Hospital Springfield, MO

Citizens Memorial Hospital

Citizens Memorial Hospital in Bolivar, MO publishes cash prices for 371 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the Missouri median for 211 of 369 procedures and above it for 153. By typical cash price it ranks #17 of 60 Missouri hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1500 N Oakland Ave,Bolivar,MO,65613 Collected Sep 27, 2026 Source price file (417) 326-6000

Acute care hospital Emergency department CMS star rating 3 of 5 CCN 260195 · CMS hospital register

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 5 actions for a hospital named Citizens Memorial Hospital in Bolivar, MO:

Jun 23, 2021 Warning notice
Dec 1, 2021 Corrective action plan requested
Mar 2, 2023 Case closed
Aug 23, 2024 Warning notice
Dec 3, 2024 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 X-RAY EXAM OF ANKLE	$85.60	$107.00	$80.42–$126.79	71% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$202.40	$253.00	$142.02–$193.86	41% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ULTRASOUND STUDY OF ARM AND LEG ARTERIES	$325.40	$406.75	$142.02–$193.86	5% below	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 SINGLE CONTRAST X-RAY OF ESOPHAGUS	$606.20	$757.75	$187.23–$255.57	39% above	20%
Bone scan, whole body (nuclear medicine) CPT 78306 NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT WHOLE BODY	$1,529.80	$1,912.25	$426.75–$798.77	3% above	20%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE IMAGING WHOLE BODY	$1,606.40	$2,008.00	$426.75–$798.77	8% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST	$2,358.00	$2,947.50	$187.23–$759.42	21% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST	$2,476.00	$3,095.00	$187.23–$759.42	28% above	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT SCAN OF BLOOD VESSELS AND GRAFTS OF HEART WITH CONTRAST	$1,593.60	$1,992.00	$372.42–$789.35	12% above	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO HRT W/3D IMAGE	$1,673.40	$2,091.75	$372.42–$789.35	18% above	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HRT W/O DYE W/CA TEST	$58.82	$73.53	$73.53–$126.79	30% below	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST	$4,060.80	$5,076.00	$254.71–$1,022.81	91% above	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST	$4,087.40	$5,109.25	$254.71–$1,022.81	92% above	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST	$5,013.20	$6,266.50	$372.42–$2,002.76	111% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST	$5,640.00	$7,050.00	$372.42–$917.37	93% above	20%
CT scan of the abdomen with contrast CPT 74160 CT SCAN OF ABDOMEN WITH CONTRAST	$2,730.60	$3,413.25	$187.23–$607.69	74% above	20%
CT scan of the abdomen without contrast CPT 74150 CT SCAN OF ABDOMEN WITHOUT CONTRAST	$2,172.20	$2,715.25	$111.60–$328.11	102% above	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SCAN OF FACE WITHOUT CONTRAST	$2,019.80	$2,524.75	$111.60–$354.22	87% above	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O DYE	$2,031.60	$2,539.50	$111.60–$354.22	88% above	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT SCAN HEAD OR BRAIN WITHOUT CONTRAST	$2,095.20	$2,619.00	$111.60–$666.76	66% above	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE	$2,105.20	$2,631.50	$111.60–$666.76	67% above	20%
CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W/DYE	$2,109.80	$2,637.25	$187.23–$382.99	47% above	20%
CT scan of the head without and with contrast CPT 70470 CT SCAN OF HEAD OR BRAIN BEFORE AND AFTER CONTRAST	$2,839.80	$3,549.75	$187.23–$465.28	59% above	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SCAN OF LOWER SPINE WITHOUT CONTRAST	$2,368.20	$2,960.25	$111.60–$439.16	72% above	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SCAN OF UPPER SPINE WITHOUT CONTRAST	$2,506.80	$3,133.50	$111.60–$439.16	54% above	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT SCAN OF PELVIS WITH CONTRAST	$2,580.40	$3,225.50	$187.23–$610.33	58% above	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE	$2,626.00	$3,282.50	$187.23–$610.33	60% above	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 EXTRACRANIAL BILAT STUDY	$250.40	$313.00	$254.71–$347.68	—	20%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 ULTRASOUND OF BOTH SIDES OF HEAD AND NECK BLOOD FLOW	$897.00	$1,121.25	$254.71–$347.68	8% above	20%
Chest X-ray, 2 views CPT 71046 X-RAY EXAM CHEST 2 VIEWS	$92.00	$115.00	$92.89–$126.79	63% below	20%
Chest X-ray, 2 views CPT 71046 X-RAY OF CHEST; 2 VIEWS	$317.20	$396.50	$92.89–$138.56	26% above	20%
Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW	$71.20	$89.00	$48.05–$126.79	66% below	20%
Chest X-ray, single view CPT 71045 X-RAY OF CHEST; 1 VIEW	$237.80	$297.25	$48.05–$126.79	13% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US EXAM ABDO BACK WALL COMP	$118.40	$148.00	$111.60–$152.33	79% below	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY	$955.60	$1,194.50	$111.60–$632.37	69% above	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL	$457.60	$572.00	$111.60–$256.06	34% above	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY MEASUREMENT OF HIP; PELVIS; SPINE	$533.40	$666.75	$111.60–$256.06	56% above	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 OB US DETAILED SNGL FETUS	$1,087.80	$1,359.75	$254.71–$347.68	64% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT SCAN OF CHEST WITHOUT CONTRAST	$2,278.60	$2,848.25	$111.60–$1,097.92	77% above	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT SCAN OF CHEST WITH CONTRAST	$2,582.80	$3,228.50	$187.23–$1,519.25	57% above	20%
Diagnostic mammogram, both breasts CPT 77066 DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS	$690.40	$863.00	$44.76–$308.92	213% above	20%
Diagnostic mammogram, one breast CPT 77065 DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST	$536.80	$671.00	$36.36–$246.17	131% above	20%
Duplex ultrasound of the leg arteries, both legs CPT 93925 LOWER EXTREMITY STUDY	$284.80	$356.00	$254.71–$347.68	59% below	20%
Duplex ultrasound of the leg arteries, both legs CPT 93925 ULTRASOUND OF LEG ARTERIES OR ARTERY GRAFTS	$961.60	$1,202.00	$254.71–$347.68	38% above	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY	$420.00	$525.00	$254.71–$347.68	48% below	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 ULTRASOUND STUDY OF ARM OR LEG VEINS WITH COMPRESSION AND MANEUVERS	$1,411.80	$1,764.75	$254.71–$347.68	75% above	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER COMPLETE	$240.00	$300.00	$583.29–$796.19	84% below	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ULTRASOUND OF HEART WITH COLOR-DEPICTED BLOOD FLOW; RATE; DIRECTION AND VALVE FUNCTION	$2,118.60	$2,648.25	$583.29–$796.19	40% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NUCLEAR MEDICINE STUDY OF LIVER AND BILE DUCT SYSTEM	$2,050.80	$2,563.50	$426.75–$1,121.50	49% above	20%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY INCLUDING HEART RATE; BREATHING; AIRFLOW; AND EFFORT	$691.40	$864.25	$230.49–$462.95	4% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP STUDY IN SLEEP LAB WITH CONTINUOUS AIRWAY PRESSURE (6 YEARS OR OLDER)	$4,237.40	$5,296.75	$916.68–$2,319.01	61% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM	$4,449.40	$5,561.75	$916.68–$2,319.01	69% above	20%
Knee X-ray, 3 views CPT 73562 X-RAY OF KNEE; 3 VIEWS	$87.20	$109.00	$88.19–$126.79	68% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN	$96.00	$120.00	$111.60–$152.33	81% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 LIMITED ULTRASOUND SCAN OF ABDOMEN	$749.40	$936.75	$111.60–$514.86	49% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING	$1,215.60	$1,519.50	$111.60–$335.92	179% above	20%
MRI of the abdomen without contrast CPT 74181 MRI SCAN OF ABDOMEN WITHOUT CONTRAST	$2,726.80	$3,408.50	$254.71–$947.42	64% above	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST	$4,048.20	$5,060.25	$372.42–$1,434.92	67% above	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN STEM W/O DYE	$520.00	$650.00	$254.71–$650.00	68% below	20%
MRI of the brain, no contrast dye CPT 70551 MRI SCAN OF BRAIN WITHOUT CONTRAST	$2,708.60	$3,385.75	$254.71–$1,417.99	68% above	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST	$3,900.00	$4,875.00	$372.42–$2,391.78	53% above	20%
MRI of the lower back, no contrast dye CPT 72148 MRI SCAN OF LOWER SPINAL CANAL WITHOUT CONTRAST	$2,954.60	$3,693.25	$254.71–$1,342.90	59% above	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CONTRAST	$3,870.00	$4,837.50	$372.42–$958.05	55% above	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST	$3,129.40	$3,911.75	$254.71–$542.36	78% above	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CONTRAST	$4,031.60	$5,039.50	$372.42–$964.56	62% above	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST	$2,958.60	$3,698.25	$254.71–$1,355.93	49% above	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI NECK SPINE W/O DYE	$3,041.80	$3,802.25	$254.71–$1,355.93	54% above	20%
MRI of the pelvis without and with contrast CPT 72197 MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST	$3,889.00	$4,861.25	$372.42–$1,431.00	52% above	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI SCAN OF PELVIS WITHOUT CONTRAST	$3,005.80	$3,757.25	$254.71–$1,046.86	60% above	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O DYE	$3,024.40	$3,780.50	$254.71–$1,046.86	61% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NUCLEAR MEDICINE STUDIES OF HEART MUSCLE AT REST AND WITH STRESS AND SPECT	$4,598.20	$5,747.75	$1,382.00–$3,373.72	12% above	20%
OCT scan of the retina (optical coherence tomography) CPT 92134 CPTRZ OPH DX IMG PST SGM RTA	$92.80	$116.00	$62.97–$85.95	191% above	20%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN	$6,958.20	$8,697.75	$1,526.43–$5,404.92	52% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED	$106.40	$133.00	$83.03–$152.33	74% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 LIMITED ULTRASOUND SCAN OF PELVIS	$606.40	$758.00	$83.03–$152.33	50% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 COMPLETE ULTRASOUND SCAN OF PELVIS	$264.80	$331.00	$111.60–$331.00	59% below	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM PELVIC COMPLETE	$391.20	$489.00	$111.60–$489.00	40% below	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE); SINGLE OR FIRST FETUS	$178.40	$223.00	$111.60–$223.00	69% below	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >= 14 WKS SNGL FETUS	$252.00	$315.00	$111.60–$315.00	56% below	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 ULTRASOUND SCAN OF PREGNANT UTERUS (LESS THAN 14 WEEKS); SINGLE OR FIRST FETUS	$232.00	$290.00	$111.60–$290.00	55% below	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS SINGLE FETUS	$314.40	$393.00	$111.60–$393.00	39% below	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US LIMITED FETUS(S)	$152.80	$191.00	$111.60–$189.61	57% below	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 LIMITED ULTRASOUND OF PREGNANT UTERUS	$418.80	$523.50	$111.60–$189.61	17% above	20%
Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD	$270.60	$338.25	$33.79–$218.72	—	20%
Screening mammogram, both breasts CPT 77067 SCREENING MAMMOGRAPHY	$257.60	$322.00	$33.79–$218.72	56% above	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY OF SHOULDER; MINIMUM OF 2 VIEWS	$89.60	$112.00	$68.76–$126.79	67% below	20%
Sleep study in a lab (polysomnography) CPT 95810 SLEEP STUDY IN SLEEP LAB (6 YEARS OR OLDER)	$4,183.20	$5,229.00	$916.68–$2,319.01	65% above	20%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/> YRS 4/> PARAM	$4,392.40	$5,490.50	$916.68–$2,319.01	73% above	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 IMAGING FOR EVALUATION OF SWALLOWING FUNCTION	$623.80	$779.75	$187.23–$371.20	41% above	20%
Transvaginal pelvic ultrasound CPT 76830 ULTRASOUND SCAN OF UTERUS; OVARIES; TUBES; CERVIX AND PELVIC AREA THROUGH VAGINA	$104.00	$130.00	$111.60–$152.33	82% below	20%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON-OB	$153.60	$192.00	$111.60–$192.00	74% below	20%
Transvaginal ultrasound during pregnancy CPT 76817 VAGINAL ULTRASOUND OF PREGNANT UTERUS	$104.00	$130.00	$111.60–$152.33	78% below	20%
Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US OBSTETRIC	$158.40	$198.00	$111.60–$198.00	66% below	20%
Ultrasound of the abdomen, complete CPT 76700 COMPLETE ULTRASOUND SCAN OF ABDOMEN	$1,375.60	$1,719.50	$111.60–$682.41	75% above	20%
Ultrasound of the abdomen, complete CPT 76700 US EXAM ABDOM COMPLETE	$1,378.80	$1,723.50	$111.60–$682.41	75% above	20%
Ultrasound of the scrotum and testicles CPT 76870 ULTRASOUND SCAN OF SCROTUM	$885.80	$1,107.25	$111.60–$152.33	53% above	20%
Ultrasound of the scrotum and testicles CPT 76870 US EXAM SCROTUM	$899.80	$1,124.75	$111.60–$152.33	55% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE	$52.80	$66.00	$66.00–$152.33	91% below	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM OF HEAD AND NECK	$152.80	$191.00	$111.60–$191.00	73% below	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 X-RAY XM UPR GI TRC 1CNTRST	$792.80	$991.00	$187.23–$286.31	40% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY	$331.20	$414.00	$111.60–$152.33	41% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 ULTRASOUND STUDY OF ONE ARM OR LEG VEINS WITH COMPRESSION AND MANEUVERS	$776.80	$971.00	$111.60–$152.33	38% above	20%
Wrist X-ray, complete, 3 or more views CPT 73110 X-RAY EXAM OF WRIST	$86.40	$108.00	$92.89–$126.79	67% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-RAY EXAM HIP UNI 2-3 VIEWS	$89.60	$112.00	$92.89–$126.79	62% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-RAY OF HIP; 2-3 VIEWS	$347.20	$434.00	$92.89–$126.79	46% above	20%
X-ray of the abdomen, 1 view CPT 74018 RADEX ABDOMEN 1 VIEW	$101.60	$127.00	$51.93–$126.79	53% below	20%
X-ray of the abdomen, 1 view CPT 74018 X-RAY OF ABDOMEN; 1 VIEW	$305.00	$381.25	$51.93–$126.79	40% above	20%
X-ray of the ankle, 2 views CPT 73600 X-RAY EXAM OF ANKLE	$77.60	$97.00	$67.48–$126.79	59% below	20%
X-ray of the foot, 2 views CPT 73620 X-RAY EXAM OF FOOT	$77.60	$97.00	$64.91–$126.79	61% below	20%
X-ray of the foot, complete, 3 or more views CPT 73630 X-RAY OF FOOT; MINIMUM OF 3 VIEWS	$55.20	$69.00	$69.00–$126.79	80% below	20%
X-ray of the foot, complete, 3 or more views CPT 73630 X-RAY EXAM OF FOOT	$85.60	$107.00	$92.89–$126.79	69% below	20%
X-ray of the hand, 3 or more views CPT 73130 X-RAY OF HAND; MINIMUM OF 3 VIEWS	$55.20	$69.00	$69.00–$126.79	78% below	20%
X-ray of the hand, 3 or more views CPT 73130 X-RAY EXAM OF HAND	$85.60	$107.00	$77.85–$126.79	66% below	20%
X-ray of the knee, 1 or 2 views CPT 73560 X-RAY EXAM OF KNEE 1 OR 2	$77.60	$97.00	$71.36–$126.79	66% below	20%
X-ray of the knee, 1 or 2 views CPT 73560 X-RAY OF KNEE; 1-2 VIEWS	$648.00	$810.00	$71.36–$126.79	183% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY OF LOWER AND SACRAL SPINE; 2-3 VIEWS	$67.20	$84.00	$84.00–$152.33	77% below	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS	$101.60	$127.00	$84.30–$152.33	66% below	20%
X-ray of the lower back, 4 or more views CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS	$136.80	$171.00	$111.60–$152.33	68% below	20%
X-ray of the lower back, 4 or more views CPT 72110 X-RAY OF LOWER AND SACRAL SPINE; MINIMUM OF 4 VIEWS	$636.60	$795.75	$111.60–$152.33	49% above	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-RAY EXAM THORAC SPINE 2VWS	$96.80	$121.00	$71.36–$152.33	63% below	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-RAY OF MIDDLE SPINE; 2 VIEWS	$378.40	$473.00	$71.36–$152.33	44% above	20%
X-ray of the nasal bones, 3 or more views CPT 70160 X-RAY OF NOSE BONES; MINIMUM OF 3 VIEWS	$37.60	$47.00	$47.00–$126.79	85% below	20%
X-ray of the nasal bones, 3 or more views CPT 70160 X-RAY EXAM OF NASAL BONES	$71.20	$89.00	$85.63–$126.79	71% below	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW	$90.40	$113.00	$77.85–$126.79	70% below	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY OF UPPER SPINE; 2-3 VIEWS	$458.20	$572.75	$77.85–$126.79	53% above	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY EXAM OF PELVIS	$78.40	$98.00	$66.21–$152.33	65% below	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY OF PELVIS; 1-2 VIEWS	$319.60	$399.50	$66.21–$152.33	42% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-RAY EXAM SACRUM TAILBONE	$87.20	$109.00	$68.76–$126.79	67% below	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-RAY OF SACRUM AND TAILBONE; MINIMUM OF 2 VIEWS	$365.00	$456.25	$68.76–$126.79	39% above	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 LIVER ENZYME (SGPT); LEVEL	$41.60	$52.00	$5.30–$27.19	14% below	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT)	$65.80	$82.25	$5.30–$27.19	36% above	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 LIVER ENZYME (SGOT); LEVEL	$41.60	$52.00	$5.18–$26.54	11% below	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT)	$65.80	$82.25	$5.18–$26.54	41% above	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$306.60	$383.25	$47.63–$243.50	30% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA	$27.20	$34.00	$5.22–$26.77	23% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE; CRUDE ALLERGEN EXTRACT; EACH	$81.60	$102.00	$5.22–$26.77	269% above	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT	$75.20	$94.00	$12.95–$66.44	6% below	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY	$130.00	$162.50	$12.95–$66.44	62% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 SCREENING TEST FOR AUTOIMMUNE DISORDER	$66.40	$83.00	$12.09–$62.02	2% below	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES	$144.20	$180.25	$12.09–$62.02	112% above	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL	$124.00	$155.00	$39.26–$143.18	1% above	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE	$148.40	$185.50	$39.26–$143.18	21% above	20%
Basic metabolic panel (blood test) CPT 80048 BLOOD TEST; BASIC GROUP OF BLOOD CHEMICALS (CALCIUM; TOTAL)	$159.60	$199.50	$8.46–$93.00	29% above	20%
Basic metabolic panel (blood test) CPT 80048 METABOLIC PANEL TOTAL CA	$167.60	$209.50	$8.46–$93.00	35% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST	$110.40	$138.00	$55.63–$138.00	46% below	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; INTERMEDIATE COMPLEXITY	$685.80	$857.25	$55.63–$233.02	236% above	20%
Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA	$23.20	$29.00	$10.32–$29.00	79% below	20%
Blood culture for bacteria CPT 87040 BACTERIAL BLOOD CULTURE	$155.60	$194.50	$10.32–$52.98	40% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE	$20.80	$26.00	$9.34–$24.24	24% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE	$48.00	$60.00	$9.34–$24.24	186% above	20%
Blood glucose (sugar) test CPT 82947 BLOOD GLUCOSE (SUGAR) LEVEL	$22.40	$28.00	$3.93–$20.14	31% below	20%
Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE BLOOD QUANT	$48.00	$60.00	$3.93–$20.14	47% above	20%
Blood lead test CPT 83655 LEAD LEVEL	$66.40	$83.00	$12.11–$62.10	22% above	20%
Blood lead test CPT 83655 ASSAY OF LEAD	$128.00	$160.00	$12.11–$62.10	134% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHORIONIC GONADOTROPIN ASSAY	$48.80	$61.00	$7.52–$38.58	8% below	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS	$96.00	$120.00	$7.52–$38.58	80% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD GROUP TYPING (ABO)	$31.20	$39.00	$15.17–$193.86	57% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO	$48.20	$60.25	$15.17–$193.86	33% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION	$56.00	$70.00	$5.18–$56.89	6% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$58.80	$73.50	$5.18–$56.89	1% below	20%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED PROBE	$106.40	$133.00	$37.27–$133.00	24% below	20%
C. difficile toxin gene test (stool PCR) CPT 87493 DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE; AMPLIFIED PROBE TECHNIQUE	$217.40	$271.75	$37.27–$180.10	55% above	20%
CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN; QUANTITATIVE; CA 19-9	$158.00	$197.50	$20.81–$106.78	44% above	20%
CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR CA 19-9	$166.00	$207.50	$20.81–$106.78	51% above	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN; QUANTITATIVE; CA 125	$221.20	$276.50	$20.81–$106.78	103% above	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125	$232.40	$290.50	$20.81–$106.78	113% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN	$100.00	$125.00	$51.31–$125.00	at median	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS; AMPLIFIED PROBE TECHNIQUE	$88.80	$111.00	$35.09–$111.00	1% below	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE	$300.60	$375.75	$35.09–$180.10	234% above	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 BLOOD TEST; LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)	$104.00	$130.00	$13.39–$130.00	1% above	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$165.40	$206.75	$13.39–$147.21	61% above	20%
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$38.40	$48.00	$7.77–$48.00	28% below	20%
Complete blood count (CBC) with differential CPT 85025 COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT	$92.20	$115.25	$7.77–$85.49	73% above	20%
Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED	$31.20	$39.00	$6.47–$33.22	36% below	20%
Complete blood count (CBC), no differential CPT 85027 COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST	$73.80	$92.25	$6.47–$33.22	50% above	20%
Comprehensive metabolic panel (blood test) CPT 80053 BLOOD TEST; COMPREHENSIVE GROUP OF BLOOD CHEMICALS	$187.20	$234.00	$10.56–$116.13	49% above	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL	$196.60	$245.75	$10.56–$116.13	56% above	20%
D-dimer blood test (blood clot marker) CPT 85379 COAGULATION FUNCTION MEASUREMENT; D-DIMER; QUANTITATIVE	$80.00	$100.00	$10.18–$52.24	36% below	20%
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION QUANT	$92.00	$115.00	$10.18–$52.24	27% below	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL	$101.60	$127.00	$22.23–$114.11	26% below	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE	$168.00	$210.00	$22.23–$114.11	23% above	20%
Estradiol blood test CPT 82670 MEASUREMENT OF TOTAL ESTRADIOL (HORMONE)	$140.60	$175.75	$27.94–$143.37	2% below	20%
Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL	$147.80	$184.75	$27.94–$143.37	3% above	20%
FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN; FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL	$88.80	$111.00	$18.58–$95.37	13% below	20%
FSH (follicle-stimulating hormone) test CPT 83001 ASSAY OF GONADOTROPIN (FSH)	$221.80	$277.25	$18.58–$95.37	117% above	20%
Fecal calprotectin (stool inflammation test) CPT 83993 STOOL CALPROTECTIN (PROTEIN) LEVEL	$310.00	$387.50	$19.63–$100.72	67% above	20%
Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$325.60	$407.00	$19.63–$100.72	75% above	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN (BLOOD PROTEIN) LEVEL	$64.00	$80.00	$13.63–$80.00	24% below	20%
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN	$154.40	$193.00	$13.63–$149.80	84% above	20%
Folate (folic acid) blood test CPT 82746 FOLIC ACID LEVEL; SERUM	$68.80	$86.00	$14.70–$75.46	10% below	20%
Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM	$104.80	$131.00	$14.70–$75.46	38% above	20%
Free T3 thyroid hormone test CPT 84481 THYROID HORMONE; T3 MEASUREMENT; FREE	$101.60	$127.00	$16.94–$86.93	2% above	20%
Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3)	$190.20	$237.75	$16.94–$86.93	92% above	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE (THYROID CHEMICAL); FREE	$66.40	$83.00	$9.02–$83.00	10% below	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE	$88.80	$111.00	$9.02–$99.15	20% above	20%
Free testosterone test CPT 84402 TESTOSTERONE (HORMONE) LEVEL; FREE	$115.20	$144.00	$25.47–$130.65	8% below	20%
Free testosterone test CPT 84402 ASSAY OF FREE TESTOSTERONE	$321.80	$402.25	$25.47–$130.65	157% above	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$173.60	$217.00	$146.15–$147.47	37% below	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TEST	$27.20	$34.00	$4.75–$24.37	36% below	20%
Glucose tolerance test, 3 samples CPT 82951 BLOOD GLUCOSE (SUGAR) TOLERANCE TEST; 3 SPECIMENS	$57.60	$72.00	$12.87–$66.06	37% below	20%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$143.80	$179.75	$12.87–$66.06	58% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA); AMPLIFIED PROBE TECHNIQUE	$92.80	$116.00	$35.09–$116.00	14% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA AMP PROB	$286.20	$357.75	$35.09–$180.10	252% above	20%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI ANTIBODY	$80.00	$100.00	$16.85–$74.44	7% above	20%
H. pylori stool antigen test CPT 87338 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI (GI TRACT BACTERIA) IN STOOL	$66.40	$83.00	$14.38–$38.35	45% below	20%
H. pylori stool antigen test CPT 87338 HPYLORI STOOL AG IA	$120.80	$151.00	$14.38–$38.35	1% above	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ	$588.00	$735.00	$85.10–$436.64	68% above	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS; QUANTIFICATION	$617.40	$771.75	$85.10–$436.64	77% above	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES	$64.00	$80.00	$24.08–$80.00	21% below	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA	$146.20	$182.75	$24.08–$123.56	80% above	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV); HIGH-RISK TYPES	$66.40	$83.00	$35.09–$83.00	40% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HI-RISK TYP POOLED RSLT	$353.60	$442.00	$35.09–$180.10	220% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C	$53.60	$67.00	$9.71–$67.00	13% below	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C LEVEL	$88.80	$111.00	$9.71–$106.74	45% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY MEASUREMENT	$66.40	$83.00	$10.74–$55.12	4% below	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY	$128.60	$160.75	$10.74–$55.12	87% above	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN	$62.40	$78.00	$10.33–$52.12	4% below	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA	$121.00	$151.25	$10.33–$52.12	87% above	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY MEASUREMENT	$119.20	$149.00	$14.27–$73.23	41% above	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB TEST	$170.00	$212.50	$14.27–$73.23	101% above	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS; QUANTIFICATION	$375.20	$469.00	$42.84–$219.80	26% above	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ	$486.00	$607.50	$42.84–$219.80	63% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS; TYPE 2	$97.60	$122.00	$19.35–$99.32	61% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST	$178.20	$222.75	$19.35–$99.32	194% above	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION; HIGH SENSITIVITY	$28.80	$36.00	$12.95–$36.00	59% below	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS	$129.20	$161.50	$12.95–$66.44	82% above	20%
Homocysteine blood test CPT 83090 HOMOCYSTEINE (AMINO ACID) LEVEL	$84.00	$105.00	$17.92–$86.54	23% below	20%
Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE	$137.60	$172.00	$17.92–$86.54	26% above	20%
Insulin blood test CPT 83525 INSULIN MEASUREMENT; TOTAL	$40.00	$50.00	$11.43–$50.00	33% below	20%
Insulin blood test CPT 83525 ASSAY OF INSULIN	$138.40	$173.00	$11.43–$58.64	133% above	20%
Iron blood test (serum iron) CPT 83540 IRON LEVEL	$31.20	$39.00	$6.47–$39.00	32% below	20%
Iron blood test (serum iron) CPT 83540 ASSAY OF IRON	$70.20	$87.75	$6.47–$71.18	52% above	20%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY	$36.00	$45.00	$8.74–$45.00	47% below	20%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST	$94.80	$118.50	$8.74–$96.16	40% above	20%
Kidney function blood test panel CPT 80069 KIDNEY FUNCTION BLOOD TEST PANEL	$44.80	$56.00	$8.68–$44.57	58% below	20%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$69.60	$87.00	$8.68–$44.57	35% below	20%
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN; LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL	$88.80	$111.00	$18.52–$95.02	13% below	20%
LH (luteinizing hormone) test CPT 83002 ASSAY OF GONADOTROPIN (LH)	$219.20	$274.00	$18.52–$95.02	115% above	20%
Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE	$22.20	$27.75	$6.89–$27.75	65% below	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE (FAT ENZYME) LEVEL	$76.20	$95.25	$6.89–$35.37	21% above	20%
Liver function blood test panel CPT 80076 LIVER FUNCTION BLOOD TEST PANEL	$194.00	$242.50	$8.17–$89.77	45% above	20%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$203.80	$254.75	$8.17–$89.77	53% above	20%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY	$139.00	$173.75	$17.03–$87.41	52% above	20%
Lyme disease antibody test CPT 86618 ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA)	$171.20	$214.00	$17.03–$87.41	87% above	20%
Magnesium blood test CPT 83735 MAGNESIUM LEVEL	$36.00	$45.00	$6.70–$45.00	23% below	20%
Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM	$80.20	$100.25	$6.70–$73.60	71% above	20%
Measles (rubeola) antibody test CPT 86765 ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS)	$92.80	$116.00	$12.88–$66.10	57% above	20%
Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY	$144.20	$180.25	$12.88–$66.10	144% above	20%
Mono test (heterophile antibody, Monospot) CPT 86308 SCREENING TEST FOR MONONUCLEOSIS (MONO)	$40.00	$50.00	$5.18–$26.54	2% below	20%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN	$70.20	$87.75	$5.18–$26.54	71% above	20%
Obstetric blood test panel CPT 80055 OBSTETRIC PANEL	$81.60	$102.00	$47.81–$102.00	75% below	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; FREE	$71.20	$89.00	$18.39–$89.00	7% below	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PSA FREE	$142.80	$178.50	$18.39–$94.37	87% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL	$150.00	$187.50	$18.39–$94.37	95% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL	$157.60	$197.00	$18.39–$94.37	105% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 PAP TEST; AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING	$78.40	$98.00	$26.61–$94.40	6% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATH C/V AUTO FLUID REDO	$93.40	$116.75	$26.61–$94.40	26% above	20%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH C/V THIN LAYER	$83.40	$104.25	$20.26–$77.48	14% above	20%
Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE	$132.80	$166.00	$41.28–$166.00	22% below	20%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PARATHYROID HORMONE) LEVEL	$145.60	$182.00	$41.28–$182.00	15% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 COAGULATION ASSESSMENT BLOOD TEST; PLASMA OR WHOLE BLOOD	$36.00	$45.00	$6.01–$30.81	32% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL	$56.40	$70.50	$6.01–$30.81	7% above	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 TEST FOR DETECTING GENES ASSOCIATED WITH FETAL DISEASE; ANEUPLOIDY GENOMIC SEQUENCE ANALYSIS PANEL	$635.20	$794.00	$759.05–$1,036.10	46% below	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 FETAL CHRMOML ANEUPLOIDY	$735.60	$919.50	$759.05–$1,036.10	37% below	20%
Progesterone blood test CPT 84144 PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL	$88.80	$111.00	$20.86–$107.06	20% below	20%
Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE	$215.00	$268.75	$20.86–$107.06	95% above	20%
Prolactin blood test CPT 84146 PROLACTIN (MILK PRODUCING HORMONE) LEVEL	$110.40	$138.00	$19.38–$99.44	10% below	20%
Prolactin blood test CPT 84146 ASSAY OF PROLACTIN	$219.80	$274.75	$19.38–$99.44	79% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$22.40	$28.00	$4.29–$28.00	20% below	20%
Prothrombin time (PT/INR) clotting test CPT 85610 BLOOD TEST; CLOTTING TIME	$53.60	$67.00	$4.29–$43.23	91% above	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 TESTING FOR PRESENCE OF DRUG; READ BY DIRECT OBSERVATION	$46.40	$58.00	$12.60–$54.91	32% below	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRSMV DIR OPT OBS	$51.40	$64.25	$12.60–$54.91	24% below	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/OPTIC	$75.20	$94.00	$16.55–$61.54	26% above	20%
Rapid flu test (influenza antigen) CPT 87804 DETECTION TEST BY IMMUNOASSAY WITH DIRECT VISUAL OBSERVATION FOR INFLUENZA VIRUS	$194.40	$243.00	$16.55–$61.54	225% above	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 DETECTION TEST BY IMMUNOASSAY WITH DIRECT VISUAL OBSERVATION FOR STREPTOCOCCUS; GROUP A (STREP)	$96.00	$120.00	$16.53–$61.54	142% above	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ASSAY W/OPTIC	$100.80	$126.00	$16.53–$61.54	154% above	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT	$36.00	$45.00	$5.67–$29.12	19% below	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR LEVEL	$72.00	$90.00	$5.67–$29.12	61% above	20%
Rubella antibody test (immunity check) CPT 86762 ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS)	$62.40	$78.00	$14.39–$73.84	18% above	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY	$162.40	$203.00	$14.39–$73.84	208% above	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RED BLOOD CELL SEDIMENTATION RATE; TO DETECT INFLAMMATION; AUTOMATED	$18.40	$23.00	$2.70–$13.86	47% below	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE AUTOMATED	$47.00	$58.75	$2.70–$13.86	37% above	20%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANAL VOL/COUNT/MOT	$30.40	$38.00	$12.31–$38.00	74% below	20%
Stool ova and parasites exam CPT 87177 SMEAR FOR PARASITES	$62.40	$78.00	$8.90–$45.67	8% above	20%
Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS	$90.40	$113.00	$8.90–$45.67	57% above	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECES	$18.40	$23.00	$4.38–$16.72	14% below	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 STOOL ANALYSIS FOR BLOOD; BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY	$67.20	$84.00	$15.92–$81.65	32% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS DETECTION TEST	$31.20	$39.00	$4.27–$21.91	5% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL	$31.60	$39.50	$4.27–$21.91	7% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TUBERCULOSIS TEST; GAMMA INTERFERON	$285.60	$357.00	$61.98–$318.06	50% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUN MEASURE	$459.40	$574.25	$61.98–$318.06	141% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE (HORMONE) LEVEL; TOTAL	$119.20	$149.00	$25.81–$132.46	at median	20%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$262.80	$328.50	$25.81–$132.46	121% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT	$80.00	$100.00	$14.55–$74.66	4% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EACH	$173.20	$216.50	$14.55–$74.66	126% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE	$83.20	$104.00	$16.80–$104.00	82% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 BLOOD TEST; THYROID STIMULATING HORMONE (TSH)	$173.00	$216.25	$16.80–$184.79	278% above	20%
Trichomonas test (NAAT) CPT 87661 DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE); AMPLIFIED PROBE TECHNIQUE	$136.00	$170.00	$35.09–$170.00	1% below	20%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$173.40	$216.75	$35.09–$180.10	26% above	20%
Uric acid blood test CPT 84550 URIC ACID LEVEL; BLOOD	$22.40	$28.00	$4.52–$23.20	47% below	20%
Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID	$57.20	$71.50	$4.52–$23.20	35% above	20%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$37.60	$47.00	$3.17–$16.25	at median	20%
Urinalysis with microscope exam, automated CPT 81001 MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE; AUTOMATED	$60.00	$75.00	$3.17–$16.25	60% above	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE	$28.80	$36.00	$2.25–$22.94	43% above	20%
Urinalysis without microscope exam, automated CPT 81003 AUTOMATED URINALYSIS TEST	$43.00	$53.75	$2.25–$22.94	114% above	20%
Urine culture for bacteria, with colony count CPT 87086 BACTERIAL COLONY COUNT; URINE	$76.20	$95.25	$8.07–$35.90	18% above	20%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT	$80.20	$100.25	$8.07–$35.90	24% above	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$44.80	$56.00	$8.61–$32.47	10% below	20%
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN (VITAMIN B-12) LEVEL	$102.40	$128.00	$15.08–$77.34	33% above	20%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12	$107.60	$134.50	$15.08–$77.34	40% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D-3 LEVEL	$185.60	$232.00	$29.60–$232.00	37% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY	$441.80	$552.25	$29.60–$325.54	225% above	20%
Zinc blood test CPT 84630 ZINC LEVEL	$57.60	$72.00	$11.39–$58.44	6% below	20%
Zinc blood test CPT 84630 ASSAY OF ZINC	$101.40	$126.75	$11.39–$58.44	66% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN; CHORIONIC (REPRODUCTIVE HORMONE) LEVEL	$84.00	$105.00	$15.05–$35.87	1% below	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST	$94.20	$117.75	$15.05–$35.87	11% above	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 REMOVAL OF ADENOIDS	$422.40	$528.00	$3,539.16–$4,830.95	87% below	20%
Adenoid removal (adenoidectomy), child under 12 CPT 42830 PRIMARY REMOVAL OF ADENOIDS (YOUNGER THAN 12 YEARS)	$2,453.60	$3,067.00	$3,539.16–$5,182.00	24% below	20%
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 FUSION OF UPPER SPINE BONE WITH REMOVAL OF DISC AND RELEASE OF SPINAL CORD OR NERVE; 1 DISC	$3,895.20	$4,869.00	$5,182.00–$18,707.26	72% below	20%
Botox injections for chronic migraine CPT 64615 INJECTION OF CHEMICAL FOR PARALYSIS OF FACIAL AND NECK NERVE MUSCLES ON BOTH SIDES OF FACE	$192.00	$240.00	$327.67–$447.27	26% below	20%
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE	$236.00	$295.00	$327.67–$5,182.00	9% below	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT OF ANKLE FRACTURE	$684.00	$855.00	$263.30–$359.40	40% above	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE	$407.20	$509.00	$263.30–$359.40	4% above	20%
Bunion correction with removal of part of the big toe joint CPT 28292 COR HLX VLGS RSC PRX PHLX BS	$2,414.40	$3,018.00	$3,492.77–$4,767.63	105% above	20%
Cardiac catheterization with coronary angiogram CPT 93458 L HRT ARTERY/VENTRICLE ANGIO	$11,748.40	$14,685.50	$3,460.67–$4,723.81	11% above	20%
Cardiac catheterization with coronary angiogram one side CPT 93458 INSERTION OF TUBE IN LEFT LOWER HEART CHAMBER AND CORONARY ARTERY FOR DIAGNOSIS WITH REVIEW BY RADIOLOGIST	$11,188.80	$13,986.00	$3,460.67–$4,723.81	6% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT	$512.00	$640.00	$705.54–$963.06	38% below	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 EXTERNAL SHOCK TO HEART TO REGULATE HEART BEAT	$1,709.80	$2,137.25	$705.54–$5,182.00	108% above	20%
Cataract surgery with lens implant CPT 66984 XCAPSL CTRC RMVL W/O ECP	$883.20	$1,104.00	$2,463.54–$5,182.00	83% below	20%
Cataract surgery with lens implant CPT 66984 REMOVAL OF CATARACT WITH INSERTION OF PROSTHETIC LENS	$3,539.60	$4,424.50	$2,463.54–$5,182.00	32% below	20%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX	$211.20	$264.00	$983.20–$1,342.07	80% below	20%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX OR REMOVAL OF GROWTH	$3,821.50	$4,776.87	$983.20–$5,182.00	260% above	20%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUM 28 DAYS OR OLDER	$407.20	$509.00	$2,231.42–$5,182.00	87% below	20%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 REMOVAL OF FORESKIN (OLDER THAN 28 DAYS)	$5,152.80	$6,441.00	$2,231.42–$5,182.00	62% above	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONL BLOCK	$643.00	$803.75	$2,231.42–$5,182.00	93% above	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 REMOVAL OF FORESKIN USING CLAMP OR DEVICE	$4,907.20	$6,134.00	$2,231.42–$5,182.00	1372% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLTX DST RDL FX/EPHYS SEP WO	$719.20	$899.00	$263.30–$359.40	22% above	20%
Colonoscopy with polyp removal CPT 45385 REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE	$3,821.50	$4,776.87	$1,277.38–$5,182.00	125% above	20%
Colonoscopy with tissue sample CPT 45380 BIOPSY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE	$5,152.80	$6,441.00	$1,277.38–$5,182.00	189% above	20%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY	$745.60	$932.00	$992.71–$5,182.00	41% below	20%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE	$4,907.20	$6,134.00	$992.71–$5,182.00	288% above	20%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX OF CERVIX W/SCOPE LEEP	$248.80	$311.00	$3,455.53–$4,716.80	88% below	20%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$280.80	$351.00	$325.29–$5,182.00	38% below	20%
Complex cataract surgery with lens implant CPT 66982 XCAPSL CTRC RMVL CPLX WO ECP	$1,595.20	$1,994.00	$2,463.54–$5,182.00	64% below	20%
Coronary stent placement, one artery CPT 92928 PRQ TCAT PLMT NTRAC ST 1 LES	$14,283.20	$17,854.00	$12,323.11–$16,821.05	at median	20%
Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY AND TREATMENT	$1,021.60	$1,277.00	$3,762.82–$5,182.00	83% below	20%
Cystoscopy with ureteral stent placement CPT 52332 INSERTION OF STENT IN URETER USING AN ENDOSCOPE	$3,539.60	$4,424.50	$3,762.82–$5,182.00	40% below	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$489.60	$612.00	$744.34–$5,182.00	54% below	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 DIAGNOSTIC EXAM OF BLADDER AND URETHRA USING AN ENDOSCOPE	$1,730.40	$2,163.00	$744.34–$1,016.02	61% above	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION OF PRECANCER SKIN GROWTH; 1 GROWTH	$84.00	$105.00	$214.17–$5,182.00	28% below	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION	$127.20	$159.00	$214.17–$5,182.00	9% above	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM OPENING	$277.60	$347.00	$1,656.27–$2,260.81	92% below	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 CREATE EARDRUM OPENING	$521.60	$652.00	$575.72–$785.86	26% above	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$54.40	$68.00	$62.97–$5,182.00	27% below	20%
Earwax removal with instruments, one ear CPT 69210 REMOVAL OF IMPACTED EAR WAX	$108.00	$135.00	$62.97–$85.95	18% above	20%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI	$297.60	$372.00	$62.97–$85.95	225% above	20%
Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 NSL/SINS NDSC W/TOT ETHMDCT	$2,109.60	$2,637.00	$7,533.64–$10,283.42	75% below	20%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 NSL/SINS NDSC FRNT TISS RMVL	$898.40	$1,123.00	$7,533.64–$10,283.42	89% below	20%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 EXPLORATION MAXILLARY SINUS	$1,757.60	$2,197.00	$3,979.91–$5,432.58	40% below	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 ENDOSCOPY MAXILLARY SINUS	$699.20	$874.00	$7,533.64–$10,283.42	91% below	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJECTION OF SUBSTANCE INTO MIDDLE OR UPPER SPINE CANAL USING IMAGING GUIDANCE	$679.20	$849.00	$753.51–$1,028.54	33% below	20%
Eye injection into the vitreous (intravitreal injection) CPT 67028 INJECTION EYE DRUG	$269.60	$337.00	$352.59–$481.29	19% below	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$382.40	$478.00	$944.15–$1,288.76	63% below	20%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE; EPIGASTRIC; INCISIONAL; VENTRAL; UMBILICAL; SPIGELIAN); ANY APPROACH (IE; OPEN; LAPAROSCOPIC; ROBOTIC); INITIAL; INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED; TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM; REDUCIBLE	$7,278.60	$9,098.25	$5,182.00–$9,433.01	13% above	20%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE; EPIGASTRIC; INCISIONAL; VENTRAL; UMBILICAL; SPIGELIAN); ANY APPROACH (IE; OPEN; LAPAROSCOPIC; ROBOTIC); INITIAL; INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED; TOTAL LENGTH OF DEFECT(S); GREATER THAN 10 CM; REDUCIBLE	$11,445.60	$14,307.00	$5,182.00–$9,433.01	504% above	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE; EPIGASTRIC; INCISIONAL; VENTRAL; UMBILICAL; SPIGELIAN); ANY APPROACH (IE; OPEN; LAPAROSCOPIC; ROBOTIC); INITIAL; INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED; TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM; REDUCIBLE	$7,278.60	$9,098.25	$3,821.98–$5,217.00	54% above	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$224.80	$281.00	$992.71–$1,355.05	80% below	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC EXAM OF LOWER PORTION OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE	$2,521.00	$3,151.25	$992.71–$1,355.05	123% above	20%
Gallbladder removal, laparoscopic CPT 47562 REMOVAL OF GALLBLADDER USING AN ENDOSCOPE	$9,053.20	$11,316.50	$5,182.00–$8,808.93	50% above	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DUCTS USING AN ENDOSCOPE	$7,278.60	$9,098.25	$5,182.00–$8,808.93	17% above	20%
Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE	$2,414.40	$3,018.00	$3,492.77–$4,767.63	1% above	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 REMOVAL OF EXTERNAL HEMORRHOIDS BY RUBBER BANDING	$543.20	$679.00	$992.71–$1,355.05	60% below	20%
Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVAL OF SINGLE EXTERNAL AND INTERNAL HEMORRHOID GROUP	$7,189.40	$8,986.75	$2,962.94–$5,182.00	73% above	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 INSERTION OF TUBE AND INTRODUCTION OF CONTRAST FOR X-RAY OF UTERUS AND FALLOPIAN TUBES	$162.00	$202.50	$49.40–$5,182.00	44% below	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER FOR HYSTEROGRAPHY	$400.80	$501.00	$49.40–$5,182.00	40% above	20%
Hysteroscopy with endometrial ablation CPT 58563 EXAM OF UTERUS WITH DESTRUCTION OF LINING OF UTERUS USING AN ENDOSCOPE	$8,569.60	$10,712.00	$5,182.00–$7,289.09	13% above	20%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE	$7,375.80	$9,219.75	$3,455.53–$5,182.00	77% above	20%
IUD insertion (the device itself billed separately) CPT 58300 INSERTION OF IUD FOR PREGNANCY PREVENTION	$277.60	$347.00	$5,182.00	55% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 SIMPLE OR SINGLE DRAINAGE OF SKIN ABSCESS	$176.80	$221.00	$214.17–$292.34	21% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$227.20	$284.00	$214.17–$5,182.00	1% above	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR OF GROIN HERNIA (5 YEARS OR OLDER)	$6,846.60	$8,558.25	$3,821.98–$5,217.00	9% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT	$124.80	$156.00	$327.67–$447.27	37% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION INTO TENDON OR LIGAMENT	$212.80	$266.00	$327.67–$5,182.00	7% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$128.00	$160.00	$327.67–$5,182.00	40% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION AND/OR INJECTION OF FLUID FROM LARGE JOINT	$239.20	$299.00	$327.67–$447.27	12% above	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION DRUG DLVR IMPLANT	$321.60	$402.00	$142.02–$193.86	79% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$135.20	$169.00	$327.67–$447.27	32% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASPIRATION AND/OR INJECTION OF FLUID FROM SMALL JOINT	$212.80	$266.00	$327.67–$447.27	6% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$300.00	$375.00	$327.67–$447.27	49% above	20%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 REMOVAL OF APPENDIX USING AN ENDOSCOPE	$7,278.60	$9,098.25	$5,182.00–$8,808.93	9% below	20%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 REMOVAL OF UTERUS THROUGH ABDOMEN USING AN ENDOSCOPE; 250.0 G OR LESS	$11,445.60	$14,307.00	$5,182.00–$15,488.74	28% below	20%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 REMOVAL OF UTERUS; TUBES; AND/OR OVARIES THROUGH ABDOMEN USING AN ENDOSCOPE; 250.0 G OR LESS	$10,581.60	$13,227.00	$5,182.00–$15,488.74	35% below	20%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP ING HERNIA REPAIR INIT	$689.60	$862.00	$5,182.00–$8,808.93	91% below	20%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 REPAIR OF GROIN HERNIA USING AN ENDOSCOPE	$10,581.60	$13,227.00	$5,182.00–$8,808.93	44% above	20%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP ING HERNIA REPAIR RECUR	$911.20	$1,139.00	$5,182.00–$8,808.93	91% below	20%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 REMOVAL OF OVARIES AND/OR TUBES USING AN ENDOSCOPE	$7,710.60	$9,638.25	$5,182.00–$8,808.93	28% below	20%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 AFTER CATARACT LASER SURGERY	$452.80	$566.00	$587.11–$801.41	36% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERMEDIATE REPAIR OF WOUND OF SCALP; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.5 CM OR LESS	$333.60	$417.00	$433.94–$592.33	12% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC	$175.20	$219.00	$753.51–$1,028.54	82% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL USING IMAGING GUIDANCE	$663.20	$829.00	$753.51–$1,028.54	32% below	20%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC	$488.00	$610.00	$944.15–$1,288.76	56% below	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE; SINGLE LEVEL	$1,198.40	$1,498.00	$944.15–$1,288.76	20% below	20%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 PARTIAL REMOVAL OF SPINE BONE WITH RELEASE OF LOWER SPINAL CORD OR NERVES AND/OR REMOVAL OF DISC	$7,694.60	$9,618.25	$5,182.00–$10,573.03	36% below	20%
Lumbar laminectomy (spinal decompression), one level CPT 63047 PARTIAL REMOVAL OF SPINE BONE WITH RELEASE OF LOWER SPINAL CORD AND/OR NERVES; 1 SEGMENT	$7,327.80	$9,159.75	$5,182.00–$10,573.03	46% below	20%
Lumbar spinal fusion (posterior), one level CPT 22612 FUSION OF SPINE IN LOWER BACK	$1,008.65	$1,260.81	$5,182.00–$25,548.53	59% below	20%
Mastectomy (total removal of the breast) CPT 19303 MAST SIMPLE COMPLETE	$1,477.60	$1,847.00	$5,182.00–$9,675.39	at median	20%
Miscarriage treatment with D&C, first trimester CPT 59820 CARE OF MISCARRIAGE	$574.40	$718.00	$3,455.53–$5,182.00	88% below	20%
Miscarriage treatment with D&C, first trimester CPT 59820 TREATMENT OF MISCARRIAGE DURING FIRST TRIMESTER	$6,199.80	$7,749.75	$3,455.53–$5,182.00	27% above	20%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 MOHS 1 STAGE H/N/HF/G	$506.40	$633.00	$788.94–$5,182.00	—	20%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 REMOVAL AND MICROSCOPIC EXAM OF GROWTH OF HEAD; NECK; HANDS; FEET; OR GENITALS; 1-5 TISSUE BLOCKS	$1,012.80	$1,266.00	$788.94–$5,182.00	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<	$245.60	$307.00	$755.92–$5,182.00	1% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 REMOVAL OF NONCANCER SKIN GROWTH OF BODY; ARMS; OR LEGS; 0.5 CM OR LESS	$418.40	$523.00	$755.92–$1,031.83	69% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/<	$276.80	$346.00	$755.92–$5,182.00	4% below	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 REMOVAL OF NONCANCER SKIN GROWTH OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 0.5 CM OR LESS	$458.40	$573.00	$755.92–$1,031.83	59% above	20%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$252.80	$316.00	$214.17–$5,182.00	54% above	20%
Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV	$664.00	$830.00	$327.67–$447.27	118% above	20%
Pacemaker implant (dual chamber) CPT 33208 INSRT HEART PM ATRIAL & VENT	$12,460.20	$15,575.25	$11,157.22–$15,229.61	28% below	20%
Paracentesis with imaging guidance CPT 49083 DRAINAGE OF FLUID FROM ABDOMINAL CAVITY USING IMAGING GUIDANCE	$769.20	$961.50	$968.18–$1,321.57	11% below	20%
Partial knee replacement (one compartment) CPT 27446 REVISION OF KNEE JOINT	$5,285.60	$6,607.00	$5,182.00–$18,707.26	42% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 PERMANENT REMOVAL FINGERNAIL OR TOENAIL	$366.40	$458.00	$433.94–$592.33	8% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$739.20	$924.00	$433.94–$592.33	86% above	20%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE GLAND	$1,238.40	$1,548.00	$5,182.00	58% below	20%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE	$1,300.40	$1,625.50	—	56% below	20%
Prostate removal (prostatectomy), laparoscopic CPT 55866 SURGICAL REMOVAL OF PROSTATE AND SURROUNDING LYMPH NODES USING AN ENDOSCOPE	$12,573.00	$15,716.25	$5,182.00–$15,488.74	54% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JNT	$2,079.00	$2,598.75	$2,084.49–$5,182.00	45% above	20%
Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION	$1,888.80	$2,361.00	$4,179.62–$5,705.18	90% above	20%
Removal of a breast lump, open surgery CPT 19120 REMOVAL OF GROWTH AND TISSUE OF BREAST; DUCT; OR NIPPLE	$7,073.10	$8,841.38	$4,179.62–$5,705.18	611% above	20%
Removal of a foreign object under the skin, simple CPT 10120 REMOVAL OF FOREIGN BODY FROM TISSUE; ACCESSED BENEATH THE SKIN; SIMPLE	$400.80	$501.00	$433.94–$592.33	32% above	20%
Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL	$630.40	$788.00	$433.94–$5,182.00	107% above	20%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK	$1,436.00	$1,795.00	$992.71–$1,355.05	88% above	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK	$1,640.60	$2,050.75	$992.71–$1,355.05	117% above	20%
Septoplasty to straighten the nasal septum CPT 30520 REPAIR OF NASAL SEPTUM	$2,052.00	$2,565.00	$3,539.16–$4,830.95	70% below	20%
Septoplasty to straighten the nasal septum CPT 30520 RESHAPING OF NASAL CARTILAGE	$2,547.67	$3,184.59	$3,539.16–$5,182.00	63% below	20%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 FRAGMENTING OF KIDNEY STONE	$1,272.00	$1,590.00	$3,762.82–$5,182.00	87% below	20%
Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST	$314.40	$393.00	$298.57–$5,182.00	31% above	20%
Short arm splint (forearm and hand) CPT 29125 APPLICATION OF NONMOVEABLE FOREARM TO HAND SPLINT	$265.70	$332.12	$142.02–$193.86	80% above	20%
Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST	$199.20	$249.00	$298.57–$407.55	29% below	20%
Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLINT	$130.40	$163.00	$173.47–$236.79	21% below	20%
Short leg splint (calf to foot) CPT 29515 APPLICATION OF SHORT LEG SPLINT FROM CALF TO FOOT	$436.20	$545.25	$173.47–$236.79	164% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR OF SURFACE WOUND OF SCALP; NECK; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.5 CM OR LESS	$313.60	$392.00	$214.17–$292.34	42% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/<	$354.40	$443.00	$214.17–$5,182.00	60% above	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY; FIRST SKIN GROWTH	$158.40	$198.00	$433.94–$5,182.00	40% below	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$736.00	$920.00	$433.94–$5,182.00	181% above	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC TR-EXT MAL+MARG 0.5 CM/<	$744.00	$930.00	$755.92–$1,031.83	116% above	20%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAG; 1-15 SKIN TAGS	$118.40	$148.00	$214.17–$292.34	20% below	20%
Skin tag removal, up to 15 tags CPT 11200 RMVL SKIN TAGS UP TO&INC 15	$165.60	$207.00	$214.17–$292.34	13% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR	$659.20	$824.00	$753.51–$1,028.54	31% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 REMOVAL OF CEREBROSPINAL FLUID WITH LOWER BACK SPINAL TAP FOR DIAGNOSTIC TEST	$862.60	$1,078.25	$753.51–$1,028.54	71% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE REPAIR OF SURFACE WOUND OF SCALP; NECK; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.6-7.5 CM	$396.00	$495.00	$214.17–$292.34	37% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM	$536.00	$670.00	$214.17–$5,182.00	86% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR OF SURFACE WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 2.5 CM OR LESS	$148.00	$185.00	$214.17–$292.34	44% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5 CM/<	$462.40	$578.00	$214.17–$292.34	74% above	20%
TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP)	$1,858.40	$2,323.00	$5,182.00–$7,812.67	81% below	20%
TURP (transurethral resection of the prostate) CPT 52601 REMOVAL OF PROSTATE GLAND USING AN ELECTROCAUTERY KNIFE THROUGH URETHRA WITH CONTROL OF BLEEDING USING AN ENDOSCOPE	$4,907.20	$6,134.00	$5,182.00–$7,812.67	51% below	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$132.80	$166.00	$433.94–$5,182.00	31% below	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 BIOPSY OF RELATED SKIN GROWTH; FIRST GROWTH	$224.80	$281.00	$433.94–$5,182.00	17% above	20%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING	$212.00	$265.00	$669.62–$5,182.00	76% below	20%
Thoracentesis with imaging guidance CPT 32555 ASPIRATION OF FLUID FROM CHEST CAVITY USING IMAGING GUIDANCE	$1,631.40	$2,039.25	$669.62–$914.03	82% above	20%
Tonsil and adenoid removal, age 12 or older CPT 42821 REMOVE TONSILS AND ADENOIDS	$1,114.40	$1,393.00	$3,539.16–$4,830.95	73% below	20%
Tonsil and adenoid removal, age 12 or older CPT 42821 REMOVAL OF TONSILS AND ADENOID GLANDS (12 YEARS OR OLDER)	$3,716.80	$4,646.00	$3,539.16–$5,182.00	9% below	20%
Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS AND ADENOIDS	$1,055.20	$1,319.00	$5,182.00–$8,625.78	72% below	20%
Tonsil and adenoid removal, child under 12 CPT 42820 REMOVAL OF TONSILS AND ADENOID GLANDS (YOUNGER THAN 12 YEARS)	$11,813.20	$14,766.50	$5,182.00–$8,625.78	213% above	20%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS	$996.80	$1,246.00	$3,539.16–$4,830.95	69% below	20%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS (12 YEARS OR OLDER)	$4,907.20	$6,134.00	$3,539.16–$5,182.00	51% above	20%
Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 REMOVAL OF TONSILS	$996.80	$1,246.00	$6,319.25–$8,625.78	78% below	20%
Total hip replacement CPT 27130 REPLACEMENT OF THIGH BONE AND HIP JOINT WITH PROSTHESIS	$3,855.30	$4,819.13	$5,182.00–$18,707.26	30% above	20%
Total knee replacement CPT 27447 REPLACEMENT OF KNEE JOINT; BOTH SIDES OF KNEE	$4,501.90	$5,627.38	$5,182.00–$18,707.26	46% above	20%
Total shoulder replacement CPT 23472 RECONSTRUCT SHOULDER JOINT	$6,480.00	$8,100.00	$5,182.00–$25,548.53	52% below	20%
Total thyroid removal (thyroidectomy) CPT 60240 REMOVAL OF THYROID	$1,601.60	$2,002.00	$5,182.00–$8,808.93	88% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$148.00	$185.00	$327.67–$447.27	28% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION OF TRIGGER POINTS; 1-2 MUSCLES	$337.60	$422.00	$327.67–$447.27	65% above	20%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAPAROSCOPY TUBAL CAUTERY	$935.20	$1,169.00	$5,182.00–$8,808.93	59% below	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING ULTRASOUND; FIRST GROWTH	$3,142.80	$3,928.50	$1,763.03–$2,406.54	77% above	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 BALLOON DILATION OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE; LESS THAN 3.0 CM	$471.20	$589.00	$2,048.37–$2,796.03	81% below	20%
Upper endoscopy (EGD) with biopsy CPT 43239 BIOPSY OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE	$1,640.60	$2,050.75	$968.18–$1,321.57	3% below	20%
Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPR GI SCOPE W/SUBMUC INJ	$570.40	$713.00	$968.18–$5,182.00	72% below	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE	$1,367.80	$1,709.75	$2,048.37–$2,796.03	31% below	20%
Upper endoscopy (EGD), diagnostic CPT 43235 DIAGNOSTIC EXAM OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE	$3,312.60	$4,140.75	$968.18–$5,182.00	204% above	20%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOURETERO W/LITHOTRIPSY	$973.60	$1,217.00	$5,723.57–$7,812.67	90% below	20%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CRUSHING OF STONE OF URETER USING AN ENDOSCOPE	$10,377.00	$12,971.25	$5,182.00–$7,812.67	12% above	20%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URETERO W/LITHOTRIPSY	$960.00	$1,200.00	$5,182.00–$7,812.67	92% below	20%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CRUSHING OF STONE OF URETER WITH INSERTION OF STENT USING AN ENDOSCOPE	$6,199.80	$7,749.75	$5,182.00–$7,812.67	50% below	20%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 VBAC DELIVERY	$3,489.60	$4,362.00	$2,234.04–$3,049.46	9% above	20%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT	$320.00	$400.00	$2,231.42–$3,045.89	62% below	20%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT(S)	$1,120.00	$1,400.00	$2,231.42–$5,182.00	33% above	20%
Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS RF 1ST VEIN	$3,706.40	$4,633.00	$3,370.52–$4,600.76	26% below	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION OF SKIN GROWTH; 1-14 GROWTHS	$169.60	$212.00	$214.17–$5,182.00	7% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 REMOVAL OF SKIN AND TISSUE; 20.0 SQ CM OR LESS	$380.80	$476.00	$433.94–$5,182.00	1% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<	$931.60	$1,164.50	$433.94–$592.33	142% above	20%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 OPTX DST RD XARTC FX/EPI SEP	$1,183.20	$1,479.00	$5,182.00–$10,573.03	77% below	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION OF BLOOD OR BLOOD PRODUCTS	$1,034.40	$1,293.00	$470.94–$642.83	58% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$31.20	$39.00	$1,200.00–$2,291.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHALATION TREATMENT FOR AIRWAY OBSTRUCTION OR SPUTUM PRODUCTION	$492.40	$615.50	$1,200.00–$2,291.00	—	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR	$103.20	$129.00	$352.59–$481.29	76% below	20%
Chemotherapy IV infusion, first hour CPT 96413 ADMINISTRATION OF CHEMOTHERAPY INTO VEIN; 1 HOUR OR LESS	$594.00	$742.50	$352.59–$481.29	37% above	20%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 COMPRE OPH EXAM NEW PT 1/>	$162.40	$203.00	$142.12–$193.99	73% above	20%
Comprehensive eye exam, returning patient CPT 92014 COMPRE OPH EXAM EST PT 1/>	$103.20	$129.00	$142.12–$193.99	35% above	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE; FIRST 30-74 MINUTES	$947.40	$1,184.25	$881.77–$1,203.62	30% below	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR	$1,989.60	$2,487.00	$881.77–$1,203.62	48% above	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 MEASUREMENT OF BRAIN WAVE ACTIVITY (EEG); AWAKE AND DROWSY	$744.60	$930.75	$230.49–$314.62	at median	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY	$990.60	$1,238.25	$230.49–$314.62	33% above	20%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ROUTINE ELECTROCARDIOGRAM (ECG) USING AT LEAST 12 LEADS WITH INTERPRETATION AND REPORT	$84.00	$105.00	—	24% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING	$48.80	$61.00	$62.97–$85.95	74% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ROUTINE ELECTROCARDIOGRAM (ECG) USING AT LEAST 12 LEADS WITH TRACING	$302.40	$378.00	$62.97–$85.95	59% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMR DPT VST MAYX REQ PHY/QHP	$253.00	$316.25	$90.02–$122.88	81% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY	$352.80	$441.00	$163.90–$223.72	48% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT SF MDM	$370.60	$463.25	$163.90–$223.72	56% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY	$531.40	$664.25	$291.40–$397.76	22% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LOW MDM	$558.00	$697.50	$291.40–$397.76	28% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY	$872.40	$1,090.50	$445.42–$608.00	30% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM	$916.20	$1,145.25	$445.42–$608.00	37% above	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPARTMENT VISIT FOR LIFE THREATENING OR FUNCTIONING SEVERITY	$1,001.00	$1,251.25	$635.72–$867.76	5% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT HI MDM	$1,051.20	$1,314.00	$635.72–$867.76	1% below	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 EXERCISE OR DRUG-INDUCED HEART STRESS TEST WITH ELECTROCARDIOGRAM (ECG)	$101.60	$127.00	$230.49–$314.62	88% below	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST	$831.00	$1,038.75	$230.49–$314.62	1% above	20%
Eye exam, returning patient, intermediate CPT 92012 INTRM OPH EXAM EST PATIENT	$188.80	$236.00	$142.12–$193.99	83% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT	$92.80	$116.00	$227.05–$309.92	62% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INFUSION INTO A VEIN FOR HYDRATION; 31-60 MINUTES	$464.80	$581.00	$227.05–$309.92	88% above	20%
IV infusion of a medicine, first hour CPT 96365 INFUSION INTO A VEIN FOR THERAPY; PREVENTION; OR DIAGNOSIS; 1 HOUR OR LESS	$488.20	$610.25	$227.05–$309.92	61% above	20%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT	$520.00	$650.00	$227.05–$309.92	71% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION OF DRUG OR SUBSTANCE UNDER SKIN OR INTO MUSCLE	$53.60	$67.00	$76.85–$104.90	45% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM	$98.40	$123.00	$76.85–$104.90	1% above	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE CONDUCTION; 7-8 STUDIES	$136.00	$170.00	$398.34–$543.73	71% below	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NRV CNDJ TEST 7-8 STUDIES	$316.00	$395.00	$398.34–$543.73	32% below	20%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION	$149.40	$186.75	$30.56–$41.71	68% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 THERAPY PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION; EACH 15 MINUTES	$533.60	$667.00	$30.56–$166.00	500% above	20%
New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30 MIN	$104.80	$131.00	$69.59–$94.99	22% below	20%
New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45 MIN	$126.40	$158.00	$113.65–$155.13	30% below	20%
New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60 MIN	$188.00	$235.00	$155.68–$212.50	27% below	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE O/P NEW SF 15 MIN	$80.00	$100.00	$39.96–$54.55	20% below	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 THERAPY PROCEDURE FOR NUTRITION MANAGEMENT; EACH 15 MINUTES	$49.40	$61.75	$25.22–$34.43	13% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION INDIV IN	$52.00	$65.00	$25.22–$34.43	19% above	20%
Occupational therapy evaluation, low complexity CPT 97165 EVALUATION FOR OCCUPATIONAL THERAPY; TYPICALLY 30 MINUTES	$237.20	$296.50	$93.80–$166.00	71% above	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 45 MINUTES	$357.80	$447.25	$91.50–$166.00	108% above	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 20 MINUTES	$244.40	$305.50	$91.50–$166.00	92% above	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 30 MINUTES	$301.00	$376.25	$91.50–$166.00	92% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 1/> REGIONS	$134.40	$168.00	$25.92–$35.38	66% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 THERAPY PROCEDURE USING MANUAL TECHNIQUE; EACH 15 MINUTES	$269.60	$337.00	$25.92–$166.00	232% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES	$123.00	$153.75	$27.16–$37.07	59% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPY PROCEDURE USING EXERCISE TO DEVELOP STRENGTH; ENDURANCE; RANGE OF MOTION; AND FLEXIBILITY; EACH 15 MINUTES	$246.00	$307.50	$27.16–$166.00	217% above	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV VISIT EST AGE 40-64	$32.00	$40.00	—	76% below	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING AND TOBACCO USE INTENSIVE COUNSELING; 4-10 MINUTES	$22.40	$28.00	$40.00–$54.60	1% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40 MIN	$188.00	$235.00	$121.95–$166.46	7% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20 MIN	$104.80	$131.00	$55.85–$76.24	10% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30 MIN	$126.40	$158.00	$82.22–$112.23	21% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10 MIN	$80.00	$100.00	$30.22–$41.25	17% above	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFF/OP CNSLTJ NEW/EST MOD 40	$412.80	$516.00	—	69% above	20%
Speech and language evaluation CPT 92523 EVALUATION OF SPEECH SOUND PRODUCTION WITH EVALUATION OF LANGUAGE COMPREHENSION AND EXPRESSION	$376.40	$470.50	$161.00–$290.66	39% above	20%
Speech therapy session, individual CPT 92507 TREATMENT OF SPEECH; LANGUAGE; VOICE; COMMUNICATION; AND/OR HEARING PROCESSING DISORDER	$259.80	$324.75	$71.67–$166.00	63% above	20%
Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST	$261.60	$327.00	$230.49–$314.62	22% above	20%
Spirometry (breathing test) CPT 94010 TEST TO MEASURE EXPIRATORY AIRFLOW AND VOLUME	$302.20	$377.75	$230.49–$314.62	41% above	20%
Spirometry before and after a bronchodilator CPT 94060 EVALUATION OF WHEEZING	$386.00	$482.50	$398.34–$543.73	15% below	20%
Spirometry before and after a bronchodilator CPT 94060 TEST TO MEASURE EXPIRATORY AIRFLOW AND VOLUME CHANGES BEFORE AND AFTER MEDICATION ADMINISTRATION	$468.40	$585.50	$398.34–$543.73	4% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES	$124.20	$155.25	$32.30–$44.09	50% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPY PROCEDURE USING FUNCTIONAL ACTIVITIES	$372.60	$465.75	$32.30–$166.00	351% above	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 DRAWING OF BLOOD FOR A MEDICAL PROBLEM	$332.40	$415.50	$142.02–$193.86	77% above	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY	$349.20	$436.50	$142.02–$193.86	86% above	20%
Visual field test, extended CPT 92083 EXTENDED VISUAL FIELD XM	$140.00	$175.00	$142.02–$193.86	29% above	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VAR VACCINE LIVE SUBQ	$182.40	$228.00	—	at median	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varivax	$585.31	$731.64	—	221% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VACCINE; TRIVALENT; SPLIT VIRUS; PRESERVATIVE-FREE; 0.5 ML DOSAGE	$24.00	$30.00	—	60% below	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 9VHPV VACCINE 2/3 DOSE IM	$314.40	$393.00	—	4% below	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Gardasil 9	$636.10	$795.13	—	93% above	20%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEP A/HEP B VACC ADULT IM	$110.40	$138.00	—	at median	20%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Twinrix	$423.17	$528.96	—	283% above	20%
Hepatitis A vaccine, adult dose CPT 90632 HEPA VACCINE ADULT IM	$74.40	$93.00	—	10% below	20%
Hepatitis A vaccine, adult dose CPT 90632 Havrix	$305.60	$382.00	—	270% above	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High-Dose 2024-2025 Formula	$60.00	$75.00	—	41% below	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VACCINE SPLIT VIRUS; PRESERVATIVE FREE	$61.60	$77.00	—	39% below	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High-Dose 2025-2026 Formula	$61.60	$77.00	—	39% below	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE SC	$96.80	$121.00	—	42% below	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 M-M-R II	$309.51	$386.89	—	86% above	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACWYD/MENACWYCRM VACC IM	$119.20	$149.00	—	7% below	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Menveo	$528.28	$660.35	—	310% above	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENB-4C VACCINE IM	$189.60	$237.00	—	39% below	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Bexsero	$751.38	$939.23	—	144% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumovax 23	$127.20	$159.00	—	32% below	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 RSV MONOC ANTB SEASN .5ML IM	$540.00	$675.00	—	55% below	20%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM	$316.80	$396.00	$319.75–$436.46	64% below	20%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE FOR INJECTION INTO MUSCLE	$1,390.74	$1,738.42	$319.75–$436.46	60% above	20%
Rabies vaccine, one dose CPT 90675 RabAvert	$1,390.74	$1,738.42	$319.75–$436.46	60% above	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HZV VACC RECOMBINANT IM	$190.40	$238.00	—	21% below	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Shingrix	$664.92	$831.15	—	177% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACC NO PRESV 7 YRS+ IM	$51.00	$63.75	—	29% below	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tenivac	$141.50	$176.88	—	98% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE 7 YRS/> IM	$51.00	$63.75	—	50% below	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Adacel	$140.26	$175.32	—	39% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix	$180.54	$225.68	—	78% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTHERIA; TETANUS; AND ACELLULAR PERTUSSIS VACCINE (7 YEARS OR OLDER)	$185.76	$232.20	—	84% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION OF VACCINE	$54.60	$68.25	$76.85–$104.90	8% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN	$57.40	$71.75	$76.85–$104.90	3% below	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMINISTRATION OF VACCINE; EACH ADDITIONAL VACCINE	$20.80	$26.00	—	56% below	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD	$61.00	$76.25	—	29% above	20%

Source file: https://apim.services.craneware.com/api-pricing-transparency/api/public/70a2f3e86bcb0aa7bc3459a5555265ca/charges/mrf