Hospital

Sullivan County Memorial Hospital

Sullivan County Memorial Hospital in Milan, MO publishes cash prices for 316 common procedures listed here, from its own machine-readable price file updated Jul 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Missouri median for 193 of 312 procedures and above it for 116. By typical cash price it ranks #25 of 67 Missouri hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

630 W. Third Street, Milan, MO, 63556 Collected Sep 27, 2026 Source price file (660) 265-4212

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 261306 · CMS hospital register NPI 1114067832

The price file shows no self-pay discount

For 1034 of the 1034 prices listed here, the cash price in Sullivan County Memorial Hospital's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing. Other US hospitals whose cash price is their full list price.

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 2 actions for a hospital named Sullivan County Memorial Hospital in Milan, MO:

Apr 13, 2026 Corrective action plan requested
Jul 28, 2026 Case closed

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
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN WITH & WITHOUT	$1,082.00	$1,082.00	—	42% below	—
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN WITH & WITHOUT	$1,082.00	$1,082.00	—	—	—
Abdominal X-ray, 2 views CPT 74019 XR ABDOMEN W/UPRIGHT 2 VIEW	$321.00	$321.00	—	8% above	—
Abdominal X-ray, 2 views CPT 74019 XR ABDOMEN DECUB 2 VIEW	$321.00	$321.00	—	8% above	—
Abdominal X-ray, 2 views inpatient CPT 74019 XR ABDOMEN W/UPRIGHT 2 VIEW	$321.00	$321.00	—	—	—
Abdominal X-ray, 2 views inpatient CPT 74019 XR ABDOMEN DECUB 2 VIEW	$321.00	$321.00	—	—	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE L 3 VIEW,LEFT	$261.00	$261.00	—	10% below	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE R 3 VIEW,RIGHT	$261.00	$261.00	—	10% below	—
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE L 3 VIEW,LEFT	$261.00	$261.00	—	—	—
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE R 3 VIEW,RIGHT	$261.00	$261.00	—	—	—
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 PV ARTERIAL DOPPLER LIMITED	$215.00	$215.00	—	31% below	—
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 PV ANKLE BRACHIAL INDEX	$355.00	$355.00	—	14% above	—
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 PV ARTERIAL DOPPLER LIMITED	$215.00	$215.00	—	—	—
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 PV ANKLE BRACHIAL INDEX	$355.00	$355.00	—	—	—
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UPPER EXTREMITY WITHOUT LT,LEFT	$641.00	$641.00	—	46% below	—
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UPPER EXTREMITY WITHOUT RIGHT,RIGHT	$641.00	$641.00	—	46% below	—
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPPER EXTREMITY WITHOUT LT,LEFT	$641.00	$641.00	—	—	—
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPPER EXTREMITY WITHOUT RIGHT,RIGHT	$641.00	$641.00	—	—	—
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR ESOPHAGUS	$541.00	$541.00	—	27% above	—
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR ESOPHAGUS	$541.00	$541.00	—	—	—
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE LEFT,LEFT	$428.00	$428.00	—	6% above	—
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE RIGHT,RIGHT	$428.00	$428.00	—	6% above	—
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE RIGHT,RIGHT	$428.00	$428.00	—	—	—
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE LEFT,LEFT	$428.00	$428.00	—	—	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED LEFT,LEFT	$348.00	$348.00	—	at median	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED RIGHT,RIGHT	$348.00	$348.00	—	at median	—
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED LEFT,LEFT	$348.00	$348.00	—	—	—
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED RIGHT,RIGHT	$348.00	$348.00	—	—	—
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIOGRAPHY ABD & PELVIS W/ CONTRAST	$2,211.00	$2,211.00	—	11% below	—
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ANGIOGRAPHY ABD & PELVIS W/ CONTRAST	$2,211.00	$2,211.00	—	—	—
CT angiography (CTA) of the head CPT 70496 CTA BRAIN W CONTRAST & IMAGING POSTPROCE	$1,082.00	$1,082.00	—	44% below	—
CT angiography (CTA) of the head inpatient CPT 70496 CTA BRAIN W CONTRAST & IMAGING POSTPROCE	$1,082.00	$1,082.00	—	—	—
CT angiography (CTA) of the neck CPT 70498 CTA NECK W CONTRAST & IMAGING POSTPROCES	$1,082.00	$1,082.00	—	44% below	—
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK W CONTRAST & IMAGING POSTPROCES	$1,082.00	$1,082.00	—	—	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT CHEST ANGIOGRAPHY (NON CORONARY)	$1,082.00	$1,082.00	—	44% below	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT CHEST ANGIOGRAPHY (NON CORONARY)	$1,082.00	$1,082.00	—	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS WITHOUT CONTRAST	$1,401.00	$1,401.00	—	34% below	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS WITHOUT CONTRAST	$1,401.00	$1,401.00	—	—	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS WITH CONTRAST	$2,211.00	$2,211.00	—	13% below	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS WITH CONTRAST	$2,211.00	$2,211.00	—	—	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD & PELVIS WITH & WITHOUT	$2,211.00	$2,211.00	—	30% below	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD & PELVIS WITH & WITHOUT	$2,211.00	$2,211.00	—	—	—
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN WITH	$1,082.00	$1,082.00	—	35% below	—
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN WITH	$1,082.00	$1,082.00	—	—	—
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WITHOUT	$641.00	$641.00	—	41% below	—
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WITHOUT	$641.00	$641.00	—	—	—
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SCREENING SINUSES W/O CONTRAST	$641.00	$641.00	—	41% below	—
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL WITHOUT	$641.00	$641.00	—	41% below	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SCREENING SINUSES W/O CONTRAST	$641.00	$641.00	—	—	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL WITHOUT	$641.00	$641.00	—	—	—
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WITHOUT	$641.00	$641.00	—	48% below	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WITHOUT	$641.00	$641.00	—	—	—
CT scan of the head with contrast CPT 70460 CT HEAD WITH	$1,082.00	$1,082.00	—	25% below	—
CT scan of the head with contrast inpatient CPT 70460 CT HEAD WITH	$1,082.00	$1,082.00	—	—	—
CT scan of the head without and with contrast CPT 70470 CT HEAD COMBINED	$1,082.00	$1,082.00	—	39% below	—
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD COMBINED	$1,082.00	$1,082.00	—	—	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE WITHOUT	$641.00	$641.00	—	54% below	—
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE WITHOUT	$641.00	$641.00	—	—	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O	$641.00	$641.00	—	59% below	—
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O	$641.00	$641.00	—	—	—
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIC WITH	$1,082.00	$1,082.00	—	34% below	—
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIC WITH	$1,082.00	$1,082.00	—	—	—
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 PV CAROTID BILATERAL	$380.00	$380.00	—	—	—
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 PV CAROTID BILATERAL	$380.00	$380.00	—	—	—
Chest CT scan without and with contrast CPT 71270 CT CHEST WITH & WITHOUT	$1,082.00	$1,082.00	—	42% below	—
Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST WITH & WITHOUT	$1,082.00	$1,082.00	—	—	—
Chest X-ray, 2 views CPT 71046 XR LORDOTIC CHEST TWO VIEW	$261.00	$261.00	—	12% above	—
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEW	$261.00	$261.00	—	12% above	—
Chest X-ray, 2 views CPT 71046 XR LAT DECUB CHEST 2 VIEW	$261.00	$261.00	—	12% above	—
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEW	$261.00	$261.00	—	—	—
Chest X-ray, 2 views inpatient CPT 71046 XR LORDOTIC CHEST TWO VIEW	$261.00	$261.00	—	—	—
Chest X-ray, 2 views inpatient CPT 71046 XR LAT DECUB CHEST 2 VIEW	$261.00	$261.00	—	—	—
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW	$261.00	$261.00	—	37% above	—
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW	$261.00	$261.00	—	—	—
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR CLAVICLE RIGHT,RIGHT	$261.00	$261.00	—	9% above	—
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR CLAVICLE LEFT,LEFT	$261.00	$261.00	—	9% above	—
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR CLAVICLE LEFT,LEFT	$261.00	$261.00	—	—	—
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR CLAVICLE RIGHT,RIGHT	$261.00	$261.00	—	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys both sides CPT 76770 US RENAL BILAT	$428.00	$428.00	—	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient both sides CPT 76770 US RENAL BILAT	$428.00	$428.00	—	—	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 XR DXA AXIAL SKELETON	$321.00	$321.00	—	1% above	—
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 XR DXA AXIAL SKELETON	$321.00	$321.00	—	—	—
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 XR DXA PERIPHERAL SKELETON	$261.00	$261.00	—	41% above	—
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 XR DXA PERIPHERAL SKELETON	$261.00	$261.00	—	—	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WITHOUT	$641.00	$641.00	—	49% below	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST WITHOUT	$641.00	$641.00	—	—	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST WITH	$1,082.00	$1,082.00	—	34% below	—
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST WITH	$1,082.00	$1,082.00	—	—	—
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 PV BILAT ARTERIAL DUPLEX DOP EXTREM LOW	$355.00	$355.00	—	—	—
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 PV BILAT ARTERIAL DUPLEX DOP EXTREM LOW	$355.00	$355.00	—	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 PV BILATERAL VENOUS DOPPLER	$690.00	$690.00	—	—	—
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 PV BILATERAL VENOUS DOPPLER	$690.00	$690.00	—	—	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 PV ECHO 2D&M/CARD. DOP/COLOR	$985.00	$985.00	—	39% below	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 PV ECHO 2D&M/CARD. DOP/COLOR	$985.00	$985.00	—	—	—
Elbow X-ray, 2 views one side CPT 73070 XR ELBOW LEFT 2 VIEW,LEFT	$261.00	$261.00	—	28% above	—
Elbow X-ray, 2 views one side CPT 73070 XR ELBOW RIGHT 2 VIEW,RIGHT	$261.00	$261.00	—	28% above	—
Elbow X-ray, 2 views inpatient one side CPT 73070 XR ELBOW LEFT 2 VIEW,LEFT	$261.00	$261.00	—	—	—
Elbow X-ray, 2 views inpatient one side CPT 73070 XR ELBOW RIGHT 2 VIEW,RIGHT	$261.00	$261.00	—	—	—
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR ELBOW RIGHT 3 VIEW,RIGHT	$261.00	$261.00	—	4% below	—
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR ELBOW LEFT 3 VIEW,LEFT	$261.00	$261.00	—	4% below	—
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR ELBOW RIGHT 3 VIEW,RIGHT	$261.00	$261.00	—	—	—
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR ELBOW LEFT 3 VIEW,LEFT	$261.00	$261.00	—	—	—
Eye socket (orbit) CT scan without contrast CPT 70480 CT POSTERIOR FOSSA WITHOUT	$641.00	$641.00	—	50% below	—
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORB FOSSA OR IN OUT EAR WITHOUT	$641.00	$641.00	—	50% below	—
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORB FOSSA OR IN OUT EAR WITHOUT	$641.00	$641.00	—	—	—
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT POSTERIOR FOSSA WITHOUT	$641.00	$641.00	—	—	—
Facial bones X-ray, complete, 3 or more views CPT 70150 XR FACIAL SERIES	$321.00	$321.00	—	8% above	—
Facial bones X-ray, complete, 3 or more views CPT 70150 XR ZYCOMATIC ARCH 3V	$321.00	$321.00	—	8% above	—
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR FACIAL SERIES	$321.00	$321.00	—	—	—
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR ZYCOMATIC ARCH 3V	$321.00	$321.00	—	—	—
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR FOREARM LEFT 2 VIEW,LEFT	$261.00	$261.00	—	25% above	—
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR FOREARM RIGHT 2 VIEW,RIGHT	$261.00	$261.00	—	25% above	—
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR FOREARM RIGHT 2 VIEW,RIGHT	$261.00	$261.00	—	—	—
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR FOREARM LEFT 2 VIEW,LEFT	$261.00	$261.00	—	—	—
Hand X-ray, 2 views one side CPT 73120 XR HAND 2 V LEFT,LEFT	$321.00	$321.00	—	69% above	—
Hand X-ray, 2 views one side CPT 73120 XR HAND 2 V RIGHT,RIGHT	$321.00	$321.00	—	69% above	—
Hand X-ray, 2 views inpatient one side CPT 73120 XR HAND 2 V LEFT,LEFT	$321.00	$321.00	—	—	—
Hand X-ray, 2 views inpatient one side CPT 73120 XR HAND 2 V RIGHT,RIGHT	$321.00	$321.00	—	—	—
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR OS CALCIS LEFT 2V MIN.,LEFT	$261.00	$261.00	—	30% above	—
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR OS CALCIS RIGHT 2V MIN.,RIGHT	$261.00	$261.00	—	30% above	—
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR OS CALCIS LEFT 2V MIN.,LEFT	$261.00	$261.00	—	—	—
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR OS CALCIS RIGHT 2V MIN.,RIGHT	$261.00	$261.00	—	—	—
Knee X-ray, 3 views one side CPT 73562 XR KNEE RIGHT 3 VIEW,RIGHT	$261.00	$261.00	—	3% below	—
Knee X-ray, 3 views one side CPT 73562 XR KNEE LEFT 3 VIEW,LEFT	$261.00	$261.00	—	3% below	—
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE LEFT 3 VIEW,LEFT	$261.00	$261.00	—	—	—
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE RIGHT 3 VIEW,RIGHT	$261.00	$261.00	—	—	—
Knee X-ray, complete, 4 or more views one side CPT 73564 XR KNEE AND PATELLA RIGHT,RIGHT	$321.00	$321.00	—	2% above	—
Knee X-ray, complete, 4 or more views one side CPT 73564 XR KNEE AND PATELLA LEFT,LEFT	$321.00	$321.00	—	2% above	—
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR KNEE AND PATELLA RIGHT,RIGHT	$321.00	$321.00	—	—	—
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR KNEE AND PATELLA LEFT,LEFT	$321.00	$321.00	—	—	—
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER RIGHT EXTREMITY WITHOUT,RIGHT	$641.00	$641.00	—	47% below	—
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER LEFT EXTREMITY WITHOUT,LEFT	$641.00	$641.00	—	47% below	—
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER LEFT EXTREMITY WITHOUT,LEFT	$641.00	$641.00	—	—	—
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER RIGHT EXTREMITY WITHOUT,RIGHT	$641.00	$641.00	—	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US GALL BLADDER	$428.00	$428.00	—	17% below	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US LIVER	$428.00	$428.00	—	17% below	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US KINEVAC GALL BLADDER	$428.00	$428.00	—	17% below	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SPLEEN	$428.00	$428.00	—	17% below	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US LIMITED SINGLE ORGAN	$428.00	$428.00	—	17% below	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PANCREAS	$428.00	$428.00	—	17% below	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder one side CPT 76705 US RIGHT UPPER QUADRANT	$428.00	$428.00	—	17% below	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US PANCREAS	$428.00	$428.00	—	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US LIMITED SINGLE ORGAN	$428.00	$428.00	—	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US SPLEEN	$428.00	$428.00	—	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US KINEVAC GALL BLADDER	$428.00	$428.00	—	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US LIVER	$428.00	$428.00	—	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US GALL BLADDER	$428.00	$428.00	—	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient one side CPT 76705 US RIGHT UPPER QUADRANT	$428.00	$428.00	—	—	—
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXTREM NONVASC W/ IMAGE DOC LIMIT ANA	$428.00	$428.00	—	21% above	—
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXTREM NONVASC W/ IMAGE DOC LIMIT ANA	$428.00	$428.00	—	—	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LOW DOSE LUNG SCREEN WO CONTRAST	$500.00	$500.00	—	15% above	—
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LOW DOSE LUNG SCREEN WO CONTRAST	$500.00	$500.00	—	—	—
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR TIBIA - FIBULA LEFT 2V,LEFT	$261.00	$261.00	—	9% above	—
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR TIBIA - FIBULA RIGHT 2V,RIGHT	$261.00	$261.00	—	9% above	—
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR TIBIA - FIBULA RIGHT 2V,RIGHT	$261.00	$261.00	—	—	—
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR TIBIA - FIBULA LEFT 2V,LEFT	$261.00	$261.00	—	—	—
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD WITHOUT CONTRAST	$1,401.00	$1,401.00	—	10% below	—
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD WITHOUT CONTRAST	$1,401.00	$1,401.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOW LT EXTREM ANY JOINT W/O CONTRAST,LEFT	$1,401.00	$1,401.00	—	17% below	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOW RT EXTREM ANY JOINT W/O CONTRAST,RIGHT	$1,401.00	$1,401.00	—	17% below	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LOW RT EXTREM ANY JOINT W/O CONTRAST,RIGHT	$1,401.00	$1,401.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LOW LT EXTREM ANY JOINT W/O CONTRAST,LEFT	$1,401.00	$1,401.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOW RT EXT JOINT W & W/O CONTRAST,RIGHT	$2,211.00	$2,211.00	—	2% below	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOW LT EXT JOINT W & W/O CONTRAST,LEFT	$2,211.00	$2,211.00	—	2% below	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LOW LT EXT JOINT W & W/O CONTRAST,LEFT	$2,211.00	$2,211.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LOW RT EXT JOINT W & W/O CONTRAST,RIGHT	$2,211.00	$2,211.00	—	—	—
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WITHOUT CONTRAST	$1,401.00	$1,401.00	—	13% below	—
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN WITHOUT CONTRAST	$1,401.00	$1,401.00	—	—	—
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMENWITH AND WITHOUT CONTRAST	$2,211.00	$2,211.00	—	5% below	—
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMENWITH AND WITHOUT CONTRAST	$2,211.00	$2,211.00	—	—	—
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WITHOUT CONTRAST	$1,401.00	$1,401.00	—	8% below	—
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WITHOUT CONTRAST	$1,401.00	$1,401.00	—	—	—
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WITH AND WITHOUT CONTRAST	$2,211.00	$2,211.00	—	10% below	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WITH AND WITHOUT CONTRAST	$2,211.00	$2,211.00	—	—	—
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE WITHOUT CONTRAST	$1,401.00	$1,401.00	—	24% below	—
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE WITHOUT CONTRAST	$1,401.00	$1,401.00	—	—	—
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR WITH & WITHOUT CONTRAST	$2,211.00	$2,211.00	—	11% below	—
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR WITH & WITHOUT CONTRAST	$2,211.00	$2,211.00	—	—	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE WITHOUT CONTRAST	$1,401.00	$1,401.00	—	18% below	—
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE WITHOUT CONTRAST	$1,401.00	$1,401.00	—	—	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W & W/O CONTRAST	$2,211.00	$2,211.00	—	10% below	—
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE W & W/O CONTRAST	$2,211.00	$2,211.00	—	—	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE WITHOUT CONTRAST	$1,401.00	$1,401.00	—	28% below	—
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE WITHOUT CONTRAST	$1,401.00	$1,401.00	—	—	—
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WITH & WITHOUT CONTRAST	$2,211.00	$2,211.00	—	11% below	—
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WITH & WITHOUT CONTRAST	$2,211.00	$2,211.00	—	—	—
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/OUT CONTRAST	$1,401.00	$1,401.00	—	24% below	—
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/OUT CONTRAST	$1,401.00	$1,401.00	—	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UP. RIGHT EXTREM. JOINT W/O CONTRAST,RIGHT	$1,401.00	$1,401.00	—	23% below	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UP. LEFT EXTREM. JOINT W/O CONTRAST,LEFT	$1,401.00	$1,401.00	—	23% below	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UP. RIGHT EXTREM. JOINT W/O CONTRAST,RIGHT	$1,401.00	$1,401.00	—	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UP. LEFT EXTREM. JOINT W/O CONTRAST,LEFT	$1,401.00	$1,401.00	—	—	—
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR CERVICAL 5 VIEW	$321.00	$321.00	—	23% below	—
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR CERVICAL 5 VIEW	$321.00	$321.00	—	—	—
Neck soft tissue CT scan with contrast CPT 70491 CT NECK SOFT TISSUE WITH CONTRAST	$1,082.00	$1,082.00	—	24% below	—
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK SOFT TISSUE WITH CONTRAST	$1,082.00	$1,082.00	—	—	—
Neck soft tissue CT scan without contrast CPT 70490 CT NECK SOFT TISSUE WITHOUT	$641.00	$641.00	—	42% below	—
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK SOFT TISSUE WITHOUT	$641.00	$641.00	—	—	—
Neck soft tissue X-ray CPT 70360 XR NECK LAT SOFT TISSUE	$261.00	$261.00	—	15% above	—
Neck soft tissue X-ray inpatient CPT 70360 XR NECK LAT SOFT TISSUE	$261.00	$261.00	—	—	—
Pelvic CT scan without contrast CPT 72192 CT PELVIS WITHOUT	$641.00	$641.00	—	52% below	—
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS WITHOUT	$641.00	$641.00	—	—	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US URINARY BLADDER	$428.00	$428.00	—	12% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US URINARY BLADDER	$428.00	$428.00	—	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC	$428.00	$428.00	—	33% below	—
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC	$428.00	$428.00	—	—	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG COMP>14 WEEKS 1ST BABY	$428.00	$428.00	—	24% below	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US MOLAR OR ECTOPIC PREG	$428.00	$428.00	—	24% below	—
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US MOLAR OR ECTOPIC PREG	$428.00	$428.00	—	—	—
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG COMP>14 WEEKS 1ST BABY	$428.00	$428.00	—	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG COMPLETE < 14 WEEKS 1ST B	$428.00	$428.00	—	16% below	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG COMPLETE < 14 WEEKS 1ST B	$428.00	$428.00	—	—	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGANCY LIMITED STUDY	$428.00	$428.00	—	10% above	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREGANCY LIMITED STUDY	$428.00	$428.00	—	—	—
Rib X-ray, one side, 2 views one side CPT 71100 XR RIBS LEFT,LEFT	$261.00	$261.00	—	11% above	—
Rib X-ray, one side, 2 views one side CPT 71100 XR RIBS RIGHT,RIGHT	$261.00	$261.00	—	11% above	—
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR RIBS RIGHT,RIGHT	$261.00	$261.00	—	—	—
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR RIBS LEFT,LEFT	$261.00	$261.00	—	—	—
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR RIBS WITH CHEST UNILATERAL LT,LEFT	$321.00	$321.00	—	17% above	—
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR RIBS WITH CHEST UNILATERAL RT,RIGHT	$321.00	$321.00	—	17% above	—
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR RIBS WITH CHEST UNILATERAL RT,RIGHT	$321.00	$321.00	—	—	—
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR RIBS WITH CHEST UNILATERAL LT,LEFT	$321.00	$321.00	—	—	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER LEFT 2 V OR MORE,LEFT	$261.00	$261.00	—	1% below	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER RT 2 V OR MORE,RIGHT	$261.00	$261.00	—	1% below	—
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER RT 2 V OR MORE,RIGHT	$261.00	$261.00	—	—	—
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER LEFT 2 V OR MORE,LEFT	$261.00	$261.00	—	—	—
Sinus X-ray, complete, 3 or more views CPT 70220 XR SINUS SERIES	$261.00	$261.00	—	14% below	—
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR SINUS SERIES	$261.00	$261.00	—	—	—
Skull X-ray, fewer than 4 views CPT 70250 XR SKULL 1/2/3 VIEWS	$321.00	$321.00	—	24% above	—
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR SKULL 1/2/3 VIEWS	$321.00	$321.00	—	—	—
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR VIDEO SWALLOW	$541.00	$541.00	—	22% above	—
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR VIDEO SWALLOW	$541.00	$541.00	—	—	—
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR FEMUR LEFT 2V,LEFT	$261.00	$261.00	—	1% above	—
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR FEMUR RIGHT 2V,RIGHT	$261.00	$261.00	—	1% above	—
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR FEMUR LEFT 2V,LEFT	$261.00	$261.00	—	—	—
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR FEMUR RIGHT 2V,RIGHT	$261.00	$261.00	—	—	—
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE WITHOUT	$641.00	$641.00	—	52% below	—
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE WITHOUT	$641.00	$641.00	—	—	—
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON OB PELVIS	$428.00	$428.00	—	17% below	—
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON OB PELVIS	$428.00	$428.00	—	—	—
Transvaginal ultrasound during pregnancy CPT 76817 US TRANSVAGINAL PREGNANCY	$428.00	$428.00	—	1% below	—
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US TRANSVAGINAL PREGNANCY	$428.00	$428.00	—	—	—
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$428.00	$428.00	—	46% below	—
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$428.00	$428.00	—	—	—
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$428.00	$428.00	—	26% below	—
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$428.00	$428.00	—	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US ECHOGRAPHY,SOFTTISSUES OF HEAD & NECK	$428.00	$428.00	—	25% below	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US PAROTID	$428.00	$428.00	—	25% below	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID	$428.00	$428.00	—	25% below	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US PAROTID	$428.00	$428.00	—	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US ECHOGRAPHY,SOFTTISSUES OF HEAD & NECK	$428.00	$428.00	—	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID	$428.00	$428.00	—	—	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UPPER GI (kub)	$360.00	$360.00	—	38% below	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UPPER GI (kub)	$360.00	$360.00	—	—	—
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR HUMERUS RIGHT 2 VIEW,RIGHT	$261.00	$261.00	—	9% above	—
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR HUMERUS LEFT 2 VIEW,LEFT	$261.00	$261.00	—	9% above	—
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR HUMERUS RIGHT 2 VIEW,RIGHT	$261.00	$261.00	—	—	—
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR HUMERUS LEFT 2 VIEW,LEFT	$261.00	$261.00	—	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 PV UNI VENOUS DOPPLER RT,RIGHT	$460.00	$460.00	—	17% below	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 PV UNI VENOUS DOPPLER LT,LEFT	$460.00	$460.00	—	17% below	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 PV UNI VENOUS DOPPLER RT,RIGHT	$460.00	$460.00	—	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 PV UNI VENOUS DOPPLER LT,LEFT	$460.00	$460.00	—	—	—
Wrist X-ray, 2 views one side CPT 73100 XR WRIST 2V RIGHT,RIGHT	$261.00	$261.00	—	30% above	—
Wrist X-ray, 2 views one side CPT 73100 XR WRIST 2V LEFT,LEFT	$261.00	$261.00	—	30% above	—
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST 2V RIGHT,RIGHT	$261.00	$261.00	—	—	—
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST 2V LEFT,LEFT	$261.00	$261.00	—	—	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST 3 VIEW LEFT,LEFT	$261.00	$261.00	—	1% below	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST 3 VIEW RIGHT,RIGHT	$261.00	$261.00	—	1% below	—
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST 3 VIEW LEFT,LEFT	$261.00	$261.00	—	—	—
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST 3 VIEW RIGHT,RIGHT	$261.00	$261.00	—	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP RIGHT 2V,RIGHT	$261.00	$261.00	—	11% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP LEFT 2V,LEFT	$261.00	$261.00	—	11% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP UNILATERAL W PELVIS LEFT 2-3V,LEFT	$275.00	$275.00	—	17% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP UNILATERAL W PELVIS RIGHT 2-3V,RIGHT	$275.00	$275.00	—	17% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP RIGHT 2V,RIGHT	$261.00	$261.00	—	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP LEFT 2V,LEFT	$261.00	$261.00	—	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP UNILATERAL W PELVIS RIGHT 2-3V,RIGHT	$275.00	$275.00	—	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP UNILATERAL W PELVIS LEFT 2-3V,LEFT	$275.00	$275.00	—	—	—
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN AP	$261.00	$261.00	—	26% above	—
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN AP	$261.00	$261.00	—	—	—
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE L 2 VIEW,LEFT	$261.00	$261.00	—	30% above	—
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE (R) 2V,RIGHT	$261.00	$261.00	—	30% above	—
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE (R) 2V,RIGHT	$261.00	$261.00	—	—	—
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE L 2 VIEW,LEFT	$261.00	$261.00	—	—	—
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEW RT,RIGHT	$261.00	$261.00	—	24% above	—
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEW LEFT,LEFT	$261.00	$261.00	—	24% above	—
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEW LEFT,LEFT	$261.00	$261.00	—	—	—
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEW RT,RIGHT	$261.00	$261.00	—	—	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT LEFT 3 VIEW,LEFT	$261.00	$261.00	—	3% below	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT RIGHT 3 VIEW,RIGHT	$261.00	$261.00	—	3% below	—
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT RIGHT 3 VIEW,RIGHT	$261.00	$261.00	—	—	—
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT LEFT 3 VIEW,LEFT	$261.00	$261.00	—	—	—
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND 3 VIEW LEFT,LEFT	$261.00	$261.00	—	at median	—
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND 3 VIEW RIGHT,RIGHT	$261.00	$261.00	—	at median	—
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND 3 VIEW RIGHT,RIGHT	$261.00	$261.00	—	—	—
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND 3 VIEW LEFT,LEFT	$261.00	$261.00	—	—	—
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 2V RIGHT,RIGHT	$261.00	$261.00	—	14% above	—
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 2V LEFT,LEFT	$261.00	$261.00	—	14% above	—
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE 2V RIGHT,RIGHT	$261.00	$261.00	—	—	—
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE 2V LEFT,LEFT	$261.00	$261.00	—	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR LUMBAR 2V	$321.00	$321.00	—	11% above	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR LUMBAR 2V	$321.00	$321.00	—	—	—
X-ray of the lower back, 4 or more views CPT 72110 XR LUMBAR W/OBLIQUES	$321.00	$321.00	—	24% below	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR LUMBAR W/OBLIQUES	$321.00	$321.00	—	—	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR THORACIC SPINE 2 VIEW	$321.00	$321.00	—	29% above	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR THORACIC SPINE 2 VIEW	$321.00	$321.00	—	—	—
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL 3 VIEW	$261.00	$261.00	—	5% above	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NASAL 3 VIEW	$261.00	$261.00	—	—	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR CERVICAL 2 VIEW	$261.00	$261.00	—	11% below	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR CERVICAL 2 VIEW	$261.00	$261.00	—	—	—
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS AP	$321.00	$321.00	—	45% above	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS AP	$321.00	$321.00	—	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR COCCYX/SACRUM	$261.00	$261.00	—	1% above	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR COCCYX/SACRUM	$261.00	$261.00	—	—	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
ACTH blood test CPT 82024 ACTH BY RIA	$159.00	$159.00	—	1% above	—
ACTH blood test inpatient CPT 82024 ACTH BY RIA	$159.00	$159.00	—	—	—
ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT-ALTV	$32.00	$32.00	—	34% below	—
ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT-ALT	$40.00	$40.00	—	17% below	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT-ALTV	$32.00	$32.00	—	—	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT-ALT	$40.00	$40.00	—	—	—
AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT-AST	$31.00	$31.00	—	33% below	—
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT-AST	$31.00	$31.00	—	—	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL, ACUTE W/ REFLEX	$171.00	$171.00	—	27% below	—
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL, ACUTE W/ REFLEX	$171.00	$171.00	—	—	—
Albumin blood test CPT 82040 ALBUMIN	$27.00	$27.00	—	13% below	—
Albumin blood test inpatient CPT 82040 ALBUMIN	$27.00	$27.00	—	—	—
Aldosterone blood test CPT 82088 ALDOSTERONE	$157.00	$157.00	—	at median	—
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE	$157.00	$157.00	—	—	—
Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE	$26.00	$26.00	—	49% below	—
Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPATASE BONE,SPECIFIC	$31.00	$31.00	—	39% below	—
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE	$26.00	$26.00	—	—	—
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPATASE BONE,SPECIFIC	$31.00	$31.00	—	—	—
Allergy blood test, specific IgE, per allergen CPT 86003 WHITE FACED HORNET ALLERGY	$13.50	$13.50	—	36% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 HONEY BEE ALLERGY	$13.50	$13.50	—	36% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 YELLOW HORNET ALLERGY	$13.50	$13.50	—	36% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 YELLOW JACKET ALLERGY	$13.50	$13.50	—	36% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 PAPER WASP ALLERGY	$13.50	$13.50	—	36% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT f13 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 COWS MILK f2 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 CODFISH f3 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 WHEAT f4 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 BRAZIL NUT f18 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 EGG WHITE f1 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 SOYBEAN f14 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 SCALLOP f338 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 WALNUT f256 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 TUNA f40 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 SHRIMP f24 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 HAZELNUT f17 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 SESAME SEED f10 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALMOND f20 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 SALMON f41 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 MACADAMIA NUT rf345 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 CINNAMON f220 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 CASHEW NUT f202 IgE	$16.00	$16.00	—	25% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGY SPECIFIC TEST	$25.00	$25.00	—	18% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 RAST PEDIATRIC ALLERGY #14	$25.00	$25.00	—	18% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 RAST OATS	$26.00	$26.00	—	22% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 LATEX SCREENING	$26.00	$26.00	—	22% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC (EA.)	$26.00	$26.00	—	22% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 RAST MILK	$26.00	$26.00	—	22% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 LAMB (f88) IgE	$40.00	$40.00	—	88% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 BEEF (f27) IgE	$40.00	$40.00	—	88% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 PORK (f26) IgE	$40.00	$40.00	—	88% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 BERMUDA GRASS (CYNODON DACTYLON G2	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALTERNARIA ALTERNATA (A MOLD) (M6)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 RUSSIAN THISTLE (SALTWORT SALSOLA KALI)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 MAPLE (BOX ELDER0 (T1)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 MAPLE LEAF SYCAMORE LONDON PLANE (T11)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ELM (T8)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 CAT DANDER (E1)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 CLADOSPORIUM HERBARUM (HORMODENDRUM M2	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 WALNUT (JUGLANS CALIFORNICA) (T10)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 TIMOTHY GRASS (PHLEUM PRATENSE) (G6)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 COCKROACH (I6)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 DERMATOPHAGOIDES FARINAE (D2)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS FUMIGATUS (M3)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 COMMON RAGWEED (SHORT) (W1)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIUM NOTATUM (M1)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 PECAN/HICKORY (CARYA SOECUE PECAN) (T22)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 DOG DANDER (E5)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 OAK (T7)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 COTTONWOOD (POPULOUS DELTOIDES) (T14)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 MOUNTAIN CEDAR (JUNIPERUS SABINOIDES)(T6	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 DERMATOPHAGOIDES PTERONYSSINUS (D1)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ROUGH MARSH ELDER (IVA) (W16)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 MOUSE URINE PROTEINS (E72)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 MULBERRY (T70)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 WHITE ASH (FRAXINUS AMERICANA) (T15)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ROUGH PIGWEED (ARMARANTHUS RETROFLEXUS)	$60.00	$60.00	—	182% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN GROUP OF 6 IGE INCLU	$147.00	$147.00	—	592% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 GALACTOSE ALPHA 1, 3 GALACTOSE IgE	$605.00	$605.00	—	2747% above	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HONEY BEE ALLERGY	$13.50	$13.50	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 YELLOW JACKET ALLERGY	$13.50	$13.50	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WHITE FACED HORNET ALLERGY	$13.50	$13.50	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 YELLOW HORNET ALLERGY	$13.50	$13.50	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PAPER WASP ALLERGY	$13.50	$13.50	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BRAZIL NUT f18 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COWS MILK f2 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CODFISH f3 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 EGG WHITE f1 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HAZELNUT f17 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CASHEW NUT f202 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MACADAMIA NUT rf345 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SALMON f41 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALMOND f20 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PEANUT f13 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CINNAMON f220 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SESAME SEED f10 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SHRIMP f24 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WHEAT f4 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TUNA f40 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WALNUT f256 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SCALLOP f338 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SOYBEAN f14 IgE	$16.00	$16.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST PEDIATRIC ALLERGY #14	$25.00	$25.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGY SPECIFIC TEST	$25.00	$25.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST OATS	$26.00	$26.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST MILK	$26.00	$26.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LATEX SCREENING	$26.00	$26.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC (EA.)	$26.00	$26.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LAMB (f88) IgE	$40.00	$40.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BEEF (f27) IgE	$40.00	$40.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PORK (f26) IgE	$40.00	$40.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 OAK (T7)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ELM (T8)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PECAN/HICKORY (CARYA SOECUE PECAN) (T22)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COCKROACH (I6)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PENICILLIUM NOTATUM (M1)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CAT DANDER (E1)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DERMATOPHAGOIDES FARINAE (D2)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CLADOSPORIUM HERBARUM (HORMODENDRUM M2	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DERMATOPHAGOIDES PTERONYSSINUS (D1)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ROUGH PIGWEED (ARMARANTHUS RETROFLEXUS)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WHITE ASH (FRAXINUS AMERICANA) (T15)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MULBERRY (T70)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUSE URINE PROTEINS (E72)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WALNUT (JUGLANS CALIFORNICA) (T10)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COMMON RAGWEED (SHORT) (W1)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BERMUDA GRASS (CYNODON DACTYLON G2	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ROUGH MARSH ELDER (IVA) (W16)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUNTAIN CEDAR (JUNIPERUS SABINOIDES)(T6	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAPLE LEAF SYCAMORE LONDON PLANE (T11)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAPLE (BOX ELDER0 (T1)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALTERNARIA ALTERNATA (A MOLD) (M6)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TIMOTHY GRASS (PHLEUM PRATENSE) (G6)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COTTONWOOD (POPULOUS DELTOIDES) (T14)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DOG DANDER (E5)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RUSSIAN THISTLE (SALTWORT SALSOLA KALI)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ASPERGILLUS FUMIGATUS (M3)	$60.00	$60.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN GROUP OF 6 IGE INCLU	$147.00	$147.00	—	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GALACTOSE ALPHA 1, 3 GALACTOSE IgE	$605.00	$605.00	—	—	—
Alpha-fetoprotein (AFP) blood test CPT 82105 TRIPLE MATERNAL SERUM-TEST 1 (AFP)	$37.00	$37.00	—	61% below	—
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN	$87.00	$87.00	—	9% below	—
Alpha-fetoprotein (AFP) blood test CPT 82105 .MATERNAL SERUM SCREEN 4 TEST 2	$113.00	$113.00	—	18% above	—
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 TRIPLE MATERNAL SERUM-TEST 1 (AFP)	$37.00	$37.00	—	—	—
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN	$87.00	$87.00	—	—	—
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 .MATERNAL SERUM SCREEN 4 TEST 2	$113.00	$113.00	—	—	—
Ammonia blood test CPT 82140 AMMONIA	$76.00	$76.00	—	1% below	—
Ammonia blood test inpatient CPT 82140 AMMONIA	$76.00	$76.00	—	—	—
Amylase blood test CPT 82150 AMYLASE-SERUM	$39.00	$39.00	—	31% below	—
Amylase blood test CPT 82150 AMYLASE URINE	$70.00	$70.00	—	23% above	—
Amylase blood test CPT 82150 AMYLASE, BODY FLUID	$70.00	$70.00	—	23% above	—
Amylase blood test inpatient CPT 82150 AMYLASE-SERUM	$39.00	$39.00	—	—	—
Amylase blood test inpatient CPT 82150 AMYLASE URINE	$70.00	$70.00	—	—	—
Amylase blood test inpatient CPT 82150 AMYLASE, BODY FLUID	$70.00	$70.00	—	—	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE AbIgG	$200.00	$200.00	—	149% above	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 ANTI-CCP (CYCLIC CITRULLINATED PEPTIDE)	$221.00	$221.00	—	175% above	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE AbIgG	$200.00	$200.00	—	—	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 ANTI-CCP (CYCLIC CITRULLINATED PEPTIDE)	$221.00	$221.00	—	—	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANAchoice SPECIFIC Ab W/ RFLEX TO ds-DNA	$15.00	$15.00	—	78% below	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA W/ REFLEX	$29.00	$29.00	—	57% below	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA MULTIPLEX W/ REFLEX 11 ANTIBODY CASC	$29.00	$29.00	—	57% below	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA PANEL	$693.00	$693.00	—	918% above	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANAchoice SPECIFIC Ab W/ RFLEX TO ds-DNA	$15.00	$15.00	—	—	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA MULTIPLEX W/ REFLEX 11 ANTIBODY CASC	$29.00	$29.00	—	—	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA W/ REFLEX	$29.00	$29.00	—	—	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA PANEL	$693.00	$693.00	—	—	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BRAIN NATRIURETIC PEPTIDE	$259.00	$259.00	—	109% above	—
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BRAIN NATRIURETIC PEPTIDE	$259.00	$259.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CSF CULTURE	$35.00	$35.00	—	49% below	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE GENITAL	$45.00	$45.00	—	34% below	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE AEROBIC	$45.00	$45.00	—	34% below	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE THROAT	$50.00	$50.00	—	27% below	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE SPUTUM	$52.00	$52.00	—	24% below	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE EAR	$62.00	$62.00	—	9% below	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 MRSA SCREEN	$65.00	$65.00	—	5% below	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE EYE	$80.00	$80.00	—	17% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE WOUND ASPIRATE	$118.00	$118.00	—	73% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CSF CULTURE	$35.00	$35.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE AEROBIC	$45.00	$45.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE GENITAL	$45.00	$45.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE THROAT	$50.00	$50.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE SPUTUM	$52.00	$52.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE EAR	$62.00	$62.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 MRSA SCREEN	$65.00	$65.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE EYE	$80.00	$80.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE WOUND ASPIRATE	$118.00	$118.00	—	—	—
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$71.00	$71.00	—	40% below	—
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$71.00	$71.00	—	—	—
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$30.00	$30.00	—	39% below	—
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL	$30.00	$30.00	—	—	—
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PAP W/CB INTERPRETATION	$78.00	$78.00	—	61% below	—
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PAP W/CB INTERPRETATION	$78.00	$78.00	—	—	—
Blood culture for bacteria CPT 87040 CULTURE BLOOD	$120.00	$120.00	—	8% above	—
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD	$120.00	$120.00	—	—	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$22.00	$22.00	—	35% above	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$22.00	$22.00	—	—	—
Blood glucose (sugar) test CPT 82947 GLUCOSE SERUM	$24.00	$24.00	—	23% below	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE SERUM	$24.00	$24.00	—	—	—
Blood lead test CPT 83655 LEAD LEVEL	$41.00	$41.00	—	25% below	—
Blood lead test inpatient CPT 83655 LEAD LEVEL	$41.00	$41.00	—	—	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 SERUM PREGNANCY TEST (QUALITATIVE)	$45.00	$45.00	—	16% below	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 SERUM PREGNANCY TEST (QUALITATIVE)	$45.00	$45.00	—	—	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 .BB BLOOD GROUP A B O	$348.00	$348.00	—	466% above	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 .BB BLOOD GROUP A B O	$348.00	$348.00	—	—	—
Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN BLOOD	$20.00	$20.00	—	47% below	—
Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN BLOOD	$20.00	$20.00	—	—	—
C-peptide blood test CPT 84681 C-PEPTIDE	$69.00	$69.00	—	35% below	—
C-peptide blood test inpatient CPT 84681 C-PEPTIDE	$69.00	$69.00	—	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 COMPREHENSIVE ANEMIA PROFILE TEST 6	$72.00	$72.00	—	21% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 ARTHRITIS PANEL 4 CRP	$72.00	$72.00	—	21% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP QUANTITATIVE	$72.00	$72.00	—	21% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 COMPREHENSIVE ANEMIA PROFILE TEST 6	$72.00	$72.00	—	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 ARTHRITIS PANEL 4 CRP	$72.00	$72.00	—	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP QUANTITATIVE	$72.00	$72.00	—	—	—
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF TOXIN B R-TIME PCR	$238.00	$238.00	—	68% above	—
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF TOXIN B R-TIME PCR	$238.00	$238.00	—	—	—
CA 19-9 blood test (tumor marker) CPT 86301 CANCER ANTIGEN 19 9	$88.00	$88.00	—	20% below	—
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CANCER ANTIGEN 19 9	$88.00	$88.00	—	—	—
CA-125 blood test (ovarian cancer marker) CPT 86304 CANCER ANTIGEN 125 CA 125	$39.00	$39.00	—	64% below	—
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CANCER ANTIGEN 125 CA 125	$39.00	$39.00	—	—	—
Calcium blood test, total CPT 82310 CALCIUM (TOTAL)	$21.00	$21.00	—	55% below	—
Calcium blood test, total CPT 82310 CALCIUM ,RANDOM URINE (W/O CREATININE)	$34.00	$34.00	—	27% below	—
Calcium blood test, total CPT 82310 PTH - C TERMINAL TEST 2	$360.00	$360.00	—	677% above	—
Calcium blood test, total inpatient CPT 82310 CALCIUM (TOTAL)	$21.00	$21.00	—	—	—
Calcium blood test, total inpatient CPT 82310 CALCIUM ,RANDOM URINE (W/O CREATININE)	$34.00	$34.00	—	—	—
Calcium blood test, total inpatient CPT 82310 PTH - C TERMINAL TEST 2	$360.00	$360.00	—	—	—
Carcinoembryonic antigen (CEA) test CPT 82378 CEA CARCINOEMBRYONIC ANTIGEN	$31.00	$31.00	—	70% below	—
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA CARCINOEMBRYONIC ANTIGEN	$31.00	$31.00	—	—	—
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER VIRUS IGG Ab	$60.00	$60.00	—	23% below	—
Chickenpox (varicella) immunity blood test CPT 86787 HERPES ZOSTER VIRUS Ab	$106.00	$106.00	—	36% above	—
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER VIRUS IGG/IGM	$158.00	$158.00	—	103% above	—
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER VIRUS IGG Ab	$60.00	$60.00	—	—	—
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HERPES ZOSTER VIRUS Ab	$106.00	$106.00	—	—	—
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER VIRUS IGG/IGM	$158.00	$158.00	—	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE	$84.00	$84.00	—	7% below	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C TRACHOMATIS AMPLIFIED DNA	$150.00	$150.00	—	67% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE	$84.00	$84.00	—	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 C TRACHOMATIS AMPLIFIED DNA	$150.00	$150.00	—	—	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$113.00	$113.00	—	11% above	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$113.00	$113.00	—	—	—
Complete blood count (CBC) with differential CPT 85025 HEMOGRAM W/ PLATELET COUNT	$23.00	$23.00	—	55% below	—
Complete blood count (CBC) with differential CPT 85025 CBC W/ DIFF AND PLATELETS -REFL	$23.00	$23.00	—	55% below	—
Complete blood count (CBC) with differential CPT 85025 .CBC WITH AUTOMATED DIFF	$66.00	$66.00	—	29% above	—
Complete blood count (CBC) with differential inpatient CPT 85025 HEMOGRAM W/ PLATELET COUNT	$23.00	$23.00	—	—	—
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/ DIFF AND PLATELETS -REFL	$23.00	$23.00	—	—	—
Complete blood count (CBC) with differential inpatient CPT 85025 .CBC WITH AUTOMATED DIFF	$66.00	$66.00	—	—	—
Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFF (HEMOGRAM)	$32.00	$32.00	—	40% below	—
Complete blood count (CBC), no differential CPT 85027 .HEMOGRAM CHARGE ONLY	$66.00	$66.00	—	23% above	—
Complete blood count (CBC), no differential inpatient CPT 85027 CBC WITHOUT DIFF (HEMOGRAM)	$32.00	$32.00	—	—	—
Complete blood count (CBC), no differential inpatient CPT 85027 .HEMOGRAM CHARGE ONLY	$66.00	$66.00	—	—	—
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$89.00	$89.00	—	29% below	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$89.00	$89.00	—	—	—
Cortisol blood test, total CPT 82533 CORTISOL AM	$66.00	$66.00	—	22% below	—
Cortisol blood test, total CPT 82533 CORTISOL ONE TOTAL SERUM	$92.00	$92.00	—	8% above	—
Cortisol blood test, total inpatient CPT 82533 CORTISOL AM	$66.00	$66.00	—	—	—
Cortisol blood test, total inpatient CPT 82533 CORTISOL ONE TOTAL SERUM	$92.00	$92.00	—	—	—
Creatine kinase (CK) blood test, total CPT 82550 ISO - CPK TEST 1	$30.00	$30.00	—	52% below	—
Creatine kinase (CK) blood test, total CPT 82550 CPK TOTAL	$55.00	$55.00	—	12% below	—
Creatine kinase (CK) blood test, total inpatient CPT 82550 ISO - CPK TEST 1	$30.00	$30.00	—	—	—
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK TOTAL	$55.00	$55.00	—	—	—
Creatinine blood test CPT 82565 CREATININE	$31.00	$31.00	—	4% below	—
Creatinine blood test inpatient CPT 82565 CREATININE	$31.00	$31.00	—	—	—
Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGOLORVIRUS ANTIBODIES IgG	$246.00	$246.00	—	218% above	—
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGOLORVIRUS ANTIBODIES IgG	$246.00	$246.00	—	—	—
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER	$61.00	$61.00	—	51% below	—
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QUANTITATIVE	$231.00	$231.00	—	84% above	—
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER	$61.00	$61.00	—	—	—
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER QUANTITATIVE	$231.00	$231.00	—	—	—
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S	$120.00	$120.00	—	11% below	—
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S	$120.00	$120.00	—	—	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG DOT NIDA WITHOUT NICOTINE	$57.00	$57.00	—	38% below	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 PHENCYCLIDINE QUALITATIVE	$67.00	$67.00	—	27% below	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 COCAINE METABOLITES QUALITATIVE	$67.00	$67.00	—	27% below	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 ALCOHOL ETHYL QL WO CONFIRMATION URINE	$120.00	$120.00	—	31% above	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TOX MONITOR ALCOHOL METAB W CONF UR	$120.00	$120.00	—	31% above	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 LSD SCREEN	$138.00	$138.00	—	51% above	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 ALCOHOL ETHYL QL WITH CONFIRMATION URINE	$154.00	$154.00	—	68% above	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN, COMP W/CONFIRM URINE	$160.00	$160.00	—	75% above	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG PANEL 10 - 100 W/O CONF. URINE	$186.00	$186.00	—	103% above	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN PANEL 9, SERUM	$286.00	$286.00	—	212% above	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN PANEL 8 W CONFIRMATION SERUM	$600.00	$600.00	—	555% above	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG DOT NIDA WITHOUT NICOTINE	$57.00	$57.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 COCAINE METABOLITES QUALITATIVE	$67.00	$67.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 PHENCYCLIDINE QUALITATIVE	$67.00	$67.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ALCOHOL ETHYL QL WO CONFIRMATION URINE	$120.00	$120.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TOX MONITOR ALCOHOL METAB W CONF UR	$120.00	$120.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 LSD SCREEN	$138.00	$138.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ALCOHOL ETHYL QL WITH CONFIRMATION URINE	$154.00	$154.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN, COMP W/CONFIRM URINE	$160.00	$160.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG PANEL 10 - 100 W/O CONF. URINE	$186.00	$186.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN PANEL 9, SERUM	$286.00	$286.00	—	—	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN PANEL 8 W CONFIRMATION SERUM	$600.00	$600.00	—	—	—
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYE PANEL	$42.00	$42.00	—	49% below	—
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYE PANEL	$42.00	$42.00	—	—	—
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN BARR VIRUS VCA IgM Ab	$65.00	$65.00	—	18% below	—
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN BARR VIRUS VCA IgG Ab	$130.00	$130.00	—	64% above	—
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN BARR VIRUS VCA IgM Ab	$65.00	$65.00	—	—	—
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN BARR VIRUS VCA IgG Ab	$130.00	$130.00	—	—	—
Estradiol blood test CPT 82670 ESTRADIOL	$245.00	$245.00	—	71% above	—
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$245.00	$245.00	—	—	—
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$19.00	$19.00	—	81% below	—
FSH (follicle-stimulating hormone) test CPT 83001 HUMAN GRANULOCYTIC EHRILICHLOSIS (FSH)	$82.00	$82.00	—	20% below	—
FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN FSH	$396.00	$396.00	—	288% above	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$19.00	$19.00	—	—	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HUMAN GRANULOCYTIC EHRILICHLOSIS (FSH)	$82.00	$82.00	—	—	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN FSH	$396.00	$396.00	—	—	—
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, STOOL	$350.00	$350.00	—	88% above	—
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, STOOL	$350.00	$350.00	—	—	—
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$84.00	$84.00	—	3% below	—
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$84.00	$84.00	—	—	—
Fibrinogen blood test CPT 85384 FIBRINOGEN	$45.00	$45.00	—	49% below	—
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN	$45.00	$45.00	—	—	—
Folate (folic acid) blood test CPT 82746 FOLATE-SERUM FOLIC ACID	$84.00	$84.00	—	5% above	—
Folate (folic acid) blood test inpatient CPT 82746 FOLATE-SERUM FOLIC ACID	$84.00	$84.00	—	—	—
Free T3 thyroid hormone test CPT 84481 FREE T3	$90.00	$90.00	—	7% below	—
Free T3 thyroid hormone test inpatient CPT 84481 FREE T3	$90.00	$90.00	—	—	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 T-4 FREE DIRECT DIALYSIS	$65.00	$65.00	—	12% below	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 T-4 (FREE THYROXINE)	$76.00	$76.00	—	3% above	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T-4 FREE DIRECT DIALYSIS	$65.00	$65.00	—	—	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T-4 (FREE THYROXINE)	$76.00	$76.00	—	—	—
Free testosterone test CPT 84402 TESTOSTERONE FREE TEST 1	$265.00	$265.00	—	111% above	—
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE TEST 1	$265.00	$265.00	—	—	—
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT GAMMA GLUTAMYL TRANSPEPT	$45.00	$45.00	—	21% below	—
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT GAMMA GLUTAMYL TRANSPEPT	$45.00	$45.00	—	—	—
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$146.00	$146.00	—	49% below	—
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$146.00	$146.00	—	—	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TOLERANCE 1 HOUR	$29.00	$29.00	—	32% below	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE TOLERANCE 1 HOUR	$29.00	$29.00	—	—	—
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 3 SPECIMENS	$77.00	$77.00	—	15% below	—
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 3 SPECIMENS	$77.00	$77.00	—	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE AMPLIFIED PROBE	$84.00	$84.00	—	4% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONORRHOEAE AMPLIFIED DNA	$150.00	$150.00	—	85% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE AMPLIFIED PROBE	$84.00	$84.00	—	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GONORRHOEAE AMPLIFIED DNA	$150.00	$150.00	—	—	—
H. pylori stool antigen test CPT 87338 HELICOBACTER PYLORI STOOL	$245.00	$245.00	—	104% above	—
H. pylori stool antigen test inpatient CPT 87338 HELICOBACTER PYLORI STOOL	$245.00	$245.00	—	—	—
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA QUANTITATIVE	$492.00	$492.00	—	41% above	—
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA QUANTITATIVE	$492.00	$492.00	—	—	—
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1AG W/ HIV-1 & HIV-2 AB	$150.00	$150.00	—	72% above	—
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1AG W/ HIV-1 & HIV-2 AB	$150.00	$150.00	—	—	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH-RISK TYPES	$88.00	$88.00	—	22% below	—
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HIGH-RISK TYPES	$88.00	$88.00	—	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOHEMOGLOBIN (Hb A1c)	$82.00	$82.00	—	34% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOHEMOGLOBIN (Hb A1c)	$82.00	$82.00	—	—	—
Hemoglobin blood test CPT 85018 HEMOGLOBIN	$10.00	$10.00	—	64% below	—
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN	$10.00	$10.00	—	—	—
Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE ANTIBODY TOTAL	$22.00	$22.00	—	67% below	—
Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE ANTIBODY TOTAL	$22.00	$22.00	—	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURF Ab QUALITATIVE	$25.00	$25.00	—	62% below	—
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURF Ab QUALITATIVE	$25.00	$25.00	—	—	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURF ANTIGEN	$20.00	$20.00	—	68% below	—
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURF ANTIGEN	$20.00	$20.00	—	—	—
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C Ab W/ REFLEX	$36.00	$36.00	—	56% below	—
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C Ab W/ REFLEX	$36.00	$36.00	—	—	—
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C GENOTYPE	$560.00	$560.00	—	99% above	—
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C V RNA QUANTITATIVE R-T PCR	$717.00	$717.00	—	155% above	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C GENOTYPE	$560.00	$560.00	—	—	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C V RNA QUANTITATIVE R-T PCR	$717.00	$717.00	—	—	—
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX IgG TYPE 1	$54.00	$54.00	—	15% below	—
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX IgM TYPE 1	$68.00	$68.00	—	7% above	—
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLE Ab	$81.00	$81.00	—	27% above	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX IgG TYPE 1	$54.00	$54.00	—	—	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX IgM TYPE 1	$68.00	$68.00	—	—	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLE Ab	$81.00	$81.00	—	—	—
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX IgG TYPE 2	$54.00	$54.00	—	11% below	—
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX IgM TYPE 2	$68.00	$68.00	—	12% above	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX IgG TYPE 2	$54.00	$54.00	—	—	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX IgM TYPE 2	$68.00	$68.00	—	—	—
High-sensitivity CRP (hs-CRP) test CPT 86141 CARDIO-CRP/HS/CRP	$57.00	$57.00	—	21% below	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CARDIO-CRP/HS/CRP	$57.00	$57.00	—	—	—
Homocysteine blood test CPT 83090 HOMOCYSTEINE QUANTITATIVE	$258.00	$258.00	—	136% above	—
Homocysteine blood test CPT 83090 HOMOCYSTEINE, CARDIOVASCULAR	$276.00	$276.00	—	153% above	—
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE QUANTITATIVE	$258.00	$258.00	—	—	—
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE, CARDIOVASCULAR	$276.00	$276.00	—	—	—
Insulin blood test CPT 83525 INSULIN	$50.00	$50.00	—	16% below	—
Insulin blood test inpatient CPT 83525 INSULIN	$50.00	$50.00	—	—	—
Iron blood test (serum iron) CPT 83540 IRON-TOTAL	$42.00	$42.00	—	9% below	—
Iron blood test (serum iron) inpatient CPT 83540 IRON-TOTAL	$42.00	$42.00	—	—	—
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY	$54.00	$54.00	—	20% below	—
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY	$54.00	$54.00	—	—	—
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$52.00	$52.00	—	52% below	—
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$52.00	$52.00	—	—	—
LH (luteinizing hormone) test CPT 83002 HUMAN GRANULOCYIC EHRLICHLOSIS (LH)	$57.00	$57.00	—	44% below	—
LH (luteinizing hormone) test CPT 83002 LH LUTEINIZING HORMONE	$105.00	$105.00	—	3% above	—
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LH	$396.00	$396.00	—	288% above	—
LH (luteinizing hormone) test inpatient CPT 83002 HUMAN GRANULOCYIC EHRLICHLOSIS (LH)	$57.00	$57.00	—	—	—
LH (luteinizing hormone) test inpatient CPT 83002 LH LUTEINIZING HORMONE	$105.00	$105.00	—	—	—
LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN LH	$396.00	$396.00	—	—	—
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID - PLASMA	$90.00	$90.00	—	3% above	—
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID - PLASMA	$90.00	$90.00	—	—	—
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH BODY FLUID	$192.00	$192.00	—	274% above	—
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH- SERUM LACTIC DEHYDROGENAS	$192.00	$192.00	—	274% above	—
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH- SERUM LACTIC DEHYDROGENAS	$192.00	$192.00	—	—	—
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH BODY FLUID	$192.00	$192.00	—	—	—
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE-SERUM	$41.00	$41.00	—	37% below	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE-SERUM	$41.00	$41.00	—	—	—
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$49.00	$49.00	—	61% below	—
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$49.00	$49.00	—	—	—
Lyme disease antibody test CPT 86618 LYME DISEASE Ab W REFLEX TO BLOT IgG,IgM	$72.00	$72.00	—	22% below	—
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE Ab W REFLEX TO BLOT IgG,IgM	$72.00	$72.00	—	—	—
Magnesium blood test CPT 83735 MAGNESIUM 24 URINE	$21.00	$21.00	—	56% below	—
Magnesium blood test CPT 83735 MAGNESIUM SERUM	$40.00	$40.00	—	17% below	—
Magnesium blood test CPT 83735 MAGNESIUM - URINE	$45.00	$45.00	—	7% below	—
Magnesium blood test CPT 83735 MAGNESIUM RBC	$98.00	$98.00	—	104% above	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM 24 URINE	$21.00	$21.00	—	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM SERUM	$40.00	$40.00	—	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM - URINE	$45.00	$45.00	—	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM RBC	$98.00	$98.00	—	—	—
Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY IgG (part of panel)	$45.00	$45.00	—	24% below	—
Measles (rubeola) antibody test CPT 86765 MEASLES ANTIBODY IgG	$54.00	$54.00	—	9% below	—
Measles (rubeola) antibody test CPT 86765 RUBEOLA VIRUS ANTI	$58.00	$58.00	—	2% below	—
Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY IgG	$70.00	$70.00	—	18% above	—
Measles (rubeola) antibody test CPT 86765 MEASLES ANTIBODY IgM	$113.00	$113.00	—	91% above	—
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ANTIBODY IgG (part of panel)	$45.00	$45.00	—	—	—
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES ANTIBODY IgG	$54.00	$54.00	—	—	—
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA VIRUS ANTI	$58.00	$58.00	—	—	—
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ANTIBODY IgG	$70.00	$70.00	—	—	—
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES ANTIBODY IgM	$113.00	$113.00	—	—	—
Mono test (heterophile antibody, Monospot) CPT 86308 MONOTEST (MONO-DIFF)	$31.00	$31.00	—	25% below	—
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ABSORPTION	$52.00	$52.00	—	26% above	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOTEST (MONO-DIFF)	$31.00	$31.00	—	—	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ABSORPTION	$52.00	$52.00	—	—	—
Mumps immunity blood test CPT 86735 MUMPS IgG (part of panel)	$45.00	$45.00	—	24% below	—
Mumps immunity blood test CPT 86735 MUMPS VIRUS ANTIBODIES (IgG,IgM)	$59.00	$59.00	—	at median	—
Mumps immunity blood test inpatient CPT 86735 MUMPS IgG (part of panel)	$45.00	$45.00	—	—	—
Mumps immunity blood test inpatient CPT 86735 MUMPS VIRUS ANTIBODIES (IgG,IgM)	$59.00	$59.00	—	—	—
Obstetric blood test panel CPT 80055 OBSTETRIC (OB) PANEL W/O HIV	$213.00	$213.00	—	28% below	—
Obstetric blood test panel inpatient CPT 80055 OBSTETRIC (OB) PANEL W/O HIV	$213.00	$213.00	—	—	—
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$76.00	$76.00	—	4% below	—
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE	$76.00	$76.00	—	—	—
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA ULTRA SENSITIVE	$160.00	$160.00	—	104% above	—
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL (DIAGNOSTIC	$190.00	$190.00	—	142% above	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA ULTRA SENSITIVE	$160.00	$160.00	—	—	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL (DIAGNOSTIC	$190.00	$190.00	—	—	—
Pap test (liquid-based, automated screening with review) CPT 88175 THIN PREP PAP SMEAR SCREENING & REVIEW	$142.00	$142.00	—	91% above	—
Pap test (liquid-based, automated screening with review) CPT 88175 THIN PREP PAP (REFL) HPV mRNA E6/E7	$142.00	$142.00	—	91% above	—
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 THIN PREP PAP SMEAR SCREENING & REVIEW	$142.00	$142.00	—	—	—
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 THIN PREP PAP (REFL) HPV mRNA E6/E7	$142.00	$142.00	—	—	—
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE, INTACT W/O CALCIUM	$196.00	$196.00	—	15% above	—
Parathyroid hormone (PTH) blood test CPT 83970 PTH - C TERMINAL TEST 1	$360.00	$360.00	—	111% above	—
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT W IONIZED CALCIUM	$412.00	$412.00	—	141% above	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE, INTACT W/O CALCIUM	$196.00	$196.00	—	—	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH - C TERMINAL TEST 1	$360.00	$360.00	—	—	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT W IONIZED CALCIUM	$412.00	$412.00	—	—	—
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME	$51.00	$51.00	—	8% below	—
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT LUPUS ANTICOAGULANT	$54.00	$54.00	—	2% below	—
Partial thromboplastin time (PTT) clotting test CPT 85730 LUPUS ANTICOAGULANT EVAULATION TEST 4	$78.00	$78.00	—	41% above	—
Partial thromboplastin time (PTT) clotting test CPT 85730 MIXING PLASMA CORRECTION STUDY TEST 3	$78.00	$78.00	—	41% above	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLASTIN TIME	$51.00	$51.00	—	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT LUPUS ANTICOAGULANT	$54.00	$54.00	—	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LUPUS ANTICOAGULANT EVAULATION TEST 4	$78.00	$78.00	—	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 MIXING PLASMA CORRECTION STUDY TEST 3	$78.00	$78.00	—	—	—
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS	$28.00	$28.00	—	25% below	—
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS	$28.00	$28.00	—	—	—
Potassium blood test CPT 84132 POTASSIUM SERUM	$19.00	$19.00	—	54% below	—
Potassium blood test inpatient CPT 84132 POTASSIUM SERUM	$19.00	$19.00	—	—	—
Progesterone blood test CPT 84144 PROGESTERONE	$40.00	$40.00	—	63% below	—
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$40.00	$40.00	—	—	—
Prolactin blood test CPT 84146 PROLACTIN BY RIA	$125.00	$125.00	—	13% above	—
Prolactin blood test inpatient CPT 84146 PROLACTIN BY RIA	$125.00	$125.00	—	—	—
Prothrombin time (PT/INR) clotting test CPT 85610 MIXING PLASMA CORRECTION STUDY TEST 1	$20.00	$20.00	—	31% below	—
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PROTIME)	$33.00	$33.00	—	14% above	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 MIXING PLASMA CORRECTION STUDY TEST 1	$20.00	$20.00	—	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (PROTIME)	$33.00	$33.00	—	—	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 URINE DRUG SCREEN (IN-HOUSE)	$76.00	$76.00	—	12% above	—
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 URINE DRUG SCREEN (IN-HOUSE)	$76.00	$76.00	—	—	—
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ANTIGEN A	$126.00	$126.00	—	113% above	—
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ANTIGEN B	$126.00	$126.00	—	113% above	—
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA ANTIGEN A	$126.00	$126.00	—	—	—
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA ANTIGEN B	$126.00	$126.00	—	—	—
Renin blood test CPT 84244 RENIN BY RIA	$120.00	$120.00	—	3% above	—
Renin blood test inpatient CPT 84244 RENIN BY RIA	$120.00	$120.00	—	—	—
Rh blood typing CPT 86901 .BB RHO D&DU	$102.00	$102.00	—	130% above	—
Rh blood typing inpatient CPT 86901 .BB RHO D&DU	$102.00	$102.00	—	—	—
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIVE	$20.00	$20.00	—	59% below	—
Rheumatoid factor (RF) test CPT 86431 ANTINUCLEAR ANTIBODY 1 TEST 2	$24.00	$24.00	—	51% below	—
Rheumatoid factor (RF) test CPT 86431 RA TITER	$45.00	$45.00	—	8% below	—
Rheumatoid factor (RF) test CPT 86431 ARTHRITIS PANEL 4 RHEAMOTOID	$63.00	$63.00	—	29% above	—
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTITATIVE	$20.00	$20.00	—	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 ANTINUCLEAR ANTIBODY 1 TEST 2	$24.00	$24.00	—	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 RA TITER	$45.00	$45.00	—	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 ARTHRITIS PANEL 4 RHEAMOTOID	$63.00	$63.00	—	—	—
Rubella antibody test (immunity check) CPT 86762 RUBELLA (IGG) (part of panel)	$45.00	$45.00	—	10% below	—
Rubella antibody test (immunity check) CPT 86762 RUBELLA SCREEN (IGG)	$74.00	$74.00	—	48% above	—
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA (IGG) (part of panel)	$45.00	$45.00	—	—	—
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA SCREEN (IGG)	$74.00	$74.00	—	—	—
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE AUTOMATED (ESR)	$32.00	$32.00	—	7% below	—
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE AUTOMATED (ESR)	$32.00	$32.00	—	—	—
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN EXAMINATION	$57.00	$57.00	—	51% below	—
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN EXAMINATION	$57.00	$57.00	—	—	—
Sodium blood test CPT 84295 SODIUM-SERUM	$19.00	$19.00	—	52% below	—
Sodium blood test inpatient CPT 84295 SODIUM-SERUM	$19.00	$19.00	—	—	—
Stool ova and parasites exam CPT 87177 OVA & PARASITE COMPLETE EXAM	$41.00	$41.00	—	29% below	—
Stool ova and parasites exam CPT 87177 OVA & PARASITE CON & ID	$123.00	$123.00	—	114% above	—
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITE COMPLETE EXAM	$41.00	$41.00	—	—	—
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITE CON & ID	$123.00	$123.00	—	—	—
Syphilis antibody test (Treponema pallidum) CPT 86780 FTA-ABS	$50.00	$50.00	—	2% below	—
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM ANTIBODY, IMMUNASSAY	$116.00	$116.00	—	127% above	—
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 FTA-ABS	$50.00	$50.00	—	—	—
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM ANTIBODY, IMMUNASSAY	$116.00	$116.00	—	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR	$24.00	$24.00	—	19% below	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL-CSF (DO NOT USE FOR SERUM	$31.00	$31.00	—	5% above	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 A R T RPR OR VDRL	$35.00	$35.00	—	18% above	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL SERUM	$141.00	$141.00	—	376% above	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR	$24.00	$24.00	—	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL-CSF (DO NOT USE FOR SERUM	$31.00	$31.00	—	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 A R T RPR OR VDRL	$35.00	$35.00	—	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL SERUM	$141.00	$141.00	—	—	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON-TB GOLD	$160.00	$160.00	—	16% below	—
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON-TB GOLD	$160.00	$160.00	—	—	—
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$150.00	$150.00	—	26% above	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL	$150.00	$150.00	—	—	—
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID SUTOANTIBODIES TEST 2	$32.00	$32.00	—	58% below	—
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB	$54.00	$54.00	—	30% below	—
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSOMAL ANTIBODY IgG	$85.00	$85.00	—	11% above	—
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES	$144.00	$144.00	—	88% above	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID SUTOANTIBODIES TEST 2	$32.00	$32.00	—	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AB	$54.00	$54.00	—	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY MICROSOMAL ANTIBODY IgG	$85.00	$85.00	—	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODIES	$144.00	$144.00	—	—	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH (THYROID STIMULATING HORMO)W/HAMA	$84.00	$84.00	—	88% above	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH (THYROID STIMULATING HORMO)	$141.00	$141.00	—	215% above	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH WITH REFLEX TO FREE T4	$150.00	$150.00	—	236% above	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH (THYROID STIMULATING HORMO)W/HAMA	$84.00	$84.00	—	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH (THYROID STIMULATING HORMO)	$141.00	$141.00	—	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH WITH REFLEX TO FREE T4	$150.00	$150.00	—	—	—
Total IgE blood test CPT 82785 IMMUNOGLOBULIN IgE	$60.00	$60.00	—	17% below	—
Total IgE blood test CPT 82785 IMM IgE	$60.00	$60.00	—	17% below	—
Total IgE blood test CPT 82785 IMMUNOGLOBULIN E IGE BY RIA	$87.00	$87.00	—	20% above	—
Total IgE blood test inpatient CPT 82785 IMM IgE	$60.00	$60.00	—	—	—
Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN IgE	$60.00	$60.00	—	—	—
Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN E IGE BY RIA	$87.00	$87.00	—	—	—
Total cholesterol blood test CPT 82465 CHOLESTEROL TOTAL	$17.00	$17.00	—	49% below	—
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL TOTAL	$17.00	$17.00	—	—	—
Total thyroxine (T4) blood test CPT 84436 TOTAL T4 (THYROXINE)	$45.00	$45.00	—	25% below	—
Total thyroxine (T4) blood test inpatient CPT 84436 TOTAL T4 (THYROXINE)	$45.00	$45.00	—	—	—
Total triiodothyronine (T3) blood test CPT 84480 TOTAL T3	$43.00	$43.00	—	43% below	—
Total triiodothyronine (T3) blood test inpatient CPT 84480 TOTAL T3	$43.00	$43.00	—	—	—
Transferrin blood test CPT 84466 TRANSFERRIN	$53.00	$53.00	—	37% below	—
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$53.00	$53.00	—	—	—
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS RNA QUALITATIVE TM	$168.00	$168.00	—	22% above	—
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS RNA QUALITATIVE TM	$168.00	$168.00	—	—	—
Triglycerides blood test CPT 84478 TRIGLYCERIDE	$17.00	$17.00	—	62% below	—
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDE	$17.00	$17.00	—	—	—
Troponin test, quantitative CPT 84484 TROPONIN -I QUANTITATIVE	$75.00	$75.00	—	32% below	—
Troponin test, quantitative CPT 84484 TROPONIN -T	$160.00	$160.00	—	45% above	—
Troponin test, quantitative inpatient CPT 84484 TROPONIN -I QUANTITATIVE	$75.00	$75.00	—	—	—
Troponin test, quantitative inpatient CPT 84484 TROPONIN -T	$160.00	$160.00	—	—	—
Uric acid blood test CPT 84550 URIC ACID	$27.00	$27.00	—	36% below	—
Uric acid blood test inpatient CPT 84550 URIC ACID	$27.00	$27.00	—	—	—
Urinalysis with microscope exam, automated CPT 81001 .URINALYSIS W/ MICRO	$27.00	$27.00	—	23% below	—
Urinalysis with microscope exam, automated inpatient CPT 81001 .URINALYSIS W/ MICRO	$27.00	$27.00	—	—	—
Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITY URINE	$3.00	$3.00	—	87% below	—
Urinalysis without microscope exam, automated CPT 81003 URINE AUTOMATED W/O MICROSCOPY	$19.00	$19.00	—	15% below	—
Urinalysis without microscope exam, automated inpatient CPT 81003 SPECIFIC GRAVITY URINE	$3.00	$3.00	—	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE AUTOMATED W/O MICROSCOPY	$19.00	$19.00	—	—	—
Urine culture for bacteria, with colony count CPT 87086 COLONY COUNT URINE	$13.00	$13.00	—	81% below	—
Urine culture for bacteria, with colony count inpatient CPT 87086 COLONY COUNT URINE	$13.00	$13.00	—	—	—
Urine microalbumin (albumin) test CPT 82043 24 HR URINE MICROALBUMIN w/o CREATININE	$30.00	$30.00	—	18% below	—
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN RANDOM URINE W/O CREATININE	$40.00	$40.00	—	10% above	—
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN QUANTITATIVE w/ CREATININE	$46.00	$46.00	—	26% above	—
Urine microalbumin (albumin) test inpatient CPT 82043 24 HR URINE MICROALBUMIN w/o CREATININE	$30.00	$30.00	—	—	—
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN RANDOM URINE W/O CREATININE	$40.00	$40.00	—	—	—
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN QUANTITATIVE w/ CREATININE	$46.00	$46.00	—	—	—
Urine pregnancy test, read by color change CPT 81025 URINE PREG TEST HCG QUALITATIVE	$52.00	$52.00	—	7% above	—
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREG TEST HCG QUALITATIVE	$52.00	$52.00	—	—	—
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12	$87.00	$87.00	—	13% above	—
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12	$87.00	$87.00	—	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VIT D25-OH (D2, D3)	$51.00	$51.00	—	65% below	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D (25 HYDROXY)	$249.00	$249.00	—	71% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VIT D25-OH (D2, D3)	$51.00	$51.00	—	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D (25 HYDROXY)	$249.00	$249.00	—	—	—
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D 1,25-DIHYROXY	$172.00	$172.00	—	1% below	—
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D PANEL	$305.00	$305.00	—	76% above	—
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D 1,25-DIHYROXY	$172.00	$172.00	—	—	—
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D PANEL	$305.00	$305.00	—	—	—
Zinc blood test CPT 84630 ZINC	$93.00	$93.00	—	52% above	—
Zinc blood test inpatient CPT 84630 ZINC	$93.00	$93.00	—	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 MATERNAL HCG QUANTITATIVE	$45.00	$45.00	—	47% below	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 TRIPLE MATERNAL SERUM-TEST 3 (HCG QUANTI	$45.00	$45.00	—	47% below	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG TUMOR MARKER	$49.00	$49.00	—	42% below	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG BETA CHAIN	$110.00	$110.00	—	29% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 .MATERNAL SERUM SCREEN 4 TEST 3	$113.00	$113.00	—	33% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 TRIPLE MATERNAL SERUM-TEST 3 (HCG QUANTI	$45.00	$45.00	—	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 MATERNAL HCG QUANTITATIVE	$45.00	$45.00	—	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG TUMOR MARKER	$49.00	$49.00	—	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG BETA CHAIN	$110.00	$110.00	—	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 .MATERNAL SERUM SCREEN 4 TEST 3	$113.00	$113.00	—	—	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLSD FRACT REDUCT W/O MANIP DISTAL FIBUL	$621.00	$621.00	—	33% above	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLSD FRACT REDUCT W/O MANIP METATARSAL	$621.00	$621.00	—	65% above	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION CONV ARRHYTHMIA - PROF FEE	$215.00	$215.00	—	73% below	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION CONVERSION ARRHYTHMIA	$522.00	$522.00	—	34% below	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLD TX DIST RAD FRACTURE W/O MANIP	$621.00	$621.00	—	8% above	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVAL IMPACTED CERUMEN - IRRIGATION UN	$172.00	$172.00	—	138% above	—
Earwax removal with instruments, one ear CPT 69210 REMOVAL IMPACTED CERUMEN - INSTRUMENT UN	$172.00	$172.00	—	88% above	—
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 CESI/TESI W FLURO PROCEDURE ROOM	$1,500.00	$1,500.00	—	30% above	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 LUMBAR W FLURO LEVEL 1 PROCEDURE ROOM	$1,500.00	$1,500.00	—	38% above	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 NEEDLE INJ W/ US FACET THORACIC	$2,557.00	$2,557.00	—	136% above	—
Incision and drainage of a simple or single skin abscess CPT 10060 I & O ABCESS SIMPLE SINGLE	$230.00	$230.00	—	at median	—
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION AND DRAINAGE ABSCESS PRO	$269.00	$269.00	—	17% above	—
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGL	$542.00	$542.00	—	136% above	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ SINGLE TENDON SHEATH/LIGAM PROC ROOM	$1,500.00	$1,500.00	—	502% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJECTION OF MAJOR JOINT	$121.00	$121.00	—	52% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHO MAJOR JOINT/INJECT W/O US	$816.00	$816.00	—	222% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 JOINT INJECTION MAJOR JOINT PROC ROOM	$1,500.00	$1,500.00	—	491% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHO INTERM JOINT/INJECT W/O US	$816.00	$816.00	—	227% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 JOINT INJECTION INTERMEDIATE PROC ROOM	$1,500.00	$1,500.00	—	501% above	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHO INTERM SMALL JOINT/INJECT W/O US	$816.00	$816.00	—	230% above	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 JOINT/BURSA INJ W/O US PROCEDURE ROOM	$1,500.00	$1,500.00	—	507% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERM RPR S/A/T/EXT 2.5CM/<	$1,119.00	$1,119.00	—	193% above	—
Lower-back epidural injection, with imaging guidance CPT 62323 LESI W FLURO PROCEDURE ROOM	$1,500.00	$1,500.00	—	29% above	—
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 LUMBAR LEVEL 1 PROCEDURE ROOM	$1,500.00	$1,500.00	—	2% above	—
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE SIMPLE	$542.00	$542.00	—	184% above	—
Occipital nerve block (injection for headaches) CPT 64405 NERVE BLOCK INJ GREAT OCCIPITAL PRO	$92.00	$92.00	—	74% below	—
Occipital nerve block (injection for headaches) CPT 64405 NERVE BLOCK INJ GREAT OCCIPITAL NERVE	$816.00	$816.00	—	127% above	—
Paracentesis with imaging guidance CPT 49083 ABDOMINAL PARACENTESIS W/ IMAGING GUIDE	$2,477.00	$2,477.00	—	185% above	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$1,119.00	$1,119.00	—	148% above	—
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESCTR. LUMB\SAC W FLURO PROCEDURE ROOM	$1,500.00	$1,500.00	—	10% below	—
Removal of a foreign object under the skin, simple CPT 10120 INCIS & REMOVE FOREIGN SUBSTANCE PRO	$244.00	$244.00	—	26% below	—
Removal of a foreign object under the skin, simple CPT 10120 SOFT TISSUE FB REMOVAL SUBCUT SIMPLE	$1,119.00	$1,119.00	—	238% above	—
Short arm cast (elbow to hand) CPT 29075 CAST SHORT ARM	$720.00	$720.00	—	196% above	—
Short arm splint (forearm and hand) CPT 29125 APPLICATION SHORT ARM SPLINT PRO	$146.00	$146.00	—	1% below	—
Short arm splint (forearm and hand) CPT 29125 SPLINT SHORT ARM	$348.00	$348.00	—	136% above	—
Short leg cast (below the knee) CPT 29405 CAST SHORT LEG	$720.00	$720.00	—	196% above	—
Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT PRO	$166.00	$166.00	—	1% above	—
Short leg splint (calf to foot) CPT 29515 SPLINT SHORT LEG	$437.00	$437.00	—	165% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMP REPAIR SUPERFICAL 2.5OR LESS CM PRO	$204.00	$204.00	—	13% below	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE RPR S/N/AX/GEN/TRNK/EXTR 2.5CM/<	$542.00	$542.00	—	131% above	—
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY SKIN SINGLE LEASION PRO	$97.00	$97.00	—	64% below	—
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY SKIN SINGLE LESION	$1,119.00	$1,119.00	—	311% above	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE	$1,933.00	$1,933.00	—	272% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMP REPAIR SUPERFICAL 2.6CM- 7.5CM PRO	$251.00	$251.00	—	10% below	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE RPR S/N/AX/GEN/TRNK/EXT 2.6-7.5CM	$542.00	$542.00	—	93% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR SUPER 2.5CM OR LESS PRO	$251.00	$251.00	—	2% below	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE RPR F/E/E/N/L/M 2.5CM/<	$542.00	$542.00	—	113% above	—
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/ IMAGING GUIDANCE	$1,736.00	$1,736.00	—	84% above	—
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION TRIGGER POINT 1/2 MUSCLE PRO	$75.00	$75.00	—	67% below	—
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION TRIGGER POINT 1 OR 2 MUSCLES	$816.00	$816.00	—	256% above	—
Trigger point injections, 1 or 2 muscles CPT 20552 SINGLE OR MULTI TRIG PNT INJ PROC ROOM	$1,500.00	$1,500.00	—	554% above	—
Wart removal, up to 14 warts CPT 17110 DESTRUCT BENIGN LESION 1-14	$122.00	$122.00	—	26% below	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SUBCUT TISSUE<20CM OR LESS	$1,119.00	$1,119.00	—	182% above	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BB BLOOD ADMINISTRATION	$1,223.00	$1,223.00	—	102% above	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BB BLOOD ADMINISTRATION	$1,223.00	$1,223.00	—	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 UPDRAFT PER TREATMENT	$204.00	$204.00	—	46% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER TREATMENT	$204.00	$204.00	—	46% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 UPDRAFT PER TREATMENT	$204.00	$204.00	—	—	—
Critical care, first 30 to 74 minutes CPT 99291 ER PHYSICIAN FEE - CRITICAL	$880.00	$880.00	—	39% below	—
Critical care, first 30 to 74 minutes CPT 99291 ER CRITICAL INITIAL 30 - 74 MINS	$2,303.00	$2,303.00	—	60% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG HOOK UP & CONNECT	$115.00	$115.00	—	40% below	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG HOOK UP & CONNECT	$115.00	$115.00	—	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER PHYSICIAN FEE - MINOR	$125.00	$125.00	—	31% below	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER MINOR	$225.00	$225.00	—	24% above	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER PHYSICIAN FEE - LOW	$280.00	$280.00	—	13% below	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LOW	$419.00	$419.00	—	30% above	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER PHYSICIAN FEE - MODERATE	$420.00	$420.00	—	50% below	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER MODERATE	$735.00	$735.00	—	13% below	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER PHYSICIAN FEE - URGENT	$560.00	$560.00	—	34% below	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER URGENT	$1,145.00	$1,145.00	—	36% above	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER PHYSICIAN FEE - MAJOR	$700.00	$700.00	—	52% below	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER MAJOR	$1,644.00	$1,644.00	—	13% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION 1ST HR HYDRATION	$205.00	$205.00	—	16% below	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYDRATION 1ST HR	$205.00	$205.00	—	16% below	—
IV infusion of a medicine, first hour CPT 96365 IV INFUSION THERAPY 1ST HR	$205.00	$205.00	—	29% below	—
IV push of a medicine, first drug CPT 96374 IV PUSH INJ.INITIAL	$205.00	$205.00	—	19% above	—
IV push of a medicine, first drug CPT 96374 IV PUSH INITIAL	$205.00	$205.00	—	19% above	—
IV push of a medicine, first drug CPT 96374 IV PUSH INJ. INITIAL	$205.00	$205.00	—	19% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER PROPH DIAG INJ SC IM	$70.00	$70.00	—	26% below	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM ANTIBIOTIC INJ EACH	$70.00	$70.00	—	26% below	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ INJECTION EACH	$70.00	$70.00	—	26% below	—
Neuromuscular re-education, 15 minutes CPT 97112 OT NEUROMUSCULAR RE-EDUCATION	$90.00	$90.00	—	at median	—
Neuromuscular re-education, 15 minutes CPT 97112 PT NEUROMUSCULAR REEDUCATION	$90.00	$90.00	—	at median	—
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT NEUROMUSCULAR RE-EDUCATION	$90.00	$90.00	—	—	—
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT NEUROMUSCULAR REEDUCATION	$90.00	$90.00	—	—	—
New patient office visit, about 30 minutes CPT 99203 NEW PAIN MAN PATIENT LEVEL 3	$100.00	$100.00	—	25% below	—
New patient office visit, about 45 minutes CPT 99204 NEW PAIN MAN PATIENT LEVEL 4	$100.00	$100.00	—	43% below	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PAIN MAN PATIENT LEVEL 2	$100.00	$100.00	—	5% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 NT NUTR THERAPY INDIV ASSESS 15 MIN	$40.00	$40.00	—	at median	—
Occupational therapy evaluation, low complexity CPT 97165 OT OCCUPATIONAL THERAPY EVAL 30 MIN	$160.00	$160.00	—	18% above	—
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT OCCUPATIONAL THERAPY EVAL 30 MIN	$160.00	$160.00	—	—	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT PHYSICAL THERAPY EVALUATION 45 MIN	$200.00	$200.00	—	20% above	—
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT PHYSICAL THERAPY EVALUATION 45 MIN	$200.00	$200.00	—	—	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT PHYSICAL THERAPY EVALUATION 20 MIN	$150.00	$150.00	—	21% above	—
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT PHYSICAL THERAPY EVALUATION 20 MIN	$150.00	$150.00	—	—	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT PHYSICAL THERAPY EVALUATION 30 MIN	$160.00	$160.00	—	5% above	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT PHYSICAL THERAPY EVALUATION 30 MIN	$160.00	$160.00	—	—	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT MANUAL THERAPY 1/> REGIONS15 MINUTES	$50.00	$50.00	—	39% below	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT MANUARL THERAPY 1/> REGIONS15 MINUTES	$60.00	$60.00	—	26% below	—
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT MANUAL THERAPY 1/> REGIONS15 MINUTES	$50.00	$50.00	—	—	—
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT MANUARL THERAPY 1/> REGIONS15 MINUTES	$60.00	$60.00	—	—	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAPEUTIC EXERCISE 15 MIN	$50.00	$50.00	—	35% below	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT PER 15 MIN THERAPY	$60.00	$60.00	—	22% below	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAPEUTIC EXERCISE 15 MIN	$50.00	$50.00	—	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT PER 15 MIN THERAPY	$60.00	$60.00	—	—	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP TREATMENT ROOM LEVEL 5	$376.00	$376.00	—	109% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PAIN MAN PATIENT LEVEL 3	$100.00	$100.00	—	5% below	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP TREATMENT ROOM LEVEL 3	$206.00	$206.00	—	97% above	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PAIN MAN PATIENT LEVEL 4	$100.00	$100.00	—	28% below	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CARDIAC REHAB INITIAL EVAL	$250.00	$250.00	—	79% above	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP TREATMENT ROOM LEVEL 4	$278.00	$278.00	—	99% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PAIN MAN PATIENT LEVEL 2	$100.00	$100.00	—	46% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP TREATMENT ROOM LEVEL 2	$150.00	$150.00	—	119% above	—
Speech and language evaluation CPT 92523 ST SPEECH SOUND PRODUCTION EVALUATION	$360.00	$360.00	—	40% above	—
Speech and language evaluation inpatient CPT 92523 ST SPEECH SOUND PRODUCTION EVALUATION	$360.00	$360.00	—	—	—
Speech therapy session, individual CPT 92507 ST SPEECH THERAPY VOICE TREATMENT	$200.00	$200.00	—	25% above	—
Speech therapy session, individual inpatient CPT 92507 ST SPEECH THERAPY VOICE TREATMENT	$200.00	$200.00	—	—	—
Therapeutic activities (functional training), 15 minutes CPT 97530 PT THERAPEUTIC ACTIVITIES 15 MIN	$50.00	$50.00	—	38% below	—
Therapeutic activities (functional training), 15 minutes CPT 97530 OT THERAPEUTIC ACTIVITIES 15 MINUTES	$60.00	$60.00	—	25% below	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THERAPEUTIC ACTIVITIES 15 MIN	$50.00	$50.00	—	—	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT THERAPEUTIC ACTIVITIES 15 MINUTES	$60.00	$60.00	—	—	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$261.00	$261.00	—	50% above	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY	$261.00	$261.00	—	—	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACCINE	$347.00	$347.00	—	92% above	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACCINE	$347.00	$347.00	—	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA (Td) INJ	$147.00	$147.00	—	103% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA (Td) INJ	$147.00	$147.00	—	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 ADACEL(PREFILL SYR) TDAP	$158.00	$158.00	—	60% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 ADACEL(SDV) TDAP	$160.00	$160.00	—	62% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 ADACEL(PREFILL SYR) TDAP	$158.00	$158.00	—	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 ADACEL(SDV) TDAP	$160.00	$160.00	—	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 FLU VAC ADMINISTRATION	$56.00	$56.00	—	3% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION INJ (1ST INJ)	$70.00	$70.00	—	28% above	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION INJ (EA. ADDL.)	$46.00	$46.00	—	at median	—

Source file: https://scmhospital.org/446005595_sullivan-county-memorial-hospital_standardcharges.csv