Elbow X-ray, 2 views one side CPT 73070 Xr Elbow 2 Views Lt	$197.60	$304.00	$85.51–$108.96	6% below	35%
Elbow X-ray, complete, 3 or more views both sides CPT 73080 Xr Elbow Complete Min 3 Views Bi	$519.35	$799.00	$36.95–$123.85	—	35%
Elbow X-ray, complete, 3 or more views one side CPT 73080 Xr Elbow Complete Min 3 Views Lt	$346.45	$533.00	$176.00–$201.00	24% above	35%
Elbow X-ray, complete, 3 or more views one side CPT 73080 Xr Elbow Complete Min 3 Views Rt	$346.45	$533.00	$36.95–$123.85	24% above	35%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Orbit/Sella/Iac/Fossa WO Cont	$826.80	$1,272.00	$102.72–$130.89	35% below	35%
Facial bones X-ray, complete, 3 or more views CPT 70150 Xr Facial Bones Comp Min 3 Views	$217.75	$335.00	$52.65–$157.62	27% below	35%
Forearm X-ray (radius and ulna), 2 views both sides CPT 73090 Xr Forearm 2 Views Bi	$350.35	$539.00	$176.00–$201.00	—	35%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Xr Forearm 1 View Rt	$147.55	$227.00	$176.00–$201.00	30% below	35%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Xr Forearm 1 View Lt	$147.55	$227.00	$176.00–$201.00	30% below	35%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Xr Forearm 2 Views Rt	$234.00	$360.00	$176.00–$201.00	12% above	35%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Xr Forearm 2 Views Lt	$234.00	$360.00	$23.40–$324.00	12% above	35%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary System	$1,112.15	$1,711.00	$213.64–$1,218.51	11% below	35%
Hand X-ray, 2 views both sides CPT 73120 Xr Hand 2 Views Bilateral	$267.80	$412.00	$35.43–$149.59	—	35%
Hand X-ray, 2 views both sides CPT 73120 Xr Hand 1 View Bilateral	$271.05	$417.00	$176.00–$201.00	—	35%
Hand X-ray, 2 views one side CPT 73120 Xr Hand 2 Views Left	$178.75	$275.00	$176.00–$201.00	6% below	35%
Hand X-ray, 2 views one side CPT 73120 Xr Hand 2 Views Right	$178.75	$275.00	$17.88–$247.50	6% below	35%
Hand X-ray, 2 views one side CPT 73120 Xr Hand 1 View Rt	$188.50	$290.00	$176.00–$201.00	1% below	35%
Hand X-ray, 2 views one side CPT 73120 Xr Hand 1 View Lt	$188.50	$290.00	$18.85–$261.00	1% below	35%
Heel bone (calcaneus) X-ray, 2 or more views both sides CPT 73650 Xr Calcaneus Min 2v Bi	$211.25	$325.00	$176.00–$201.00	—	35%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Xr Calcaneus Min 2v Rt	$141.05	$217.00	$31.88–$123.85	28% below	35%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Xr Calcaneus Min 2v Lt	$141.05	$217.00	$31.88–$123.85	28% below	35%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep Study Unattended	$1,428.70	$2,198.00	$212.16–$270.34	122% above	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysom Attended W Cpap/Bip 6/> Yrs	$5,328.70	$8,198.00	$867.31–$2,158.11	103% above	35%
Knee X-ray, 3 views both sides CPT 73562 Xr Knee 3 Views Bilateral	$569.40	$876.00	$85.51–$108.96	—	35%
Knee X-ray, 3 views one side CPT 73562 Xr Knee 3 Views Right	$379.60	$584.00	$48.10–$143.98	41% above	35%
Knee X-ray, 3 views one side CPT 73562 Xr Knee 3 Views Left	$379.60	$584.00	$85.51–$108.96	41% above	35%
Knee X-ray, complete, 4 or more views both sides CPT 73564 Xr Knee Complete Min 4v Bi	$647.40	$996.00	$54.17–$162.17	—	35%
Knee X-ray, complete, 4 or more views one side CPT 73564 Xr Knee Complete Min 4v Lt	$432.25	$665.00	$176.00–$201.00	32% above	35%
Knee X-ray, complete, 4 or more views one side CPT 73564 Xr Knee Complete Min 4v Rt	$432.25	$665.00	$102.72–$130.89	32% above	35%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Extremity Lower WO Cont Bi	$1,795.30	$2,762.00	$525.00	—	35%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Extremity Lower WO Cont Rt	$1,196.65	$1,841.00	$525.00	5% below	35%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Extremity Lower WO Cont Lt	$1,196.65	$1,841.00	$90.66–$284.51	5% below	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited	$796.90	$1,226.00	$102.72–$130.89	58% above	35%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US Extrem Nonvascular Limited Bil	$363.35	$559.00	$102.00–$230.00	3% above	35%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extrem Nonvascular Limited Rt	$241.80	$372.00	$102.72–$130.89	31% below	35%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extrem Nonvascular Limited Lt	$241.80	$372.00	$14.17–$149.59	31% below	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Thorax Lung Cancer Screen	$1,110.85	$1,709.00	$90.66–$187.95	148% above	35%
Lower leg X-ray (tibia and fibula), 2 views both sides CPT 73590 Xr Tibia and Fibula 2v Bi	$361.40	$556.00	$36.44–$123.85	—	35%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Xr Tibia and Fibula 1 View Rt	$233.35	$359.00	$85.51–$108.96	3% below	35%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Xr Tibia and Fibula 1 View Lt	$233.35	$359.00	$176.00–$201.00	3% below	35%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Xr Tibia and Fibula 2v Lt	$241.15	$371.00	$85.51–$108.96	at median	35%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Xr Tibia and Fibula 2v Rt	$241.15	$371.00	$36.44–$123.85	at median	35%
MR angiography (MRA) of the head without contrast CPT 70544 Mra Head WO Cont	$1,211.60	$1,864.00	$351.00–$797.00	21% below	35%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Extr Lwr Jt WO Cont Bi	$2,354.30	$3,622.00	$351.00–$797.00	—	35%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Extr Lwr Jt WO Cont Lt	$1,569.10	$2,414.00	$560.00	11% below	35%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Extr Lwr Jt WO Cont Rt	$1,569.10	$2,414.00	$234.45–$298.73	11% below	35%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MRI Extr Lwr Jt W/WO Cont Bi	$2,598.70	$3,998.00	$351.00–$797.00	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Extr Lwr Jt W/WO Cont Rt	$1,732.90	$2,666.00	$560.00	24% below	35%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Extr Lwr Jt W/WO Cont Lt	$1,732.90	$2,666.00	$351.00–$797.00	24% below	35%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen WO Cont	$1,361.10	$2,094.00	$234.45–$298.73	18% below	35%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen W/WO Cont	$2,055.30	$3,162.00	$560.00	15% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI Brain WO for Tysabri Screen	$1,524.90	$2,346.00	$560.00	1% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI Brain WO Cont	$1,677.00	$2,580.00	$560.00	8% above	35%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain W/WO Cont	$1,785.55	$2,747.00	$304.45–$907.22	28% below	35%
MRI of the lower back, no contrast dye CPT 72148 MRI Lumbar Spine WO Cont	$1,882.40	$2,896.00	$560.00	1% above	35%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Lumbar Spine W/WO Cont	$2,074.15	$3,191.00	$304.45–$902.03	16% below	35%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Thoracic Spine WO Cont	$1,274.00	$1,960.00	$127.40–$1,764.00	27% below	35%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Cervical Spine W/WO Cont	$2,047.50	$3,150.00	$351.00–$797.00	17% below	35%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Cervical Spine WO Cont	$1,820.00	$2,800.00	$351.00–$797.00	7% below	35%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis W/WO Cont	$1,899.95	$2,923.00	$351.00–$797.00	23% below	35%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis WO Cont	$1,264.25	$1,945.00	$560.00	31% below	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MRI Extr Uppr Jt WO Cont Bi	$4,209.40	$6,476.00	$351.00–$797.00	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Extr Uppr Jt WO Cont Rt	$1,834.30	$2,822.00	$560.00	1% below	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Extr Uppr Jt WO Cont Lt	$1,834.30	$2,822.00	$351.00–$797.00	1% below	35%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Xr Spine Cervical 4 or 5 Views	$451.75	$695.00	$61.26–$183.37	9% above	35%
Neck soft tissue CT scan with contrast CPT 70491 CT Soft Tissue Neck W Cont	$1,353.30	$2,082.00	$172.35–$219.61	6% below	35%
Neck soft tissue CT scan without contrast CPT 70490 CT Soft Tissue Neck WO Cont	$1,114.10	$1,714.00	$90.66–$282.93	4% below	35%
Neck soft tissue X-ray CPT 70360 Xr Soft Tissue Neck	$267.15	$411.00	$176.00–$201.00	17% above	35%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Mycrd Perf W Wall Mot&Ejec Frt Mult	$5,278.65	$8,121.00	$691.00–$795.00	48% above	35%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM Pet Imag W CT Skl Base Mid Thg	$4,864.60	$7,484.00	$1,405.04–$1,790.32	14% above	35%
Pelvic CT scan without contrast CPT 72192 CT Pelvis WO Cont	$1,248.65	$1,921.00	$102.72–$130.89	11% below	35%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic Non OB Limited F/U	$403.00	$620.00	$102.72–$130.89	12% above	35%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Non OB Complete	$762.45	$1,173.00	$90.66–$333.43	19% above	35%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Preg Uter 14 Wks Or>	$876.20	$1,348.00	$87.62–$1,213.20	57% above	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Preg Uter <14 Weeks Gest	$856.05	$1,317.00	$102.72–$130.89	67% above	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Preg Uter Ltd 1 or More Fetus	$461.50	$710.00	$76.96–$230.38	24% above	35%
Rib X-ray, one side, 2 views one side CPT 71100 Xr Ribs 2 Views Lt	$178.10	$274.00	$176.00–$201.00	25% below	35%
Rib X-ray, one side, 2 views one side CPT 71100 Xr Ribs 2 Views Rt	$178.10	$274.00	$85.51–$108.96	25% below	35%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Xr Ribs Lt W Chest Pa Min 3 Vws	$312.65	$481.00	$176.00–$201.00	14% above	35%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Xr Ribs Rt W Chest Pa Min 3 Vws	$312.65	$481.00	$102.72–$130.89	14% above	35%
Screening mammogram, both breasts both sides CPT 77067 Mamm Scrn Bilat Implant W Cad	$279.50	$430.00	$27.95–$387.00	—	35%
Screening mammogram, both breasts both sides CPT 77067 Mamm Scrn Bilateral W Cad	$279.50	$430.00	$27.95–$387.00	—	35%
Screening mammogram, both breasts one side CPT 77067 Mamm Scrn Left W Cad	$186.55	$287.00	$18.66–$258.30	6% above	35%
Screening mammogram, both breasts one side CPT 77067 Mamm Scrn Right W Cad	$186.55	$287.00	$77.53–$419.83	6% above	35%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 Xr Shoulder Complete Min 2v Bi	$421.85	$649.00	$176.00–$201.00	—	35%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder Complete Min 2v Lt	$281.45	$433.00	$176.00–$201.00	3% above	35%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder Complete Min 2v Rt	$281.45	$433.00	$38.98–$123.85	3% above	35%
Sinus X-ray, complete, 3 or more views CPT 70220 Xr Sinuses Paranasal Comp Min 3v	$196.30	$302.00	$176.00–$201.00	34% below	35%
Skull X-ray, fewer than 4 views CPT 70250 Xr Skull <4 Views	$198.25	$305.00	$102.72–$130.89	23% below	35%
Sleep study in a lab (polysomnography) CPT 95810 Polysom Attended >3 Chn 6/> Yrs	$4,602.00	$7,080.00	$843.78–$1,075.16	87% above	35%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Echo Stress W Cont Ecg Monitor	$3,734.90	$5,746.00	$536.90–$684.12	117% above	35%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Xr Swallowing Function W Video	$386.10	$594.00	$176.00–$201.00	13% below	35%
Thigh bone (femur) X-ray, 2 or more views both sides CPT 73552 Xr Femur 2 Vw Bilat	$227.50	$350.00	$20.60–$123.85	—	35%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Xr Femur 2 Vw Right	$152.10	$234.00	$20.60–$123.85	41% below	35%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Xr Femur 2 Vw Left	$152.10	$234.00	$176.00–$201.00	41% below	35%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Thoracic Spine WO Cont	$1,066.65	$1,641.00	$102.72–$130.89	20% below	35%
Toe X-ray, 2 or more views both sides CPT 73660 Xr Toe/S Min 2v Bi	$191.75	$295.00	$19.18–$265.50	—	35%
Toe X-ray, 2 or more views one side CPT 73660 Xr Toe/S Min 2v Rt	$128.05	$197.00	$85.51–$108.96	36% below	35%
Toe X-ray, 2 or more views one side CPT 73660 Xr Toe/S Min 2v Lt	$128.05	$197.00	$34.92–$123.85	36% below	35%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non OB	$648.05	$997.00	$102.72–$130.89	26% above	35%
Transvaginal ultrasound during pregnancy CPT 76817 US Preg Uter Transvaginal	$499.20	$768.00	$87.08–$260.68	17% above	35%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$526.50	$810.00	$90.66–$359.18	34% below	35%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum and Contents	$725.40	$1,116.00	$102.72–$130.89	27% above	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head/Neck Soft Tissue	$636.35	$979.00	$90.66–$384.98	11% above	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Xr Upper GI Single Contrast	$562.25	$865.00	$176.00–$201.00	2% below	35%
Upper arm X-ray (humerus), 2 views both sides CPT 73060 Xr Humerus 1 View Bi	$292.50	$450.00	$36.95–$123.85	—	35%
Upper arm X-ray (humerus), 2 views both sides CPT 73060 Xr Humerus Min 2 Views Bi	$356.85	$549.00	$36.95–$123.85	—	35%
Upper arm X-ray (humerus), 2 views one side CPT 73060 Xr Humerus 1 View Lt	$195.00	$300.00	$36.95–$123.85	19% below	35%
Upper arm X-ray (humerus), 2 views one side CPT 73060 Xr Humerus 1 View Rt	$195.00	$300.00	$36.95–$123.85	19% below	35%
Upper arm X-ray (humerus), 2 views one side CPT 73060 Xr Humerus Min 2 Views Rt	$237.90	$366.00	$36.95–$123.85	1% below	35%
Upper arm X-ray (humerus), 2 views one side CPT 73060 Xr Humerus Min 2 Views Lt	$237.90	$366.00	$176.00–$201.00	1% below	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Venous Duplex Lower Ext Ltd Lt	$1,230.45	$1,893.00	$102.72–$130.89	105% above	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Venous Duplex Upper Ext Ltd Lt	$1,230.45	$1,893.00	$123.05–$1,703.70	105% above	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Venous Duplex Lower Ext Ltd Rt	$1,230.45	$1,893.00	$123.05–$1,703.70	105% above	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Venous Duplex Upper Ext Ltd Rt	$1,230.45	$1,893.00	$90.66–$686.01	105% above	35%
Wrist X-ray, 2 views both sides CPT 73100 Xr Wrist 1 View Bilateral	$306.80	$472.00	$39.48–$123.85	—	35%
Wrist X-ray, 2 views both sides CPT 73100 Xr Wrist 2 Views Bilateral	$383.50	$590.00	$176.00–$201.00	—	35%
Wrist X-ray, 2 views one side CPT 73100 Xr Wrist 1 View Rt	$238.55	$367.00	$176.00–$201.00	16% above	35%
Wrist X-ray, 2 views one side CPT 73100 Xr Wrist 1 View Lt	$238.55	$367.00	$85.51–$108.96	16% above	35%
Wrist X-ray, 2 views one side CPT 73100 Xr Wrist 2 Views Right	$255.45	$393.00	$39.48–$123.85	24% above	35%
Wrist X-ray, 2 views one side CPT 73100 Xr Wrist 2 Views Left	$255.45	$393.00	$25.55–$353.70	24% above	35%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 Xr Wrist Complete Min 3v Bi	$415.35	$639.00	$85.51–$108.96	—	35%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Complete Min 3v Lt	$276.90	$426.00	$176.00–$201.00	5% above	35%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Complete Min 3v Rt	$276.90	$426.00	$85.51–$108.96	5% above	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip W Pelvis 2-3 Views Lt	$175.50	$270.00	$85.51–$108.96	26% below	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip W Pelvis 2-3 Views Rt	$175.50	$270.00	$85.51–$108.96	26% below	35%
X-ray of the abdomen, 1 view CPT 74018 Xr Abdomen 1 View	$289.90	$446.00	$176.00–$201.00	40% above	35%
X-ray of the ankle, 2 views both sides CPT 73600 Xr Ankle 1 View Bilat	$256.75	$395.00	$85.51–$108.96	—	35%
X-ray of the ankle, 2 views both sides CPT 73600 Xr Ankle 2 Views Bilateral	$300.30	$462.00	$37.46–$123.85	—	35%
X-ray of the ankle, 2 views one side CPT 73600 Xr Ankle 1 View Rt	$170.95	$263.00	$37.46–$123.85	13% below	35%
X-ray of the ankle, 2 views one side CPT 73600 Xr Ankle 1 View Lt	$170.95	$263.00	$85.51–$108.96	13% below	35%
X-ray of the ankle, 2 views one side CPT 73600 Xr Ankle 2 Views Left	$200.20	$308.00	$37.46–$123.85	1% above	35%
X-ray of the ankle, 2 views one side CPT 73600 Xr Ankle 2 Views Right	$200.20	$308.00	$85.51–$108.96	1% above	35%
X-ray of the finger(s), 2 or more views both sides CPT 73140 Xr Finger/S Min 2 Views Bi	$304.85	$469.00	$47.59–$142.45	—	35%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger/S Min 2 Views Rt	$202.80	$312.00	$176.00–$201.00	2% below	35%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger/S Min 2 Views Lt	$202.80	$312.00	$176.00–$201.00	2% below	35%
X-ray of the foot, 2 views both sides CPT 73620 Xr Foot 1 View Bilateral	$218.40	$336.00	$85.51–$108.96	—	35%
X-ray of the foot, 2 views both sides CPT 73620 Xr Foot 2 Views Bilateral	$250.90	$386.00	$85.51–$108.96	—	35%
X-ray of the foot, 2 views one side CPT 73620 Xr Foot 1 View Lt	$145.60	$224.00	$31.88–$123.85	30% below	35%
X-ray of the foot, 2 views one side CPT 73620 Xr Foot 1 View Rt	$145.60	$224.00	$31.88–$123.85	30% below	35%
X-ray of the foot, 2 views one side CPT 73620 Xr Foot 2 Views Left	$167.70	$258.00	$31.88–$123.85	20% below	35%
X-ray of the foot, 2 views one side CPT 73620 Xr Foot 2 Views Right	$167.70	$258.00	$85.51–$108.96	20% below	35%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 Xr Foot Complete Min 3v Bi	$483.60	$744.00	$85.51–$108.96	—	35%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Complete Min 3v Rt	$322.40	$496.00	$176.00–$201.00	19% above	35%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Complete Min 3v Lt	$322.40	$496.00	$39.99–$123.85	19% above	35%
X-ray of the hand, 3 or more views both sides CPT 73130 Xr Hand Complete Min 3v Bi	$484.90	$746.00	$43.54–$130.34	—	35%
X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Complete Min 3v Rt	$323.05	$497.00	$43.54–$130.34	24% above	35%
X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Complete Min 3v Lt	$323.05	$497.00	$85.51–$108.96	24% above	35%
X-ray of the knee, 1 or 2 views both sides CPT 73560 Xr Knee 1 or 2 Views Bilateral	$340.60	$524.00	$85.51–$108.96	—	35%
X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee 1 or 2 Views Left	$227.50	$350.00	$176.00–$201.00	1% below	35%
X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee 1 or 2 Views Right	$227.50	$350.00	$22.75–$315.00	1% below	35%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Xr Spine Lumbar 2 or 3 Views	$223.60	$344.00	$44.55–$149.59	23% below	35%
X-ray of the lower back, 4 or more views CPT 72110 Xr Spine Lumbar Min 4 Views	$444.60	$684.00	$102.72–$130.89	5% above	35%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Xr Spine Thoracic 2 Views	$280.80	$432.00	$176.00–$201.00	11% above	35%
X-ray of the nasal bones, 3 or more views CPT 70160 Xr Nasal Bones Comp Min 3 Views	$159.25	$245.00	$45.55–$136.37	36% below	35%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xr Spine Cervical 3 Views or Less	$325.00	$500.00	$176.00–$201.00	11% above	35%
X-ray of the pelvis, 1 or 2 views CPT 72170 Xr Pelvis 1 or 2 Views	$193.05	$297.00	$29.87–$149.59	13% below	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Xr Sacrum and Coccyx Min 2 Views	$187.20	$288.00	$36.95–$123.85	27% below	35%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
ACTH blood test CPT 82024 Acth Adrenocorticotropic Hormone	$144.95	$223.00	$14.50–$200.70	10% below	35%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alt Sgpt	$39.00	$60.00	$3.90–$54.00	22% below	35%
AST (aspartate aminotransferase) enzyme test CPT 84450 Ast Sgot	$65.65	$101.00	$4.66–$8.76	38% above	35%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel Acute	$127.40	$196.00	$12.74–$176.40	46% below	35%
Albumin blood test CPT 82040 Albumin Serum	$17.55	$27.00	$4.46–$8.37	45% below	35%
Aldosterone blood test CPT 82088 Aldosterone Serum	$148.20	$228.00	$14.82–$205.20	9% below	35%
Aldosterone blood test CPT 82088 Aldosterone 24 Hr Urine	$148.20	$228.00	$14.82–$205.20	9% below	35%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$42.90	$66.00	$4.29–$59.40	16% below	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific Ige Crude Extract Ea	$24.05	$37.00	$2.41–$33.30	12% above	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Latex Antigen Ige	$58.50	$90.00	$4.70–$8.83	172% above	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Sugar Cane Ige	$58.50	$90.00	$5.85–$81.00	172% above	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Egg Whole Ige	$58.50	$90.00	$5.85–$81.00	172% above	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Macadamia Nut Ige	$58.50	$90.00	$5.85–$81.00	172% above	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Dock Yellow Rumex Crispus Ige	$58.50	$90.00	$5.85–$81.00	172% above	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Galactose Alpha 1,3-Galactose Ige	$59.15	$91.00	$4.70–$8.83	175% above	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Feather Panel Two	$61.75	$95.00	$6.18–$85.50	187% above	35%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein Serum	$94.90	$146.00	$15.09–$28.38	1% below	35%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein Maternal	$94.90	$146.00	$15.09–$28.38	1% below	35%
Ammonia blood test CPT 82140 Stone Risk Ua Ammonia	$65.00	$100.00	$6.50–$90.00	15% below	35%
Ammonia blood test CPT 82140 Ammonia	$89.70	$138.00	$13.11–$24.66	17% above	35%
Amylase blood test CPT 82150 Amylase Serum	$23.40	$36.00	$5.83–$10.96	60% below	35%
Amylase blood test CPT 82150 Amylase Fluid	$55.90	$86.00	$5.83–$10.96	5% below	35%
Amylase blood test CPT 82150 Amylase Urine	$93.60	$144.00	$9.36–$129.60	60% above	35%
Amylase blood test CPT 82150 Amylase Pancreatic	$93.60	$144.00	$9.36–$129.60	60% above	35%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide, Antibody	$87.10	$134.00	$11.66–$21.90	9% above	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Screen	$107.25	$165.00	$10.88–$20.44	62% above	35%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Brain Natriuretic Peptide	$124.15	$191.00	$12.42–$171.90	at median	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Bone Marrow	$38.35	$59.00	$7.76–$14.56	45% below	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Spinal Fluid	$38.35	$59.00	$7.76–$14.56	45% below	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Throat	$74.10	$114.00	$7.41–$102.60	7% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Eye	$78.65	$121.00	$7.76–$14.56	14% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Ear	$78.65	$121.00	$7.76–$14.56	14% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Nasopharyngeal	$78.65	$121.00	$7.76–$14.56	14% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture IV Catheter Tip	$78.65	$121.00	$7.87–$108.90	14% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Genital	$78.65	$121.00	$7.87–$108.90	14% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Respiratory	$83.85	$129.00	$7.76–$14.56	21% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Placenta	$84.50	$130.00	$8.45–$117.00	22% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Any Other Source	$98.15	$151.00	$9.82–$135.90	42% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Resp Cystic Fibrosis Pt	$98.15	$151.00	$9.82–$135.90	42% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Bronchial Brush	$100.10	$154.00	$7.76–$14.56	45% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Burn Wound	$100.75	$155.00	$10.08–$139.50	45% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Blood Product	$100.75	$155.00	$10.08–$139.50	45% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Aerobic Only	$104.65	$161.00	$7.76–$14.56	51% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Wound Aerobic	$127.40	$196.00	$12.74–$176.40	84% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Sputum	$130.65	$201.00	$13.07–$180.90	89% above	35%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Pnl Calcium Total	$118.30	$182.00	$11.83–$163.80	3% above	35%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$57.85	$89.00	$4.52–$8.48	11% above	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Path Exam-Cell Block	$125.45	$193.00	$39.07–$80.36	37% below	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Prostate Needle Bx Gross and Micro	$185.25	$285.00	$39.07–$387.59	6% below	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bone Marrow Biopsy Interp Np	$366.60	$564.00	$39.07–$80.36	85% above	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Surg Path Lev IV Gross and Micro	$4,617.88	$7,104.43	$29.84–$1,140.00	2233% above	35%
Blood culture for bacteria CPT 87040 Culture Blood Bacterial	$125.45	$193.00	$12.55–$173.70	5% above	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Ref Lab Venipuncture Blood Collect	$9.75	$15.00	$2.82–$13.42	40% below	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture	$9.75	$15.00	$2.82–$13.42	40% below	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture and Send Off	$22.75	$35.00	$2.28–$31.50	40% above	35%
Blood glucose (sugar) test CPT 82947 Glucose Quant Blood	$45.50	$70.00	$3.54–$6.64	49% above	35%
Blood glucose (sugar) test CPT 82947 POC Glucose Quant Blood	$45.50	$70.00	$4.55–$63.00	49% above	35%
Blood lead test CPT 83655 Lead Blood	$53.95	$83.00	$5.40–$74.70	1% below	35%
Blood lead test CPT 83655 Lead Urine	$53.95	$83.00	$5.40–$74.70	1% below	35%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hcg Qual Pregnancy Screen	$63.70	$98.00	$6.77–$12.71	17% above	35%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 POC Hcg Qual Pregnancy Screen	$76.05	$117.00	$7.61–$105.30	40% above	35%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo Blood Typing	$10.40	$16.00	$130.73–$166.58	83% below	35%
Blood urea nitrogen (BUN) test CPT 84520 Bun Blood Urea Nitrogen	$39.00	$60.00	$3.56–$6.67	2% above	35%
Blood urea nitrogen (BUN) test CPT 84520 POC Bun Blood Urea Nitrogen	$39.00	$60.00	$3.56–$6.67	2% above	35%
C-peptide blood test CPT 84681 C Peptide	$84.50	$130.00	$8.45–$117.00	19% below	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C Reactive Protein	$24.70	$38.00	$2.47–$34.20	58% below	35%
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium Difficile Amp Probe	$140.40	$216.00	$33.54–$59.36	8% below	35%
CA 19-9 blood test (tumor marker) CPT 86301 Ca 19 9	$120.90	$186.00	$18.73–$35.22	15% above	35%
CA-125 blood test (ovarian cancer marker) CPT 86304 Ca 125	$122.20	$188.00	$12.22–$169.20	12% above	35%
COVID-19 PCR test (SARS-CoV-2 lab test) one side CPT 87635 POC Covid-19, Rt-Pcr	$130.00	$200.00	$13.00–$180.00	34% above	35%
COVID-19 PCR test (SARS-CoV-2 lab test) one side CPT 87635 Covid-19, Rt-Pcr	$148.20	$228.00	$14.82–$205.20	53% above	35%
Calcium blood test, total CPT 82310 Calcium Total Serum	$37.05	$57.00	$4.64–$8.71	22% below	35%
Calcium blood test, total CPT 82310 Calcium Total Urine	$37.05	$57.00	$4.64–$8.71	22% below	35%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen Cea	$50.70	$78.00	$17.06–$32.09	50% below	35%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Ag Cea Fluid	$127.40	$196.00	$17.06–$32.09	25% above	35%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Ab Igg	$102.70	$158.00	$10.27–$142.20	39% above	35%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Antibody	$102.70	$158.00	$11.59–$21.79	39% above	35%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Ab Igm	$102.70	$158.00	$10.27–$142.20	39% above	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis Ampl Probe	$74.10	$114.00	$7.41–$102.60	16% below	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis Ampl Probe Other	$159.90	$246.00	$15.99–$221.40	81% above	35%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 POC Lipid Panel	$128.05	$197.00	$12.05–$22.65	26% above	35%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$128.05	$197.00	$12.05–$22.65	26% above	35%
Complete blood count (CBC) with differential CPT 85025 Cbc W Auto Diff	$17.55	$27.00	$1.76–$24.30	66% below	35%
Complete blood count (CBC), no differential CPT 85027 Cbc Automated WO Diff	$14.30	$22.00	$5.82–$10.95	74% below	35%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$23.40	$36.00	$9.50–$17.88	80% below	35%
Cortisol blood test, total CPT 82533 Cortisol	$90.35	$139.00	$14.67–$27.59	4% above	35%
Cortisol blood test, total CPT 82533 Cortisol Saliva	$126.10	$194.00	$14.67–$27.59	45% above	35%
Cortisol blood test, total CPT 82533 Cortisol Total	$126.10	$194.00	$12.61–$174.60	45% above	35%
Creatine kinase (CK) blood test, total CPT 82550 Cpk Creatine Kinase Total	$55.90	$86.00	$5.59–$77.40	19% below	35%
Creatinine blood test CPT 82565 POC Creatinine	$18.20	$28.00	$1.82–$25.20	43% below	35%
Creatinine blood test CPT 82565 Creatinine Blood	$56.55	$87.00	$4.61–$8.67	76% above	35%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus Igg Antibody	$92.95	$143.00	$9.30–$128.70	33% above	35%
D-dimer blood test (blood clot marker) CPT 85379 D Dimer Quantitative	$134.55	$207.00	$13.46–$186.30	8% above	35%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dhea Sulfate	$153.40	$236.00	$20.01–$37.60	12% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 7 Meconium	$81.90	$126.00	$55.93–$92.28	at median	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Presumptive per Dos	$93.60	$144.00	$9.36–$129.60	14% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Ethyl Glucuronide Screen Urine	$105.30	$162.00	$10.53–$145.80	29% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 12 Meconium	$128.05	$197.00	$55.93–$92.28	56% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 9 Meconium	$128.05	$197.00	$55.93–$92.28	56% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Cotinine Screen Urine	$128.05	$197.00	$55.93–$92.28	56% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 12 + Faee Meconium	$128.05	$197.00	$12.81–$177.30	56% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Synthetic Cannabis Drug Screen Urine	$128.05	$197.00	$12.81–$177.30	56% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Mult Drug Class Method Ea	$128.05	$197.00	$55.93–$92.28	56% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Mephedrone, Mdpv, Methylone Drug Scrn Urine	$128.05	$197.00	$12.81–$177.30	56% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 5 Meconium	$128.05	$197.00	$12.81–$177.30	56% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Scn Mult Drug Class Ea Proc Non Chrom	$128.05	$197.00	$55.93–$92.28	56% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 13 Meconium	$128.05	$197.00	$55.93–$92.28	56% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 5 Umbilical Cord	$133.90	$206.00	$13.39–$185.40	63% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 7 Umbilical Cord	$157.30	$242.00	$55.93–$92.28	92% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 8 Umbilical Cord	$160.55	$247.00	$16.06–$222.30	96% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 9 Umbilical Cord	$164.45	$253.00	$16.45–$227.70	101% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 12 + Etoh Cord	$165.10	$254.00	$55.93–$92.28	102% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 12 Umbilical Cord	$181.35	$279.00	$55.93–$92.28	121% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 14 Meconium	$184.60	$284.00	$55.93–$92.28	125% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Meconium Drug Test	$185.25	$285.00	$55.93–$92.28	126% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Scn Meconium Mult Drug Non Chrom	$185.25	$285.00	$18.53–$256.50	126% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 13 Umbilical Cord	$213.85	$329.00	$55.93–$92.28	161% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 14 Umbilical Cord	$231.40	$356.00	$55.93–$92.28	183% above	35%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte Panel	$200.20	$308.00	$6.31–$11.89	138% above	35%
Epstein-Barr virus (EBV) antibody test CPT 86665 Ebv Vca Igg	$86.45	$133.00	$8.65–$119.70	9% above	35%
Epstein-Barr virus (EBV) antibody test CPT 86665 Ebv Vca Igm	$86.45	$133.00	$8.65–$119.70	9% above	35%
Estradiol blood test CPT 82670 Estradiol, Total	$89.70	$138.00	$8.97–$124.20	37% below	35%
FSH (follicle-stimulating hormone) test CPT 83001 Fsh Follicle Stimulating Hormone	$66.30	$102.00	$14.86–$30.12	35% below	35%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin Fecal	$117.65	$181.00	$17.67–$33.19	38% below	35%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$110.50	$170.00	$11.05–$153.00	16% above	35%
Fibrinogen blood test CPT 85384 Fibrinogen Activity	$22.75	$35.00	$8.75–$14.44	75% below	35%
Folate (folic acid) blood test CPT 82746 Folic Acid Serum	$52.65	$81.00	$5.27–$72.90	36% below	35%
Free T3 thyroid hormone test CPT 84481 T3 Free	$60.45	$93.00	$6.05–$83.70	39% below	35%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Thyroxine Free	$125.45	$193.00	$8.12–$15.25	63% above	35%
Free testosterone test CPT 84402 Testosterone Free	$91.00	$140.00	$22.92–$43.07	28% below	35%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Ggt Glutamyltransferase Gamma	$47.45	$73.00	$6.48–$12.16	18% below	35%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Tolerance 1 Hr OB	$72.80	$112.00	$4.28–$8.03	71% above	35%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Postprandial	$72.80	$112.00	$4.28–$8.03	71% above	35%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Post Glucose Dose	$72.80	$112.00	$7.28–$100.80	71% above	35%
Glucose tolerance test, 3 samples CPT 82951 Glucose Tol Test 3 Specimen	$41.60	$64.00	$4.16–$57.60	55% below	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae Ampl Probe	$74.10	$114.00	$31.58–$59.36	8% below	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae Ampl Probe Other	$110.50	$170.00	$31.58–$59.36	37% above	35%
H. pylori antibody blood test CPT 86677 Helicobacter Pylori Antibody	$133.25	$205.00	$13.33–$184.50	67% above	35%
H. pylori stool antigen test CPT 87338 Helicobacter Pylori Stool Eia	$141.70	$218.00	$9.95–$21.35	20% above	35%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv 1 Quantification	$352.30	$542.00	$35.23–$487.80	1% below	35%
HIV-1 and HIV-2 antibody test CPT 86703 Hiv 1-2 Rapid Screen	$106.60	$164.00	$10.66–$147.60	2% below	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hiv-1 Ag W Hiv-1 & 2 Ab Ia	$48.75	$75.00	$21.67–$40.75	45% below	35%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Human Papillomavirus Ampl Probe High Risk	$79.30	$122.00	$7.93–$109.80	28% below	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c Glycated	$34.45	$53.00	$8.74–$16.42	44% below	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 POC Hemoglobin A1c Glycated	$61.75	$95.00	$8.74–$16.42	1% above	35%
Hemoglobin blood test CPT 85018 Hemoglobin	$10.40	$16.00	$2.13–$4.00	62% below	35%
Hemoglobin blood test CPT 85018 POC Hemoglobin	$25.35	$39.00	$2.54–$35.10	9% below	35%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Antibody Total	$76.70	$118.00	$7.67–$106.20	14% above	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab	$94.90	$146.00	$9.49–$131.40	41% above	35%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen Eia	$37.05	$57.00	$9.30–$17.17	41% below	35%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody	$50.70	$78.00	$5.07–$70.20	35% below	35%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Virus Quantification	$191.10	$294.00	$139.65–$264.60	32% below	35%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Ab Type 1	$83.85	$129.00	$11.87–$22.30	31% above	35%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Type 1 Igm Ab	$83.85	$129.00	$11.87–$22.30	31% above	35%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Type 1 Igm Titer	$83.85	$129.00	$11.87–$22.30	31% above	35%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Ab Type 2	$87.10	$134.00	$8.71–$120.60	37% above	35%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Type 2 Igm Titer	$87.10	$134.00	$17.42–$32.73	37% above	35%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Type 2 Igm Ab	$89.70	$138.00	$17.42–$32.73	41% above	35%
High-sensitivity CRP (hs-CRP) test CPT 86141 C Reactive Protein High Sensitive	$72.80	$112.00	$7.28–$100.80	1% above	35%
High-sensitivity CRP (hs-CRP) test CPT 86141 C Reactive Protein CSF	$91.00	$140.00	$9.10–$126.00	26% above	35%
Homocysteine blood test CPT 83090 Homocysteine	$109.20	$168.00	$16.13–$28.52	10% below	35%
Homocysteine blood test CPT 83090 Homocysteine Urine	$127.40	$196.00	$16.13–$28.52	5% above	35%
Insulin blood test CPT 83525 Insulin Total	$56.55	$87.00	$10.29–$19.34	6% below	35%
Iron blood test (serum iron) CPT 83540 Iron Serum	$17.55	$27.00	$1.76–$24.30	62% below	35%
Iron blood test (serum iron) CPT 83540 Iron, Tissue	$49.40	$76.00	$5.82–$10.96	7% above	35%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity	$91.00	$140.00	$7.87–$14.78	34% above	35%
Kidney function blood test panel CPT 80069 Renal Function Panel	$145.60	$224.00	$7.81–$14.69	33% above	35%
LH (luteinizing hormone) test CPT 83002 Lh Luteinizing Hormone	$53.30	$82.00	$5.33–$73.80	48% below	35%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone Pediatric Lh	$161.85	$249.00	$16.19–$224.10	58% above	35%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid	$79.95	$123.00	$10.41–$18.07	9% below	35%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid CSF	$79.95	$123.00	$8.00–$110.70	9% below	35%
Lactate (lactic acid) blood test CPT 83605 POC Lactic Acid	$96.20	$148.00	$9.62–$133.20	10% above	35%
Lactate (lactic acid) blood test CPT 83605 D Lactate	$126.10	$194.00	$10.41–$18.07	44% above	35%
Lactate dehydrogenase (LDH) blood test CPT 83615 Ldh Lactate Dehydrogenase Fluid	$21.45	$33.00	$2.15–$29.70	58% below	35%
Lactate dehydrogenase (LDH) blood test CPT 83615 Ldh Lactate Dehydrogenase	$21.45	$33.00	$2.15–$29.70	58% below	35%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Fluid	$16.90	$26.00	$6.20–$11.65	77% below	35%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase	$22.10	$34.00	$6.20–$11.65	71% below	35%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$172.90	$266.00	$17.29–$239.40	45% above	35%
Lyme disease antibody test CPT 86618 Lyme Disease Antibody	$110.50	$170.00	$11.05–$153.00	21% above	35%
Lyme disease antibody test CPT 86618 Lyme Disease Antibody CSF	$137.15	$211.00	$15.33–$28.80	50% above	35%
Lyme disease antibody test CPT 86618 Lyme Disease Antibody Igg	$154.70	$238.00	$15.33–$28.80	69% above	35%
Magnesium blood test CPT 83735 Magnesium Urine	$60.45	$93.00	$6.05–$83.70	24% above	35%
Magnesium blood test CPT 83735 Magnesium	$62.40	$96.00	$6.03–$11.33	28% above	35%
Magnesium blood test CPT 83735 Magnesium 24 Hr Urine	$83.85	$129.00	$6.03–$11.33	72% above	35%
Magnesium blood test CPT 83735 Magnesium Stool	$83.85	$129.00	$8.39–$116.10	72% above	35%
Magnesium blood test CPT 83735 Stone Risk Ua Magnesium	$83.85	$129.00	$8.39–$116.10	72% above	35%
Magnesium blood test CPT 83735 Magnesium RBC	$83.85	$129.00	$6.03–$11.33	72% above	35%
Measles (rubeola) antibody test CPT 86765 Rubeola Antibody	$109.85	$169.00	$10.99–$152.10	115% above	35%
Measles (rubeola) antibody test CPT 86765 Rubeola Antibody Igm	$109.85	$169.00	$10.99–$152.10	115% above	35%
Measles (rubeola) antibody test CPT 86765 Rubeola Antibody Igg	$109.85	$169.00	$11.59–$21.79	115% above	35%
Mono test (heterophile antibody, Monospot) CPT 86308 POC Monotest Heterophile Ab Screen	$92.95	$143.00	$4.66–$8.76	107% above	35%
Mono test (heterophile antibody, Monospot) CPT 86308 Monotest Heterophile Ab Screen	$92.95	$143.00	$4.66–$8.76	107% above	35%
Mumps immunity blood test CPT 86735 Mumps Igg Antibody	$74.10	$114.00	$11.75–$22.08	25% above	35%
Mumps immunity blood test CPT 86735 Mumps Igm Antibody	$74.10	$114.00	$11.75–$22.08	25% above	35%
PSA (prostate-specific antigen) blood test, free CPT 84154 Psa Free	$68.90	$106.00	$6.89–$95.40	14% below	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 Psa Total Diagnostic	$65.65	$101.00	$16.55–$31.12	16% below	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 Psa Ultrasensitive	$75.40	$116.00	$7.54–$104.40	4% below	35%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap Smear Auto Scrn Man Rescrn	$50.05	$77.00	$5.01–$69.30	33% below	35%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Pap Smear Manual Screen	$119.60	$184.00	$18.23–$30.08	64% above	35%
Parathyroid hormone (PTH) blood test CPT 83970 Pth Intact	$158.60	$244.00	$37.15–$69.80	8% below	35%
Parathyroid hormone (PTH) blood test CPT 83970 Pth Intact Surg Baseline	$204.10	$314.00	$20.41–$282.60	18% above	35%
Parathyroid hormone (PTH) blood test CPT 83970 Pth Intact Surg Post Rese	$204.10	$314.00	$20.41–$282.60	18% above	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 Ptt Partial Thromboplastin Time	$59.80	$92.00	$5.98–$82.80	8% above	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 Ptt Mixing	$70.85	$109.00	$7.09–$98.10	28% above	35%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus	$50.70	$78.00	$4.27–$8.02	31% above	35%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Stool	$53.95	$83.00	$5.40–$74.70	39% above	35%
Potassium blood test CPT 84132 POC Potassium Ser Plasma Wb	$27.30	$42.00	$4.28–$7.78	34% below	35%
Potassium blood test CPT 84132 Potassium Plasma/Wb	$34.45	$53.00	$4.28–$7.78	17% below	35%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 Fetal Chromosomal Aneupoidy 13 18 21 Blood	$1,998.10	$3,074.00	$199.81–$2,766.60	71% above	35%
Progesterone blood test CPT 84144 Progesterone	$97.50	$150.00	$9.75–$135.00	11% below	35%
Prolactin blood test CPT 84146 Prolactin	$110.50	$170.00	$11.05–$153.00	5% below	35%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time	$14.30	$22.00	$1.43–$19.80	51% below	35%
Prothrombin time (PT/INR) clotting test CPT 85610 POC Prothrombin Time	$14.30	$22.00	$3.86–$6.64	51% below	35%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time Mixing Test	$38.35	$59.00	$3.84–$53.10	30% above	35%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Nicotine Cotinine Dir Optical Observ	$58.50	$90.00	$11.34–$18.71	14% below	35%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 POC Drug Scrn Multiclass Chromatographi	$83.20	$128.00	$8.32–$115.20	22% above	35%
Rapid flu test (influenza antigen) CPT 87804 POC Influenza a Ag Oia	$42.90	$66.00	$14.90–$24.59	27% below	35%
Rapid flu test (influenza antigen) CPT 87804 POC Influenza B Ag Oia	$42.90	$66.00	$4.29–$59.40	27% below	35%
Rapid flu test (influenza antigen) CPT 87804 Influenza a Ag Oia	$102.70	$158.00	$14.90–$24.59	74% above	35%
Rapid flu test (influenza antigen) CPT 87804 Influenza B Ag Oia	$102.70	$158.00	$14.90–$24.59	74% above	35%
Rapid flu test (influenza antigen) CPT 87804 POC Influenza Rapid Screen Oia	$111.80	$172.00	$11.18–$154.80	90% above	35%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 POC Rapid Strep Dir Optical Observ	$26.65	$41.00	$14.88–$24.55	40% below	35%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Rapid Strep Dir Optical Observ	$69.55	$107.00	$6.96–$96.30	56% above	35%
Renin blood test CPT 84244 Renin	$89.70	$138.00	$19.79–$37.19	29% below	35%
Rh blood typing CPT 86901 Rh (D) Blood Typing	$10.40	$16.00	$3.44–$55.21	78% below	35%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Quantitative	$50.05	$77.00	$5.10–$9.60	2% above	35%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibody Igg	$51.35	$79.00	$5.14–$71.10	5% above	35%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibody Igm	$78.00	$120.00	$7.80–$108.00	60% above	35%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation Rate Automated	$12.35	$19.00	$2.43–$4.57	64% below	35%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Analysis Complete	$200.85	$309.00	$11.08–$20.38	42% above	35%
Sodium blood test CPT 84295 Sodium Plasma/Wb	$29.25	$45.00	$4.33–$8.15	30% below	35%
Sodium blood test CPT 84295 POC Sodium Plasma/Wb	$29.25	$45.00	$2.93–$40.50	30% below	35%
Stool ova and parasites exam CPT 87177 Ova and Parasites	$59.15	$91.00	$8.01–$15.05	at median	35%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Bld Screen Feces Qual 1 to 3 Det	$21.45	$33.00	$3.94–$6.69	4% below	35%
Stool test for hidden blood (guaiac FOBT) CPT 82270 POC Occult Bld Screen Feces Qual 1 to 3 Det	$21.45	$33.00	$3.94–$6.69	4% below	35%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Occult Blood Feces Immuno Qual 1-3 Det	$55.90	$86.00	$5.59–$77.40	10% above	35%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Total	$8.45	$13.00	$0.85–$11.70	83% below	35%
Syphilis antibody test (Treponema pallidum) CPT 86780 Mha Treponema Pallidum Ab by Tp-Pa	$35.75	$55.00	$11.92–$22.38	30% below	35%
Syphilis antibody test (Treponema pallidum) CPT 86780 Fta Treponema Pallidum	$56.55	$87.00	$5.66–$78.30	11% above	35%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Igg	$83.85	$129.00	$11.92–$22.38	64% above	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rpr Qualitative	$14.95	$23.00	$3.84–$7.22	49% below	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl Qualitative CSF	$38.35	$59.00	$3.84–$53.10	30% above	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl Qualitative	$55.90	$86.00	$3.84–$7.22	89% above	35%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon R TB Gold	$138.45	$213.00	$55.78–$104.82	27% below	35%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total	$92.30	$142.00	$9.23–$127.80	23% below	35%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Ab Each	$81.25	$125.00	$13.10–$24.63	4% above	35%
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver Kidney Microsomal Ab Each	$81.25	$125.00	$13.10–$24.63	4% above	35%
Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal Ab Each	$81.25	$125.00	$13.10–$24.63	4% above	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh Newborn	$11.05	$17.00	$15.12–$28.42	75% below	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh Thyroid Stimulating Hormone	$71.50	$110.00	$7.15–$99.00	60% above	35%
Total IgE blood test CPT 82785 Immunoglobulin E	$102.05	$157.00	$14.81–$27.84	41% above	35%
Total cholesterol blood test CPT 82465 Cholesterol Serum/Whole Bld Total	$33.15	$51.00	$3.32–$45.90	at median	35%
Total thyroxine (T4) blood test CPT 84436 T4 Thyroxine Total	$55.25	$85.00	$6.18–$11.62	8% below	35%
Total triiodothyronine (T3) blood test CPT 84480 T3 Total	$74.75	$115.00	$7.48–$103.50	1% below	35%
Transferrin blood test CPT 84466 Transferrin	$28.60	$44.00	$2.86–$39.60	66% below	35%
Trichomonas test (NAAT) CPT 87661 Trichomonal Vaginalis Amp Probe	$56.55	$87.00	$5.66–$78.30	59% below	35%
Triglycerides blood test CPT 84478 Triglycerides	$41.60	$64.00	$4.16–$57.60	9% below	35%
Triglycerides blood test CPT 84478 Triglycerides Fluid	$207.35	$319.00	$5.17–$9.74	352% above	35%
Troponin test, quantitative CPT 84484 Troponin Quantitative	$55.25	$85.00	$5.53–$76.50	50% below	35%
Uric acid blood test CPT 84550 Uric Acid Blood	$16.25	$25.00	$4.07–$7.64	62% below	35%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis Automated W Micro	$11.05	$17.00	$1.11–$15.30	68% below	35%
Urinalysis with microscope exam, manual CPT 81000 Urinalysis Non Automated W Micro	$52.65	$81.00	$5.27–$72.90	95% above	35%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Automated W/O Micro	$7.80	$12.00	$0.78–$10.80	65% below	35%
Urinalysis without microscope exam, automated CPT 81003 POC Urinalysis Automated W/O Micro	$7.80	$12.00	$2.03–$3.53	65% below	35%
Urinalysis without microscope exam, automated CPT 81003 Urine Ph Automated	$24.05	$37.00	$2.03–$3.53	7% above	35%
Urinalysis without microscope exam, automated CPT 81003 Urine Ketones Automated	$24.05	$37.00	$2.03–$3.53	7% above	35%
Urinalysis without microscope exam, automated CPT 81003 Specific Gravity Urine Automated	$28.60	$44.00	$2.03–$3.53	28% above	35%
Urinalysis without microscope exam, manual CPT 81002 POC Urinalysis Non-Auto	$11.70	$18.00	$1.17–$16.20	15% below	35%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis Non Automated WO Micro	$55.90	$86.00	$5.59–$77.40	305% above	35%
Urinalysis without microscope exam, manual CPT 81002 Urine Ph Nonautomated	$55.90	$86.00	$5.59–$77.40	305% above	35%
Urine culture for bacteria, with colony count CPT 87086 Culture Urine Bacterial Quant Cnt	$28.60	$44.00	$7.26–$11.98	57% below	35%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Urine Quant	$20.80	$32.00	$5.20–$9.79	44% below	35%
Urine microalbumin (albumin) test CPT 82043 Microalbumin 24 Hr Urine Quant	$44.85	$69.00	$5.20–$9.79	20% above	35%
Urine microalbumin (albumin) test CPT 82043 POC Microalbumin Urine Quant	$44.85	$69.00	$5.20–$9.79	20% above	35%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test	$16.90	$26.00	$1.69–$23.40	65% below	35%
Urine pregnancy test, read by color change CPT 81025 POC Urine Pregnancy Test	$90.35	$139.00	$9.04–$125.10	85% above	35%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12	$124.80	$192.00	$12.48–$172.80	60% above	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy	$105.95	$163.00	$10.60–$146.70	25% below	35%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vitamin D 1 25 Dihydroxy	$172.90	$266.00	$34.65–$65.12	at median	35%
Zinc blood test CPT 84630 Zinc Serum	$61.10	$94.00	$6.11–$84.60	3% above	35%
Zinc blood test CPT 84630 Zinc Urine	$61.10	$94.00	$10.25–$19.24	3% above	35%
Zinc blood test CPT 84630 Zinc 24 Hr Urine	$61.10	$94.00	$10.25–$19.24	3% above	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Quant	$53.95	$83.00	$9.30–$22.44	36% below	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 POC Hcg Quant	$144.30	$222.00	$14.43–$199.80	70% above	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Quant Tumor Marker	$144.30	$222.00	$9.30–$22.44	70% above	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg-Maternal Screen	$144.30	$222.00	$14.43–$199.80	70% above	35%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 Adenoidectomy Primary <Age 12	$5,945.10	$9,146.31	$3,257.72–$4,151.01	37% above	35%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Arthrs Aided Ant Cruciate Ligm Rpr/Agmntj/Rcnstj	$21,188.62	$32,597.88	$829.36–$7,734.17	36% above	35%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 Surgical Arthroscopy Shoulder W/Rotator Cuff Rpr	$16,853.85	$25,929.00	$910.02–$7,734.17	73% above	35%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Bx Breast Stereotactic Percutaneous	$5,080.40	$7,816.00	$3,199.00–$7,801.00	120% above	35%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Cl Tx Distal Fibular Fx WO Man	$586.95	$903.00	$204.50–$1,106.00	23% above	35%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Cl Tx Metatarsal Fx WO Man	$435.50	$670.00	$239.00–$292.00	12% above	35%
Cardiac catheterization with coronary angiogram CPT 93458 Lt Heart Artery/Ventricle Angio	$9,004.45	$13,853.00	$2,741.93–$6,592.00	3% below	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Elective Ext	$1,842.10	$2,834.00	$776.00–$1,798.00	73% above	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Or Cardioversion Level 2 Initial 30 Min	$1,979.90	$3,046.00	$649.43–$827.51	86% above	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Or Cardioversion Level 2 Ea Addtl 30 Min	$1,979.90	$3,046.00	$459.82–$1,570.10	86% above	35%
Cataract surgery with lens implant CPT 66984 Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp	$5,615.21	$8,638.78	$3,199.00–$7,801.00	26% above	35%
Catheter ablation for atrial fibrillation CPT 93656 Comp Ep Eval Pvi W/3d Mapping	$39,631.15	$60,971.00	$25,682.64–$32,725.07	65% above	35%
Cervical biopsy CPT 57500 Bx/Exc Cervix Lesion W/WO Fulg	$3,669.25	$5,645.00	$742.29–$1,224.78	319% above	35%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Circumcision Age >28 Days	$7,405.37	$11,392.88	$1,286.00–$3,185.00	149% above	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision Clamp Oth Dev W/O Block	$265.85	$409.00	$3,199.00–$7,801.00	27% below	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision Clamp Oth Dev W Block	$1,429.78	$2,199.66	$80.82–$2,975.00	291% above	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision Newborn	$4,769.70	$7,338.00	$476.97–$5,870.40	1203% above	35%
Colonoscopy, diagnostic CPT 45378 GI Colonoscopy	$2,801.36	$4,309.79	$913.76–$1,164.32	68% above	35%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Colposcopy W Bx and Curettage	$1,396.85	$2,149.00	$139.69–$1,934.10	249% above	35%
Complex cataract surgery with lens implant CPT 66982 Xcapsl Ctrc Rmvl Insj Io Lens Prosth Cplx WO Ecp	$6,733.81	$10,359.71	$584.22–$2,975.00	71% above	35%
Coronary stent placement, one artery CPT 92928 Coronary Stent Single Branch Ri	$11,014.90	$16,946.00	$11,343.13–$14,453.53	21% below	35%
Coronary stent placement, one artery CPT 92928 Coronary Stent Single Branch Ld	$11,014.90	$16,946.00	$447.06–$15,951.57	21% below	35%
Coronary stent placement, one artery CPT 92928 Coronary Stent Single Branch Lm	$11,014.90	$16,946.00	$8,596.00–$17,479.00	21% below	35%
Coronary stent placement, one artery CPT 92928 Coronary Stent Single Branch Rc	$11,014.90	$16,946.00	$8,596.00–$17,479.00	21% below	35%
Coronary stent placement, one artery CPT 92928 Coronary Stent Single Branch Lc	$11,014.90	$16,946.00	$11,343.13–$14,453.53	21% below	35%
Cystoscopy with ureteral stent placement CPT 52332 Cysto W/Insert Ureteral Stent	$7,852.53	$12,080.81	$3,199.00–$7,801.00	53% above	35%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystourethroscopy	$3,987.31	$6,134.33	$1,047.00–$2,125.00	146% above	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruct Benign Les 1st Les	$1,281.80	$1,972.00	$197.14–$251.20	771% above	35%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 Tympanostomy With Tube Placement	$3,656.84	$5,625.91	$1,524.56–$1,942.61	12% above	35%
Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 Rem Impact Cerumen Irr/Lavage Bilat	$349.05	$537.00	$288.00	—	35%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Impact Cerumen Irr/Lavage Unilat	$199.55	$307.00	$14.51–$1,106.00	81% above	35%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Rem Impact Cerumen Irr/Lavage Unilat	$321.75	$495.00	$32.18–$445.50	191% above	35%
Earwax removal with instruments, one ear both sides CPT 69210 Rem Impact Cerumen Instrument Bilat	$237.90	$366.00	$25.93–$1,106.00	—	35%
Earwax removal with instruments, one ear one side CPT 69210 Rem Impact Cerumen Instrument Unilat	$3,237.00	$4,980.00	$3,199.00–$7,801.00	3021% above	35%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Endometrial Biopsy	$3,140.15	$4,831.00	$198.65–$253.12	1119% above	35%
Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 Nasal/Sinus Ndsc W/Total Ethoidectomy	$12,789.82	$19,676.65	$6,934.55–$8,836.07	64% above	35%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 Nasal/Sinus Ndsc W/Rmvl Tiss From Frontal Sinus	$17,873.13	$27,497.12	$6,934.55–$8,836.07	116% above	35%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 Nasal/Sinus Endoscopy W/Maxillary Antrostomy	$12,855.43	$19,777.59	$145.08–$3,991.69	288% above	35%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 Nsl/Sinus Ndsc Max Antrost W/Rmvl Tiss Max Sinus	$14,559.85	$22,399.77	$6,934.55–$8,836.07	79% above	35%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Inject Interlaminar Cerv or Thoracic W Imag	$3,523.47	$5,420.73	$1,286.00–$3,185.00	130% above	35%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj Paravert F Jnt L/S 1st Lev	$951.60	$1,464.00	$3,199.00–$7,801.00	12% below	35%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj Paravert F Jnt L/S 1st Lev Bil	$3,337.46	$5,134.56	$869.07–$1,107.38	208% above	35%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 Rpr Aa Hernia 1st > 10 Cm Reducible	$15,335.58	$23,593.20	$3,713.00–$12,455.00	34% above	35%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 GI Sigmoidiscope Flexible	$1,035.45	$1,593.00	$1,047.00–$2,125.00	19% below	35%
Hemorrhoid banding (rubber band ligation) CPT 46221 GI Hemorrhoid Ligation	$2,431.00	$3,740.00	$243.10–$2,992.00	78% above	35%
Hysterectomy through an abdominal incision (total) CPT 58150 Total Abdominal Hysterect W/WO Rmvl Tube Ovary	$20,479.47	$31,506.88	$3,713.00–$14,937.00	33% above	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Inj Hysterosalpingogram	$282.10	$434.00	$3,199.00–$7,801.00	21% above	35%
Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy Endometrial Ablation	$8,014.55	$12,330.08	$4,915.33–$6,263.16	18% above	35%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopyw/Bx W/WO D/C	$4,592.25	$7,065.00	$3,180.75–$4,052.94	5% above	35%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$4,706.37	$7,240.57	$1,286.00–$3,185.00	8% above	35%
IUD insertion (the device itself billed separately) CPT 58300 Insertion Intrauterine Device Iud	$4,760.77	$7,324.26	$1,286.00–$3,185.00	820% above	35%
Incision and drainage of a simple or single skin abscess CPT 10060 I/D Abscess Simple	$322.40	$496.00	$288.00	11% above	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Sgl Ten Sheath/Lig/Apo	$313.30	$482.00	$31.33–$385.60	3% below	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Asp/Inj Major Jt WO US Guid	$623.35	$959.00	$3,199.00–$7,801.00	114% above	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Asp/Inj Major Jt W/O US Guid	$623.35	$959.00	$62.34–$863.10	114% above	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Bil Asp/Inj Major Jt WO US Guid	$935.35	$1,439.00	$3,199.00–$7,801.00	222% above	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 Bilat Asp/Inj Intermed Jt WO US Guid	$507.65	$781.00	$3,199.00–$7,801.00	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Asp/Inj Interm Jt W/O US Guid	$338.65	$521.00	$288.00	at median	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Asp/Inj Intermed Jt WO US Guid	$424.45	$653.00	$301.61–$384.31	25% above	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Asp/Inj Small Jt WO US Guid	$333.45	$513.00	$301.61–$384.31	22% above	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Asp/Inj Sm Jt W/O US	$333.45	$513.00	$29.88–$1,106.00	22% above	35%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Arthroscopy Kne Surg Meniscus Rpr Medial/Lateral	$15,939.72	$24,522.65	$594.97–$4,812.00	74% above	35%
Knee arthroscopy with meniscus trim CPT 29881 Arthrs Knee Surg W/Meniscectomy Med/Lat W/Shvg	$7,628.45	$11,736.07	$474.56–$4,812.00	10% above	35%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Arthrs Knee Surg Meniscectomy Med&Lat W/Shaving	$8,449.62	$12,999.41	$3,713.00–$10,471.00	22% above	35%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Arthrs Knee Surg Debridement/Shvg Artclr Crtlg	$7,134.52	$10,976.19	$541.62–$4,812.00	3% above	35%
Laparoscopic Roux-en-Y gastric bypass, standard limb length CPT 43644 Laps Gstr Rstcv Px W/Byp Roux-en-Y Limb <150 Cm	$25,495.50	$39,223.84	$3,713.00–$32,851.00	at median	35%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Laps Surg Rpr Recurrent Inguinal Hernia	$10,076.36	$15,502.09	$3,713.00–$12,455.00	7% below	35%
Laparoscopic removal of an adjustable gastric band and its port CPT 43774 Laps Gastric Restrictive Px Remove Device & Port	$10,769.32	$16,568.19	$856.09–$17,689.00	10% below	35%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy W/Rmvl Adnexal Structures	$10,725.09	$16,500.14	$5,940.24–$7,569.11	2% above	35%
Laparoscopic sleeve gastrectomy for weight loss CPT 43775 Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy	$17,102.92	$26,312.19	$306.65–$17,689.00	19% below	35%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Laser Yag Treatment	$756.60	$1,164.00	$3,199.00–$7,801.00	1% below	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Int Rep Sc/Ax/Tr/Ext 2.5/<	$1,264.25	$1,945.00	$239.00–$292.00	188% above	35%
Left heart catheterization, diagnostic one side CPT 93452 Lt Heart Cath Including Inj Lt Ventriculography, S/I	$5,682.30	$8,742.00	$4,901.00–$10,011.00	14% below	35%
Lower-back epidural injection, with imaging guidance CPT 62323 Inject Interlaminar Lumbar or Sacral W Imag	$2,486.90	$3,826.00	$693.59–$883.78	74% above	35%
Lower-back epidural injection, without imaging guidance CPT 62322 Inj Dx/Tx Epid/Subaracr Lmbr/Sac WO Imag	$3,348.80	$5,152.00	$334.88–$4,121.60	201% above	35%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 Bilat Inj Epi/Lumb/Sacral Sngl Level	$1,207.70	$1,858.00	$3,199.00–$7,801.00	—	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj Epi/Lumb/Sacral Sngl Level	$1,838.85	$2,829.00	$3,199.00–$7,801.00	22% above	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj Transforminal Epi/Lumb/Sacral Sngl Level	$2,198.55	$3,382.38	$93.63–$1,445.82	46% above	35%
Miscarriage treatment with D&C, first trimester CPT 59820 Tx Missed Abortion First Trimester Surgical	$4,272.11	$6,572.47	$325.59–$3,442.32	9% below	35%
Miscarriage treatment with D&C, first trimester CPT 59820 Treatment Missed Abort 1st Trim	$5,320.90	$8,186.00	$2,710.49–$4,472.31	13% above	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc Ben Les Tru <.5cm	$3,487.25	$5,365.00	$695.80–$886.59	503% above	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc Ben Les Ext/Tr 0.5cm/<	$3,487.25	$5,365.00	$69.41–$1,140.00	503% above	35%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Exc Ben Les Face-.5cm Or<	$3,677.70	$5,658.00	$367.77–$5,092.20	465% above	35%
Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate Single	$850.85	$1,309.00	$46.37–$1,106.00	239% above	35%
Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate,Single	$963.95	$1,483.00	$197.14–$251.20	285% above	35%
Occipital nerve block (injection for headaches) both sides CPT 64405 Bilat Inj Anes Gtr Occiptal Nerve	$2,085.85	$3,209.00	$3,199.00–$7,801.00	—	35%
Occipital nerve block (injection for headaches) CPT 64405 Inj Anes Gtr Occiptal Nerve	$1,391.00	$2,140.00	$3,199.00–$7,801.00	249% above	35%
Pacemaker implant (dual chamber) CPT 33208 Ins New or Repl Perm Pacemaker a and V	$16,497.03	$25,380.05	$10,269.96–$13,086.09	at median	35%
Paracentesis with imaging guidance CPT 49083 Abd Paracentesis With Imag Guidance	$1,228.50	$1,890.00	$3,199.00–$7,801.00	22% above	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Exc Nail Matrix	$3,861.00	$5,940.00	$87.56–$1,140.00	538% above	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Exc Nail/Matrix Perm Rem	$5,115.50	$7,870.00	$3,199.00–$7,801.00	746% above	35%
Prostate biopsy CPT 55700 Bx Prostate Needle/Punch	$6,545.67	$10,070.26	$358.10–$2,217.81	138% above	35%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Destruct Neu Facet W Imag Guid L/S Sngl	$1,852.50	$2,850.00	$3,199.00–$7,801.00	3% above	35%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Bil Destruct Neu Facet W Imag Guid L/S Sngl	$5,117.57	$7,873.19	$1,918.72–$2,444.85	183% above	35%
Removal of a foreign object under the skin, simple CPT 10120 Rfb Subq Tissue Simple	$878.80	$1,352.00	$239.00–$292.00	79% above	35%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 Total Thyroid Lobectomy Uni W/WO Isthmusectomy	$12,765.98	$19,639.97	$3,199.00–$7,801.00	6% above	35%
Septoplasty to straighten the nasal septum CPT 30520 Septoplasty/Submucous Resecj W/WO Cartilage Grf	$8,276.31	$12,732.78	$3,199.00–$7,801.00	13% above	35%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 Lithotripsy Xtrcorp Shock Wave	$9,708.10	$14,935.54	$3,463.59–$4,413.34	22% above	35%
Short arm splint (forearm and hand) CPT 29125 Appl Splint Short Arm	$401.70	$618.00	$288.00	110% above	35%
Short leg splint (calf to foot) CPT 29515 Appl Splint Short Leg	$332.80	$512.00	$239.00–$292.00	57% above	35%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Surgical Arthroscopy Shoulder Dstl Claviculc	$15,868.70	$24,413.38	$7,129.84–$9,084.91	29% above	35%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls	$13,867.94	$21,335.30	$3,713.00–$10,471.00	2% above	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple Wound Repair <2.5cm	$322.40	$496.00	$197.14–$251.20	18% above	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simp Rep S/Nk/Tr/Ext 2.5/<	$322.40	$496.00	$197.14–$251.20	18% above	35%
Skin biopsy, punch, one lesion CPT 11104 Punch Bx Skin Single Lesion	$600.60	$924.00	$3,199.00–$7,801.00	76% above	35%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Exc.Malig.Les.Tr,0.5 Cm or <	$1,924.00	$2,960.00	$695.80–$886.59	204% above	35%
Skin tag removal, up to 15 tags CPT 11200 Rem Skin Tags Up to 15 Lesions	$1,548.30	$2,382.00	$288.00	820% above	35%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Puncture Spinal/Lumbar Dx	$509.60	$784.00	$50.96–$627.20	23% below	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simp Rep S/Nk/Tr/Ext 2.6 to 7.5cm	$354.90	$546.00	$288.00	7% above	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple Wnd Rpr-Face <2.5c	$322.40	$496.00	$197.14–$251.20	17% above	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simp Rep F/Een/Lp/Mm 2.5cm/<	$334.10	$514.00	$239.00–$292.00	21% above	35%
TURP (transurethral resection of the prostate) CPT 52601 Trurl Electrosurg Rescj Prostate Bleed Complete	$7,886.52	$12,133.11	$3,199.00–$7,801.00	15% below	35%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangntl Bx Skin Single Les	$677.30	$1,042.00	$288.00	147% above	35%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis Pleural Space W Guidance	$1,901.90	$2,926.00	$90.61–$1,140.00	86% above	35%
Tonsil and adenoid removal, age 12 or older CPT 42821 Tonsillectomy & Adenoidectomy Age 12/>	$5,799.79	$8,922.75	$252.90–$3,511.11	at median	35%
Tonsil and adenoid removal, child under 12 CPT 42820 Tonsillectomy & Adenoidectomy <Age 12	$5,909.03	$9,090.82	$5,816.73–$7,411.73	11% above	35%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Tonsillectomy Primary/Secondary Age 12/>	$6,358.97	$9,783.03	$3,257.72–$4,151.01	34% above	35%
Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 Tonsillectomy Primary/Secondary <Age 12	$5,652.00	$8,695.39	$224.24–$6,404.60	4% above	35%
Total thyroid removal (thyroidectomy) CPT 60240 Thyroidectomy Total/Complete	$13,623.20	$20,958.77	$3,199.00–$7,801.00	4% below	35%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Pt 1 or 2 Musc	$350.35	$539.00	$251.65–$1,106.00	11% above	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Bx Breast Ultrasound Percutaneous	$4,319.90	$6,646.00	$3,199.00–$7,801.00	146% above	35%
Upper endoscopy (EGD) with injection into the lining CPT 43236 Esophagogastroduodenoscopy Submucosal Injection	$6,702.35	$10,311.31	$1,885.49–$2,402.51	229% above	35%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Egd Insert Guide Wire Dilator Passage Esophagus	$3,901.49	$6,002.30	$139.91–$1,576.00	122% above	35%
Upper endoscopy (EGD), diagnostic CPT 43235 GI Upper Endoscopy Complex	$1,147.90	$1,766.00	$1,047.00–$2,125.00	24% below	35%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 Egd Transoral Transmural Drainage Pseudocyst	$15,610.29	$24,015.83	$325.25–$6,444.82	35% above	35%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt	$14,236.48	$21,902.27	$5,268.41–$6,713.07	43% above	35%
Vein ablation, radiofrequency, first vein CPT 36475 Endovenous Rf 1st Vein	$4,945.20	$7,608.00	$1,286.00–$3,185.00	17% above	35%
Wart removal, up to 14 warts CPT 17110 Destruct Benign/ Cutaneous Vasc Lesions 1-14	$301.60	$464.00	$3,199.00–$7,801.00	68% above	35%
Wart removal, up to 14 warts CPT 17110 Destruct Flat Wart Up to 14 Lesion	$2,858.70	$4,398.00	$56.43–$1,106.00	1488% above	35%
Wart removal, up to 14 warts CPT 17110 Destruct Benign Lesion Up to 14	$3,409.25	$5,245.00	$288.00	1794% above	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Subq 1st 20sqcm or Less	$699.40	$1,076.00	$340.59–$1,106.00	17% above	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debrid Subq 1st 20sqcm or Less	$699.40	$1,076.00	$288.00	17% above	35%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Rapid Blood / Products Transfusion	$598.65	$921.00	$433.49–$552.36	5% below	35%
Blood transfusion (giving blood or blood components) CPT 36430 Blood / Products Transfusion per Hour	$9,490.73	$14,601.13	$40.42–$1,135.00	1406% above	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler	$115.70	$178.00	$55.84–$286.09	16% below	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler Repeat	$115.70	$178.00	$55.84–$286.09	16% below	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation/Nebulizer Treatment Initial	$115.70	$178.00	$55.84–$286.09	16% below	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation/Nebulizer Treatment Repeat	$115.70	$178.00	$215.16–$274.16	16% below	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation/Nebulizer Treatment	$115.70	$178.00	$215.16–$274.16	16% below	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Obstruction Sputum Induct	$115.70	$178.00	$55.84–$286.09	16% below	35%
Chemotherapy IV infusion, first hour CPT 96413 Chemo IV Infusion Sgl/Init<1hr	$313.30	$482.00	$324.55–$413.55	28% below	35%
Critical care, first 30 to 74 minutes CPT 99291 Critical Care First 30 - 74 Min	$2,564.90	$3,946.00	$776.00–$1,798.00	25% above	35%
EEG (brain wave test), awake and drowsy, routine CPT 95816 Eeg W Awake and Drowsy Record	$939.90	$1,446.00	$212.16–$270.34	26% above	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg Child 0-16yr	$202.80	$312.00	$20.28–$280.80	7% above	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg 12 Lead Tracing Only	$218.40	$336.00	$57.96–$73.86	16% above	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED Visit Care Level 1	$193.05	$297.00	$451.00–$1,823.00	20% below	35%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED Visit Care Level 2	$767.00	$1,180.00	$134.99–$222.73	105% above	35%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED Visit Care Level 3	$1,583.76	$2,436.55	$268.22–$341.77	87% above	35%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED Visit Care Level 4	$1,836.90	$2,826.00	$183.69–$2,543.40	93% above	35%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED Visit Care Level 5	$1,989.65	$3,061.00	$776.00–$1,798.00	23% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiac Stress Test Tracing Only	$1,703.65	$2,621.00	$188.64–$1,015.71	121% above	35%
Family therapy with the patient, 50 minutes CPT 90847 Cd Fam Ther W Patient 50 Min (Max Qty 2)	$234.00	$360.00	$137.00	2% above	35%
Family therapy with the patient, 50 minutes CPT 90847 Psych Fam Ther W Pt 50min (Max Qty 2)	$234.00	$360.00	$132.00–$272.00	2% above	35%
Family therapy without the patient, 50 minutes CPT 90846 Cd Fam Ther WO Patient 50 Min (Max Qty 2)	$258.05	$397.00	$137.00	10% above	35%
Family therapy without the patient, 50 minutes CPT 90846 Psych Fam Ther WO Pt 50min (Max Qty 2)	$258.05	$397.00	$137.00	10% above	35%
Group psychotherapy session CPT 90853 Group Therapy 60 Min	$211.25	$325.00	$21.13–$292.50	at median	35%
Group psychotherapy session CPT 90853 Group Tx-Iop	$487.50	$750.00	$48.75–$675.00	131% above	35%
Group psychotherapy session CPT 90853 Group Tx-Cd/Psych Iop	$487.50	$750.00	$78.86–$130.12	131% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Infusion, Hydration Init Up to 1hr	$133.90	$206.00	$29.19–$296.36	44% below	35%
IV infusion of a medicine, first hour CPT 96365 IV Infusion,Tx,Proph,Dx Init Up to 1 Hr	$542.10	$834.00	$209.00–$266.31	89% above	35%
IV infusion of a medicine, first hour CPT 96365 IV Infusion Tx Up to 1 Hr	$567.45	$873.00	$209.00–$266.31	97% above	35%
IV push of a medicine, first drug CPT 96374 Injection Intravenous	$324.35	$499.00	$179.61–$296.36	81% above	35%
IV push of a medicine, first drug CPT 96374 Inj Ivp,Initial Drugs/Sub	$371.15	$571.00	$37.12–$513.90	107% above	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection Subq/Im	$182.65	$281.00	$60.68–$100.12	96% above	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection Antibiotic Im	$182.65	$281.00	$70.75–$90.15	96% above	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection Sq/Im	$182.65	$281.00	$18.27–$252.90	96% above	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psy Diag Inter W/O Med Ser Up to 15 Min	$165.75	$255.00	$16.58–$229.50	23% below	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psy Diag Inter W/O Med Ser Up to 30 Min	$193.05	$297.00	$134.19–$736.40	10% below	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psy Diag Inter W/O Med Ser Up to 45 Min	$221.00	$340.00	$22.10–$306.00	3% above	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psy Diag Inter W/O Med Ser Up to 60 Min	$248.30	$382.00	$134.19–$736.40	16% above	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Pysch Eval W/O Med Services	$276.25	$425.00	$300.56	29% above	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psy Diag Inter W/O Med Ser Up to 75 Min	$276.25	$425.00	$134.19–$736.40	29% above	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psy Diag Inter W/O Med Ser Up to 90 Min	$303.55	$467.00	$30.36–$420.30	42% above	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psy Diag Inter W/O Med Ser Up to 105 Mn	$331.50	$510.00	$134.19–$736.40	55% above	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psy Diag Inter W/O Med Ser > 120 Min	$333.45	$513.00	$33.35–$461.70	56% above	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psy Diag Inter W/O Med Ser Up to 120 Mn	$395.20	$608.00	$39.52–$547.20	84% above	35%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 Nerve Conduct Studies 7-8 Studies	$2,109.25	$3,245.00	$210.93–$2,920.50	228% above	35%
Neuromuscular re-education, 15 minutes CPT 97112 Ot Neuro Re ED 1 or > Area Ea 15m	$114.40	$176.00	$28.15–$46.45	27% above	35%
Neuromuscular re-education, 15 minutes CPT 97112 Pt Neuro Re ED 1 or > Area Ea 15m	$114.40	$176.00	$28.15–$46.45	27% above	35%
New patient office visit, about 30 minutes CPT 99203 OP Visit Level III New Patient	$180.70	$278.00	$18.07–$250.20	17% above	35%
New patient office visit, about 30 minutes CPT 99203 OP Uc Visit Level III New Pt	$180.70	$278.00	$68.60–$1,901.38	17% above	35%
New patient office visit, about 30 minutes CPT 99203 OP Visit Level III New Pt/Behavioral Health	$180.70	$278.00	$68.60–$86.08	17% above	35%
New patient office visit, about 30 minutes CPT 99203 OP Visit Level III New Pt	$180.70	$278.00	$18.07–$250.20	17% above	35%
New patient office visit, about 45 minutes CPT 99204 OP Uc Visit Level IV New Pt	$230.75	$355.00	$112.05–$3,059.39	8% above	35%
New patient office visit, about 45 minutes CPT 99204 OP Visit Level IV New Pt/Behavioral Health	$288.60	$444.00	$28.86–$399.60	35% above	35%
New patient office visit, about 45 minutes CPT 99204 OP Visit Level IV New Pt	$288.60	$444.00	$112.05–$140.60	35% above	35%
New patient office visit, about 60 minutes CPT 99205 OP Uc Visit Level V New Pt	$319.15	$491.00	$239.00–$292.00	at median	35%
New patient office visit, about 60 minutes CPT 99205 OP Visit Level V New Patient	$319.15	$491.00	$31.92–$441.90	at median	35%
New patient office visit, about 60 minutes CPT 99205 OP Visit Level V New Pt	$319.15	$491.00	$31.92–$441.90	at median	35%
New patient office visit, about 60 minutes CPT 99205 OP Visit Level V New Pt/Behavioral Health	$319.15	$491.00	$31.92–$441.90	at median	35%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP Uc Visit Level II New Pt	$160.55	$247.00	$39.40–$1,102.50	29% above	35%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP Visit Level II New Pt	$171.60	$264.00	$17.16–$237.60	38% above	35%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP Visit Level II New Pt/Behavioral Health	$171.60	$264.00	$39.40–$49.44	38% above	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Med Nutrition Therapy Ea 15m	$74.10	$114.00	$7.41–$102.60	85% above	35%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Level I 15 Min	$131.95	$203.00	$13.20–$182.70	1% below	35%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Level I 30 Min	$167.70	$258.00	$133.00–$274.00	26% above	35%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Level I 45 Min	$171.60	$264.00	$88.39–$145.84	29% above	35%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Level I 60 Min	$209.30	$322.00	$88.39–$145.84	57% above	35%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Level I 75 Min	$246.35	$379.00	$88.39–$145.84	85% above	35%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Level I 90 Min	$284.05	$437.00	$133.00–$274.00	113% above	35%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Level I 105 Min	$398.45	$613.00	$88.39–$145.84	199% above	35%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Level I 120 Min	$444.60	$684.00	$133.00–$274.00	234% above	35%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Level I 135 Min	$491.40	$756.00	$49.14–$680.40	269% above	35%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Level I 150 Min	$537.55	$827.00	$53.76–$744.30	303% above	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval Level III 15 Min	$103.35	$159.00	$86.18–$142.20	41% below	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval Level III 30 Min	$122.85	$189.00	$133.00–$274.00	30% below	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval Level III 45 Min	$147.55	$227.00	$86.18–$142.20	16% below	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval Level III 60 Min	$172.90	$266.00	$86.18–$142.20	1% below	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval Level III 75 Min	$344.50	$530.00	$133.00–$274.00	97% above	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval Level III 90 Min	$362.70	$558.00	$86.18–$142.20	107% above	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval Level III 105 Min	$456.30	$702.00	$133.00–$274.00	161% above	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval Level III 120 Min	$502.45	$773.00	$86.18–$142.20	187% above	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval Level III 135 Min	$548.60	$844.00	$86.18–$142.20	213% above	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval Level III 150 Min	$594.75	$915.00	$133.00–$274.00	240% above	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Level I 15 Min	$96.85	$149.00	$9.69–$134.10	27% below	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Level I 30 Min	$187.85	$289.00	$133.00–$274.00	41% above	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Level I 45 Min	$207.35	$319.00	$133.00–$274.00	56% above	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Level I 60 Min	$215.15	$331.00	$21.52–$297.90	61% above	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Level I 75 Min	$247.00	$380.00	$86.18–$142.20	85% above	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Level I 90 Min	$259.35	$399.00	$133.00–$274.00	95% above	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Level I 105 Min	$267.80	$412.00	$86.18–$142.20	101% above	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Level I 120 Min	$433.55	$667.00	$43.36–$600.30	225% above	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Level I 135 Min	$479.05	$737.00	$86.18–$142.20	260% above	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Level I 150 Min	$523.90	$806.00	$86.18–$142.20	293% above	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Level II 15 Min	$118.30	$182.00	$133.00–$274.00	25% below	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Level II 30 Min	$190.45	$293.00	$133.00–$274.00	21% above	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Level II 45 Min	$193.70	$298.00	$86.18–$142.20	23% above	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Level II 60 Min	$203.45	$313.00	$20.35–$281.70	29% above	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Level II 75 Min	$214.50	$330.00	$133.00–$274.00	36% above	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Level II 90 Min	$302.90	$466.00	$30.29–$419.40	92% above	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Level II 105 Min	$425.75	$655.00	$86.18–$142.20	169% above	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Level II 120 Min	$471.90	$726.00	$133.00–$274.00	199% above	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Level II 135 Min	$518.05	$797.00	$86.18–$142.20	228% above	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Level II 150 Min	$564.85	$869.00	$56.49–$782.10	258% above	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Ot Manual Therapy 15 Min	$93.60	$144.00	$23.90–$39.44	13% above	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Ther 1 or > Reg Ea 15m	$123.50	$190.00	$12.35–$171.00	50% above	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Ot Manual Ther 1 or > Reg Ea 15m	$123.50	$190.00	$23.90–$39.44	50% above	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Pt Manual Ther 1 or > Reg Ea 15m	$123.50	$190.00	$23.90–$39.44	50% above	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Pt Cpm Fitting Recovery Room Ea 15in	$109.85	$169.00	$133.00–$274.00	41% above	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Pt Cpm Set Up Ea 15min	$109.85	$169.00	$25.31–$41.76	41% above	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Pt Ther Exer 1 or > Area Ea 15m	$133.90	$206.00	$133.00–$274.00	71% above	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ot Ther Exer 1 or > Area Ea 15m	$133.90	$206.00	$25.31–$41.76	71% above	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 St Ther Exer 1 or > Areas Ea 15m	$133.90	$206.00	$25.31–$41.76	71% above	35%
Preventive checkup, new patient aged 18–39 CPT 99385 Prevent Visit New 18 to 39 Yrs	$242.45	$373.00	$24.25–$335.70	76% above	35%
Preventive checkup, new patient aged 40–64 CPT 99386 Prevent Visit New 40 to 64 Yrs	$200.20	$308.00	$20.02–$277.20	19% above	35%
Preventive checkup, new patient aged 65 or older CPT 99387 Prevent Visit New 65 and Older	$165.10	$254.00	$16.51–$228.60	at median	35%
Preventive checkup, new patient aged 65 or older CPT 99387 Prevent Visit New 65+ Yrs	$165.10	$254.00	$16.51–$228.60	at median	35%
Preventive checkup, returning patient aged 18–39 CPT 99395 Comp Preventive Med E/M 18/39 Yrs	$211.90	$326.00	$21.19–$293.40	70% above	35%
Preventive checkup, returning patient aged 18–39 CPT 99395 Prevent Visit Est 18 to 39 Yrs	$211.90	$326.00	$21.19–$293.40	70% above	35%
Preventive checkup, returning patient aged 40–64 CPT 99396 Comp Preventive Med E/M 40/64 Yrs	$183.95	$283.00	$18.40–$254.70	48% above	35%
Preventive checkup, returning patient aged 40–64 CPT 99396 Prevent Visit Est 40 to 64 Yrs	$183.95	$283.00	$18.40–$254.70	48% above	35%
Preventive checkup, returning patient aged 65 or older CPT 99397 Comp Preventive Med E/M 65 and Older	$159.90	$246.00	$15.99–$221.40	9% above	35%
Preventive checkup, returning patient aged 65 or older CPT 99397 Prevent Visit Est 65+ Yrs	$159.90	$246.00	$15.99–$221.40	9% above	35%
Psychiatric evaluation with medical services CPT 90792 Psy Diag Inter W/Med Ser Up to 15 Min	$156.65	$241.00	$136.97–$226.00	8% below	35%
Psychiatric evaluation with medical services CPT 90792 Psy Diag Inter W/Med Ser Up to 30 Min	$172.90	$266.00	$136.97–$226.00	2% above	35%
Psychiatric evaluation with medical services CPT 90792 Psy Diag Inter W/Med Ser Up to 45 Min	$180.70	$278.00	$136.97–$226.00	6% above	35%
Psychiatric evaluation with medical services CPT 90792 Psy Diag Inter W/Med Ser Up to 60 Min	$191.75	$295.00	$136.97–$226.00	13% above	35%
Psychiatric evaluation with medical services CPT 90792 Psy Diag Inter W/Med Ser Up to 75 Min	$211.90	$326.00	$136.97–$226.00	25% above	35%
Psychiatric evaluation with medical services CPT 90792 Psy Diag Inter W/Med Ser Up to 90 Min	$237.25	$365.00	$136.97–$226.00	40% above	35%
Psychiatric evaluation with medical services CPT 90792 Psy Diag Inter W/Med Ser Up to 105 Mn	$262.60	$404.00	$136.97–$226.00	54% above	35%
Psychiatric evaluation with medical services CPT 90792 Psy Diag Inter W/Med Ser Up to 120 Mn	$287.95	$443.00	$136.97–$226.00	69% above	35%
Psychiatric evaluation with medical services CPT 90792 Psy Diag Inter W/Med Ser > 120 Min	$313.30	$482.00	$31.33–$433.80	84% above	35%
Psychotherapy for crisis, first 60 minutes CPT 90839 Psychotherapy for Crisis/1st 60 Min	$442.65	$681.00	$136.97–$226.00	108% above	35%
Psychotherapy session, 30 minutes CPT 90832 Psych Ther 30 Min With Patient	$237.25	$365.00	$23.73–$328.50	46% above	35%
Psychotherapy session, 30 minutes CPT 90832 Cd Ther 30 Min W Patient	$263.90	$406.00	$67.90–$324.40	62% above	35%
Psychotherapy session, 45 minutes CPT 90834 Psych Ther 45 Min With Patient	$250.90	$386.00	$25.09–$347.40	31% above	35%
Psychotherapy session, 45 minutes CPT 90834 Cd Ther 45 Min W Patient	$278.85	$429.00	$89.77–$430.21	46% above	35%
Psychotherapy session, 60 minutes CPT 90837 Cd Ther 60 Min W Patient	$278.85	$429.00	$27.89–$386.10	16% above	35%
Psychotherapy session, 60 minutes CPT 90837 Psych Ther 60 Min With Patient	$278.85	$429.00	$27.89–$386.10	16% above	35%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking Cess > 3min Up to 10 Min	$49.40	$76.00	$10.25–$41.91	100% above	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Level V Visit Anticoagulation	$221.65	$341.00	$22.17–$306.90	2% below	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est Pt-Level 5 Twoc	$276.90	$426.00	$27.69–$383.40	22% above	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP Uc Visit Level V Est Pt	$276.90	$426.00	$120.23–$3,285.65	22% above	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Lactation Consult >60 Minutes	$276.90	$426.00	$27.69–$383.40	22% above	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP Visit Level V Est Pt	$290.55	$447.00	$29.06–$402.30	28% above	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP Visit Level V Est Pt/Behavioral Health	$290.55	$447.00	$120.23–$150.87	28% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Lactation Consult 31-45 Minutes	$165.10	$254.00	$55.06–$69.10	22% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Pt-Level 3 Twoc	$172.90	$266.00	$55.06–$69.10	27% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP Uc Visit Level III Est Pt	$175.50	$270.00	$288.00	29% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP Visit Level III Est Pt/Behavioral Health	$175.50	$270.00	$55.06–$69.10	29% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP Visit Level III Est Pt	$175.50	$270.00	$55.06–$69.10	29% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Level III Visit Anticoagulation	$206.70	$318.00	$55.06–$69.10	52% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Radiation Oncology Outpatient Clinic Visit	$212.55	$327.00	$55.06–$69.10	56% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 L&D Level II, 0-6 Hrs	$444.60	$684.00	$844.00–$2,270.00	227% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 L&D Level II, 6-12 Hrs	$733.85	$1,129.00	$844.00–$2,270.00	440% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 L&D Level II, 12-18 Hrs	$994.50	$1,530.00	$99.45–$1,377.00	632% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 L&D Level II, 18-24 Hrs	$1,325.35	$2,039.00	$55.06–$69.10	876% above	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Lactation Consult 46-60 Minutes	$210.60	$324.00	$21.06–$291.60	19% above	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Pt-Level 4 Twoc	$210.60	$324.00	$21.06–$291.60	19% above	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP Uc Visit Level IV Est Pt	$214.50	$330.00	$288.00	21% above	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Level IV Visit Anticoagulation	$214.50	$330.00	$21.45–$297.00	21% above	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP Visit Level IV Est Pt	$285.35	$439.00	$81.06–$101.72	61% above	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP Visit Level IV Est Pt/Behavioral Health	$285.35	$439.00	$81.06–$101.72	61% above	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Lactation Consult 16-30 Minutes	$124.15	$191.00	$29.80–$37.40	22% above	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Pt-Level 2 Twoc	$128.05	$197.00	$12.81–$177.30	26% above	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP Uc Visit Level II Est Pt	$150.80	$232.00	$288.00	48% above	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP Visit Level II Est Pt	$163.80	$252.00	$29.80–$37.40	61% above	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP Visit Level II Est Pt/Behavioral Health	$163.80	$252.00	$29.80–$37.40	61% above	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Level II Visit Anticoagulation	$167.05	$257.00	$16.71–$231.30	64% above	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 L&D Level I, 0-6 Hours	$410.80	$632.00	$29.80–$37.40	304% above	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 L&D Level I, 6-12 Hrs	$661.70	$1,018.00	$844.00–$2,270.00	551% above	35%
Speech and language evaluation CPT 92523 Eval Spch Sound Prod W/Lang Comp Up to 15m	$95.55	$147.00	$196.99–$325.03	61% below	35%
Speech and language evaluation CPT 92523 Eval Spch Sound Prod W/Lang Comp Up to 30m	$170.30	$262.00	$133.00–$274.00	31% below	35%
Speech and language evaluation CPT 92523 Eval Spch Sound Prod W/Lang Comp Up to 45m	$198.90	$306.00	$196.99–$325.03	19% below	35%
Speech and language evaluation CPT 92523 Eval Spch Sound Prod W/Lang Comp Up to 60m	$204.75	$315.00	$133.00–$274.00	17% below	35%
Speech and language evaluation CPT 92523 Eval Spch Sound Prod W/Lang Comp Up to 75m	$215.15	$331.00	$196.99–$325.03	13% below	35%
Speech and language evaluation CPT 92523 Eval Spch Sound Prod W/Lang Comp Up to 90m	$327.60	$504.00	$196.99–$325.03	33% above	35%
Speech and language evaluation CPT 92523 Eval Spch Sound Prod W/Lang Comp Up to 105m	$364.65	$561.00	$196.99–$325.03	48% above	35%
Speech and language evaluation CPT 92523 Eval Spch Sound Prod W/Lang Comp Up to 120m	$401.70	$618.00	$40.17–$556.20	63% above	35%
Speech therapy session, individual CPT 92507 St/Hear/Voice Tx Ind Up to 15m	$64.35	$99.00	$66.15–$109.15	62% below	35%
Speech therapy session, individual CPT 92507 St/Hear/Voice Tx Ind Up to 30m	$122.20	$188.00	$133.00–$274.00	28% below	35%
Speech therapy session, individual CPT 92507 St/Hear/Voice Tx Ind Up to 45m	$170.95	$263.00	$66.15–$109.15	1% above	35%
Speech therapy session, individual CPT 92507 St/Hear/Voice Tx Ind Up to 60m	$196.95	$303.00	$66.15–$109.15	17% above	35%
Speech therapy session, individual CPT 92507 St/Hear/Voice Tx Ind Up to 75m	$217.10	$334.00	$21.71–$300.60	28% above	35%
Speech therapy session, individual CPT 92507 St/Hear/Voice Tx Ind Up to 90m	$330.85	$509.00	$33.09–$458.10	96% above	35%
Spirometry (breathing test) CPT 94010 Spirometry W/WO Max Voluntary Vnt	$367.25	$565.00	$93.78–$250.39	59% above	35%
Spirometry before and after a bronchodilator CPT 94060 Bronchodial Pre and Post W Mvv	$945.10	$1,454.00	$161.37–$438.01	115% above	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 St Therapeutic Activ Pat Ea 15m	$93.60	$144.00	$30.29–$49.98	15% above	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 Pt Transfer Training Ea 15 Min	$93.60	$144.00	$133.00–$274.00	15% above	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 Pt Therapeutic Activ Pat Ea 15m	$94.25	$145.00	$9.43–$130.50	16% above	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 Ot Therapeutic Activ Pat Ea 15m	$94.25	$145.00	$9.43–$130.50	16% above	35%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy	$200.20	$308.00	$83.64–$767.94	15% above	35%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP	$621.94	$956.83	$245.22	275% above	35%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH,PERTUS(ACEL),TET PEDI (PF) 15 LF UNIT-10 MCG-5 LF/0.5 ML IM SUSP	$95.13	$146.35	$39.65	17% above	35%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25 LF-25 MCG-10LF-40-8-32D IM SUSP	$217.67	$334.87	$138.85	71% above	35%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE	$349.24	$537.30	$138.85	174% above	35%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE TRIV 2025-26 (6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE	$64.15	$98.70	$29.95	37% above	35%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VIRUS VACCINE RECMB(PF) 5 MCG/0.5 ML SYRINGE FOR PED/ADOL DOSE	$92.68	$142.58	$9.27–$128.32	24% above	35%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG IM SOLN (ACTHIB)	$42.77	$65.80	$4.28–$59.22	22% above	35%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACCINE TRIV 2025-26 (65YR UP)(PF)180 MCG/0.5 ML IM SYRINGE	$277.81	$427.40	$111.88	196% above	35%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT	$311.15	$478.70	$31.12–$430.83	96% above	35%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION	$573.17	$881.80	$230.44	62% above	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$1,000.61	$1,539.40	$100.06–$1,385.46	100% above	35%
Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION	$152.95	$235.31	$59.94	254% above	35%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION	$1,143.70	$1,759.54	$313.67–$399.69	35% above	35%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION	$331.47	$509.96	$33.15–$458.96	194% above	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH,PERTUS(ACEL)TETANUS(PF)2LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SUSP	$158.70	$244.15	$53.21–$87.98	61% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Adm 1st Vaccine Clinic	$85.80	$132.00	$70.75–$90.15	46% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Hepatitis B Vaccine	$85.80	$132.00	$60.68–$100.12	46% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Imm Admin Vac/Toxoid X1	$95.55	$147.00	$70.75–$90.15	62% above	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Imm Admin Vac/Toxoid Ea Addl	$33.15	$51.00	$14.34	27% below	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Ea Addtl After 1 Clinic	$70.85	$109.00	$7.09–$98.10	56% above	35%

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.mercy.net/content/dam/mercy/en/web-assets/charge-files/562410022_mercy-hospital-washington_standardcharges.zip