Hospital

Norton County Hospital

Norton County Hospital in Norton, KS publishes cash prices for 279 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Kansas median for 138 of 274 procedures and below it for 130. By typical cash price it ranks #32 of 55 Kansas hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

102 E Holme Street, Norton, KS 67654 Collected Sep 27, 2026 Source price file (785) 877-3351

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 171348 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete 3+ Views Left	$174.30	$249.00	—	20% below	30%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete 3+ Views Right	$174.30	$249.00	—	20% below	30%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete 3+ Views Right	$174.30	$249.00	—	—	30%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete 3+ Views Left	$174.30	$249.00	—	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABI	$744.10	$1,063.00	—	24% above	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 US ABI Limited Right	$744.10	$1,063.00	—	24% above	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 US ABI Limited Left	$744.10	$1,063.00	—	24% above	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ABI	$744.10	$1,063.00	—	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 US ABI Limited Right	$744.10	$1,063.00	—	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 US ABI Limited Left	$744.10	$1,063.00	—	—	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus	$471.10	$673.00	—	4% above	30%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus	$471.10	$673.00	—	—	30%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Imaging Whole Body	$1,346.80	$1,924.00	—	3% above	30%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Imaging Whole Body	$1,346.80	$1,924.00	—	—	30%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Left.	$408.80	$584.00	—	68% above	30%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Right.	$408.80	$584.00	—	68% above	30%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Left.	$408.80	$584.00	—	—	30%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Right.	$408.80	$584.00	—	—	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Left.	$337.40	$482.00	—	35% above	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Right.	$337.40	$482.00	—	35% above	30%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Right.	$337.40	$482.00	—	—	30%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Left.	$337.40	$482.00	—	—	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest	$1,236.90	$1,767.00	—	30% below	30%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest	$1,236.90	$1,767.00	—	—	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen/Pelvis w/o Cont	$665.70	$951.00	—	48% below	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen and Pelvis w/o Contrast	$665.70	$951.00	—	48% below	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 74176 CT Abdomen and Pelvis w/o Contrast	$665.70	$951.00	—	48% below	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Renal Stone Study	$1,431.50	$2,045.00	—	11% above	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen/Pelvis w/o Cont	$665.70	$951.00	—	—	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen and Pelvis w/o Contrast	$665.70	$951.00	—	—	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 74176 CT Abdomen and Pelvis w/o Contrast	$665.70	$951.00	—	—	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Renal Stone Study	$1,431.50	$2,045.00	—	—	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen and Pelvis w/ Contrast	$665.70	$951.00	—	51% below	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 74177 CT Abdomen and Pelvis w/ Contrast	$665.70	$951.00	—	51% below	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen/Pelvis w/ Cont	$665.70	$951.00	—	51% below	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen/Pelvis w/ Cont	$665.70	$951.00	—	—	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen and Pelvis w/ Contrast	$665.70	$951.00	—	—	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 74177 CT Abdomen and Pelvis w/ Contrast	$665.70	$951.00	—	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen/Pelvis w/ + w/o Cont	$686.70	$981.00	—	63% below	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$686.70	$981.00	—	63% below	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$686.70	$981.00	—	63% below	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen/Pelvis w/ + w/o Cont	$686.70	$981.00	—	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$686.70	$981.00	—	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$686.70	$981.00	—	—	30%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Cont	$604.80	$864.00	—	57% below	30%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast	$604.80	$864.00	—	57% below	30%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Cont	$604.80	$864.00	—	—	30%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Contrast	$604.80	$864.00	—	—	30%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast	$1,183.00	$1,690.00	—	2% below	30%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Cont	$1,183.00	$1,690.00	—	2% below	30%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Cont	$1,183.00	$1,690.00	—	—	30%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Contrast	$1,183.00	$1,690.00	—	—	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Contrast	$1,010.80	$1,444.00	—	3% above	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Contrast	$1,010.80	$1,444.00	—	—	30%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head w/o Contrast	$610.40	$872.00	—	40% below	30%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head w/o Contrast	$610.40	$872.00	—	—	30%
CT scan of the head with contrast CPT 70460 CT Head w/ Contrast	$604.10	$863.00	—	47% below	30%
CT scan of the head with contrast inpatient CPT 70460 CT Head w/ Contrast	$604.10	$863.00	—	—	30%
CT scan of the head without and with contrast CPT 70470 CT HEAD W and W/O CONTRAST	$754.60	$1,078.00	—	40% below	30%
CT scan of the head without and with contrast CPT 70470 CT Head w/ + w/o Contrast	$1,366.40	$1,952.00	—	9% above	30%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W and W/O CONTRAST	$754.60	$1,078.00	—	—	30%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head w/ + w/o Contrast	$1,366.40	$1,952.00	—	—	30%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Contrast	$1,139.60	$1,628.00	—	at median	30%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Contrast	$1,139.60	$1,628.00	—	—	30%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Contrast	$665.70	$951.00	—	33% below	30%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Contrast	$665.70	$951.00	—	—	30%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast	$604.80	$864.00	—	47% below	30%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast	$604.80	$864.00	—	—	30%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Bilateral	$651.00	$930.00	—	—	30%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Duplex Bilateral	$651.00	$930.00	—	—	30%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$239.40	$342.00	—	4% above	30%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$239.40	$342.00	—	—	30%
Chest X-ray, single view CPT 71045 XR Chest 1 View	$132.30	$189.00	—	32% below	30%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View	$132.30	$189.00	—	—	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$465.50	$665.00	—	13% above	30%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete	$465.50	$665.00	—	—	30%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton	$335.30	$479.00	—	6% above	30%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Density DEXA Axial Skeleton	$335.30	$479.00	—	—	30%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB Detailed Complete First Gest	$247.80	$354.00	—	43% below	30%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB Detailed Complete First Gest	$247.80	$354.00	—	—	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest/Abdomen w/o Contrast	$945.00	$1,350.00	—	1% below	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Cont	$945.00	$1,350.00	—	1% below	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Contrast	$945.00	$1,350.00	—	1% below	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest/Abd/Pelvis w/o Contrast	$945.00	$1,350.00	—	1% below	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Contrast	$945.00	$1,350.00	—	—	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest/Abdomen w/o Contrast	$945.00	$1,350.00	—	—	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Cont	$945.00	$1,350.00	—	—	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest/Abd/Pelvis w/o Contrast	$945.00	$1,350.00	—	—	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Cont	$1,171.10	$1,673.00	—	7% above	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest/Abdomen w/ Contrast	$1,171.10	$1,673.00	—	7% above	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest/Abd/Pelvis w/ Contrast	$1,171.10	$1,673.00	—	7% above	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Contrast	$1,171.10	$1,673.00	—	7% above	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Cont	$1,171.10	$1,673.00	—	—	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Contrast	$1,171.10	$1,673.00	—	—	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest/Abd/Pelvis w/ Contrast	$1,171.10	$1,673.00	—	—	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest/Abdomen w/ Contrast	$1,171.10	$1,673.00	—	—	30%
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Digital Diagnostic Bilat.	$206.50	$295.00	—	—	30%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Digital Diagnostic Bilat.	$206.50	$295.00	—	—	30%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Digital Diagnostic Right.	$196.00	$280.00	—	at median	30%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Digital Diagnostic Left.	$196.00	$280.00	—	at median	30%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Digital Diagnostic Left.	$196.00	$280.00	—	—	30%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Digital Diagnostic Right.	$196.00	$280.00	—	—	30%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral	$658.70	$941.00	—	—	30%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral	$658.70	$941.00	—	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Upper Ext Venous Duplex Bilateral	$595.00	$850.00	—	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Lower Ext Venous Duplex Bilateral	$595.00	$850.00	—	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Upper Ext Venous Duplex Bilateral	$595.00	$850.00	—	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Lower Ext Venous Duplex Bilateral	$595.00	$850.00	—	—	30%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo Doppler Complete	$1,729.70	$2,471.00	—	9% below	30%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo Doppler Complete	$1,729.70	$2,471.00	—	—	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary Imaging	$1,046.50	$1,495.00	—	32% below	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary Imaging	$1,046.50	$1,495.00	—	—	30%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 95800 HOME SLEEP TEST W/INTERPETATION	$335.30	$479.00	—	7% below	30%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 95800 HOME SLEEP TEST W/INTERPETATION	$335.30	$479.00	—	—	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 ATTEND SPLIT NIGHT SLEEP STUDY W/ INTERP	$3,603.60	$5,148.00	—	9% above	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 95811 ATTEND SPLIT NIGHT SLEEP STUDY W/ INTERP	$3,603.60	$5,148.00	—	—	30%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Right	$234.50	$335.00	—	at median	30%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Left	$234.50	$335.00	—	at median	30%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Right	$234.50	$335.00	—	—	30%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Left	$234.50	$335.00	—	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited	$420.70	$601.00	—	21% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Limited	$420.70	$601.00	—	—	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Cancer Screening	$746.20	$1,066.00	—	16% above	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Cancer Screening	$746.20	$1,066.00	—	—	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Contrast Left	$907.90	$1,297.00	—	11% below	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Contrast Right	$907.90	$1,297.00	—	11% below	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Contrast Left	$907.90	$1,297.00	—	11% below	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Left	$907.90	$1,297.00	—	11% below	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Right	$907.90	$1,297.00	—	11% below	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Contrast Right	$907.90	$1,297.00	—	11% below	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Contrast Right	$907.90	$1,297.00	—	—	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Contrast Left	$907.90	$1,297.00	—	—	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Contrast Right	$907.90	$1,297.00	—	—	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Contrast Left	$907.90	$1,297.00	—	—	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Contrast Right	$907.90	$1,297.00	—	—	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Contrast Left	$907.90	$1,297.00	—	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Left	$1,680.00	$2,400.00	—	at median	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Contrast Left	$1,680.00	$2,400.00	—	at median	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Right	$1,680.00	$2,400.00	—	at median	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Contrast Right	$1,680.00	$2,400.00	—	at median	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Left	$1,680.00	$2,400.00	—	at median	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Right	$1,680.00	$2,400.00	—	at median	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Contrast Left	$1,680.00	$2,400.00	—	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Contrast Right	$1,680.00	$2,400.00	—	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Contrast Left	$1,680.00	$2,400.00	—	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Contrast Right	$1,680.00	$2,400.00	—	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Contrast Right	$1,680.00	$2,400.00	—	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Contrast Left	$1,680.00	$2,400.00	—	—	30%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Contrast	$907.90	$1,297.00	—	29% below	30%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Contrast	$907.90	$1,297.00	—	—	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Contrast	$1,680.00	$2,400.00	—	1% above	30%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Contrast	$1,680.00	$2,400.00	—	—	30%
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast	$907.90	$1,297.00	—	29% below	30%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast	$907.90	$1,297.00	—	—	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast	$1,680.00	$2,400.00	—	2% below	30%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast	$1,680.00	$2,400.00	—	—	30%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast	$907.90	$1,297.00	—	26% below	30%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast	$907.90	$1,297.00	—	—	30%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ Contrast	$907.90	$1,297.00	—	49% below	30%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ Contrast	$907.90	$1,297.00	—	—	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast	$907.90	$1,297.00	—	19% below	30%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Contrast	$907.90	$1,297.00	—	—	30%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$1,680.00	$2,400.00	—	1% below	30%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$1,680.00	$2,400.00	—	—	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast	$907.90	$1,297.00	—	20% below	30%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Contrast	$907.90	$1,297.00	—	—	30%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Contrast	$1,680.00	$2,400.00	—	at median	30%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Contrast	$1,680.00	$2,400.00	—	—	30%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast	$907.90	$1,297.00	—	19% below	30%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Contrast	$907.90	$1,297.00	—	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Contrast Right	$907.90	$1,297.00	—	13% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Contrast Right	$907.90	$1,297.00	—	13% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Scapula w/o Contrast Right	$907.90	$1,297.00	—	13% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Contrast Left	$907.90	$1,297.00	—	13% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Contrast Right	$907.90	$1,297.00	—	13% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Contrast Left	$907.90	$1,297.00	—	13% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Scapula w/o Contrast Left	$907.90	$1,297.00	—	13% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Contrast Left	$907.90	$1,297.00	—	13% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Scapula w/o Contrast Right	$907.90	$1,297.00	—	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Contrast Right	$907.90	$1,297.00	—	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Contrast Left	$907.90	$1,297.00	—	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Scapula w/o Contrast Left	$907.90	$1,297.00	—	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Contrast Right	$907.90	$1,297.00	—	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Contrast Right	$907.90	$1,297.00	—	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Contrast Left	$907.90	$1,297.00	—	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Contrast Left	$907.90	$1,297.00	—	—	30%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial SPECT Multiple Studies	$1,499.40	$2,142.00	—	45% below	30%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial SPECT Multiple Studies	$1,499.40	$2,142.00	—	—	30%
OCT scan of the retina (optical coherence tomography) CPT 92134 OCULAR COHERENCE TOMOGRAPHY	$39.90	$57.00	—	—	30%
OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 OCULAR COHERENCE TOMOGRAPHY	$39.90	$57.00	—	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic Ltd	$343.70	$491.00	—	2% above	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic Ltd	$343.70	$491.00	—	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Comp w/Transvag if indicated	$605.50	$865.00	—	74% above	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Non OB	$605.50	$865.00	—	74% above	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Non OB	$605.50	$865.00	—	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis Comp w/Transvag if indicated	$605.50	$865.00	—	—	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 NORT US OB > 14 Weeks	$210.00	$300.00	—	45% below	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Greater Than 14 Weeks	$614.60	$878.00	—	62% above	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 NORT US OB > 14 Weeks	$210.00	$300.00	—	—	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Greater Than 14 Weeks	$614.60	$878.00	—	—	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB Less Than 14 Weeks Single	$372.40	$532.00	—	7% above	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB < 14 Weeks Addl Fetus	$632.80	$904.00	—	81% above	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB Less Than 14 Weeks Single	$372.40	$532.00	—	—	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB < 14 Weeks Addl Fetus	$632.80	$904.00	—	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited	$423.50	$605.00	—	34% above	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 NORT US OB Limited	$423.50	$605.00	—	34% above	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited	$423.50	$605.00	—	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 NORT US OB Limited	$423.50	$605.00	—	—	30%
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Digital Screening Bilateral.	$234.50	$335.00	—	—	30%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Digital Screening Left.	$196.00	$280.00	—	at median	30%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Digital Screening Right.	$196.00	$280.00	—	at median	30%
Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Digital Screening Bilateral.	$234.50	$335.00	—	—	30%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Digital Screening Right.	$196.00	$280.00	—	—	30%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Digital Screening Left.	$196.00	$280.00	—	—	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete 2+ Views Right	$210.70	$301.00	—	1% below	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete 2+ Views Left	$210.70	$301.00	—	1% below	30%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete 2+ Views Left	$210.70	$301.00	—	—	30%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete 2+ Views Right	$210.70	$301.00	—	—	30%
Sleep study in a lab (polysomnography) CPT 95810 95810 ATTEND BASELINE SLEEP STUDY W/INT	$3,109.40	$4,442.00	—	at median	30%
Sleep study in a lab (polysomnography) inpatient CPT 95810 95810 ATTEND BASELINE SLEEP STUDY W/INT	$3,109.40	$4,442.00	—	—	30%
Transvaginal pelvic ultrasound CPT 76830 NORT US Transvaginal Non-OB	$199.50	$285.00	—	38% below	30%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB	$510.30	$729.00	—	59% above	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 NORT US Transvaginal Non-OB	$199.50	$285.00	—	—	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB	$510.30	$729.00	—	—	30%
Transvaginal ultrasound during pregnancy CPT 76817 NORT US OB Transvaginal	$227.50	$325.00	—	36% below	30%
Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal	$516.60	$738.00	—	44% above	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 NORT US OB Transvaginal	$227.50	$325.00	—	—	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal	$516.60	$738.00	—	—	30%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$408.80	$584.00	—	5% below	30%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$408.80	$584.00	—	—	30%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents)	$557.20	$796.00	—	43% above	30%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents)	$557.20	$796.00	—	—	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid	$492.10	$703.00	—	18% below	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid	$492.10	$703.00	—	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Venous Duplex Left	$621.60	$888.00	—	4% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Ext Venous Duplex Right	$621.60	$888.00	—	4% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Venous Duplex Right	$621.60	$888.00	—	4% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Ext Venous Duplex Left	$621.60	$888.00	—	4% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Ext Venous Duplex Left	$621.60	$888.00	—	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Venous Duplex Left	$621.60	$888.00	—	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Venous Duplex Right	$621.60	$888.00	—	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Ext Venous Duplex Right	$621.60	$888.00	—	—	30%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete 3+ Views Left	$161.70	$231.00	—	29% below	30%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete 3+ Views Right	$161.70	$231.00	—	29% below	30%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete 3+ Views Right	$161.70	$231.00	—	—	30%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete 3+ Views Left	$161.70	$231.00	—	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Left	$250.60	$358.00	—	3% below	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Right	$250.60	$358.00	—	3% below	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Right	$250.60	$358.00	—	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Left	$250.60	$358.00	—	—	30%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View	$239.40	$342.00	—	14% above	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View	$239.40	$342.00	—	—	30%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Left	$251.30	$359.00	—	32% above	30%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Right	$251.30	$359.00	—	32% above	30%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Right	$251.30	$359.00	—	—	30%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Left	$251.30	$359.00	—	—	30%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger(s) 2+ Views Left	$133.70	$191.00	—	20% below	30%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger(s) 2+ Views Right	$133.70	$191.00	—	20% below	30%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger(s) 2+ Views Left	$133.70	$191.00	—	—	30%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger(s) 2+ Views Right	$133.70	$191.00	—	—	30%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Right	$260.40	$372.00	—	38% above	30%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Left	$260.40	$372.00	—	38% above	30%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Left	$260.40	$372.00	—	—	30%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Right	$260.40	$372.00	—	—	30%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete 3+ Views Left	$202.30	$289.00	—	7% below	30%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete 3+ Views Right	$217.00	$310.00	—	1% below	30%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete 3+ Views Left	$202.30	$289.00	—	—	30%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete 3+ Views Right	$217.00	$310.00	—	—	30%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete 3+ Views Left	$322.00	$460.00	—	50% above	30%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete 3+ Views Right	$322.00	$460.00	—	50% above	30%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete 3+ Views Right	$322.00	$460.00	—	—	30%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete 3+ Views Left	$322.00	$460.00	—	—	30%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Left	$126.70	$181.00	—	33% below	30%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Right	$126.70	$181.00	—	33% below	30%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Right	$126.70	$181.00	—	—	30%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Left	$126.70	$181.00	—	—	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$197.40	$282.00	—	28% below	30%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$197.40	$282.00	—	—	30%
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral 4+ Views	$336.70	$481.00	—	15% below	30%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral 4+ Views	$336.70	$481.00	—	—	30%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views	$318.50	$455.00	—	44% above	30%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views	$318.50	$455.00	—	—	30%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones 3+ Views	$253.40	$362.00	—	9% above	30%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones 3+ Views	$253.40	$362.00	—	—	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 Views	$318.50	$455.00	—	28% above	30%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical 2 or 3 Views	$318.50	$455.00	—	—	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views	$148.40	$212.00	—	28% below	30%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views	$148.40	$212.00	—	—	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx 2+ Views	$308.00	$440.00	—	37% above	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum/Coccyx 2+ Views	$308.00	$440.00	—	—	30%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine aminotransferase	$33.60	$48.00	—	10% below	30%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine aminotransferase	$33.60	$48.00	—	—	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate aminotransferase	$35.70	$51.00	—	4% below	30%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Aspartate aminotransferase	$35.70	$51.00	—	—	30%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel Acute with rfx to conf QST	$207.20	$296.00	—	at median	30%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Panel Acute with rfx to conf QST	$207.20	$296.00	—	—	30%
Allergy blood test, specific IgE, per allergen CPT 86003 .Resp Allergy Profile Reg X Interp QST	$25.90	$37.00	—	16% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Sesame Seed (F10) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Cashew Nut (F202) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Cow's Milk (F2) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Tuna (F40) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Soybean (F14) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White (F1) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Almond (F20) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp (F24) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut (F13) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Codfish (F3) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Hazelnut (F17) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut (F256) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Salmon (F41) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Wheat (F4) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Scallop (F338) IgE QST	$27.30	$39.00	—	12% below	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 .Resp Allergy Profile Reg X Interp QST	$25.90	$37.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Shrimp (F24) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peanut (F13) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Salmon (F41) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Scallop (F338) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hazelnut (F17) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Almond (F20) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg White (F1) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cow's Milk (F2) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cashew Nut (F202) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sesame Seed (F10) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Codfish (F3) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Soybean (F14) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tuna (F40) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Wheat (F4) IgE QST	$27.30	$39.00	—	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut (F256) IgE QST	$27.30	$39.00	—	—	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Lambda Light Chain Free Serum QST	$71.40	$102.00	—	2% above	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Screen, IFA, Reflex Titer/Pattern, and reflex to Multipl	$73.50	$105.00	—	5% above	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Lambda Light Chain Free Serum QST	$71.40	$102.00	—	—	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Screen, IFA, Reflex Titer/Pattern, and reflex to Multipl	$73.50	$105.00	—	—	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Pro BNP	$109.20	$156.00	—	15% below	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-Type Natriuretic Peptide	$248.50	$355.00	—	93% above	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 RL PRO BNP	$248.50	$355.00	—	93% above	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP POCT	$248.50	$355.00	—	93% above	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Pro BNP	$109.20	$156.00	—	—	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP POCT	$248.50	$355.00	—	—	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-Type Natriuretic Peptide	$248.50	$355.00	—	—	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 RL PRO BNP	$248.50	$355.00	—	—	30%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel POCT	$66.50	$95.00	—	19% below	30%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$77.70	$111.00	—	5% below	30%
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel POCT	$66.50	$95.00	—	—	30%
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel	$77.70	$111.00	—	—	30%
Blood culture for bacteria CPT 87040 Culture Blood QST	$61.60	$88.00	—	18% below	30%
Blood culture for bacteria inpatient CPT 87040 Culture Blood QST	$61.60	$88.00	—	—	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$19.60	$28.00	—	7% above	30%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$19.60	$28.00	—	—	30%
Blood glucose (sugar) test CPT 82947 Glucose Level	$50.40	$72.00	—	56% above	30%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level	$50.40	$72.00	—	—	30%
Blood lead test CPT 83655 Lead, Blood QST	$62.30	$89.00	—	19% above	30%
Blood lead test inpatient CPT 83655 Lead, Blood QST	$62.30	$89.00	—	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Beta hCG Qualitative	$225.40	$322.00	—	293% above	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Beta hCG Qualitative	$225.40	$322.00	—	—	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh	$336.00	$480.00	—	283% above	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 .Post TR ABO/Rh	$336.00	$480.00	—	283% above	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 .Pre TR ABO/Rh	$336.00	$480.00	—	283% above	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 .Post TR ABO/Rh	$336.00	$480.00	—	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh	$336.00	$480.00	—	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 .Pre TR ABO/Rh	$336.00	$480.00	—	—	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$48.30	$69.00	—	1% above	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein High Sensitivity	$93.10	$133.00	—	94% above	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$48.30	$69.00	—	—	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein High Sensitivity	$93.10	$133.00	—	—	30%
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium Difficile Toxin B, Ql Real Time PCR QST	$123.20	$176.00	—	14% above	30%
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium difficile PCR	$154.70	$221.00	—	43% above	30%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Clostridium Difficile Toxin B, Ql Real Time PCR QST	$123.20	$176.00	—	—	30%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Clostridium difficile PCR	$154.70	$221.00	—	—	30%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 QST	$162.40	$232.00	—	89% above	30%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 QST	$162.40	$232.00	—	—	30%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 QST	$126.00	$180.00	—	37% above	30%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 QST	$126.00	$180.00	—	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 RNA (COVID-19), Qualitative NAAT QST	$136.50	$195.00	—	at median	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) RNA (ID Now)	$182.00	$260.00	—	33% above	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 RNA (COVID-19), Qualitative NAAT QST	$136.50	$195.00	—	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) RNA (ID Now)	$182.00	$260.00	—	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis RNA, TMA, Uro QST	$152.60	$218.00	—	35% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Trachomatis RNA, TMA, Uro QST	$152.60	$218.00	—	—	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$104.30	$149.00	—	21% above	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$104.30	$149.00	—	—	30%
Complete blood count (CBC) with differential CPT 85025 CBC w/ Differential	$15.40	$22.00	—	62% below	30%
Complete blood count (CBC) with differential CPT 85025 Auto Diff	$53.90	$77.00	—	33% above	30%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Differential	$15.40	$22.00	—	—	30%
Complete blood count (CBC) with differential inpatient CPT 85025 Auto Diff	$53.90	$77.00	—	—	30%
Complete blood count (CBC), no differential CPT 85027 CBC without Differential	$42.70	$61.00	—	9% below	30%
Complete blood count (CBC), no differential CPT 85027 CBC w/ Manual Differential	$42.70	$61.00	—	9% below	30%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC w/ Manual Differential	$42.70	$61.00	—	—	30%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC without Differential	$42.70	$61.00	—	—	30%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$66.50	$95.00	—	36% below	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$66.50	$95.00	—	—	30%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer Quantitative QST	$117.60	$168.00	—	1% above	30%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$119.70	$171.00	—	3% above	30%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer Quantitative QST	$117.60	$168.00	—	—	30%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer	$119.70	$171.00	—	—	30%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA Sulfate QST	$129.50	$185.00	—	1% above	30%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA Sulfate QST	$129.50	$185.00	—	—	30%
Estradiol blood test CPT 82670 Estradiol QST	$199.50	$285.00	—	18% above	30%
Estradiol blood test inpatient CPT 82670 Estradiol QST	$199.50	$285.00	—	—	30%
FSH (follicle-stimulating hormone) test CPT 83001 FSH QST	$127.40	$182.00	—	11% above	30%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH QST	$127.40	$182.00	—	—	30%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Stool QST	$296.10	$423.00	—	36% above	30%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Stool QST	$296.10	$423.00	—	—	30%
Ferritin blood test (iron stores) CPT 82728 FERRITIN QST	$90.30	$129.00	—	2% above	30%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$90.30	$129.00	—	2% above	30%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN QST	$90.30	$129.00	—	—	30%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$90.30	$129.00	—	—	30%
Folate (folic acid) blood test CPT 82746 FOLATE, SERUM QST	$98.70	$141.00	—	1% above	30%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE, SERUM QST	$98.70	$141.00	—	—	30%
Free T3 thyroid hormone test CPT 84481 T3 Free QST	$154.00	$220.00	—	21% above	30%
Free T3 thyroid hormone test inpatient CPT 84481 T3 Free QST	$154.00	$220.00	—	—	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 Level	$56.00	$80.00	—	8% below	30%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4 Level	$56.00	$80.00	—	—	30%
Free testosterone test CPT 84402 TESTOSTERONE, FREE (DIALYSIS) AND TOTAL,MS QST	$300.30	$429.00	—	112% above	30%
Free testosterone test CPT 84402 TESTOSTERONE, FREE QST	$300.30	$429.00	—	112% above	30%
Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE (DIALYSIS) AND TOTAL,MS QST	$300.30	$429.00	—	—	30%
Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE QST	$300.30	$429.00	—	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae RNA, TMA, Uro QST	$150.50	$215.00	—	48% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Gonorrhoeae RNA, TMA, Uro QST	$150.50	$215.00	—	—	30%
H. pylori stool antigen test CPT 87338 Helicobacter Pylori Ag, EIA, Stool QST	$156.80	$224.00	—	38% above	30%
H. pylori stool antigen test inpatient CPT 87338 Helicobacter Pylori Ag, EIA, Stool QST	$156.80	$224.00	—	—	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA, Qn, Real-Time PCR QST	$486.50	$695.00	—	43% above	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA, Qn, Real-Time PCR QST	$486.50	$695.00	—	—	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 Ag/Ab ,Fourth Gen w/RFL QST	$95.20	$136.00	—	3% above	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 Ag/Ab ,Fourth Gen w/RFL QST	$95.20	$136.00	—	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C	$57.40	$82.00	—	17% below	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C	$57.40	$82.00	—	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab Immunity, Qnt QST	$128.80	$184.00	—	77% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY QL QST	$128.80	$184.00	—	77% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY QL QST	$128.80	$184.00	—	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Ab Immunity, Qnt QST	$128.80	$184.00	—	—	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag w/Reflex Conf QST	$109.90	$157.00	—	86% above	30%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Ag w/Reflex Conf QST	$109.90	$157.00	—	—	30%
Hepatitis C antibody blood test (screening) CPT 86803 Hep C Ab w/Rfx HCV, RNA, Quant, PCR QST	$112.00	$160.00	—	48% above	30%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hep C Ab w/Rfx HCV, RNA, Quant, PCR QST	$112.00	$160.00	—	—	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Viral RNA, QN Real Time PCR w/Refls QST	$146.30	$209.00	—	52% below	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA, Qn Real Time PCR QST	$401.80	$574.00	—	32% above	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Viral RNA, QN Real Time PCR w/Refls QST	$146.30	$209.00	—	—	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA, Qn Real Time PCR QST	$401.80	$574.00	—	—	30%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN QST	$104.30	$149.00	—	15% above	30%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN QST	$104.30	$149.00	—	—	30%
Homocysteine blood test CPT 83090 Homocysteine QST	$281.40	$402.00	—	22% above	30%
Homocysteine blood test inpatient CPT 83090 Homocysteine QST	$281.40	$402.00	—	—	30%
Insulin blood test CPT 83525 Insulin QST	$105.70	$151.00	—	31% above	30%
Insulin blood test inpatient CPT 83525 Insulin QST	$105.70	$151.00	—	—	30%
Iron blood test (serum iron) CPT 83540 Iron Level	$41.30	$59.00	—	4% below	30%
Iron blood test (serum iron) CPT 83540 Transferrin Saturation %	$123.90	$177.00	—	189% above	30%
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$41.30	$59.00	—	—	30%
Iron blood test (serum iron) inpatient CPT 83540 Transferrin Saturation %	$123.90	$177.00	—	—	30%
Iron-binding capacity (TIBC) test CPT 83550 Total Iron Binding Capacity	$73.50	$105.00	—	17% above	30%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Total Iron Binding Capacity	$73.50	$105.00	—	—	30%
Kidney function blood test panel CPT 80069 Renal Function Panel	$97.30	$139.00	—	37% above	30%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$97.30	$139.00	—	—	30%
LH (luteinizing hormone) test CPT 83002 LH QST	$132.30	$189.00	—	19% above	30%
LH (luteinizing hormone) test inpatient CPT 83002 LH QST	$132.30	$189.00	—	—	30%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$68.60	$98.00	—	10% above	30%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$68.60	$98.00	—	—	30%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$93.10	$133.00	—	1% above	30%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$93.10	$133.00	—	—	30%
Lyme disease antibody test CPT 86618 Lyme Disease Ab w/Rfx Blot(IgG, IgM) QST	$130.20	$186.00	—	7% above	30%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Ab w/Rfx Blot(IgG, IgM) QST	$130.20	$186.00	—	—	30%
Magnesium blood test CPT 83735 Magnesium Level	$51.80	$74.00	—	4% below	30%
Magnesium blood test inpatient CPT 83735 Magnesium Level	$51.80	$74.00	—	—	30%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$56.70	$81.00	—	23% above	30%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen	$56.70	$81.00	—	—	30%
Obstetric blood test panel CPT 80055 Prenatal Panel	$257.60	$368.00	—	47% above	30%
Obstetric blood test panel inpatient CPT 80055 Prenatal Panel	$257.60	$368.00	—	—	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, Free QST	$105.00	$150.00	—	14% above	30%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, Free QST	$105.00	$150.00	—	—	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA-Total	$14.00	$20.00	—	86% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic	$81.20	$116.00	—	22% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Total QST	$147.00	$210.00	—	42% above	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA-Total	$14.00	$20.00	—	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic	$81.20	$116.00	—	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Total QST	$147.00	$210.00	—	—	30%
Parathyroid hormone (PTH) blood test CPT 83970 PTH, Intact w/o Calcium QST	$247.10	$353.00	—	23% above	30%
Parathyroid hormone (PTH) blood test CPT 83970 PTH, Intact and Calcium QST	$247.10	$353.00	—	23% above	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, Intact w/o Calcium QST	$247.10	$353.00	—	—	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, Intact and Calcium QST	$247.10	$353.00	—	—	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT-LA Screen QST	$59.50	$85.00	—	34% above	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$60.20	$86.00	—	36% above	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT-LA Screen QST	$59.50	$85.00	—	—	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time	$60.20	$86.00	—	—	30%
Progesterone blood test CPT 84144 Progesterone QST	$114.10	$163.00	—	4% above	30%
Progesterone blood test inpatient CPT 84144 Progesterone QST	$114.10	$163.00	—	—	30%
Prolactin blood test CPT 84146 Prolactin QST	$140.70	$201.00	—	10% above	30%
Prolactin blood test inpatient CPT 84146 Prolactin QST	$140.70	$201.00	—	—	30%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time and INR	$36.40	$52.00	—	18% above	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time and INR	$36.40	$52.00	—	—	30%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TESTING DIP STICK PER SERVICE DATE	$44.80	$64.00	—	19% below	30%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Fentanyl Screen Urine	$47.60	$68.00	—	14% below	30%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TESTING DIP STICK PER SERVICE DATE	$44.80	$64.00	—	—	30%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Fentanyl Screen Urine	$47.60	$68.00	—	—	30%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep A Rapid	$87.50	$125.00	—	27% above	30%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Strep A Rapid	$87.50	$125.00	—	—	30%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor QST	$49.70	$71.00	—	4% above	30%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor QST	$49.70	$71.00	—	—	30%
Rubella antibody test (immunity check) CPT 86762 Rubella Ab (IgG) Diagnostic QST	$183.40	$262.00	—	216% above	30%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB (IGG), IMMUNE STATUS QST	$183.40	$262.00	—	216% above	30%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Ab (IgG) Diagnostic QST	$183.40	$262.00	—	—	30%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB (IGG), IMMUNE STATUS QST	$183.40	$262.00	—	—	30%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESR (Erythrocyte Sedimentation Rate)	$27.30	$39.00	—	15% below	30%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESR Westergren	$70.70	$101.00	—	119% above	30%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESR (Erythrocyte Sedimentation Rate)	$27.30	$39.00	—	—	30%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESR Westergren	$70.70	$101.00	—	—	30%
Stool ova and parasites exam CPT 87177 Ova and Parasites Source QST	$50.40	$72.00	—	17% below	30%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasites Source QST	$50.40	$72.00	—	—	30%
Stool test for hidden blood (guaiac FOBT) CPT 82270 CL OCCULT BLOOD FECES	$28.00	$40.00	—	4% above	30%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 CL OCCULT BLOOD FECES	$28.00	$40.00	—	—	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fecal Globin by Immunochemistry QST	$54.60	$78.00	—	7% above	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Occult Blood Stool Screen	$63.00	$90.00	—	23% above	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Fecal Globin by Immunochemistry QST	$54.60	$78.00	—	—	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Occult Blood Stool Screen	$63.00	$90.00	—	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR TITER QST	$46.20	$66.00	—	29% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR (DX) W/REFL TITER AND CONFIRMATORY TESTING QST	$46.20	$66.00	—	29% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR TITER QST	$46.20	$66.00	—	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR (DX) W/REFL TITER AND CONFIRMATORY TESTING QST	$46.20	$66.00	—	—	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Celiac Disease Comprehensive Panel QST	$232.40	$332.00	—	23% above	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON(R)-TB Gold Plus, 1 Tube QST	$232.40	$332.00	—	23% above	30%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QuantiFERON(R)-TB Gold Plus, 1 Tube QST	$232.40	$332.00	—	—	30%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Celiac Disease Comprehensive Panel QST	$232.40	$332.00	—	—	30%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total MS QST	$130.20	$186.00	—	9% below	30%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone,Total,Males (Adult), IA QST	$130.20	$186.00	—	9% below	30%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Level Total	$145.60	$208.00	—	1% above	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total MS QST	$130.20	$186.00	—	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone,Total,Males (Adult), IA QST	$130.20	$186.00	—	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Level Total	$145.60	$208.00	—	—	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Abs QST	$105.00	$150.00	—	34% above	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Abs QST	$105.00	$150.00	—	—	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$10.50	$15.00	—	88% below	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$10.50	$15.00	—	—	30%
Uric acid blood test CPT 84550 Uric Acid	$36.40	$52.00	—	3% below	30%
Uric acid blood test inpatient CPT 84550 Uric Acid	$36.40	$52.00	—	—	30%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Culture if Indicated	$71.40	$102.00	—	107% above	30%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Microscopic	$71.40	$102.00	—	107% above	30%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Culture if Indicated	$71.40	$102.00	—	—	30%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Microscopic	$71.40	$102.00	—	—	30%
Urinalysis with microscope exam, manual CPT 81000 CL URINALYSIS NON AUTO W\\SCOPE	$26.60	$38.00	—	34% above	30%
Urinalysis with microscope exam, manual CPT 81000 Glucose Urine	$26.60	$38.00	—	34% above	30%
Urinalysis with microscope exam, manual inpatient CPT 81000 CL URINALYSIS NON AUTO W\\SCOPE	$26.60	$38.00	—	—	30%
Urinalysis with microscope exam, manual inpatient CPT 81000 Glucose Urine	$26.60	$38.00	—	—	30%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick POCT	$12.60	$18.00	—	44% below	30%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick Only	$21.70	$31.00	—	4% below	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick POCT	$12.60	$18.00	—	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick Only	$21.70	$31.00	—	—	30%
Urine culture for bacteria, with colony count CPT 87086 Culture, Urine QST	$56.70	$81.00	—	7% above	30%
Urine culture for bacteria, with colony count inpatient CPT 87086 Culture, Urine QST	$56.70	$81.00	—	—	30%
Urine pregnancy test, read by color change CPT 81025 CL URINE PREGNANCY TEST	$35.00	$50.00	—	24% below	30%
Urine pregnancy test, read by color change CPT 81025 Beta hCG Qualitative Urine	$186.90	$267.00	—	305% above	30%
Urine pregnancy test, read by color change inpatient CPT 81025 CL URINE PREGNANCY TEST	$35.00	$50.00	—	—	30%
Urine pregnancy test, read by color change inpatient CPT 81025 Beta hCG Qualitative Urine	$186.90	$267.00	—	—	30%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 QST	$91.70	$131.00	—	4% above	30%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$116.90	$167.00	—	33% above	30%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 QST	$91.70	$131.00	—	—	30%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level	$116.90	$167.00	—	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy Level	$347.90	$497.00	—	42% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D, 25-OH, Total ,IA QST	$347.90	$497.00	—	42% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D, 1,25 Dihydroxy QST	$347.90	$497.00	—	42% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D, 1,25 Dihydroxy QST	$347.90	$497.00	—	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D, 25-OH, Total ,IA QST	$347.90	$497.00	—	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy Level	$347.90	$497.00	—	—	30%
Zinc blood test CPT 84630 Zinc QST	$98.70	$141.00	—	70% above	30%
Zinc blood test inpatient CPT 84630 Zinc QST	$98.70	$141.00	—	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta hCG Quantitative	$186.90	$267.00	—	96% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta hCG Quantitative	$186.90	$267.00	—	—	30%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
Botox injections for chronic migraine CPT 64615 CHEMODENERVATION MUSCLE FOR MIGRAINE	$343.00	$490.00	—	5% below	30%
Botox injections for chronic migraine CPT 64615 TR CHEMODENERVATION FOR MIGRAINE	$1,036.00	$1,480.00	—	186% above	30%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERVATION MUSCLE FOR MIGRAINE	$343.00	$490.00	—	—	30%
Botox injections for chronic migraine inpatient CPT 64615 TR CHEMODENERVATION FOR MIGRAINE	$1,036.00	$1,480.00	—	—	30%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 OP FRACTURE FIBULA DISTAL W/O MANIP	$674.80	$964.00	—	64% above	30%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 OP FRACTURE FIBULA DISTAL W/O MANIP	$674.80	$964.00	—	—	30%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 OP FRACTURE METATARSAL CLOSED W/O MANIP	$1,482.60	$2,118.00	—	348% above	30%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 OP FRACTURE METATARSAL CLOSED W/O MANIP	$1,482.60	$2,118.00	—	—	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE EXTERNAL	$420.00	$600.00	—	25% below	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 TR CARDIOVERSION ELECTIVE EXTERNAL	$465.50	$665.00	—	17% below	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee	$700.00	$1,000.00	—	25% above	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 - Cardioversion; Elective	$700.00	$1,000.00	—	25% above	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTIVE EXTERNAL	$420.00	$600.00	—	—	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 TR CARDIOVERSION ELECTIVE EXTERNAL	$465.50	$665.00	—	—	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 - Cardioversion; Elective	$700.00	$1,000.00	—	—	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee	$700.00	$1,000.00	—	—	30%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMCISION EXCISION AGE > 28DAYS	$450.10	$643.00	—	79% below	30%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUMCISION EXCISION AGE > 28DAYS	$450.10	$643.00	—	—	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 Newborn Circumcision	$325.50	$465.00	—	17% below	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION	$325.50	$465.00	—	17% below	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision, using clamp or other device with regional dors	$1,280.30	$1,829.00	—	225% above	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 54150 Newborn Circumcision	$325.50	$465.00	—	—	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION	$325.50	$465.00	—	—	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision, using clamp or other device with regional dors	$1,280.30	$1,829.00	—	—	30%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ	$501.90	$717.00	—	9% above	30%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 DISTAL RADIAL FX TREATMENT W/O MAN	$1,498.00	$2,140.00	—	227% above	30%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600-Distal Radial w/o Manipulation	$1,498.00	$2,140.00	—	227% above	30%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ	$501.90	$717.00	—	—	30%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 DISTAL RADIAL FX TREATMENT W/O MAN	$1,498.00	$2,140.00	—	—	30%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 25600-Distal Radial w/o Manipulation	$1,498.00	$2,140.00	—	—	30%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 57460 Colposcopy of the cervix incl. upper vagina; with loop	$217.00	$310.00	—	71% below	30%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 57460 Colposcopy of the cervix incl. upper vagina; with loop	$217.00	$310.00	—	—	30%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$1,207.50	$1,725.00	—	15% above	30%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY	$1,207.50	$1,725.00	—	—	30%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DC (NONOBSTETRICAL)	$645.40	$922.00	—	55% below	30%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DC (NONOBSTETRICAL)	$645.40	$922.00	—	—	30%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION PREMALIGNANT LESION 1ST	$216.30	$309.00	—	102% above	30%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION PREMALIGNANT LESION 1ST	$216.30	$309.00	—	—	30%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209-Cerumen Irrigation/Lavage	$342.30	$489.00	—	317% above	30%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209 REMOVAL CERUMEN W/IRRIGAT TechFee	$565.60	$808.00	—	590% above	30%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 69209-Cerumen Irrigation/Lavage	$342.30	$489.00	—	—	30%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 69209 REMOVAL CERUMEN W/IRRIGAT TechFee	$565.60	$808.00	—	—	30%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED CERUMEN W/INSTRUMENT	$83.30	$119.00	—	at median	30%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED CERUMEN W/INSTRUMENT	$83.30	$119.00	—	—	30%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY ENDOMETRIAL	$242.20	$346.00	—	4% above	30%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 OP BIOPSY OF UTERUS LINING	$1,306.20	$1,866.00	—	460% above	30%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BIOPSY ENDOMETRIAL	$242.20	$346.00	—	—	30%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 OP BIOPSY OF UTERUS LINING	$1,306.20	$1,866.00	—	—	30%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 62321 INJECTION INTRLAMNR CRV/THRC W/ IMAGE TechFee	$399.00	$570.00	—	67% below	30%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 62321 INJECTION INTRLAMNR CRV/THRC W/ IMAGE TechFee	$399.00	$570.00	—	—	30%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 Bilateral Inj paravertebral facet lumbar or sacral single level	$4,718.00	$6,740.00	—	—	30%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 64493 Lumbar facet/medial branch.	$332.50	$475.00	—	66% below	30%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 64493 Lumbar facet/medial branch	$3,145.10	$4,493.00	—	221% above	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 Bilateral Inj paravertebral facet lumbar or sacral single level	$4,718.00	$6,740.00	—	—	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 64493 Lumbar facet/medial branch.	$332.50	$475.00	—	—	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 64493 Lumbar facet/medial branch	$3,145.10	$4,493.00	—	—	30%
Hammertoe correction surgery CPT 28285 CORRECTION HAMMERTOE	$809.20	$1,156.00	—	55% below	30%
Hammertoe correction surgery inpatient CPT 28285 CORRECTION HAMMERTOE	$809.20	$1,156.00	—	—	30%
Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY INT/EXT 1 COLUMN	$912.10	$1,303.00	—	at median	30%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HEMORRHOIDECTOMY INT/EXT 1 COLUMN	$912.10	$1,303.00	—	—	30%
Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL ABDOMINAL HYSTERECTOMY	$2,414.30	$3,449.00	—	24% below	30%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL ABDOMINAL HYSTERECTOMY	$2,414.30	$3,449.00	—	—	30%
IUD insertion (the device itself billed separately) CPT 58300 INSERTION OF IUD	$189.70	$271.00	—	5% below	30%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERTION OF IUD	$189.70	$271.00	—	—	30%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 I & D ABSCESS SIMPLE/SINGLE	$165.90	$237.00	—	20% below	30%
Incision and drainage of a simple or single skin abscess CPT 10060 PF IP ONLY ID ABCESS SKIN SIMPLE	$197.40	$282.00	—	5% below	30%
Incision and drainage of a simple or single skin abscess CPT 10060 ID SIMPLE ABCESS IP	$872.20	$1,246.00	—	320% above	30%
Incision and drainage of a simple or single skin abscess CPT 10060 10060-I&D Abscess/Cyst/Hematoma Simple	$872.20	$1,246.00	—	320% above	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 I & D ABSCESS SIMPLE/SINGLE	$165.90	$237.00	—	—	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 PF IP ONLY ID ABCESS SKIN SIMPLE	$197.40	$282.00	—	—	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060-I&D Abscess/Cyst/Hematoma Simple	$872.20	$1,246.00	—	—	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ID SIMPLE ABCESS IP	$872.20	$1,246.00	—	—	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Injection(s); single tendon sheath, or ligament, apone	$130.90	$187.00	—	10% below	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 OP INJ TENDON SHEATH/LIGAMENT	$226.80	$324.00	—	57% above	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 INJECTION TENDON SHEATH CHARGE	$226.80	$324.00	—	57% above	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Injections Single Tendon Sheath, Ligament, or aponeuro	$226.80	$324.00	—	57% above	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection single tendon sheath or ligament aponeurosis	$487.20	$696.00	—	237% above	30%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550 Injection(s); single tendon sheath, or ligament, apone	$130.90	$187.00	—	—	30%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550 Injections Single Tendon Sheath, Ligament, or aponeuro	$226.80	$324.00	—	—	30%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550 INJECTION TENDON SHEATH CHARGE	$226.80	$324.00	—	—	30%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 OP INJ TENDON SHEATH/LIGAMENT	$226.80	$324.00	—	—	30%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Injection single tendon sheath or ligament aponeurosis	$487.20	$696.00	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610-Major Joint Aspirate/Inject w/o US	$154.00	$220.00	—	30% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US TechFee	$154.00	$220.00	—	30% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ MAJOR JOINT/BURSA W/O US	$192.50	$275.00	—	12% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 TR INJ MAJOR JOINT/BURSA W/O US	$336.00	$480.00	—	53% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 OP INJ MAJOR JOINT/BURSA W/O US	$527.10	$753.00	—	140% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 ARTHROCENTESIS ASPIRATION/INJ/DRAIN JOINT/BURSA CHARG	$527.10	$753.00	—	140% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Bialteral Arthrocentesis aspiration and/or injection major joint or bursa w/o US	$1,050.00	$1,500.00	—	377% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Right	$466.90	$667.00	—	112% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Left	$466.90	$667.00	—	112% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US TechFee	$154.00	$220.00	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610-Major Joint Aspirate/Inject w/o US	$154.00	$220.00	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJ MAJOR JOINT/BURSA W/O US	$192.50	$275.00	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 TR INJ MAJOR JOINT/BURSA W/O US	$336.00	$480.00	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 OP INJ MAJOR JOINT/BURSA W/O US	$527.10	$753.00	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 ARTHROCENTESIS ASPIRATION/INJ/DRAIN JOINT/BURSA CHARG	$527.10	$753.00	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Bialteral Arthrocentesis aspiration and/or injection major joint or bursa w/o US	$1,050.00	$1,500.00	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Right	$466.90	$667.00	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Left	$466.90	$667.00	—	—	30%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG DELIVERY IMPLANT	$288.40	$412.00	—	80% above	30%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG DELIVERY IMPLANT	$288.40	$412.00	—	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 Bilateral Arthrocentesis aspiration and/or injection Intermediate joint or bursa	$1,167.60	$1,668.00	—	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605-Intermediate Aspiration/Inj w/o US	$119.70	$171.00	—	47% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 INJ INTERMED JOINT/BURSA W/O US	$162.40	$232.00	—	28% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 TR INJ INTERMED JOINT/BURSA W/O US	$367.50	$525.00	—	62% above	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US TechFee	$478.80	$684.00	—	111% above	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient both sides CPT 20605 Bilateral Arthrocentesis aspiration and/or injection Intermediate joint or bursa	$1,167.60	$1,668.00	—	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605-Intermediate Aspiration/Inj w/o US	$119.70	$171.00	—	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 INJ INTERMED JOINT/BURSA W/O US	$162.40	$232.00	—	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 TR INJ INTERMED JOINT/BURSA W/O US	$367.50	$525.00	—	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US TechFee	$478.80	$684.00	—	—	30%
Joint injection or drainage, small joint (fingers, toes) both sides CPT 20600 Bilateral Arthrocentesis aspiration and/or injection Small joint or bursa	$903.00	$1,290.00	—	—	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US TechFee	$102.20	$146.00	—	52% below	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600-Small Joint Aspirate/Inject w/o US	$323.40	$462.00	—	52% above	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 OP INJ SMALL JOINT/BURSA W/O US	$527.10	$753.00	—	148% above	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis aspiration and/or injection Small joint or bursa	$602.00	$860.00	—	183% above	30%
Joint injection or drainage, small joint (fingers, toes) inpatient both sides CPT 20600 Bilateral Arthrocentesis aspiration and/or injection Small joint or bursa	$903.00	$1,290.00	—	—	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US TechFee	$102.20	$146.00	—	—	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600-Small Joint Aspirate/Inject w/o US	$323.40	$462.00	—	—	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 OP INJ SMALL JOINT/BURSA W/O US	$527.10	$753.00	—	—	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis aspiration and/or injection Small joint or bursa	$602.00	$860.00	—	—	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee	$324.80	$464.00	—	6% below	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031-Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm	$324.80	$464.00	—	6% below	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERMED REPAIR TRUNK < 2.5CM	$342.30	$489.00	—	1% below	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031-Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm	$324.80	$464.00	—	—	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee	$324.80	$464.00	—	—	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTERMED REPAIR TRUNK < 2.5CM	$342.30	$489.00	—	—	30%
Lower-back epidural injection, with imaging guidance CPT 62323 62323 Lumbar/Sacral	$1,750.00	$2,500.00	—	46% above	30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 62323 Lumbar/Sacral	$1,750.00	$2,500.00	—	—	30%
Lower-back epidural injection, without imaging guidance CPT 62322 TR INJECT SPINE LUMBAR/SACRAL (LESI)	$690.20	$986.00	—	13% below	30%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 TR INJECT SPINE LUMBAR/SACRAL (LESI)	$690.20	$986.00	—	—	30%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 Bilateral Inj Anesthetic/steroid transforaminal epidural lumbar/sacral single level	$4,250.40	$6,072.00	—	—	30%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 64483 Transforaminal Lumbar	$1,619.10	$2,313.00	—	56% above	30%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 Bilateral Inj Anesthetic/steroid transforaminal epidural lumbar/sacral single level	$4,250.40	$6,072.00	—	—	30%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 64483 Transforaminal Lumbar	$1,619.10	$2,313.00	—	—	30%
Miscarriage treatment with D&C, first trimester CPT 59820 TREATMENT MISSED ABORTION	$848.40	$1,212.00	—	56% below	30%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 TREATMENT MISSED ABORTION	$848.40	$1,212.00	—	—	30%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCISION BENIGN LESION TRUNK < 0.5CM	$189.00	$270.00	—	2% above	30%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCISION BENIGN LESION TRUNK < 0.5CM	$189.00	$270.00	—	—	30%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC BENIGN LESION FACE < 0.5CM	$209.30	$299.00	—	12% above	30%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC BENIGN LESION FACE < 0.5CM	$209.30	$299.00	—	—	30%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SIMPLE	$150.50	$215.00	—	8% above	30%
Nail removal (partial or complete), one nail CPT 11730 11730-Avulsion Nail Plate Single	$165.20	$236.00	—	19% above	30%
Nail removal (partial or complete), one nail CPT 11730 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee	$210.00	$300.00	—	51% above	30%
Nail removal (partial or complete), one nail CPT 11730 Ambulatory Charges:Avulsion of Nail Plate	$315.00	$450.00	—	126% above	30%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SIMPLE	$150.50	$215.00	—	—	30%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730-Avulsion Nail Plate Single	$165.20	$236.00	—	—	30%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee	$210.00	$300.00	—	—	30%
Nail removal (partial or complete), one nail inpatient CPT 11730 Ambulatory Charges:Avulsion of Nail Plate	$315.00	$450.00	—	—	30%
Occipital nerve block (injection for headaches) both sides CPT 64405 Bilateral Injection anesthetic/steroid greater occipital nerve	$2,100.00	$3,000.00	—	—	30%
Occipital nerve block (injection for headaches) CPT 64405 NJX AA/STRD GR OCPL NRV CLINIC	$210.00	$300.00	—	44% below	30%
Occipital nerve block (injection for headaches) CPT 64405 Injection anesthetic/steroid greater occipital nerve	$2,450.00	$3,500.00	—	555% above	30%
Occipital nerve block (injection for headaches) inpatient both sides CPT 64405 Bilateral Injection anesthetic/steroid greater occipital nerve	$2,100.00	$3,000.00	—	—	30%
Occipital nerve block (injection for headaches) inpatient CPT 64405 NJX AA/STRD GR OCPL NRV CLINIC	$210.00	$300.00	—	—	30%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Injection anesthetic/steroid greater occipital nerve	$2,450.00	$3,500.00	—	—	30%
Paracentesis with imaging guidance CPT 49083 49083 Incision Procedures on the Abdomen, Peritoneum, and Omentum TechFee	$394.80	$564.00	—	40% below	30%
Paracentesis with imaging guidance CPT 49083 49083 Abominal Paracentesis with Imaging Guidance	$394.80	$564.00	—	40% below	30%
Paracentesis with imaging guidance CPT 49083 US Paracentesis	$709.10	$1,013.00	—	8% above	30%
Paracentesis with imaging guidance CPT 49083 49083-Abdominal Paracentesis w/ Imaging Guide	$709.10	$1,013.00	—	8% above	30%
Paracentesis with imaging guidance inpatient CPT 49083 49083 Incision Procedures on the Abdomen, Peritoneum, and Omentum TechFee	$394.80	$564.00	—	—	30%
Paracentesis with imaging guidance inpatient CPT 49083 49083 Abominal Paracentesis with Imaging Guidance	$394.80	$564.00	—	—	30%
Paracentesis with imaging guidance inpatient CPT 49083 49083-Abdominal Paracentesis w/ Imaging Guide	$709.10	$1,013.00	—	—	30%
Paracentesis with imaging guidance inpatient CPT 49083 US Paracentesis	$709.10	$1,013.00	—	—	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Ambulatory Charges:11750 Excision of Nail and Nail Matrix	$136.50	$195.00	—	64% below	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL/MATRIX PERMANENT	$332.50	$475.00	—	13% below	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 TR EXC NAIL/MATRIX PERMANENT	$437.50	$625.00	—	15% above	30%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Ambulatory Charges:11750 Excision of Nail and Nail Matrix	$136.50	$195.00	—	—	30%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL/MATRIX PERMANENT	$332.50	$475.00	—	—	30%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 TR EXC NAIL/MATRIX PERMANENT	$437.50	$625.00	—	—	30%
Radiofrequency ablation of facet joint nerves, lower back, one level both sides CPT 64635 Bilateral Destroy l/s facet joint 1st level	$3,951.50	$5,645.00	—	—	30%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 64635 Destroy lumb/sac facet jnt	$3,950.80	$5,644.00	—	113% above	30%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient both sides CPT 64635 Bilateral Destroy l/s facet joint 1st level	$3,951.50	$5,645.00	—	—	30%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 64635 Destroy lumb/sac facet jnt	$3,950.80	$5,644.00	—	—	30%
Removal of a breast lump, open surgery CPT 19120 EXCISION CYST BREAST	$931.00	$1,330.00	—	61% below	30%
Removal of a breast lump, open surgery inpatient CPT 19120 EXCISION CYST BREAST	$931.00	$1,330.00	—	—	30%
Removal of a foreign object under the skin, simple CPT 10120 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee	$200.90	$287.00	—	15% below	30%
Removal of a foreign object under the skin, simple CPT 10120 10120-Subcutaneous Tissue Simple	$200.90	$287.00	—	15% below	30%
Removal of a foreign object under the skin, simple CPT 10120 INCISION REMOVAL FB SIMPLE	$214.90	$307.00	—	9% below	30%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee	$200.90	$287.00	—	—	30%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120-Subcutaneous Tissue Simple	$200.90	$287.00	—	—	30%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION REMOVAL FB SIMPLE	$214.90	$307.00	—	—	30%
Short arm cast (elbow to hand) CPT 29075 29075-Cast Application Elbow to Finger (short arm)	$175.00	$250.00	—	19% below	30%
Short arm cast (elbow to hand) CPT 29075 APPLICATION SHORT ARM CAST	$177.10	$253.00	—	18% below	30%
Short arm cast (elbow to hand) CPT 29075 29075 APPLICATION CAST ELBOW FINGER SHORT ARM TechFee	$378.00	$540.00	—	75% above	30%
Short arm cast (elbow to hand) inpatient CPT 29075 29075-Cast Application Elbow to Finger (short arm)	$175.00	$250.00	—	—	30%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION SHORT ARM CAST	$177.10	$253.00	—	—	30%
Short arm cast (elbow to hand) inpatient CPT 29075 29075 APPLICATION CAST ELBOW FINGER SHORT ARM TechFee	$378.00	$540.00	—	—	30%
Short arm splint (forearm and hand) CPT 29125 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee	$147.00	$210.00	—	15% below	30%
Short arm splint (forearm and hand) CPT 29125 APPLICATION SHORT ARM SPLINT STATIC	$147.00	$210.00	—	15% below	30%
Short arm splint (forearm and hand) CPT 29125 29125-Short Arm	$266.00	$380.00	—	53% above	30%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION SHORT ARM SPLINT STATIC	$147.00	$210.00	—	—	30%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee	$147.00	$210.00	—	—	30%
Short arm splint (forearm and hand) inpatient CPT 29125 29125-Short Arm	$266.00	$380.00	—	—	30%
Short leg cast (below the knee) CPT 29405 29405-App of Short Leg Cast (below knee to toes)	$188.30	$269.00	—	1% above	30%
Short leg cast (below the knee) CPT 29405 APPLICATION SHORT LEG CAST	$190.40	$272.00	—	2% above	30%
Short leg cast (below the knee) CPT 29405 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$402.50	$575.00	—	116% above	30%
Short leg cast (below the knee) inpatient CPT 29405 29405-App of Short Leg Cast (below knee to toes)	$188.30	$269.00	—	—	30%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATION SHORT LEG CAST	$190.40	$272.00	—	—	30%
Short leg cast (below the knee) inpatient CPT 29405 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$402.50	$575.00	—	—	30%
Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT	$165.20	$236.00	—	4% above	30%
Short leg splint (calf to foot) CPT 29515 29515-Short Leg	$321.30	$459.00	—	102% above	30%
Short leg splint (calf to foot) CPT 29515 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee	$333.90	$477.00	—	110% above	30%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION SHORT LEG SPLINT	$165.20	$236.00	—	—	30%
Short leg splint (calf to foot) inpatient CPT 29515 29515-Short Leg	$321.30	$459.00	—	—	30%
Short leg splint (calf to foot) inpatient CPT 29515 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee	$333.90	$477.00	—	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE WOUND REPAIR TRUNK UP TO 2.5CM	$296.80	$424.00	—	22% above	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or	$296.80	$424.00	—	22% above	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001-Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm	$421.40	$602.00	—	73% above	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee	$554.40	$792.00	—	127% above	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE WOUND REPAIR TRUNK UP TO 2.5CM	$296.80	$424.00	—	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or	$296.80	$424.00	—	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001-Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm	$421.40	$602.00	—	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee	$554.40	$792.00	—	—	30%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SINGLE LESION	$162.40	$232.00	—	68% below	30%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY OF SINGLE LESION	$162.40	$232.00	—	—	30%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC MAL LESION TRUNK < 0.5CM	$270.90	$387.00	—	16% above	30%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC MAL LESION TRUNK < 0.5CM	$270.90	$387.00	—	—	30%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKIN TAGS FIRST 15	$122.50	$175.00	—	9% below	30%
Skin tag removal, up to 15 tags CPT 11200 TR REMOVAL SKIN TAGS FIRST 15	$210.00	$300.00	—	56% above	30%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKIN TAGS FIRST 15	$122.50	$175.00	—	—	30%
Skin tag removal, up to 15 tags inpatient CPT 11200 TR REMOVAL SKIN TAGS FIRST 15	$210.00	$300.00	—	—	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC	$312.20	$446.00	—	40% below	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 TR SPINAL PUNCTURE LUMBAR DIAGNOSTIC	$396.90	$567.00	—	24% below	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Lumbar Puncture, Diagnost TechFee	$767.90	$1,097.00	—	47% above	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270-Lumbar Puncture Diagnostic	$849.10	$1,213.00	—	62% above	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC	$312.20	$446.00	—	—	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 TR SPINAL PUNCTURE LUMBAR DIAGNOSTIC	$396.90	$567.00	—	—	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 Lumbar Puncture, Diagnost TechFee	$767.90	$1,097.00	—	—	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270-Lumbar Puncture Diagnostic	$849.10	$1,213.00	—	—	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE WOUND REPAIR TRUNK 2.6-7.5CM	$340.90	$487.00	—	23% above	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002-Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm	$503.30	$719.00	—	81% above	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee	$662.90	$947.00	—	138% above	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPLE WOUND REPAIR TRUNK 2.6-7.5CM	$340.90	$487.00	—	—	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002-Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm	$503.30	$719.00	—	—	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee	$662.90	$947.00	—	—	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE WOUND REPAIR FACE < 2.5CM	$305.90	$437.00	—	14% above	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes;	$305.90	$437.00	—	14% above	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm	$305.90	$437.00	—	14% above	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< TechFee	$689.50	$985.00	—	156% above	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes;	$305.90	$437.00	—	—	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPLE WOUND REPAIR FACE < 2.5CM	$305.90	$437.00	—	—	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm	$305.90	$437.00	—	—	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< TechFee	$689.50	$985.00	—	—	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$135.10	$193.00	—	48% below	30%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES	$135.10	$193.00	—	—	30%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS GUIDED	$371.00	$530.00	—	58% below	30%
Thoracentesis with imaging guidance CPT 32555 TR THORACENTESIS GUIDED	$833.00	$1,190.00	—	5% below	30%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS GUIDED	$371.00	$530.00	—	—	30%
Thoracentesis with imaging guidance inpatient CPT 32555 TR THORACENTESIS GUIDED	$833.00	$1,190.00	—	—	30%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1 OR 2 MUSCLES	$126.70	$181.00	—	16% below	30%
Trigger point injections, 1 or 2 muscles CPT 20552 TR INJ TRIGGER POINT 1 OR 2 MUSCLES	$436.80	$624.00	—	191% above	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1 OR 2 MUSCLES	$126.70	$181.00	—	—	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 TR INJ TRIGGER POINT 1 OR 2 MUSCLES	$436.80	$624.00	—	—	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 TR BIOPSY BREAST W/US GUIDE 1ST LESION	$1,584.10	$2,263.00	—	20% below	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 TR BIOPSY BREAST W/US GUIDE 1ST LESION	$1,584.10	$2,263.00	—	—	30%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY	$830.20	$1,186.00	—	16% below	30%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 TR VASECTOMY	$2,167.20	$3,096.00	—	119% above	30%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY	$830.20	$1,186.00	—	—	30%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 TR VASECTOMY	$2,167.20	$3,096.00	—	—	30%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LESION/WART UP TO 14	$148.40	$212.00	—	9% below	30%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION BENIGN LESION/WART UP TO 14	$148.40	$212.00	—	—	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SUBQ FIRST 20 SQ CM	$175.00	$250.00	—	46% below	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 TR DEBRIDEMENT SUBQ FIRST 20 SQ CM	$410.20	$586.00	—	27% above	30%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT SUBQ FIRST 20 SQ CM	$175.00	$250.00	—	—	30%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 TR DEBRIDEMENT SUBQ FIRST 20 SQ CM	$410.20	$586.00	—	—	30%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
Blood transfusion (giving blood or blood components) CPT 36430 36430 BLOOD TRANSFUSION TechFee	$746.90	$1,067.00	—	30% above	30%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Product Administration	$871.50	$1,245.00	—	51% above	30%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE Red Blood Cells Leukoreduced:Blood Product Adminis	$871.50	$1,245.00	—	51% above	30%
Blood transfusion (giving blood or blood components) CPT 36430 E0686 Aph RBC CP2D AS3 LR 2	$871.50	$1,245.00	—	51% above	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 BLOOD TRANSFUSION TechFee	$746.90	$1,067.00	—	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Product Administration	$871.50	$1,245.00	—	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 E0686 Aph RBC CP2D AS3 LR 2	$871.50	$1,245.00	—	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE Red Blood Cells Leukoreduced:Blood Product Adminis	$871.50	$1,245.00	—	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT EzPAP Initial CHARGE	$141.40	$202.00	—	23% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Aerosol Initial CHARGE	$141.40	$202.00	—	23% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Aerosol Subsequent CHARGE	$141.40	$202.00	—	23% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT EzPAP Subsequent CHARGE	$141.40	$202.00	—	23% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Meter Dose Inhaler Initial CHARGE	$141.40	$202.00	—	23% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Meter Dose Inhaler Subsequent CHARGE	$141.40	$202.00	—	23% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Meter Dose Inhaler Subsequent CHARGE	$141.40	$202.00	—	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Aerosol Subsequent CHARGE	$141.40	$202.00	—	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Meter Dose Inhaler Initial CHARGE	$141.40	$202.00	—	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT EzPAP Subsequent CHARGE	$141.40	$202.00	—	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT EzPAP Initial CHARGE	$141.40	$202.00	—	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Aerosol Initial CHARGE	$141.40	$202.00	—	—	30%
Critical care, first 30 to 74 minutes CPT 99291 99291 CRITICAL CARE 30-74	$576.80	$824.00	—	13% below	30%
Critical care, first 30 to 74 minutes CPT 99291 99291 Critical care, evaluation and management of the critically ill or critically injured patient;	$576.80	$824.00	—	13% below	30%
Critical care, first 30 to 74 minutes CPT 99291 99291 - Critical Care, 30-74	$1,480.50	$2,115.00	—	123% above	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 Critical care, evaluation and management of the critically ill or critically injured patient;	$576.80	$824.00	—	—	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 CRITICAL CARE 30-74	$576.80	$824.00	—	—	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 - Critical Care, 30-74	$1,480.50	$2,115.00	—	—	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG POC - Nursing	$262.50	$375.00	—	43% above	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge one side CPT 93005 EKG RT	$262.50	$375.00	—	43% above	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG POC - Nursing	$262.50	$375.00	—	—	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient one side CPT 93005 EKG RT	$262.50	$375.00	—	—	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 - Emergency department visit for the evaluation and management of a patient	$89.60	$128.00	—	36% below	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 - Level 1	$193.20	$276.00	—	38% above	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 - Emergency department visit for the evaluation and management of a patient	$89.60	$128.00	—	—	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 - Level 1	$193.20	$276.00	—	—	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 Emergency department visit for the evaluation and management of a patient, which requires thes	$156.10	$223.00	—	19% below	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 - Level 2	$277.20	$396.00	—	44% above	30%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 Emergency department visit for the evaluation and management of a patient, which requires thes	$156.10	$223.00	—	—	30%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 - Level 2	$277.20	$396.00	—	—	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 - Emergency department visit for the evaluation and management of a patient	$308.00	$440.00	—	12% above	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 - Level 3	$410.20	$586.00	—	50% above	30%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 - Emergency department visit for the evaluation and management of a patient	$308.00	$440.00	—	—	30%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 - Level 3	$410.20	$586.00	—	—	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 - Emergency department visit for the evaluation and management of a patient	$508.90	$727.00	—	29% above	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 - Level 4	$628.60	$898.00	—	60% above	30%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 - Emergency department visit for the evaluation and management of a patient	$508.90	$727.00	—	—	30%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 - Level 4	$628.60	$898.00	—	—	30%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 - Emergency department visit for the evaluation and management of a patient	$786.10	$1,123.00	—	23% above	30%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 - Level 5	$1,044.40	$1,492.00	—	63% above	30%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 - Emergency department visit for the evaluation and management of a patient	$786.10	$1,123.00	—	—	30%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 - Level 5	$1,044.40	$1,492.00	—	—	30%
Exercise stress test, tracing only, the hospital charge CPT 93017 Stress Test Treadmill Only	$535.50	$765.00	—	6% below	30%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Stress Test Treadmill Only	$535.50	$765.00	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 Hydration, first hour	$246.40	$352.00	—	1% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 IV INF HYDRATION 31 MIN TO 1HR CHARGE	$364.00	$520.00	—	50% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 IV HYDRATION INIT UP TO 1HR	$364.00	$520.00	—	50% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 Hydration, first hour	$246.40	$352.00	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 IV INF HYDRATION 31 MIN TO 1HR CHARGE	$364.00	$520.00	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 IV HYDRATION INIT UP TO 1HR	$364.00	$520.00	—	—	30%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY INITIAL UP TO 1HR (>15MIN)	$246.40	$352.00	—	7% below	30%
IV infusion of a medicine, first hour CPT 96365 96365 IV tx, first hour	$246.40	$352.00	—	7% below	30%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 IV tx, first hour	$246.40	$352.00	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY INITIAL UP TO 1HR (>15MIN)	$246.40	$352.00	—	—	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inj Subq/IM	$38.50	$55.00	—	42% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Subq/IM Injection	$81.20	$116.00	—	21% above	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 IM THERAPEUTIC	$110.60	$158.00	—	65% above	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Inj Subq/IM	$38.50	$55.00	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Subq/IM Injection	$81.20	$116.00	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 IM THERAPEUTIC	$110.60	$158.00	—	—	30%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation Units	$52.50	$75.00	—	32% below	30%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation Assistant Units	$52.50	$75.00	—	32% below	30%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Units	$80.50	$115.00	—	4% above	30%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Assist Unit	$80.50	$115.00	—	4% above	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT Neuromuscular Reeducation Assistant Units	$52.50	$75.00	—	—	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT Neuromuscular Reeducation Units	$52.50	$75.00	—	—	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducation Assist Unit	$80.50	$115.00	—	—	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducation Units	$80.50	$115.00	—	—	30%
New patient office visit, about 30 minutes CPT 99203 CLINIC VISIT LEVEL 3 NEW PT	$127.40	$182.00	—	16% below	30%
New patient office visit, about 30 minutes CPT 99203 OFFICE VISIT NEW PATIENT LEVEL 3	$147.00	$210.00	—	3% below	30%
New patient office visit, about 30 minutes CPT 99203 99203 Office Visit New Pt. Level 3	$156.10	$223.00	—	3% above	30%
New patient office visit, about 30 minutes inpatient CPT 99203 CLINIC VISIT LEVEL 3 NEW PT	$127.40	$182.00	—	—	30%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VISIT NEW PATIENT LEVEL 3	$147.00	$210.00	—	—	30%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office Visit New Pt. Level 3	$156.10	$223.00	—	—	30%
New patient office visit, about 45 minutes CPT 99204 CLINIC VISIT LEVEL 4 NEW PT - VISITING	$161.00	$230.00	—	20% below	30%
New patient office visit, about 45 minutes CPT 99204 OFFICE VISIT NEW PATIENT LEVEL 4	$222.60	$318.00	—	11% above	30%
New patient office visit, about 45 minutes CPT 99204 99204 Office Visit New Pt. Level 4	$238.00	$340.00	—	19% above	30%
New patient office visit, about 45 minutes inpatient CPT 99204 CLINIC VISIT LEVEL 4 NEW PT - VISITING	$161.00	$230.00	—	—	30%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE VISIT NEW PATIENT LEVEL 4	$222.60	$318.00	—	—	30%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office Visit New Pt. Level 4	$238.00	$340.00	—	—	30%
New patient office visit, about 60 minutes CPT 99205 CLINIC VISIT LEVEL 5 NEW PT	$269.50	$385.00	—	3% below	30%
New patient office visit, about 60 minutes CPT 99205 OFFICE VISIT NEW PATIENT LEVEL 5	$286.30	$409.00	—	4% above	30%
New patient office visit, about 60 minutes CPT 99205 99205 Office Visit New Pt. Level 5	$306.60	$438.00	—	11% above	30%
New patient office visit, about 60 minutes inpatient CPT 99205 CLINIC VISIT LEVEL 5 NEW PT	$269.50	$385.00	—	—	30%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE VISIT NEW PATIENT LEVEL 5	$286.30	$409.00	—	—	30%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 Office Visit New Pt. Level 5	$306.60	$438.00	—	—	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 CLINIC VISIT LEVEL 2 NEW PT	$35.93	$51.33	—	69% below	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE VISIT NEW PATIENT LEVEL 2	$92.40	$132.00	—	20% below	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Office Visit New Pt. Level 2	$101.50	$145.00	—	12% below	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 CLINIC VISIT LEVEL 2 NEW PT	$35.93	$51.33	—	—	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE VISIT NEW PATIENT LEVEL 2	$92.40	$132.00	—	—	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 Office Visit New Pt. Level 2	$101.50	$145.00	—	—	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION INDIV 15 MIN	$32.90	$47.00	—	11% above	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MEDICAL NUTRITION INDIV 15 MIN	$32.90	$47.00	—	—	30%
Occupational therapy evaluation, low complexity CPT 97165 OT Evaluation Units, Low Complexity	$149.80	$214.00	—	10% below	30%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT Evaluation Units, Low Complexity	$149.80	$214.00	—	—	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT Evaluation Units, High Complexity	$246.40	$352.00	—	18% above	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT Evaluation Units, High Complexity	$246.40	$352.00	—	—	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Evaluation Units, Low Complexity	$192.50	$275.00	—	18% above	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT Evaluation Units, Low Complexity	$192.50	$275.00	—	—	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Evaluation Units, Moderate Complexity	$208.60	$298.00	—	14% above	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT Evaluation Units, Moderate Complexity	$208.60	$298.00	—	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Assistant Units	$58.10	$83.00	—	24% below	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Units	$73.50	$105.00	—	3% below	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Assistant Units	$80.50	$115.00	—	6% above	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Units	$80.50	$115.00	—	6% above	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Assistant Units	$58.10	$83.00	—	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Units	$73.50	$105.00	—	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Units	$80.50	$115.00	—	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Assistant Units	$80.50	$115.00	—	—	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Assistant Units	$56.00	$80.00	—	28% below	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Units	$72.80	$104.00	—	7% below	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Units	$79.10	$113.00	—	1% above	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Assistant Units	$79.10	$113.00	—	1% above	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise Assistant Units	$56.00	$80.00	—	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise Units	$72.80	$104.00	—	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Assistant Units	$79.10	$113.00	—	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Units	$79.10	$113.00	—	—	30%
Preventive checkup, new patient aged 18–39 CPT 99385 PREVENTIVE MED NEW PT 18-39 Y/O	$191.10	$273.00	—	3% above	30%
Preventive checkup, new patient aged 18–39 CPT 99385 99385 Preventive Evaluation, New Pt; 18-39 Yrs	$191.10	$273.00	—	3% above	30%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 99385 Preventive Evaluation, New Pt; 18-39 Yrs	$191.10	$273.00	—	—	30%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREVENTIVE MED NEW PT 18-39 Y/O	$191.10	$273.00	—	—	30%
Preventive checkup, new patient aged 40–64 CPT 99386 99386 Preventive Evaluation, New Pt; 40-64 Yrs	$198.80	$284.00	—	6% above	30%
Preventive checkup, new patient aged 40–64 CPT 99386 PREVENTIVE MED NEW PT 40-64 Y/O	$198.80	$284.00	—	6% above	30%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREVENTIVE MED NEW PT 40-64 Y/O	$198.80	$284.00	—	—	30%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 99386 Preventive Evaluation, New Pt; 40-64 Yrs	$198.80	$284.00	—	—	30%
Preventive checkup, new patient aged 65 or older CPT 99387 PREVENTIVE MED NEW PT 65+ Y/O	$210.70	$301.00	—	at median	30%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 PREVENTIVE MED NEW PT 65+ Y/O	$210.70	$301.00	—	—	30%
Preventive checkup, returning patient aged 18–39 CPT 99395 99395 Preventive Evaluation, Established Pt; 18-39 Yrs	$161.00	$230.00	—	7% below	30%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREVENTIVE MED EST PT 18-39 Y/O	$161.00	$230.00	—	7% below	30%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREVENTIVE MED EST PT 18-39 Y/O	$161.00	$230.00	—	—	30%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 99395 Preventive Evaluation, Established Pt; 18-39 Yrs	$161.00	$230.00	—	—	30%
Preventive checkup, returning patient aged 40–64 CPT 99396 99396 Preventive Evaluation, Established Pt; 40-64 Yrs	$168.00	$240.00	—	11% below	30%
Preventive checkup, returning patient aged 40–64 CPT 99396 PREVENTIVE MED EST PT 40-64 Y/O	$168.00	$240.00	—	11% below	30%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 99396 Preventive Evaluation, Established Pt; 40-64 Yrs	$168.00	$240.00	—	—	30%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PREVENTIVE MED EST PT 40-64 Y/O	$168.00	$240.00	—	—	30%
Preventive checkup, returning patient aged 65 or older CPT 99397 99397 Preventive Evaluation, Established Pt; 65+ Yrs	$175.00	$250.00	—	12% below	30%
Preventive checkup, returning patient aged 65 or older CPT 99397 PREVENTIVE MED EST PT 65+ Y/O	$175.00	$250.00	—	12% below	30%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 99397 Preventive Evaluation, Established Pt; 65+ Yrs	$175.00	$250.00	—	—	30%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PREVENTIVE MED EST PT 65+ Y/O	$175.00	$250.00	—	—	30%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco Cessation Counseling 3-10 MIN	$25.20	$36.00	—	9% below	30%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco Cessation Counseling 3-10 MIN	$25.20	$36.00	—	—	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 CLINIC VISIT EST PT LEVEL 5	$85.63	$122.33	—	59% below	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Office/Outpatient Visit - Established Patient, Level 5 (40 min)	$240.10	$343.00	—	15% above	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 CLINIC VISIT EST PT LEVEL 5	$85.63	$122.33	—	—	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 Office/Outpatient Visit - Established Patient, Level 5 (40 min)	$240.10	$343.00	—	—	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CLINIC VISIT EST PT LEVEL 3	$43.17	$61.67	—	68% below	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office/Outpatient Visit - Established Patient, Level 3 (15 min)	$127.40	$182.00	—	6% below	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OB Postpartum Visit - 99213	$127.40	$182.00	—	6% below	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OB Subsequent Visit - 99213	$127.40	$182.00	—	6% below	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 CLINIC VISIT EST PT LEVEL 3	$43.17	$61.67	—	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OB Postpartum Visit - 99213	$127.40	$182.00	—	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OB Subsequent Visit - 99213	$127.40	$182.00	—	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Office/Outpatient Visit - Established Patient, Level 3 (15 min)	$127.40	$182.00	—	—	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CLINIC VISIT EST PT LEVEL 4	$67.67	$96.67	—	61% below	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office/Outpatient Visit - Established Patient, Level 4 (25 min)	$170.80	$244.00	—	1% below	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OB High Risk Visit - 99214	$170.80	$244.00	—	1% below	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 CLINIC VISIT EST PT LEVEL 4	$67.67	$96.67	—	—	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OB High Risk Visit - 99214	$170.80	$244.00	—	—	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 Office/Outpatient Visit - Established Patient, Level 4 (25 min)	$170.80	$244.00	—	—	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CLINIC VISIT EST PT LEVEL 2	$27.30	$39.00	—	74% below	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office Visit Established Pt. Level 2	$62.30	$89.00	—	40% below	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office/Outpatient Visit - Established Patient, Level 2 (10 min)	$88.20	$126.00	—	15% below	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 CLINIC VISIT EST PT LEVEL 2	$27.30	$39.00	—	—	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 Office Visit Established Pt. Level 2	$62.30	$89.00	—	—	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 Office/Outpatient Visit - Established Patient, Level 2 (10 min)	$88.20	$126.00	—	—	30%
Specialist consultation, low complexity or 30+ minutes CPT 99243 99243 Office Consultation, Level 3	$200.20	$286.00	—	4% above	30%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 99243 Office Consultation, Level 3	$200.20	$286.00	—	—	30%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 99244 Office Consultation, Level 4	$273.70	$391.00	—	11% above	30%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 99244 Office Consultation, Level 4	$273.70	$391.00	—	—	30%
Speech and language evaluation CPT 92523 SLP Eval Lang Comprehension,Express Unit	$315.00	$450.00	—	34% above	30%
Speech and language evaluation inpatient CPT 92523 SLP Eval Lang Comprehension,Express Unit	$315.00	$450.00	—	—	30%
Speech therapy session, individual CPT 92507 SLP Auditory Processing Tx Units	$167.30	$239.00	—	23% above	30%
Speech therapy session, individual inpatient CPT 92507 SLP Auditory Processing Tx Units	$167.30	$239.00	—	—	30%
Spirometry (breathing test) CPT 94010 RT CHARGE PFT:Spirometry	$479.50	$685.00	—	63% above	30%
Spirometry (breathing test) inpatient CPT 94010 RT CHARGE PFT:Spirometry	$479.50	$685.00	—	—	30%
Spirometry before and after a bronchodilator CPT 94060 RT CHARGE PFT:Spirometry before and after	$473.90	$677.00	—	7% above	30%
Spirometry before and after a bronchodilator inpatient CPT 94060 RT CHARGE PFT:Spirometry before and after	$473.90	$677.00	—	—	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Assistant Units	$57.40	$82.00	—	27% below	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Units	$67.90	$97.00	—	14% below	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activity Assistant Units	$79.10	$113.00	—	1% above	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activity Units	$79.10	$113.00	—	1% above	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activities Assistant Units	$57.40	$82.00	—	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activities Units	$67.90	$97.00	—	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activity Units	$79.10	$113.00	—	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activity Assistant Units	$79.10	$113.00	—	—	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 99195 PHLEBOTOMY CHARGE	$216.30	$309.00	—	83% above	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy	$249.20	$356.00	—	111% above	30%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 99195 PHLEBOTOMY CHARGE	$216.30	$309.00	—	—	30%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Therapeutic Phlebotomy	$249.20	$356.00	—	—	30%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90656 infl prsv free tri im	$61.60	$88.00	—	92% above	30%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 AMB influenza vaccine Charge:Fluzone - single dose	$61.60	$88.00	—	92% above	30%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 90656 infl prsv free tri im	$61.60	$88.00	—	—	30%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 AMB influenza vaccine Charge:Fluzone - single dose	$61.60	$88.00	—	—	30%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 90662 prsv free inc antig	$246.40	$352.00	—	188% above	30%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High-Dose	$246.40	$352.00	—	188% above	30%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone High-Dose	$246.40	$352.00	—	—	30%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 90662 prsv free inc antig	$246.40	$352.00	—	—	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate vaccine - Sus UD [NORT]	$838.34	$1,197.63	—	123% above	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conjugate vaccine - Sus UD [NORT]	$838.34	$1,197.63	—	—	30%
Rabies vaccine, one dose CPT 90675 rabies vaccine, purified chick embyro cell 2.5 intl units IM Inj [NORT]	$786.44	$1,123.48	—	37% above	30%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, purified chick embyro cell 2.5 intl units IM Inj [NORT]	$786.44	$1,123.48	—	—	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 AMB tetanus diptheria toxoids Charge:vaccine (Tenivac)	$87.85	$125.50	—	42% above	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diphth toxoids (Td) adult/adol 5 units-2 units/0.5 mL preservative-free Sus [NORT]	$117.38	$167.69	—	90% above	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 AMB tetanus diptheria toxoids Charge:vaccine (Tenivac)	$87.85	$125.50	—	—	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus-diphth toxoids (Td) adult/adol 5 units-2 units/0.5 mL preservative-free Sus [NORT]	$117.38	$167.69	—	—	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphtheria/pertussis, acel (Tdap) 0.5 mL IM Susp [NORT]	$138.45	$197.78	—	95% above	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap 90715 AGE OVER 7	$138.60	$198.00	—	95% above	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphtheria/pertussis, acel (Tdap) 0.5 mL IM Susp [NORT]	$138.45	$197.78	—	—	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tdap 90715 AGE OVER 7	$138.60	$198.00	—	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE TechFee	$25.90	$37.00	—	32% below	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION, 1ST VACCINE	$33.60	$48.00	—	12% below	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin	$33.60	$48.00	—	12% below	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471-Vaccine Administration	$56.00	$80.00	—	47% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE TechFee	$25.90	$37.00	—	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin	$33.60	$48.00	—	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION, 1ST VACCINE	$33.60	$48.00	—	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471-Vaccine Administration	$56.00	$80.00	—	—	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472-Vaccine Administration Each Addl	$11.90	$17.00	—	50% below	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION, EA ADDITIONAL VACCINE	$22.40	$32.00	—	6% below	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin 2+	$22.40	$32.00	—	6% below	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE TechFee	$25.90	$37.00	—	9% above	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472-Vaccine Administration Each Addl	$11.90	$17.00	—	—	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION, EA ADDITIONAL VACCINE	$22.40	$32.00	—	—	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Admin 2+	$22.40	$32.00	—	—	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE TechFee	$25.90	$37.00	—	—	30%

Source file: https://www.ntcohosp.com/48-6013207_norton-county-hospital_standardcharges.json