Sumner Regional Medical Center
Sumner Regional Medical Center in Gallatin, TN publishes cash prices for 352 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 above the Tennessee median for 291 of 345 procedures and below it for 47. By typical cash price it ranks #58 of 76 Tennessee hospitals and #6 of 18 hospitals in the Nashville, TN area, cheapest first. Click a procedure to compare it with other hospitals nearby.
555 Hartsville Pike Gallatin TN 37066 Collected Sep 27, 2026 Source price file (615) 328-8888
Acute care hospital Emergency department CMS star rating 3 of 5 CCN 440003 · 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 3 actions for a hospital named Sumner Regional Medical Center in Gallatin, TN:
- Feb 19, 2025 Met requirements
- Jun 18, 2025 Met requirements
- May 7, 2026 Warning notice
Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken. Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules.
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 Tennessee | Off list |
|---|---|---|---|---|---|
| Ankle X-ray, complete, 3 or more views CPT 73610 Radiologic examination, ankle; complete, minimum of 3 views | $244.29 | $1,048.44 | $182.03 | 97% above | 77% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial | $395.63 | $1,697.97 | $132.32 | — | 77% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study | $359.51 | $1,542.96 | $130.44 | 72% above | 77% |
| Bone scan, whole body (nuclear medicine) CPT 78306 Bone and/or joint imaging; whole body | $594.58 | $2,551.86 | $848.52 | 5% below | 77% |
| Breast ultrasound, complete, one breast one side CPT 76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete | $137.15 | $588.63 | $142.32 | 21% below | 77% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited | $137.15 | $588.63 | $99.32 | 16% below | 77% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing | $2,073.38 | $8,898.62 | $447.07 | 104% above | 77% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) | $1,325.15 | $5,687.34 | $289.00 | 77% above | 77% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium | $144.42 | $619.82 | $153.79 | 46% above | 77% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Computed tomography, abdomen and pelvis; without contrast material | $2,543.77 | $10,917.46 | $312.00 | 81% above | 77% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Computed tomography, abdomen and pelvis; with contrast material(s) | $2,625.66 | $11,268.91 | $289.00 | 45% above | 77% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions | $3,686.63 | $15,822.43 | $312.00 | 84% above | 77% |
| CT scan of the abdomen with contrast CPT 74160 Computed tomography, abdomen; with contrast material(s) | $1,300.56 | $5,581.80 | $289.00 | 49% above | 77% |
| CT scan of the abdomen without contrast CPT 74150 Computed tomography, abdomen; without contrast material | $1,242.95 | $5,334.54 | $193.10 | 60% above | 77% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Computed tomography, maxillofacial area; without contrast material | $958.71 | $4,114.64 | $312.00 | 64% above | 77% |
| CT scan of the head or brain, no contrast dye CPT 70450 Computed tomography, head or brain; without contrast material | $1,041.68 | $4,470.73 | $144.47 | 51% above | 77% |
| CT scan of the head with contrast CPT 70460 Computed tomography, head or brain; with contrast material(s) | $1,051.68 | $4,513.64 | $401.74 | 19% above | 77% |
| CT scan of the head without and with contrast CPT 70470 Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections | $1,623.97 | $6,969.81 | $252.32 | 49% above | 77% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 Computed tomography, lumbar spine; without contrast material | $1,733.83 | $7,441.32 | $289.00 | 132% above | 77% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 Computed tomography, cervical spine; without contrast material | $1,232.96 | $5,291.66 | $280.18 | 57% above | 77% |
| CT scan of the pelvis, with contrast dye CPT 72193 Computed tomography, pelvis; with contrast material(s) | $1,482.62 | $6,363.17 | $289.00 | 77% above | 77% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Duplex scan of extracranial arteries; complete bilateral study | $769.74 | $3,303.61 | $293.88 | — | 77% |
| Chest X-ray, 2 views CPT 71046 Radiologic examination, chest; 2 views | $212.80 | $913.31 | $41.42 | 94% above | 77% |
| Chest X-ray, single view CPT 71045 Radiologic examination, chest; single view | $149.03 | $639.63 | $182.03 | 55% above | 77% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete | $497.80 | $2,136.46 | $152.27 | 87% above | 77% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) | $157.49 | $675.94 | $51.38 | 3% below | 77% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 Computed tomography, thorax, diagnostic; without contrast material | $1,547.92 | $6,643.45 | $254.44 | 126% above | 77% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Computed tomography, thorax, diagnostic; with contrast material(s) | $1,383.52 | $5,937.87 | $329.67 | 66% above | 77% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral | $246.56 | $1,058.19 | $263.00 | — | 77% |
| Diagnostic mammogram, one breast one side CPT 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral | $204.86 | $879.22 | $205.70 | 43% above | 77% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study | $977.93 | $4,197.11 | $553.00 | — | 77% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study | $764.36 | $3,280.53 | $296.38 | — | 77% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography | $740.63 | $3,178.65 | $699.00 | 33% below | 77% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary system imaging, including gallbladder when present | $649.68 | $2,788.31 | $660.19 | 1% above | 77% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist | $2,768.59 | $11,882.35 | $999.00 | 90% above | 77% |
| Knee X-ray, 3 views CPT 73562 Radiologic examination, knee; 3 views | $163.62 | $702.22 | $47.96 | 35% above | 77% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up) | $476.30 | $2,044.19 | $123.87 | 89% above | 77% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) | $88.29 | $378.91 | $182.03 | 51% below | 77% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material | $1,407.36 | $6,040.16 | $520.00 | 75% above | 77% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences | $2,070.30 | $8,885.40 | $718.91 | 103% above | 77% |
| MRI of the abdomen without contrast CPT 74181 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) | $1,862.12 | $7,991.92 | $514.16 | 101% above | 77% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences | $2,043.42 | $8,770.03 | $493.00 | 64% above | 77% |
| MRI of the brain, no contrast dye CPT 70551 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material | $2,007.31 | $8,615.05 | $334.10 | 105% above | 77% |
| MRI of the brain, with and without contrast dye CPT 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences | $2,773.19 | $11,902.12 | $563.42 | 96% above | 77% |
| MRI of the lower back, no contrast dye CPT 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material | $1,994.25 | $8,559.00 | $493.00 | 104% above | 77% |
| MRI of the lower back, without and then with contrast dye CPT 72158 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar | $2,545.05 | $10,922.95 | $564.19 | 89% above | 77% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material | $1,981.96 | $8,506.26 | $517.79 | 103% above | 77% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical | $2,875.38 | $12,340.70 | $493.00 | 117% above | 77% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material | $1,899.76 | $8,153.46 | $294.17 | 95% above | 77% |
| MRI of the pelvis without and with contrast CPT 72197 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences | $3,148.07 | $13,511.01 | $776.40 | 154% above | 77% |
| MRI of the pelvis, no contrast dye CPT 72195 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) | $2,479.75 | $10,642.70 | $650.50 | 201% above | 77% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) | $1,763.02 | $7,566.63 | $520.00 | 98% above | 77% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or red | $3,070.50 | $13,178.11 | $2,938.37 | 63% above | 77% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh | $5,937.58 | $25,483.16 | $4,919.57 | 206% above | 77% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles) | $232.76 | $998.98 | $245.18 | 46% above | 77% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete | $522.38 | $2,241.98 | $139.16 | 92% above | 77% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation | $259.65 | $1,114.38 | $245.18 | 3% below | 77% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation | $259.65 | $1,114.38 | $134.18 | 15% above | 77% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses | $348.76 | $1,496.84 | $95.58 | 130% above | 77% |
| Screening mammogram, both breasts both sides CPT 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed | $236.91 | $1,016.80 | $172.16 | — | 77% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 Radiologic examination, shoulder; complete, minimum of 2 views | $193.59 | $830.86 | $45.16 | 66% above | 77% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist | $2,004.24 | $8,601.87 | $999.00 | 50% above | 77% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuo | $933.87 | $4,008.04 | $699.00 | 108% above | 77% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 Radiologic examination, swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study | $376.42 | $1,615.54 | $218.52 | 85% above | 77% |
| Transvaginal pelvic ultrasound CPT 76830 Ultrasound, transvaginal | $522.38 | $2,241.98 | $174.26 | 95% above | 77% |
| Transvaginal ultrasound during pregnancy CPT 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal | $739.02 | $3,171.75 | $127.61 | 252% above | 77% |
| Ultrasound of the abdomen, complete CPT 76700 Ultrasound, abdominal, real time with image documentation; complete | $679.87 | $2,917.88 | $245.18 | 113% above | 77% |
| Ultrasound of the scrotum and testicles CPT 76870 Ultrasound, scrotum and contents | $259.65 | $1,114.38 | $134.80 | 2% below | 77% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation | $389.47 | $1,671.56 | $162.20 | 62% above | 77% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study | $181.30 | $778.11 | $401.74 | 27% below | 77% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study | $395.63 | $1,697.97 | $185.22 | 31% above | 77% |
| Wrist X-ray, complete, 3 or more views CPT 73110 Radiologic examination, wrist; complete, minimum of 3 views | $222.78 | $956.13 | $55.92 | 84% above | 77% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views | $110.02 | $472.21 | $64.46 | 2% below | 77% |
| X-ray of the abdomen, 1 view CPT 74018 Radiologic examination, abdomen; 1 view | $205.10 | $880.25 | $182.03 | 106% above | 77% |
| X-ray of the ankle, 2 views CPT 73600 Radiologic examination, ankle; 2 views | $152.10 | $652.78 | $43.92 | 78% above | 77% |
| X-ray of the finger(s), 2 or more views CPT 73140 Radiologic examination, finger(s), minimum of 2 views | $178.22 | $764.91 | $47.25 | 55% above | 77% |
| X-ray of the foot, 2 views CPT 73620 Radiologic examination, foot; 2 views | $196.66 | $844.04 | $182.03 | 180% above | 77% |
| X-ray of the foot, complete, 3 or more views CPT 73630 Radiologic examination, foot; complete, minimum of 3 views | $207.40 | $890.15 | $47.04 | 63% above | 77% |
| X-ray of the hand, 3 or more views CPT 73130 Radiologic examination, hand; minimum of 3 views | $227.39 | $975.93 | $42.28 | 90% above | 77% |
| X-ray of the knee, 1 or 2 views CPT 73560 Radiologic examination, knee; 1 or 2 views | $155.94 | $669.27 | $182.03 | 54% above | 77% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Radiologic examination, spine, lumbosacral; 2 or 3 views | $391.78 | $1,681.48 | $49.78 | 178% above | 77% |
| X-ray of the lower back, 4 or more views CPT 72110 Radiologic examination, spine, lumbosacral; minimum of 4 views | $423.27 | $1,816.61 | $68.82 | 100% above | 77% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 Radiologic examination, spine; thoracic, 2 views | $85.27 | $365.97 | $42.07 | 30% below | 77% |
| X-ray of the nasal bones, 3 or more views CPT 70160 Radiologic examination, nasal bones, complete, minimum of 3 views | $323.41 | $1,388.04 | $46.54 | 232% above | 77% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Radiologic examination, spine, cervical; 2 or 3 views | $288.08 | $1,236.41 | $51.38 | 126% above | 77% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 Radiologic examination, pelvis; 1 or 2 views | $186.67 | $801.14 | $35.89 | 54% above | 77% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Radiologic examination, sacrum and coccyx, minimum of 2 views | $222.02 | $952.86 | $40.51 | 77% above | 77% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Tennessee | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Transferase; alanine amino (ALT) (SGPT) | $33.81 | $145.09 | $15.96 | 20% above | 77% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Transferase; aspartate amino (AST) (SGOT) | $31.50 | $135.19 | $5.18 | 8% above | 77% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803) | $271.94 | $1,167.13 | $138.66 | 83% above | 77% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each | $23.06 | $98.97 | $15.71 | 115% above | 77% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic citrullinated peptide (CCP), antibody | $34.57 | $148.35 | $38.96 | 3% below | 77% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear antibodies (ANA) | $83.73 | $359.34 | $12.09 | 145% above | 77% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Natriuretic peptide | $147.50 | $633.05 | $79.13 | 61% above | 77% |
| Basic metabolic panel (blood test) CPT 80048 Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) | $125.22 | $537.42 | $22.56 | 67% above | 77% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Level IV - Surgical pathology, gross and microscopic examination Abortion - spontaneous/missed Artery, biopsy Bone marrow, biopsy Bone exostosis Brain/meninges, other than for tumor resection Breast, biopsy, not requiring microscopic evaluation of surgical margins Breast, reduction mammoplasty Bronc | $123.31 | $529.22 | $73.75 | 63% above | 77% |
| Blood culture for bacteria CPT 87040 Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) | $94.49 | $405.54 | $10.32 | 61% above | 77% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Collection of venous blood by venipuncture | $9.98 | $42.85 | $4.39 | 13% above | 77% |
| Blood glucose (sugar) test CPT 82947 Glucose; quantitative, blood (except reagent strip) | $59.16 | $253.90 | $7.70 | 153% above | 77% |
| Blood lead test CPT 83655 Lead | $45.32 | $194.52 | $24.50 | 23% above | 77% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Gonadotropin, chorionic (hCG); qualitative | $127.53 | $547.32 | $15.41 | 131% above | 77% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood typing, serologic; ABO | $45.32 | $194.52 | $6.30 | 4% below | 77% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive protein | $46.09 | $197.81 | $10.51 | 116% above | 77% |
| C. difficile toxin gene test (stool PCR) CPT 87493 Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique | $78.97 | $338.91 | $114.72 | 4% below | 77% |
| CA 19-9 blood test (tumor marker) CPT 86301 Immunoassay for tumor antigen, quantitative; CA 19-9 | $75.28 | $323.09 | $68.04 | 14% above | 77% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Immunoassay for tumor antigen, quantitative; CA 125 | $196.66 | $844.04 | $62.65 | 182% above | 77% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique | $90.39 | $387.94 | $51.31 | 76% above | 77% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique | $127.53 | $547.32 | $70.74 | 116% above | 77% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478) | $126.76 | $544.02 | $43.78 | 211% above | 77% |
| Complete blood count (CBC) with differential CPT 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count | $106.79 | $458.32 | $25.42 | 166% above | 77% |
| Complete blood count (CBC), no differential CPT 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) | $34.57 | $148.35 | $13.30 | 41% above | 77% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155) Sodium | $169.00 | $725.33 | $21.02 | 74% above | 77% |
| D-dimer blood test (blood clot marker) CPT 85379 Fibrin degradation products, D-dimer; quantitative | $133.66 | $573.66 | $30.65 | 158% above | 77% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone-sulfate (DHEA-S) | $80.66 | $346.20 | $66.94 | 13% above | 77% |
| Estradiol blood test CPT 82670 Estradiol; total | $258.12 | $1,107.81 | $84.11 | 203% above | 77% |
| FSH (follicle-stimulating hormone) test CPT 83001 Gonadotropin; follicle stimulating hormone (FSH) | $142.12 | $609.96 | $37.13 | 128% above | 77% |
| Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, fecal | $192.05 | $824.25 | $39.22 | 91% above | 77% |
| Ferritin blood test (iron stores) CPT 82728 Ferritin | $80.66 | $346.20 | $27.32 | 79% above | 77% |
| Folate (folic acid) blood test CPT 82746 Folic acid; serum | $62.99 | $270.36 | $44.27 | 28% above | 77% |
| Free T3 thyroid hormone test CPT 84481 Triiodothyronine T3; free | $122.15 | $524.24 | $16.94 | 116% above | 77% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine; free | $70.68 | $303.35 | $27.14 | 110% above | 77% |
| Free testosterone test CPT 84402 Testosterone; free | $135.97 | $583.57 | $68.50 | 127% above | 77% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85 | $169.00 | $725.33 | $97.99 | 25% above | 77% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose; post glucose dose (includes glucose) | $47.64 | $204.48 | $9.81 | 56% above | 77% |
| Glucose tolerance test, 3 samples CPT 82951 Glucose; tolerance test (GTT), 3 specimens (includes glucose) | $66.84 | $286.86 | $26.32 | 60% above | 77% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique | $127.53 | $547.32 | $105.64 | 111% above | 77% |
| H. pylori antibody blood test CPT 86677 Antibody; Helicobacter pylori | $132.13 | $567.09 | $16.85 | 174% above | 77% |
| H. pylori stool antigen test CPT 87338 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; Helicobacter pylori, stool | $61.46 | $263.76 | $47.02 | 3% above | 77% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification, includes reverse transcription when performed | $308.05 | $1,322.10 | $256.18 | 107% above | 77% |
| HIV-1 and HIV-2 antibody test CPT 86703 Antibody; HIV-1 and HIV-2, single result | $30.86 | $132.43 | $27.32 | at median | 77% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single resu | $49.03 | $210.45 | $48.33 | 4% below | 77% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68), pooled result | $71.46 | $306.68 | $114.72 | 73% above | 77% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin; glycosylated (A1C) | $63.76 | $273.65 | $9.71 | 52% above | 77% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B surface antibody (HBsAb) | $83.73 | $359.34 | $35.11 | 69% above | 77% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; hepatitis B surface antigen (HBsAg) | $49.95 | $214.36 | $21.02 | 77% above | 77% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C antibody | $196.66 | $844.04 | $46.66 | 347% above | 77% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed | $155.19 | $666.04 | $140.04 | 19% above | 77% |
| Herpes blood test, HSV-1 antibody CPT 86695 Antibody; herpes simplex, type 1 | $56.07 | $240.66 | $26.62 | 68% above | 77% |
| Herpes blood test, HSV-2 antibody CPT 86696 Antibody; herpes simplex, type 2 | $52.24 | $224.20 | $38.52 | 21% above | 77% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-reactive protein; high sensitivity (hsCRP) | $46.86 | $201.11 | $38.96 | 19% above | 77% |
| Homocysteine blood test CPT 83090 Homocysteine | $164.40 | $705.58 | $17.92 | 219% above | 77% |
| Insulin blood test CPT 83525 Insulin; total | $41.48 | $178.04 | $23.11 | 4% above | 77% |
| Iron blood test (serum iron) CPT 83540 Iron | $40.72 | $174.75 | $19.49 | 24% above | 77% |
| Iron-binding capacity (TIBC) test CPT 83550 Iron binding capacity | $48.39 | $207.70 | $28.58 | 10% above | 77% |
| Kidney function blood test panel CPT 80069 Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) | $97.55 | $418.69 | $22.56 | 41% above | 77% |
| LH (luteinizing hormone) test CPT 83002 Gonadotropin; luteinizing hormone (LH) | $141.35 | $606.64 | $55.74 | 128% above | 77% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase | $72.21 | $309.93 | $14.00 | 106% above | 77% |
| Liver function blood test panel CPT 80076 Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) | $151.33 | $649.48 | $20.77 | 83% above | 77% |
| Lyme disease antibody test CPT 86618 Antibody; Borrelia burgdorferi (Lyme disease) | $78.37 | $336.34 | $34.31 | 89% above | 77% |
| Magnesium blood test CPT 83735 Magnesium | $67.60 | $290.14 | $13.30 | 241% above | 77% |
| Measles (rubeola) antibody test CPT 86765 Antibody; rubeola | $109.85 | $471.47 | $38.79 | 179% above | 77% |
| Mono test (heterophile antibody, Monospot) CPT 86308 Heterophile antibodies; screening | $84.51 | $362.69 | $15.58 | 161% above | 77% |
| Obstetric blood test panel CPT 80055 Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen ( | $564.63 | $2,423.31 | $143.92 | 686% above | 77% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate specific antigen (PSA); free | $54.54 | $234.09 | $18.39 | 18% above | 77% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate specific antigen (PSA); total | $66.84 | $286.86 | $37.13 | 19% above | 77% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision | $35.67 | $153.09 | $61.00 | 1% above | 77% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathormone (parathyroid hormone) | $155.94 | $669.27 | $82.64 | 35% above | 77% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplastin time, partial (PTT); plasma or whole blood | $46.86 | $201.11 | $11.90 | 112% above | 77% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 | $594.77 | $2,552.67 | $759.05 | 42% below | 77% |
| Progesterone blood test CPT 84144 Progesterone | $75.28 | $323.09 | $42.01 | 18% above | 77% |
| Prolactin blood test CPT 84146 Prolactin | $69.90 | $299.99 | $63.36 | 15% below | 77% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin time | $41.48 | $178.04 | $12.86 | 110% above | 77% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service | $11.96 | $51.33 | $25.20 | 38% below | 77% |
| Rapid flu test (influenza antigen) CPT 87804 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Influenza | $44.56 | $191.24 | $32.92 | 50% above | 77% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group A | $89.18 | $382.76 | $34.48 | 155% above | 77% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid factor; quantitative | $46.09 | $197.81 | $17.08 | 56% above | 77% |
| Rubella antibody test (immunity check) CPT 86762 Antibody; rubella | $137.51 | $590.17 | $43.34 | 333% above | 77% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation rate, erythrocyte; automated | $26.11 | $112.08 | $8.83 | 37% above | 77% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen analysis; volume, count, motility, and differential | $118.31 | $507.77 | $39.38 | 88% above | 77% |
| Stool ova and parasites exam CPT 87177 Ova and parasites, direct smears, concentration and identification | $86.81 | $372.57 | $29.09 | 189% above | 77% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection) | $23.06 | $98.97 | $9.11 | 22% above | 77% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations | $16.93 | $72.67 | $32.22 | 45% below | 77% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) | $50.70 | $217.58 | $13.46 | 97% above | 77% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon | $158.24 | $679.15 | $186.59 | 33% above | 77% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone; total | $93.73 | $402.26 | $77.73 | 30% above | 77% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibodies (eg, thyroid or liver-kidney), each | $66.84 | $286.86 | $47.57 | 64% above | 77% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid stimulating hormone (TSH) | $119.84 | $514.33 | $54.94 | 135% above | 77% |
| Trichomonas test (NAAT) CPT 87661 Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique | $37.31 | $160.15 | $70.74 | 40% below | 77% |
| Uric acid blood test CPT 84550 Uric acid; blood | $72.21 | $309.93 | $14.78 | 145% above | 77% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy | $67.60 | $290.14 | $3.17 | 139% above | 77% |
| Urinalysis with microscope exam, manual CPT 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy | $30.73 | $131.87 | $10.37 | 111% above | 77% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy | $22.28 | $95.62 | $7.34 | 106% above | 77% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy | $12.29 | $52.75 | $7.69 | 48% above | 77% |
| Urine culture for bacteria, with colony count CPT 87086 Culture, bacterial; quantitative colony count, urine | $106.01 | $454.98 | $8.07 | 190% above | 77% |
| Urine pregnancy test, read by color change CPT 81025 Urine pregnancy test, by visual color comparison methods | $50.80 | $218.02 | $20.66 | 28% above | 77% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Cyanocobalamin (Vitamin B-12) | $103.71 | $445.10 | $30.11 | 107% above | 77% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed | $107.55 | $461.58 | $59.54 | 49% above | 77% |
| Zinc blood test CPT 84630 Zinc | $30.73 | $131.87 | $34.28 | 10% below | 77% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin, chorionic (hCG); quantitative | $142.12 | $609.96 | $45.33 | 159% above | 77% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Tennessee | Off list |
|---|---|---|---|---|---|
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 Adenoidectomy, primary; younger than age 12 | $3,091.85 | $13,269.75 | $4,994.00 | at median | 77% |
| Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 | $5,436.46 | $23,332.47 | $5,747.00 | at median | 77% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction | $10,517.21 | $45,138.25 | $1,778.00 | 8% below | 77% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair | $4,240.03 | $18,197.54 | $3,055.00 | 53% below | 77% |
| Balloon dilation of the maxillary sinus opening, one side CPT 31295 Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa | $3,223.56 | $13,835.02 | $1,261.00 | at median | 77% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance | $1,066.70 | $4,578.11 | $3,689.78 | 29% below | 77% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any method | $3,642.65 | $15,633.69 | $1,565.00 | 33% below | 77% |
| Bunion correction with removal of part of the big toe joint CPT 28292 Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method | $11,664.26 | $50,061.20 | $1,261.00 | 48% above | 77% |
| Cardiac catheterization with coronary angiogram one side CPT 93458 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed | $6,164.28 | $26,456.15 | $3,373.00 | 67% above | 77% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion, elective, electrical conversion of arrhythmia; external | $700.28 | $3,005.50 | $1,915.00 | 36% above | 77% |
| Carpal tunnel release, open surgery CPT 64721 Neuroplasty and/or transposition; median nerve at carpal tunnel | $4,246.47 | $18,225.20 | $4,994.00 | 47% above | 77% |
| Cervical biopsy CPT 57500 Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) | $6,032.95 | $25,892.50 | $1,428.30 | 1747% above | 77% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age | $5,482.63 | $23,530.60 | $2,499.53 | 44% above | 77% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision, using clamp or other device with regional dorsal penile or ring block | $3,175.09 | $13,626.99 | $1,428.30 | 644% above | 77% |
| Colonoscopy with polyp removal CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique | $1,692.64 | $7,264.54 | $2,499.53 | 34% above | 77% |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple | $1,692.64 | $7,264.54 | $2,499.53 | 78% above | 77% |
| Colonoscopy, diagnostic CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | $1,692.64 | $7,264.54 | $1,261.00 | 34% above | 77% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix | $3,611.40 | $15,499.59 | $4,994.00 | 217% above | 77% |
| Coronary stent placement, one artery CPT 92928 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed, single major coronary artery and/or its branch(es); 1 lesion involving 1 or more coronary segments | $14,450.75 | $62,020.38 | $10,252.00 | 83% above | 77% |
| Cystoscopy with ureteral stent placement CPT 52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) | $3,136.37 | $13,460.83 | $2,499.53 | 21% below | 77% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystourethroscopy (separate procedure) | $5,666.11 | $24,318.06 | $1,915.00 | 1378% above | 77% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) | $4,968.43 | $21,323.72 | $2,499.53 | 82% above | 77% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia | $2,076.17 | $8,910.61 | $3,689.78 | 5% below | 77% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Removal impacted cerumen using irrigation/lavage, unilateral | $89.99 | $386.23 | $3,689.78 | 99% above | 77% |
| Earwax removal with instruments, one ear one side CPT 69210 Removal impacted cerumen requiring instrumentation, unilateral | $89.99 | $386.23 | $740.00 | 26% above | 77% |
| Endoscopic sinus surgery: opening the frontal sinus CPT 31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed | $2,046.27 | $8,782.26 | $1,565.00 | 66% below | 77% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy | $3,851.95 | $16,531.97 | $4,994.00 | 24% below | 77% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus | $2,981.01 | $12,794.01 | $3,689.78 | 61% below | 77% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level | $1,076.91 | $4,621.95 | $1,428.30 | 58% above | 77% |
| 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 | $9,783.55 | $41,989.48 | $4,880.03 | 151% above | 77% |
| 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 | $10,079.94 | $43,261.56 | $4,880.03 | 22% above | 77% |
| 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 | $7,629.62 | $32,745.15 | $4,880.03 | 183% above | 77% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | $1,065.77 | $4,574.12 | $1,428.30 | 100% above | 77% |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopy, surgical; cholecystectomy | $8,157.16 | $35,009.27 | $10,252.00 | 37% above | 77% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Laparoscopy, surgical; cholecystectomy with cholangiography | $14,457.54 | $62,049.52 | $10,831.28 | 143% above | 77% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 Cholecystectomy | $7,351.35 | $31,550.86 | $3,497.00 | 26% below | 77% |
| Hammertoe correction surgery CPT 28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) | $4,611.99 | $19,793.96 | $1,440.00 | 24% above | 77% |
| Hysterectomy through an abdominal incision (total) CPT 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s) | $14,864.90 | $63,797.85 | $3,497.00 | 38% above | 77% |
| Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation) | $5,319.31 | $22,829.67 | $10,831.28 | 31% above | 77% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C | $4,881.98 | $20,952.72 | $4,994.00 | 32% above | 77% |
| IUD insertion (the device itself billed separately) CPT 58300 Insertion of intrauterine device (IUD) | $2,108.46 | $9,049.20 | $3,689.78 | 1% below | 77% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single | $182.75 | $784.33 | $740.00 | 13% above | 77% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair initial inguinal hernia, age 5 years or older; reducible | $9,790.52 | $42,019.41 | $1,778.00 | 260% above | 77% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance | $341.41 | $1,465.26 | $1,428.30 | 10% above | 77% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance | $381.92 | $1,639.14 | $1,428.30 | 36% above | 77% |
| Knee arthroscopy with meniscus trim CPT 29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed | $8,624.25 | $37,013.94 | $4,880.03 | 67% above | 77% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed | $13,797.76 | $59,217.84 | $4,880.03 | 115% above | 77% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) | $6,584.01 | $28,257.54 | $4,880.03 | 13% above | 77% |
| Laparoscopic Roux-en-Y gastric bypass, standard limb length CPT 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) | $35,874.41 | $153,967.41 | $2,026.00 | 249% above | 77% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Laparoscopy, surgical, appendectomy | $7,446.46 | $31,959.05 | $2,026.00 | 117% above | 77% |
| Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures) | $25,700.28 | $110,301.64 | $6,070.28 | 123% above | 77% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less | $8,953.95 | $38,428.97 | $2,813.00 | 11% below | 77% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) | $16,341.21 | $70,133.93 | $10,831.28 | 56% above | 77% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 Laparoscopy, surgical; repair initial inguinal hernia | $16,465.16 | $70,665.94 | $2,026.00 | 132% above | 77% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Laparoscopy, surgical; repair recurrent inguinal hernia | $8,427.74 | $36,170.55 | $8,450.78 | 10% above | 77% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) | $12,917.23 | $55,438.77 | $1,778.00 | 185% above | 77% |
| Laparoscopic sleeve gastrectomy for weight loss CPT 43775 Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy) | $26,233.89 | $112,591.78 | $10,252.00 | 310% above | 77% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less | $189.70 | $814.16 | $740.00 | at median | 77% |
| Left heart catheterization, diagnostic one side CPT 93452 Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed | $4,183.87 | $17,956.52 | $3,251.00 | 32% above | 77% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluorosc | $922.38 | $3,958.71 | $1,261.00 | 105% above | 77% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance | $1,630.00 | $6,995.69 | $1,428.30 | 231% above | 77% |
| Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar | $14,419.43 | $61,885.95 | $10,252.00 | 50% above | 77% |
| Lumbar laminectomy (spinal decompression), one level both sides CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar | $14,701.35 | $63,095.94 | $10,252.00 | — | 77% |
| Lumbar spinal fusion (posterior), one level CPT 22612 Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed) | $5,716.38 | $24,533.83 | $10,252.00 | at median | 77% |
| Lumpectomy (partial mastectomy) CPT 19301 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy) | $6,363.90 | $27,312.86 | $1,440.00 | at median | 77% |
| Mastectomy (total removal of the breast) CPT 19303 Mastectomy, simple, complete | $17,343.37 | $74,435.08 | $4,880.03 | 45% above | 77% |
| Miscarriage treatment with D&C, first trimester CPT 59820 Treatment of missed abortion, completed surgically; first trimester | $3,101.13 | $13,309.59 | $1,565.00 | 11% above | 77% |
| Nail removal (partial or complete), one nail CPT 11730 Avulsion of nail plate, partial or complete, simple; single | $136.37 | $585.30 | $3,689.78 | 40% above | 77% |
| Occipital nerve block (injection for headaches) CPT 64405 Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve | $504.57 | $2,165.52 | $1,428.30 | 141% above | 77% |
| Pacemaker implant (dual chamber) CPT 33208 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular | $16,742.48 | $71,856.15 | $22,456.00 | 228% above | 77% |
| Paracentesis with imaging guidance CPT 49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance | $1,236.56 | $5,307.14 | $1,915.00 | 132% above | 77% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal | $614.60 | $2,637.76 | $1,915.00 | 133% above | 77% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed; | $20,828.82 | $89,394.07 | $13,197.00 | 137% above | 77% |
| Removal of a breast lump, open surgery CPT 19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions | $7,196.60 | $30,886.70 | $4,994.00 | 65% above | 77% |
| Removal of a foreign object under the skin, simple CPT 10120 Incision and removal of foreign body, subcutaneous tissues; simple | $456.82 | $1,960.61 | $740.00 | 91% above | 77% |
| Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 Total thyroid lobectomy, unilateral; with or without isthmusectomy | $15,740.64 | $67,556.39 | $2,499.53 | 122% above | 77% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | $1,692.64 | $7,264.54 | $1,020.00 | 55% above | 77% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal cancer screening; colonoscopy on individual at high risk | $1,597.63 | $6,856.78 | $2,499.53 | 46% above | 77% |
| Septoplasty to straighten the nasal septum CPT 30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft | $3,588.85 | $15,402.77 | $4,880.03 | 25% below | 77% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 Lithotripsy, extracorporeal shock wave | $3,990.31 | $17,125.80 | $10,831.28 | 30% below | 77% |
| Short arm cast (elbow to hand) CPT 29075 Application, cast; elbow to finger (short arm) | $420.20 | $1,803.45 | $3,689.78 | 223% above | 77% |
| Short arm splint (forearm and hand) CPT 29125 Application of short arm splint (forearm to hand); static | $200.49 | $860.46 | $3,689.78 | 106% above | 77% |
| Short leg cast (below the knee) CPT 29405 Application of short leg cast (below knee to toes) | $420.20 | $1,803.45 | $3,689.78 | 322% above | 77% |
| Short leg splint (calf to foot) CPT 29515 Application of short leg splint (calf to foot) | $187.44 | $804.46 | $3,689.78 | 97% above | 77% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure) | $4,799.23 | $20,597.56 | $2,201.00 | 9% above | 77% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure) | $5,067.38 | $21,748.42 | $3,689.78 | 17% above | 77% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less | $189.84 | $814.76 | $3,689.78 | 7% below | 77% |
| Skin biopsy, punch, one lesion CPT 11104 Punch biopsy of skin (including simple closure, when performed); single lesion | $266.16 | $1,142.30 | $3,689.78 | 81% above | 77% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less | $2,586.84 | $11,102.33 | $1,915.00 | 174% above | 77% |
| Skin tag removal, up to 15 tags CPT 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions | $2,891.10 | $12,408.13 | $3,689.78 | 3338% above | 77% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal puncture, lumbar, diagnostic | $524.32 | $2,250.30 | $1,428.30 | 44% above | 77% |
| 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 superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm | $209.37 | $898.57 | $740.00 | 8% below | 77% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less | $188.04 | $807.06 | $740.00 | 8% below | 77% |
| TURP (transurethral resection of the prostate) CPT 52601 Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included) | $6,976.35 | $29,941.43 | $4,880.03 | 38% above | 77% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion | $255.77 | $1,097.73 | $3,689.78 | 73% above | 77% |
| Thoracentesis with imaging guidance CPT 32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance | $1,029.28 | $4,417.52 | $938.00 | 102% above | 77% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 Tonsillectomy and adenoidectomy; age 12 or over | $3,903.10 | $16,751.49 | $2,026.00 | 7% below | 77% |
| Tonsil and adenoid removal, child under 12 CPT 42820 Tonsillectomy and adenoidectomy; younger than age 12 | $7,480.71 | $32,106.05 | $4,994.00 | 73% above | 77% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Tonsillectomy, primary or secondary; age 12 or over | $4,784.52 | $20,534.41 | $1,932.00 | 14% above | 77% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 Tonsillectomy, primary or secondary; younger than age 12 | $3,994.03 | $17,141.75 | $1,565.00 | 13% above | 77% |
| Total hip replacement CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft | $17,366.64 | $74,534.92 | $13,197.00 | 24% above | 77% |
| Total knee replacement CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) | $18,465.02 | $79,249.01 | $3,055.00 | 45% above | 77% |
| Total shoulder replacement CPT 23472 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) | $6,296.27 | $27,022.63 | $2,026.00 | 60% below | 77% |
| Total thyroid removal (thyroidectomy) CPT 60240 Thyroidectomy, total or complete | $15,998.68 | $68,663.88 | $1,565.00 | 355% above | 77% |
| Trigger finger release surgery CPT 26055 Tendon sheath incision (eg, for trigger finger) | $3,275.88 | $14,059.55 | $2,499.53 | 7% above | 77% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) | $353.78 | $1,518.36 | $1,428.30 | 44% above | 77% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance | $1,370.33 | $5,881.25 | $1,261.00 | 38% above | 77% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) | $1,531.25 | $6,571.88 | $1,370.00 | 40% above | 77% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | $1,562.50 | $6,706.02 | $3,707.00 | 66% above | 77% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance | $1,273.95 | $5,467.61 | $938.00 | 19% above | 77% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique | $2,422.26 | $10,395.97 | $1,370.00 | 122% above | 77% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire | $1,562.50 | $6,706.02 | $3,707.00 | 66% above | 77% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | $1,425.01 | $6,115.90 | $1,428.30 | 52% above | 77% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included) | $2,726.07 | $11,699.89 | $4,880.03 | 33% below | 77% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type) | $4,432.44 | $19,023.36 | $7,118.00 | 5% below | 77% |
| Vein ablation, radiofrequency, first vein CPT 36475 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated | $3,113.54 | $13,362.84 | $1,261.00 | 62% above | 77% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less | $577.68 | $2,479.33 | $1,261.00 | 46% above | 77% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation | $5,174.90 | $22,209.86 | $6,070.28 | 39% below | 77% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Tennessee | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Transfusion, blood or blood components | $514.70 | $2,209.00 | $1,428.30 | 37% above | 77% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device | $123.03 | $528.01 | $162.00 | 26% above | 77% |
| Chemotherapy IV infusion, first hour CPT 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug | $389.83 | $1,673.08 | $462.00 | 63% above | 77% |
| Critical care, first 30 to 74 minutes CPT 99291 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | $1,742.66 | $7,479.23 | $1,710.00 | 70% above | 77% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 Electroencephalogram (EEG); including recording awake and drowsy | $391.78 | $1,681.48 | $1,691.00 | 32% above | 77% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report | $55.38 | $237.68 | $268.00 | 18% below | 77% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | $191.28 | $820.96 | $268.00 | 79% above | 77% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional | $175.56 | $753.47 | $562.00 | 28% above | 77% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making | $316.71 | $1,359.27 | $552.00 | 52% above | 77% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making | $528.19 | $2,266.89 | $1,384.00 | 40% above | 77% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making | $726.69 | $3,118.83 | $1,710.00 | 15% above | 77% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making | $1,079.52 | $4,633.13 | $1,710.00 | 17% above | 77% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report | $821.98 | $3,527.80 | $699.00 | 143% above | 77% |
| Family therapy with the patient, 50 minutes CPT 90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes | $166.08 | $712.81 | $153.87–$712.81 | 104% above | 77% |
| Family therapy without the patient, 50 minutes CPT 90846 Family psychotherapy (without the patient present), 50 minutes | $149.04 | $648.01 | $153.87–$648.01 | 94% above | 77% |
| Group psychotherapy session CPT 90853 Group psychotherapy (other than of a multiple-family group) | $345.85 | $1,484.35 | $88.59–$1,484.35 | 597% above | 77% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour | $209.70 | $900.02 | $293.00 | 95% above | 77% |
| IV infusion of a medicine, first hour CPT 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour | $237.63 | $1,019.85 | $293.00 | 60% above | 77% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | $65.33 | $280.40 | $293.00 | 17% above | 77% |
| Neuromuscular re-education, 15 minutes CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities | $48.28 | $207.22 | $104.58 | 4% above | 77% |
| New patient office visit, about 60 minutes CPT 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | $129.12 | $554.18 | $166.25–$554.18 | 1% above | 77% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceede | $129.12 | $554.18 | $166.25–$554.18 | 105% above | 77% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes | $49.95 | $214.36 | $308.00 | 88% above | 77% |
| Occupational therapy evaluation, low complexity CPT 97165 Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance | $122.02 | $523.67 | $221.00 | 8% below | 77% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from | $222.41 | $954.56 | $221.00 | 72% above | 77% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and | $125.73 | $539.61 | $221.00 | 2% below | 77% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements fro | $163.89 | $703.37 | $162.00 | 26% above | 77% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes | $70.68 | $303.35 | $88.00 | 52% above | 77% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility | $68.77 | $295.16 | $100.95 | 47% above | 77% |
| Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 minutes with patient | $146.55 | $628.96 | $153.87–$628.96 | 228% above | 77% |
| Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 minutes with patient | $150.45 | $645.71 | $153.87–$645.71 | 166% above | 77% |
| Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 minutes with patient | $166.08 | $712.81 | $153.87–$712.81 | 76% above | 77% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes | $39.34 | $168.82 | $308.00 | 41% above | 77% |
| Speech and language evaluation CPT 92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) | $225.44 | $967.54 | $591.06 | 21% above | 77% |
| Speech therapy session, individual CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual | $171.87 | $737.65 | $250.17 | 27% above | 77% |
| Spirometry (breathing test) CPT 94010 Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation | $257.35 | $1,104.51 | $591.00 | 136% above | 77% |
| Spirometry before and after a bronchodilator CPT 94060 Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration | $257.35 | $1,104.51 | $591.00 | 5% above | 77% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes | $105.23 | $451.65 | $108.70 | 127% above | 77% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy, therapeutic (separate procedure) | $99.10 | $425.32 | $123.45–$425.32 | 31% above | 77% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Tennessee | Off list |
|---|---|---|---|---|---|
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use | $17.67 | $75.83 | $22.11 | 42% below | 77% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use | $148.91 | $639.08 | $113.73 | 31% above | 77% |
| Rabies vaccine, one dose CPT 90675 Rabies vaccine, for intramuscular use | $701.56 | $3,011.00 | $355.22 | 30% above | 77% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use | $147.43 | $632.76 | $58.32 | 75% above | 77% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) | $65.33 | $280.40 | $293.00 | 98% above | 77% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) | $46.57 | $199.85 | $293.00 | 51% above | 77% |