Community Hospital Association
Community Hospital Association in Fairfax, MO publishes cash prices for 223 common procedures listed here, from its own machine-readable price file updated Aug 21, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Missouri median for 149 of 221 procedures and above it for 66. By typical cash price it ranks #17 of 60 Missouri hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
26136 US HWY 59, Fairfax MO 64446 Collected Sep 27, 2026 Source price file (660) 686-2211
Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 3 of 5 CCN 261303 · 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 Community Hospital Association in Fairfax, MO:
- Sep 24, 2024 Warning notice
- Dec 31, 2024 Corrective action plan requested
- Feb 13, 2025 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-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ARTERIAL ANKLE/ARM INDEX | $149.80 | $214.00 | $100.58–$205.44 | 56% below | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA THORAX/ABD | $1,365.00 | $1,950.00 | $916.50–$1,872.00 | 30% below | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA THORAX | $1,365.00 | $1,950.00 | $916.50–$1,872.00 | 30% below | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA THORAX/ABD/PELV W/ASSOCIATED CHG | $3,185.00 | $4,550.00 | $2,138.50–$4,368.00 | 64% above | 30% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN PELVIS WO | $1,820.00 | $2,600.00 | $1,222.00–$2,496.00 | 14% below | 30% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN PELVIS W | $2,100.00 | $3,000.00 | $1,410.00–$2,880.00 | 12% below | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN PELVIS WWO | $2,380.00 | $3,400.00 | $1,598.00–$3,264.00 | 19% below | 30% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W CONTRAST | $1,050.00 | $1,500.00 | $705.00–$1,440.00 | 33% below | 30% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO | $840.00 | $1,200.00 | $564.00–$1,152.00 | 22% below | 30% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS WO | $945.00 | $1,350.00 | $634.50–$1,296.00 | 12% below | 30% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT FACIAL BONES WO | $945.00 | $1,350.00 | $634.50–$1,296.00 | 12% below | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO | $840.00 | $1,200.00 | $564.00–$1,152.00 | 33% below | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT TRAUMA HEAD/CSP/C/A/P WO | $4,655.00 | $6,650.00 | $2,266.00–$6,384.00 | 270% above | 30% |
| CT scan of the head with contrast CPT 70460 CT HEAD W | $1,050.00 | $1,500.00 | $705.00–$1,440.00 | 27% below | 30% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD WWO | $1,295.00 | $1,850.00 | $869.50–$1,776.00 | 27% below | 30% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE WO | $980.00 | $1,400.00 | $658.00–$1,344.00 | 29% below | 30% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SP WO | $980.00 | $1,400.00 | $658.00–$1,344.00 | 40% below | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W | $1,155.00 | $1,650.00 | $775.50–$1,584.00 | 29% below | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID DOPP BILAT | $401.10 | $573.00 | $269.31–$550.08 | — | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 BILATERAL CAROTID DUPLEX | $401.10 | $573.00 | $269.31–$550.08 | — | 30% |
| Chest X-ray, 2 views CPT 71046 CHEST 2V | $265.30 | $379.00 | $178.13–$363.84 | 5% above | 30% |
| Chest X-ray, single view CPT 71045 CHEST 1V | $150.50 | $215.00 | $101.05–$206.40 | 28% below | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US ABD RENAL | $518.00 | $740.00 | $347.80–$710.40 | 9% below | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US ABD AORTA | $518.00 | $740.00 | $347.80–$710.40 | 9% below | 30% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX/ABD/PELV WO | $1,015.00 | $1,450.00 | $681.50–$1,392.00 | 21% below | 30% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX WO | $1,015.00 | $1,450.00 | $681.50–$1,392.00 | 21% below | 30% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX W | $1,155.00 | $1,650.00 | $775.50–$1,584.00 | 30% below | 30% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX/ABD/PELV W | $1,155.00 | $1,650.00 | $775.50–$1,584.00 | 30% below | 30% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIAG BILAT | $419.30 | $599.00 | $281.53–$575.04 | — | 30% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 ARTERIAL BILATERAL LOWER | $337.40 | $482.00 | $226.54–$462.72 | — | 30% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US ARTERIAL LOWER EXT BILAT | $401.10 | $573.00 | $269.31–$550.08 | — | 30% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 ARTERIAL BILATERALGRAFT SCAN W/ABI | $337.40 | $482.00 | $226.54–$462.72 | 56% below | 30% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 BILATERAL VENOUS DUPLEX | $443.10 | $633.00 | $297.51–$607.68 | — | 30% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VENO DOPP BILAT | $443.10 | $633.00 | $297.51–$607.68 | — | 30% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 VENOUS DOPPLER | $443.10 | $633.00 | $297.51–$607.68 | 45% below | 30% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHOCARDIOGRAM M & 2D | $1,225.70 | $1,751.00 | $822.97–$1,680.96 | 27% below | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NUC MED HEPATOBILIARY WO PHARM | $782.60 | $1,118.00 | $525.46–$1,073.28 | 43% below | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOM 4 OR > WIITH CPAP | $2,778.30 | $3,969.00 | $1,865.43–$3,810.24 | 5% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED | $621.60 | $888.00 | $417.36–$852.48 | 21% above | 30% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WO | $1,365.00 | $1,950.00 | $916.50–$1,872.00 | 18% below | 30% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WWO | $2,275.00 | $3,250.00 | $1,527.50–$3,120.00 | 6% below | 30% |
| MRI of the brain, no contrast dye CPT 70551 MRI HEAD WO | $1,365.00 | $1,950.00 | $916.50–$1,872.00 | 16% below | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI HEAD WWO | $2,275.00 | $3,250.00 | $1,527.50–$3,120.00 | 11% below | 30% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SP WO | $1,365.00 | $1,950.00 | $916.50–$1,872.00 | 27% below | 30% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SP WWO | $2,275.00 | $3,250.00 | $1,527.50–$3,120.00 | 9% below | 30% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SP WO | $1,365.00 | $1,950.00 | $916.50–$1,872.00 | 22% below | 30% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SP WWO | $2,275.00 | $3,250.00 | $1,527.50–$3,120.00 | 9% below | 30% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SP WO | $1,365.00 | $1,950.00 | $916.50–$1,872.00 | 31% below | 30% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WWO | $2,275.00 | $3,250.00 | $1,527.50–$3,120.00 | 11% below | 30% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WO | $1,365.00 | $1,950.00 | $916.50–$1,872.00 | 27% below | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NUC MED CARDIAC PERFUSION SPECT MULTIPLE | $2,907.10 | $4,153.00 | $1,951.91–$3,986.88 | 29% below | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIMITED FOLLOWUP | $415.80 | $594.00 | $279.18–$570.24 | at median | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS COMPLETE | $621.60 | $888.00 | $417.36–$852.48 | 4% below | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US 2ND/3RD TRIM | $518.00 | $740.00 | $347.80–$710.40 | 10% below | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US MULTI GESTATION | $621.60 | $888.00 | $417.36–$852.48 | 20% above | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US 1ST TRIMESTER | $621.60 | $888.00 | $417.36–$852.48 | 20% above | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED | $518.00 | $740.00 | $347.80–$710.40 | 39% above | 30% |
| Screening mammogram, both breasts CPT 77067 MAMMO SCREENING | $185.50 | $265.00 | $188.15–$254.40 | 12% above | 30% |
| Screening mammogram, both breasts one side CPT 77067 MAMMO UNI SCREEN RT | $233.80 | $334.00 | $237.14–$320.64 | 42% above | 30% |
| Screening mammogram, both breasts one side CPT 77067 MAMMO UNI SCREEN LT | $233.80 | $334.00 | $237.14–$320.64 | 42% above | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 4 OR > | $2,173.50 | $3,105.00 | $1,459.35–$2,980.80 | 20% below | 30% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 ESOPHAGUS VIDEO | $392.00 | $560.00 | $263.20–$537.60 | 15% below | 30% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $621.60 | $888.00 | $417.36–$852.48 | 6% above | 30% |
| Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE | $621.60 | $888.00 | $417.36–$852.48 | 23% below | 30% |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM TESTICAL | $621.60 | $888.00 | $417.36–$852.48 | 7% above | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD NECK | $621.60 | $888.00 | $417.36–$852.48 | 10% above | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID | $621.60 | $888.00 | $417.36–$852.48 | 10% above | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI | $582.40 | $832.00 | $391.04–$798.72 | 2% above | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VENOUS LTD DUPLEX | $239.40 | $342.00 | $160.74–$328.32 | 59% below | 30% |
| X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1V | $170.80 | $244.00 | $114.68–$234.24 | 22% below | 30% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HAND 3RD DIGIT RT | $265.30 | $379.00 | $178.13–$363.84 | 29% above | 30% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HAND 2ND DIGIT LT | $265.30 | $379.00 | $178.13–$363.84 | 29% above | 30% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HAND 3RD DIGIT LT | $265.30 | $379.00 | $178.13–$363.84 | 29% above | 30% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HAND 4TH DIGIT LT | $265.30 | $379.00 | $178.13–$363.84 | 29% above | 30% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HAND 5TH DIGIT RT | $265.30 | $379.00 | $178.13–$363.84 | 29% above | 30% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HAND 4TH DIGIT RT | $265.30 | $379.00 | $178.13–$363.84 | 29% above | 30% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HAND 5TH DIGIT LT | $265.30 | $379.00 | $178.13–$363.84 | 29% above | 30% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HAND THUMB LT | $265.30 | $379.00 | $178.13–$363.84 | 29% above | 30% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HAND THUMB RT | $265.30 | $379.00 | $178.13–$363.84 | 29% above | 30% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HAND 2ND DIGIT RT | $265.30 | $379.00 | $178.13–$363.84 | 29% above | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR AP LAT OR FLEX EXT | $220.50 | $315.00 | $148.05–$302.40 | 25% below | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 LUMBAR MIN 4V | $270.20 | $386.00 | $181.42–$370.56 | 37% below | 30% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 DORSAL THORACIC 2V | $220.50 | $315.00 | $148.05–$302.40 | 16% below | 30% |
| X-ray of the nasal bones, 3 or more views CPT 70160 NOSE MIN 3V | $220.50 | $315.00 | $148.05–$302.40 | 12% below | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 2OR3 VIEWS | $265.30 | $379.00 | $178.13–$363.84 | 12% below | 30% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS | $220.50 | $315.00 | $148.05–$302.40 | 2% below | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM COCCYX | $220.50 | $315.00 | $148.05–$302.40 | 16% below | 30% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Missouri | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT (ALT) | $33.60 | $48.00 | $22.56–$46.08 | 31% below | 30% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT (AST) | $32.90 | $47.00 | $22.09–$45.12 | 29% below | 30% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS ACUTE PANEL | $298.90 | $427.00 | $200.69–$409.92 | 27% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 BO ALLEGEN EACH ADDL REG 9A UP RESP | $9.80 | $14.00 | $6.58–$13.44 | 56% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 BO RAST (SINGLE ALLERGEN) | $9.80 | $14.00 | $6.58–$13.44 | 56% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN FOOD BEEF | $26.60 | $38.00 | $17.86–$36.48 | 20% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN FOOD PORK | $26.60 | $38.00 | $17.86–$36.48 | 20% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 BO ALLERGEN REG 8 RESP PANEL EA ADDL | $26.60 | $38.00 | $17.86–$36.48 | 20% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN FOOD LAMB | $26.60 | $38.00 | $17.86–$36.48 | 20% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN GLUTEN | $26.60 | $38.00 | $17.86–$36.48 | 20% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN FOOD CHICKEN | $26.60 | $38.00 | $17.86–$36.48 | 20% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGENS FOOD PROFILE 9 | $26.60 | $38.00 | $17.86–$36.48 | 20% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN FOOD MILK(COWS) | $26.60 | $38.00 | $17.86–$36.48 | 20% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN REG 8 RESP PANEL | $37.10 | $53.00 | $24.91–$50.88 | 68% above | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE AB (IgG) | $43.75 | $62.50 | $29.38–$60.00 | 45% below | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTI NUCLEAR AB | $20.30 | $29.00 | $13.63–$27.84 | 70% below | 30% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ProBNP (NT-proBNP) | $48.30 | $69.00 | $32.43–$66.24 | 61% below | 30% |
| Basic metabolic panel (blood test) CPT 80048 ISTAT BASIC METABOLIC PANEL | $17.50 | $25.00 | $11.75–$24.00 | 86% below | 30% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $45.50 | $65.00 | $30.55–$62.40 | 63% below | 30% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 BO SURGICAL PATH LEVEL IV | $168.70 | $241.00 | $113.27–$231.36 | 17% below | 30% |
| Blood culture for bacteria CPT 87040 CULTURE BLOOD | $54.60 | $78.00 | $36.66–$74.88 | 51% below | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 BO DRAWING FEE | $3.50 | $5.00 | $2.35–$4.80 | 79% below | 30% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE | $24.50 | $35.00 | $16.45–$33.60 | 25% below | 30% |
| Blood lead test CPT 83655 LEAD URINE 24 HR | $22.40 | $32.00 | $15.04–$30.72 | 59% below | 30% |
| Blood lead test CPT 83655 LEAD BLOOD | $63.70 | $91.00 | $42.77–$87.36 | 17% above | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREG TEST (URINE) | $35.00 | $50.00 | $23.50–$48.00 | 34% below | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB ABO TYPING (TO PC) | $7.70 | $11.00 | $5.17–$10.56 | 89% below | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BO ANTIBODY SCRN (PRENATAL) | $12.60 | $18.00 | $8.46–$17.28 | 83% below | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB ABO TYPE | $17.50 | $25.00 | $11.75–$24.00 | 76% below | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB ABO TYPING ROUTINE (TO ARC) | $51.10 | $73.00 | $34.31–$70.08 | 29% below | 30% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 | $30.80 | $44.00 | $20.68–$42.24 | 72% below | 30% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 | $109.20 | $156.00 | $73.32–$149.76 | at median | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 | $194.60 | $278.00 | $130.66–$266.88 | 95% above | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA (DNA PROBE) | $108.50 | $155.00 | $72.85–$148.80 | 21% above | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE | $42.00 | $60.00 | $28.20–$57.60 | 59% below | 30% |
| Complete blood count (CBC) with differential CPT 85025 BO CBC (PRENATAL PANEL) | $5.60 | $8.00 | $3.76–$7.68 | 89% below | 30% |
| Complete blood count (CBC) with differential CPT 85025 CBC w/DIFF | $56.00 | $80.00 | $37.60–$76.80 | 5% above | 30% |
| Complete blood count (CBC), no differential CPT 85027 CBC (COMPLETE BLOOD COUNT) | $40.60 | $58.00 | $27.26–$55.68 | 17% below | 30% |
| Complete blood count (CBC), no differential CPT 85027 CBC WITH MANUAL DIFF | $56.00 | $80.00 | $37.60–$76.80 | 14% above | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL | $52.50 | $75.00 | $35.25–$72.00 | 58% below | 30% |
| D-dimer blood test (blood clot marker) CPT 85379 D DIMER (QUANT) | $64.40 | $92.00 | $43.24–$88.32 | 49% below | 30% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDOSTERONE SULFATE | $44.80 | $64.00 | $30.08–$61.44 | 67% below | 30% |
| Estradiol blood test CPT 82670 ESTRADIOL | $31.50 | $45.00 | $21.15–$43.20 | 78% below | 30% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH | $116.90 | $167.00 | $78.49–$160.32 | 15% above | 30% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN | $105.00 | $150.00 | $70.50–$144.00 | 44% below | 30% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $86.10 | $123.00 | $57.81–$118.08 | 2% above | 30% |
| Folate (folic acid) blood test CPT 82746 FOLATE SERUM | $92.40 | $132.00 | $62.04–$126.72 | 21% above | 30% |
| Free T3 thyroid hormone test CPT 84481 FREE T3 | $44.10 | $63.00 | $29.61–$60.48 | 56% below | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 FT4 (DIRECT EQUILIBRIUM DIALYSIS) | $49.70 | $71.00 | $33.37–$68.16 | 33% below | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 | $56.00 | $80.00 | $37.60–$76.80 | 24% below | 30% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 1-HOUR | $81.20 | $116.00 | $54.52–$111.36 | 11% below | 30% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 3-HOUR | $81.20 | $116.00 | $54.52–$111.36 | 11% below | 30% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 2-HOUR | $81.20 | $116.00 | $54.52–$111.36 | 11% below | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONORRHEA (DNA PROBE) | $29.40 | $42.00 | $19.74–$40.32 | 64% below | 30% |
| H. pylori stool antigen test CPT 87338 H PYLORI AG STOOL | $73.50 | $105.00 | $49.35–$100.80 | 39% below | 30% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/2 ANTIBODIES | $86.10 | $123.00 | $57.81–$118.08 | 25% below | 30% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH RISK w/16 & 18 GENOTYPE | $115.50 | $165.00 | $77.55–$158.40 | 5% above | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HGB A1C | $56.00 | $80.00 | $37.60–$76.80 | 9% below | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE AB | $67.90 | $97.00 | $45.59–$93.12 | 1% below | 30% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP B SURFACE AG | $63.70 | $91.00 | $42.77–$87.36 | 2% below | 30% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 BO HEP BSAG (PRENATAL) | $63.70 | $91.00 | $42.77–$87.36 | 2% below | 30% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEP C AB (TOTAL) | $90.30 | $129.00 | $60.63–$123.84 | 7% above | 30% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C RNA QUANT | $224.70 | $321.00 | $150.87–$308.16 | 24% below | 30% |
| Herpes blood test, HSV-1 antibody CPT 86695 BO HSV TYPE 1 GLYCOPROTEIN IgG | $7.70 | $11.00 | $5.17–$10.56 | 88% below | 30% |
| Herpes blood test, HSV-2 antibody CPT 86696 BO HSV TYPE 2 GLYCOPROTEIN IgG | $7.70 | $11.00 | $5.17–$10.56 | 87% below | 30% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 CRP (HIGH SENSITIVITY) | $81.90 | $117.00 | $54.99–$112.32 | 16% above | 30% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE TOTAL (SERUM) | $37.10 | $53.00 | $24.91–$50.88 | 66% below | 30% |
| Insulin blood test CPT 83525 INSULIN TOTAL | $23.80 | $34.00 | $15.98–$32.64 | 60% below | 30% |
| Iron blood test (serum iron) CPT 83540 IRON TOTAL | $40.60 | $58.00 | $27.26–$55.68 | 12% below | 30% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $45.50 | $65.00 | $30.55–$62.40 | 57% below | 30% |
| LH (luteinizing hormone) test CPT 83002 LH (LUTEINIZING HORMONE) | $116.90 | $167.00 | $78.49–$160.32 | 15% above | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $43.40 | $62.00 | $29.14–$59.52 | 31% below | 30% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $65.10 | $93.00 | $43.71–$89.28 | 51% below | 30% |
| Lyme disease antibody test CPT 86618 LYME IgM | $17.50 | $25.00 | $11.75–$24.00 | 81% below | 30% |
| Lyme disease antibody test CPT 86618 LYME IgG | $17.50 | $25.00 | $11.75–$24.00 | 81% below | 30% |
| Lyme disease antibody test CPT 86618 LYME DISEASE AB REFLEX TO WESTERN BLOT | $39.20 | $56.00 | $26.32–$53.76 | 57% below | 30% |
| Magnesium blood test CPT 83735 MAGNESIUM URINE 24HR/RANDOM | $35.00 | $50.00 | $23.50–$48.00 | 26% below | 30% |
| Magnesium blood test CPT 83735 MAGNESIUM | $35.00 | $50.00 | $23.50–$48.00 | 26% below | 30% |
| Magnesium blood test CPT 83735 MAGNESIUM RBC | $72.10 | $103.00 | $48.41–$98.88 | 53% above | 30% |
| Measles (rubeola) antibody test CPT 86765 MEASLES (RUBEOLA) ANTIBODY IgG | $37.10 | $53.00 | $24.91–$50.88 | 37% below | 30% |
| Obstetric blood test panel CPT 80055 PRENATAL PANEL | $63.70 | $91.00 | $42.77–$87.36 | 81% below | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE | $36.40 | $52.00 | $24.44–$49.92 | 52% below | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA DIAGNOSTIC | $42.00 | $60.00 | $28.20–$57.60 | 45% below | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP SMEAR THIN LAYER W/REFLEX HPV | $66.50 | $95.00 | $44.65–$91.20 | 9% below | 30% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE w/CALCIUM | $217.00 | $310.00 | $145.70–$297.60 | 27% above | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $37.80 | $54.00 | $25.38–$51.84 | 28% below | 30% |
| Progesterone blood test CPT 84144 PROGESTERONE | $131.60 | $188.00 | $88.36–$180.48 | 19% above | 30% |
| Prolactin blood test CPT 84146 PROLACTIN | $122.50 | $175.00 | $82.25–$168.00 | at median | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 DAILY PROTIME | $21.00 | $30.00 | $14.10–$28.80 | 25% below | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 COAGUCHEK INR | $21.00 | $30.00 | $14.10–$28.80 | 25% below | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME W/INR | $21.00 | $30.00 | $14.10–$28.80 | 25% below | 30% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUGS OF ABUSE SCREEN | $90.30 | $129.00 | $60.63–$123.84 | 33% above | 30% |
| Rheumatoid factor (RF) test CPT 86431 RF FACTOR QUANTITATITVE | $35.70 | $51.00 | $23.97–$48.96 | 20% below | 30% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY SCREEN | $9.10 | $13.00 | $6.11–$12.48 | 83% below | 30% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECAL FOR NEOPLASM | $3.50 | $5.00 | $2.35–$4.80 | 84% below | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR | $11.20 | $16.00 | $7.52–$15.36 | 62% below | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB INTERFERON | $119.00 | $170.00 | $79.90–$163.20 | 38% below | 30% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOST & SHGB (FEMALE) | $19.60 | $28.00 | $13.16–$26.88 | 84% below | 30% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOST PANEL/TEST TOTAL&FREE MALE | $42.00 | $60.00 | $28.20–$57.60 | 65% below | 30% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL | $76.30 | $109.00 | $51.23–$104.64 | 36% below | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSOME ABS. IGG BY IFA | $22.40 | $32.00 | $15.04–$30.72 | 71% below | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL (TPO) ANTIBODY | $24.50 | $35.00 | $16.45–$33.60 | 68% below | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $52.50 | $75.00 | $35.25–$72.00 | 15% above | 30% |
| Uric acid blood test CPT 84550 URIC ACID | $23.80 | $34.00 | $15.98–$32.64 | 44% below | 30% |
| Urinalysis without microscope exam, automated CPT 81003 UA URINALYSIS AUTO W/O SCOPE | $3.50 | $5.00 | $2.35–$4.80 | 83% below | 30% |
| Urinalysis without microscope exam, manual CPT 81002 SPECIFIC GRAVITY URINE | $15.40 | $22.00 | $10.34–$21.12 | 18% above | 30% |
| Urinalysis without microscope exam, manual CPT 81002 UROGRAM | $15.40 | $22.00 | $10.34–$21.12 | 18% above | 30% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE | $37.10 | $53.00 | $24.91–$50.88 | 42% below | 30% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 | $95.20 | $136.00 | $63.92–$130.56 | 24% above | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25-HYDROXY | $186.90 | $267.00 | $125.49–$256.32 | 37% above | 30% |
| Zinc blood test CPT 84630 ZINC URINE 24 HR | $22.40 | $32.00 | $15.04–$30.72 | 63% below | 30% |
| Zinc blood test CPT 84630 ZINC SERUM | $38.50 | $55.00 | $25.85–$52.80 | 37% below | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUANTITATIVE | $44.10 | $63.00 | $29.61–$60.48 | 48% below | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Missouri | Off list |
|---|---|---|---|---|---|
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION | $1,112.30 | $1,589.00 | $746.83–$1,525.44 | 35% above | 30% |
| Cervical biopsy CPT 57500 CERVIX POLP REMOVAL BIOPSY | $774.90 | $1,107.00 | $520.29–$1,062.72 | 27% below | 30% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMCISION ADULT | $3,644.20 | $5,206.00 | $2,266.00–$4,997.76 | 8% above | 30% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION NEWBORN | $284.90 | $407.00 | $191.29–$390.72 | 22% below | 30% |
| Colonoscopy with polyp removal CPT 45385 COLON/POLYP/SNARE | $2,177.70 | $3,111.00 | $1,462.17–$2,986.56 | 28% above | 30% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY W/BIOPSY | $1,857.10 | $2,653.00 | $1,246.91–$2,546.88 | 2% above | 30% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY | $1,666.70 | $2,381.00 | $1,119.07–$2,285.76 | 27% above | 30% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 **COLPOSCOPY W/BIOPSY | $287.00 | $410.00 | $192.70–$393.60 | 36% below | 30% |
| Cystoscopy with ureteral stent placement CPT 52332 CYSTO STENT PLACEMENT | $6,460.30 | $9,229.00 | $2,266.00–$8,859.84 | 9% above | 30% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY | $1,131.90 | $1,617.00 | $759.99–$1,552.32 | 9% below | 30% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DEST OD LESION (BEN) | $366.80 | $524.00 | $246.28–$503.04 | 214% above | 30% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 CERUMEN REMOVAL SYRINGE IRR/LAVAGE | $21.70 | $31.00 | $14.57–$29.76 | 71% below | 30% |
| Earwax removal with instruments, one ear CPT 69210 EAR-REMOVAL OF IMPACTED CERUMEN | $56.70 | $81.00 | $38.07–$77.76 | 39% below | 30% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BX | $174.30 | $249.00 | $117.03–$239.04 | 34% below | 30% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 THORACIC EPIDURAL W GUIDE | $3,521.70 | $5,031.00 | $2,266.00–$4,829.76 | 165% above | 30% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 CERVICAL EPIDURAL W GUIDE | $3,521.70 | $5,031.00 | $2,266.00–$4,829.76 | 165% above | 30% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 LUMB/SAC NERVE BLOCK W/GUIDE | $2,579.50 | $3,685.00 | $1,731.95–$3,537.60 | 147% above | 30% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 FLEXIBLE SIGMOID | $968.10 | $1,383.00 | $650.01–$1,327.68 | 15% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I & D ABSCESS | $164.50 | $235.00 | $110.45–$225.60 | 28% below | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT | $259.70 | $371.00 | $174.37–$356.16 | 24% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 MAJOR JOINT INJ/ASP | $79.80 | $114.00 | $53.58–$109.44 | 63% below | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 BURSA MAJOR JOINT | $79.80 | $114.00 | $53.58–$109.44 | 63% below | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 JOINT INJECTIONS ASPIRATIONS MAJOR | $282.80 | $404.00 | $189.88–$387.84 | 31% above | 30% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG IMPLANT DEVICE | $112.00 | $160.00 | $75.20–$153.60 | 38% below | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 INTER JOINT INJ/ASP | $65.10 | $93.00 | $43.71–$89.28 | 69% below | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 BURSA INTER JOINT | $65.10 | $93.00 | $43.71–$89.28 | 69% below | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 JOINT ASPIRATION SMALL JOINT | $934.50 | $1,335.00 | $627.45–$1,281.60 | 352% above | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INT TRNK SCLP<2.5 | $259.00 | $370.00 | $173.90–$355.20 | 32% below | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 LUMBAR EPIDURAL W GUIDE | $3,521.70 | $5,031.00 | $2,266.00–$4,829.76 | 198% above | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 LUMBAR FORAMINAL INJ W GUIDE | $2,579.50 | $3,685.00 | $1,731.95–$3,537.60 | 72% above | 30% |
| Nail removal (partial or complete), one nail CPT 11730 AVUL NAIL BED | $308.70 | $441.00 | $207.27–$423.36 | 67% above | 30% |
| Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE | $309.40 | $442.00 | $207.74–$424.32 | 67% above | 30% |
| Paracentesis with imaging guidance CPT 49083 US ABD PARACENTESIS W IMAGING | $1,332.80 | $1,904.00 | $894.88–$1,827.84 | 54% above | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 TOENAIL REMOVAL (PERM) | $549.50 | $785.00 | $368.95–$753.60 | 22% above | 30% |
| Prostate biopsy CPT 55700 BIOPSY PROSTATE | $237.30 | $339.00 | $159.33–$325.44 | 92% below | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 I&REM FOREIGN BODY REMOVAL | $172.90 | $247.00 | $116.09–$237.12 | 43% below | 30% |
| Short arm splint (forearm and hand) CPT 29125 APPLICATION SHORT ARM SPLINT | $66.50 | $95.00 | $44.65–$91.20 | 56% below | 30% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT | $84.00 | $120.00 | $56.40–$115.20 | 49% below | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 LACERATION REPAIR 2.5 CM | $77.00 | $110.00 | $51.70–$105.60 | 65% below | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SMP SCLP,NCK HND FT<2.5 | $77.00 | $110.00 | $51.70–$105.60 | 65% below | 30% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS <W/15 | $377.30 | $539.00 | $253.33–$517.44 | 154% above | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR SPINAL TAP | $743.40 | $1,062.00 | $499.14–$1,019.52 | 30% above | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SMP SCLP,NCK,HND,FT2.6-7.5 | $102.20 | $146.00 | $68.62–$140.16 | 65% below | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SMP FCE ERS MUCMM<2.5 | $95.90 | $137.00 | $64.39–$131.52 | 64% below | 30% |
| Thoracentesis with imaging guidance CPT 32555 US THORACENTESIS | $621.60 | $888.00 | $417.36–$852.48 | 31% below | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT UP TO 2 W/O GUIDE | $65.80 | $94.00 | $44.18–$90.24 | 68% below | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT UP TO 2 | $129.50 | $185.00 | $86.95–$177.60 | 37% below | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US BREAST BIOPSY CORE W/GUIDE | $3,243.80 | $4,634.00 | $2,177.98–$4,448.64 | 62% above | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 GASTROSCOPY W/BIOPSY | $1,700.30 | $2,429.00 | $1,141.63–$2,331.84 | at median | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 GASTROSCOPY | $1,700.30 | $2,429.00 | $1,141.63–$2,331.84 | 27% above | 30% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY | $1,260.00 | $1,800.00 | $846.00–$1,728.00 | 20% above | 30% |
| Wart removal, up to 14 warts CPT 17110 CAUTERIZATION OF WARTS | $210.00 | $300.00 | $141.00–$288.00 | 30% above | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SUBQ TO 20 SQCM | $221.90 | $317.00 | $148.99–$304.32 | 44% below | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Missouri | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD PROD TRNSF PROC 1UNIT | $280.00 | $400.00 | $188.00–$384.00 | 57% below | 30% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD PROD TRNSF PROC 2UNITS | $420.00 | $600.00 | $282.00–$576.00 | 36% below | 30% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD PROD TRNSF PROC 3UNITS | $560.00 | $800.00 | $376.00–$768.00 | 15% below | 30% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD PROD TRNSF PROC 4UNITS | $700.00 | $1,000.00 | $470.00–$960.00 | 7% above | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI TREATMENT SUBSQNT | $196.70 | $281.00 | $132.07–$269.76 | 29% above | 30% |
| Chemotherapy IV infusion, first hour CPT 96413 OP IV INFUSION | $295.40 | $422.00 | $198.34–$405.12 | 32% below | 30% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE INT 30-74 MIN | $1,330.00 | $1,900.00 | $893.00–$1,824.00 | 2% below | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG | $197.40 | $282.00 | $132.54–$270.72 | 3% above | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 E R LEVEL I | $140.00 | $200.00 | $94.00–$192.00 | at median | 30% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 E R LEVEL II | $245.00 | $350.00 | $164.50–$336.00 | at median | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 E R LEVEL III | $350.00 | $500.00 | $235.00–$480.00 | 22% below | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 E R LEVEL IV | $455.00 | $650.00 | $305.50–$624.00 | 35% below | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 E R LEVEL IV MOD 25 | $455.00 | $650.00 | $305.50–$624.00 | 35% below | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 E R LEVEL V | $840.00 | $1,200.00 | $564.00–$1,152.00 | 21% below | 30% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS STUDY | $814.10 | $1,163.00 | $546.61–$1,116.48 | 1% below | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ER HYDRATION THERAPY 1ST HOUR | $266.70 | $381.00 | $179.07–$365.76 | 8% above | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OP HYDRATION THERAPY 1ST HOUR | $266.70 | $381.00 | $179.07–$365.76 | 8% above | 30% |
| IV infusion of a medicine, first hour CPT 96365 OP IV THERAPY 1ST HOUR | $160.30 | $229.00 | $107.63–$219.84 | 47% below | 30% |
| IV infusion of a medicine, first hour CPT 96365 IV THERAPY 1ST HOUR | $160.30 | $229.00 | $107.63–$219.84 | 47% below | 30% |
| IV infusion of a medicine, first hour CPT 96365 IV THERAPY 1ST HOUR | $160.30 | $229.00 | $107.63–$219.84 | 47% below | 30% |
| IV infusion of a medicine, first hour CPT 96365 ER IV THERAPY 1ST HOUR | $434.00 | $620.00 | $291.40–$595.20 | 43% above | 30% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY 1ST HOUR | $160.30 | $229.00 | $107.63–$219.84 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IVJ TX/DX/PROPH SUBQ/IM | $91.70 | $131.00 | $61.57–$125.76 | 6% below | 30% |
| New patient office visit, about 30 minutes CPT 99203 OP VISIT L3 NEW | $252.70 | $361.00 | $169.67–$346.56 | 89% above | 30% |
| New patient office visit, about 30 minutes CPT 99203 OB OP VISIT L3 NEW | $252.70 | $361.00 | $169.67–$346.56 | 89% above | 30% |
| New patient office visit, about 45 minutes CPT 99204 OB OP VISIT L4 NEW | $326.20 | $466.00 | $219.02–$447.36 | 85% above | 30% |
| New patient office visit, about 60 minutes CPT 99205 OB OP VISIT L5 NEW | $408.10 | $583.00 | $274.01–$559.68 | 58% above | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP VISIT L2 NEW | $144.20 | $206.00 | $96.82–$197.76 | 60% above | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OB OP VISIT L2 NEW | $144.20 | $206.00 | $96.82–$197.76 | 60% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INDIV INITIAL 15 MIN | $20.30 | $29.00 | $13.63–$27.84 | 54% below | 30% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 RT SMOKE CESS 3-10MIN | $32.20 | $46.00 | $21.62–$44.16 | 46% above | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OB OP VISIT L5 EST | $282.80 | $404.00 | $189.88–$387.84 | 50% above | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP VISIT L5 EST | $282.80 | $404.00 | $189.88–$387.84 | 50% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OB OP VISIT L3 EST | $142.10 | $203.00 | $95.41–$194.88 | 32% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP VISIT L3 EST | $142.10 | $203.00 | $95.41–$194.88 | 32% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP VISIT L4 EST | $210.70 | $301.00 | $141.47–$288.96 | 48% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OB OP VISIT L4 EST | $210.70 | $301.00 | $141.47–$288.96 | 48% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OB OP VISIT L2 EST | $84.00 | $120.00 | $56.40–$115.20 | 20% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP VISIT L2 EST | $84.00 | $120.00 | $56.40–$115.20 | 20% above | 30% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY | $268.10 | $383.00 | $180.01–$367.68 | 18% above | 30% |
| Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY PRE AND POST | $409.50 | $585.00 | $274.95–$561.60 | 7% below | 30% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 BB THER PHLEBOTOMY | $84.70 | $121.00 | $56.87–$116.16 | 55% below | 30% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Missouri | Off list |
|---|---|---|---|---|---|
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV9 VACCINE 3 DOSE SCHEDULE F/IM USE | $326.90 | $467.00 | $219.49–$448.32 | 1% below | 30% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV9 VACCINE 3 DOSE SCHEDULE F/IM USE | $326.90 | $467.00 | $219.49–$448.32 | 1% below | 30% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV9 VACCINE 3 DOSE SCHEDULE F/IM USE | $326.90 | $467.00 | $219.49–$448.32 | — | 30% |
| Hepatitis A vaccine, adult dose CPT 90632 CL-HEPATITIS A VACCINE ADULT | $50.40 | $72.00 | $33.84–$69.12 | 39% below | 30% |
| Hepatitis A vaccine, adult dose CPT 90632 CL-HEPATITIS A VACCINE ADULT | $50.40 | $72.00 | $33.84–$69.12 | 39% below | 30% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 CL-HEPATITIS A VACCINE ADULT | $50.40 | $72.00 | $33.84–$69.12 | — | 30% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 CL-INFLUENZA VACC HIGH DOSE 65 YR & OLD | $101.50 | $145.00 | $68.15–$139.20 | at median | 30% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 CL-INFLUENZA VACC HIGH DOSE 65 YR & OLD | $101.50 | $145.00 | $68.15–$139.20 | at median | 30% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 CL-INFLUENZA VACC HIGH DOSE 65 YR & OLD | $101.50 | $145.00 | $68.15–$139.20 | — | 30% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE | $166.60 | $238.00 | $111.86–$228.48 | at median | 30% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE | $166.60 | $238.00 | $111.86–$228.48 | at median | 30% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR VACCINE | $166.60 | $238.00 | $111.86–$228.48 | — | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 CL-TETANUS/DIPTHEHERIA TOXOID (ADULT):0. | $91.70 | $131.00 | $61.57–$125.76 | 28% above | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 CL-TETANUS/DIPTHEHERIA TOXOID (ADULT):0. | $91.70 | $131.00 | $61.57–$125.76 | 28% above | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 CL-TETANUS/DIPTHEHERIA TOXOID (ADULT):0. | $91.70 | $131.00 | $61.57–$125.76 | — | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 CL-ADACEL (Tdap) ADOLESCE/ADULT DOSE 0.5 | $98.70 | $141.00 | $66.27–$135.36 | 2% below | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 CL-ADACEL (Tdap) ADOLESCE/ADULT DOSE 0.5 | $98.70 | $141.00 | $66.27–$135.36 | 2% below | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 CL-ADACEL (Tdap) ADOLESCE/ADULT DOSE 0.5 | $98.70 | $141.00 | $66.27–$135.36 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION | $14.00 | $20.00 | $9.40–$19.20 | 76% below | 30% |
Source file: https://fairfax.pt.panaceainc.com/MRFDownload/fairfax/fairfax