Hospital Hutchinson, KS

Summit Surgical

Summit Surgical in Hutchinson, KS publishes cash prices for 188 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the Kansas median for 105 of 184 procedures and above it for 76. By typical cash price it ranks #19 of 55 Kansas hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1818 E. 23rd Avenue, Hutchinson, KS, 67502 Collected Sep 27, 2026 Source price file (620) 663-4800

Acute care hospital No emergency department CCN 170198 · CMS hospital register

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 1 action for a hospital named Summit Surgical in Hutchinson, KS:

Jun 9, 2026 Warning notice

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
Ankle X-ray, complete, 3 or more views one side CPT 73610 PC XR ANKLE 3 VIEWS LT	$160.00	$200.00	$48.74–$400.00	27% below	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 PC XR ANKLE 3 VIEWS RT	$160.00	$200.00	$48.74–$400.00	27% below	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE 3 VIEWS RT	$320.00	$400.00	$48.74–$400.00	47% above	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE 3 VIEWS LT	$320.00	$400.00	$48.74–$400.00	47% above	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 PC XR ANKLE 3 VIEWS RT	$160.00	$200.00	$48.74–$400.00	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 PC XR ANKLE 3 VIEWS LT	$160.00	$200.00	$48.74–$400.00	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE 3 VIEWS LT	$320.00	$400.00	$48.74–$400.00	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE 3 VIEWS RT	$320.00	$400.00	$48.74–$400.00	—	20%
Breast ultrasound, complete, one breast CPT 76641 US BREAST COMPLETE	$640.00	$800.00	—	163% above	20%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST COMPLETE	$640.00	$800.00	—	—	20%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST LIMITED	$520.00	$650.00	—	108% above	20%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST LIMITED	$520.00	$650.00	—	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 **CT SCAN CEREBRAL WO CONTRAST	$696.80	$871.00	—	32% below	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 **CT SCAN CEREBRAL WO CONTRAST	$696.80	$871.00	—	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 **CT SCAN CERVICAL SPINE WO CONTRAST	$793.60	$992.00	—	20% below	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 **CT SCAN CERVICAL SPINE WO CONTRAST	$793.60	$992.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 PC US CAROTID BILATERAL	$160.00	$200.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID BILAT	$960.00	$1,200.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 PC US CAROTID BILATERAL	$160.00	$200.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID BILAT	$960.00	$1,200.00	—	—	20%
Chest X-ray, 2 views CPT 71046 PC XR OF CHEST 2 VIEW	$160.00	$200.00	$120.42	31% below	20%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEW	$320.00	$400.00	$120.42	39% above	20%
Chest X-ray, 2 views inpatient CPT 71046 PC XR OF CHEST 2 VIEW	$160.00	$200.00	$120.42	—	20%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEW	$320.00	$400.00	$120.42	—	20%
Chest X-ray, single view CPT 71045 PC XR CHEST 1 VIEW	$160.00	$200.00	$98.72–$400.00	17% below	20%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW	$320.00	$400.00	$98.72–$400.00	65% above	20%
Chest X-ray, single view one side CPT 71045 PC XR ELBOW 2 VIEWS LT	$160.00	$200.00	$98.72–$400.00	17% below	20%
Chest X-ray, single view one side CPT 71045 PC XR ELBOW 2 VIEWS RT	$160.00	$200.00	$98.72–$400.00	17% below	20%
Chest X-ray, single view inpatient CPT 71045 PC XR CHEST 1 VIEW	$160.00	$200.00	$98.72–$400.00	—	20%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW	$320.00	$400.00	$98.72–$400.00	—	20%
Chest X-ray, single view inpatient one side CPT 71045 PC XR ELBOW 2 VIEWS LT	$160.00	$200.00	$98.72–$400.00	—	20%
Chest X-ray, single view inpatient one side CPT 71045 PC XR ELBOW 2 VIEWS RT	$160.00	$200.00	$98.72–$400.00	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 PC US RETROPERITONEAL	$160.00	$200.00	$119.28	61% below	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 **PC US RETROPERITONEAL	$160.00	$200.00	$119.28	61% below	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 **US RETROPERITONEAL	$640.00	$800.00	$119.28	55% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL	$640.00	$800.00	$119.28	55% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 **PC US RETROPERITONEAL	$160.00	$200.00	$119.28	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 PC US RETROPERITONEAL	$160.00	$200.00	$119.28	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 **US RETROPERITONEAL	$640.00	$800.00	$119.28	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL	$640.00	$800.00	$119.28	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 PC US VENOUS DOPPLER BILATERAL	$160.00	$200.00	—	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VENOUS DOPPLER BILAT	$1,600.00	$2,000.00	—	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 PC US VENOUS DOPPLER BILATERAL	$160.00	$200.00	—	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VENOUS DOPPLER BILAT	$1,600.00	$2,000.00	—	—	20%
Knee X-ray, 3 views one side CPT 73562 PC XR KNEE 3 VIEWS RT	$160.00	$200.00	$16.29–$400.00	32% below	20%
Knee X-ray, 3 views one side CPT 73562 PC XR KNEE 3 VIEWS LT	$160.00	$200.00	$16.29–$400.00	32% below	20%
Knee X-ray, 3 views one side CPT 73562 XR STRESS VIEW ANY JOINT RT	$320.00	$400.00	$16.29–$400.00	37% above	20%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEWS LT	$320.00	$400.00	$16.29–$400.00	37% above	20%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEWS RT	$320.00	$400.00	$16.29–$400.00	37% above	20%
Knee X-ray, 3 views inpatient one side CPT 73562 PC XR KNEE 3 VIEWS LT	$160.00	$200.00	$16.29–$400.00	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 PC XR KNEE 3 VIEWS RT	$160.00	$200.00	$16.29–$400.00	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XR STRESS VIEW ANY JOINT RT	$320.00	$400.00	$16.29–$400.00	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VIEWS LT	$320.00	$400.00	$16.29–$400.00	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VIEWS RT	$320.00	$400.00	$16.29–$400.00	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 PC US ABDOMEN LIMITED	$160.00	$200.00	$125.50	54% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED	$520.00	$650.00	$125.50	50% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 PC US ABDOMEN LIMITED	$160.00	$200.00	$125.50	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED	$520.00	$650.00	$125.50	—	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 PC MRI OF ANY JOINT LOWER EXTREM WO C RT	$560.00	$700.00	$72.33–$2,000.00	45% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 **PC MRI ANY JOINT LWR EXTR WO CONT RT	$560.00	$700.00	$72.33–$2,000.00	45% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LT	$1,600.00	$2,000.00	$72.33–$2,000.00	56% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE LT	$1,600.00	$2,000.00	$72.33–$2,000.00	56% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE LT	$1,600.00	$2,000.00	$72.33–$2,000.00	56% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP RT	$1,600.00	$2,000.00	$72.33–$2,000.00	56% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE RT	$1,600.00	$2,000.00	$72.33–$2,000.00	56% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE RT	$1,600.00	$2,000.00	$72.33–$2,000.00	56% above	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 **PC MRI ANY JOINT LWR EXTR WO CONT RT	$560.00	$700.00	$72.33–$2,000.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 PC MRI OF ANY JOINT LOWER EXTREM WO C RT	$560.00	$700.00	$72.33–$2,000.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE RT	$1,600.00	$2,000.00	$72.33–$2,000.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE RT	$1,600.00	$2,000.00	$72.33–$2,000.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP LT	$1,600.00	$2,000.00	$72.33–$2,000.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE LT	$1,600.00	$2,000.00	$72.33–$2,000.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE LT	$1,600.00	$2,000.00	$72.33–$2,000.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP RT	$1,600.00	$2,000.00	$72.33–$2,000.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 PC MRI LOWER EXTREM JOINT WO AND W C RT	$560.00	$700.00	$4,500.00	67% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 PC MRI LOWER EXTREM JOINT WO AND W C LT	$560.00	$700.00	$4,500.00	67% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOWER EXT JOINT W/WO LT	$4,000.00	$5,000.00	$4,500.00	138% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOWER EXT JOINT W/WO RT	$4,000.00	$5,000.00	$4,500.00	138% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 PC MRI LOWER EXTREM JOINT WO AND W C LT	$560.00	$700.00	$4,500.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 PC MRI LOWER EXTREM JOINT WO AND W C RT	$560.00	$700.00	$4,500.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LOWER EXT JOINT W/WO LT	$4,000.00	$5,000.00	$4,500.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LOWER EXT JOINT W/WO RT	$4,000.00	$5,000.00	$4,500.00	—	20%
MRI of the abdomen without contrast CPT 74181 PC MRI ABDOMEN WO CONTRAST	$560.00	$700.00	—	56% below	20%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WO	$1,600.00	$2,000.00	—	26% above	20%
MRI of the abdomen without contrast inpatient CPT 74181 PC MRI ABDOMEN WO CONTRAST	$560.00	$700.00	—	—	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN WO	$1,600.00	$2,000.00	—	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 PC MRI ABDOMEN W/WO	$560.00	$700.00	—	66% below	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/WO	$4,000.00	$5,000.00	—	140% above	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 PC MRI ABDOMEN W/WO	$560.00	$700.00	—	—	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/WO	$4,000.00	$5,000.00	—	—	20%
MRI of the brain, no contrast dye CPT 70551 PC MRI BRAIN WO CONTRAST	$560.00	$700.00	—	56% below	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTRAST	$1,600.00	$2,000.00	—	24% above	20%
MRI of the brain, no contrast dye inpatient CPT 70551 PC MRI BRAIN WO CONTRAST	$560.00	$700.00	—	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTRAST	$1,600.00	$2,000.00	—	—	20%
MRI of the brain, with and without contrast dye CPT 70553 PC MRI BRAIN WO AND W CONTRAST	$560.00	$700.00	—	67% below	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO	$4,000.00	$5,000.00	—	133% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 PC MRI BRAIN WO AND W CONTRAST	$560.00	$700.00	—	—	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO	$4,000.00	$5,000.00	—	—	20%
MRI of the lower back, no contrast dye CPT 72148 PC MRI SPINAL CANAL AND CONTENTS LUMBAR	$560.00	$700.00	$44.72–$2,000.00	54% below	20%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE WO	$1,600.00	$2,000.00	$44.72–$2,000.00	30% above	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 PC MRI SPINAL CANAL AND CONTENTS LUMBAR	$560.00	$700.00	$44.72–$2,000.00	—	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE WO	$1,600.00	$2,000.00	$44.72–$2,000.00	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 PC MRI LUMBAR SPINE WO AND W CONTRAST	$560.00	$700.00	$5,000.00	68% below	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/WO	$4,000.00	$5,000.00	$5,000.00	125% above	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 PC MRI LUMBAR SPINE WO AND W CONTRAST	$560.00	$700.00	$5,000.00	—	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/WO	$4,000.00	$5,000.00	$5,000.00	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 PC MRI THORACIC SPINE WO CONTRAST	$560.00	$700.00	$131.00–$2,000.00	50% below	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE WO	$1,600.00	$2,000.00	$131.00–$2,000.00	42% above	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 PC MRI THORACIC SPINE WO CONTRAST	$560.00	$700.00	$131.00–$2,000.00	—	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE WO	$1,600.00	$2,000.00	$131.00–$2,000.00	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 PC MRI CERVICAL SPINE WO AND W CONTRAST	$560.00	$700.00	—	67% below	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W/WO	$4,000.00	$5,000.00	—	135% above	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 PC MRI CERVICAL SPINE WO AND W CONTRAST	$560.00	$700.00	—	—	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE W/WO	$4,000.00	$5,000.00	—	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 PC MRI CERVICAL SPINE WO CONTRAST	$560.00	$700.00	$131.00–$2,000.00	51% below	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE WO	$1,600.00	$2,000.00	$131.00–$2,000.00	40% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 PC MRI CERVICAL SPINE WO CONTRAST	$560.00	$700.00	$131.00–$2,000.00	—	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE WO	$1,600.00	$2,000.00	$131.00–$2,000.00	—	20%
MRI of the pelvis without and with contrast CPT 72197 PC MRI PELVIS WO AND W CONTRAST	$560.00	$700.00	$515.80	67% below	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/WO	$4,000.00	$5,000.00	$515.80	138% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 PC MRI PELVIS WO AND W CONTRAST	$560.00	$700.00	$515.80	—	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/WO	$4,000.00	$5,000.00	$515.80	—	20%
MRI of the pelvis, no contrast dye CPT 72195 PC MRI PELVIS WO CONTRAST	$560.00	$700.00	$44.72–$2,000.00	50% below	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WO	$1,600.00	$2,000.00	$44.72–$2,000.00	42% above	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 PC MRI PELVIS WO CONTRAST	$560.00	$700.00	$44.72–$2,000.00	—	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS WO	$1,600.00	$2,000.00	$44.72–$2,000.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 **PC MRI OF ANY JOINT UPPER EXTREM WO RT	$560.00	$700.00	$99.94–$2,000.00	46% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 PC MRI OF ANY JOINT UPPER EXTREM WO LT	$560.00	$700.00	$99.94–$2,000.00	46% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW RT	$1,600.00	$2,000.00	$99.94–$2,000.00	53% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST LT	$1,600.00	$2,000.00	$99.94–$2,000.00	53% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER RT	$1,600.00	$2,000.00	$99.94–$2,000.00	53% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST RT	$1,600.00	$2,000.00	$99.94–$2,000.00	53% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW LT	$1,600.00	$2,000.00	$99.94–$2,000.00	53% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER LT	$1,600.00	$2,000.00	$99.94–$2,000.00	53% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 PC MRI OF ANY JOINT UPPER EXTREM WO LT	$560.00	$700.00	$99.94–$2,000.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 **PC MRI OF ANY JOINT UPPER EXTREM WO RT	$560.00	$700.00	$99.94–$2,000.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST LT	$1,600.00	$2,000.00	$99.94–$2,000.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST RT	$1,600.00	$2,000.00	$99.94–$2,000.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW LT	$1,600.00	$2,000.00	$99.94–$2,000.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER RT	$1,600.00	$2,000.00	$99.94–$2,000.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER LT	$1,600.00	$2,000.00	$99.94–$2,000.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW RT	$1,600.00	$2,000.00	$99.94–$2,000.00	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 PC ULTRASOUND PELVIC LIMITED	$160.00	$200.00	—	53% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIMITED	$640.00	$800.00	—	90% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 PC ULTRASOUND PELVIC LIMITED	$160.00	$200.00	—	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LIMITED	$640.00	$800.00	—	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PC US TRANSABDOMINIAL PELVIC NON OB	$160.00	$200.00	$19.67–$800.00	54% below	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC TRANSABDOMINAL	$640.00	$800.00	$19.67–$800.00	84% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 PC US TRANSABDOMINIAL PELVIC NON OB	$160.00	$200.00	$19.67–$800.00	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC TRANSABDOMINAL	$640.00	$800.00	$19.67–$800.00	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 PC US OB SECONDARY OR THIRD TRIMESTER	$160.00	$200.00	$59.96–$720.00	58% below	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB SECOND OR THRID TRIMESTER	$640.00	$800.00	$59.96–$720.00	68% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 PC US OB SECONDARY OR THIRD TRIMESTER	$160.00	$200.00	$59.96–$720.00	—	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB SECOND OR THRID TRIMESTER	$640.00	$800.00	$59.96–$720.00	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB FIRST TRI EA ADDITIONAL GESTATION	$160.00	$200.00	$55.38–$149.63	54% below	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 PC US OB FIRST TRIMESTER	$160.00	$200.00	$55.38–$149.63	54% below	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB FIRST TRIMESTER	$520.00	$650.00	$55.38–$149.63	49% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB FIRST TRI EA ADDITIONAL GESTATION	$160.00	$200.00	$55.38–$149.63	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 PC US OB FIRST TRIMESTER	$160.00	$200.00	$55.38–$149.63	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB FIRST TRIMESTER	$520.00	$650.00	$55.38–$149.63	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED	$520.00	$650.00	$104.03–$149.63	64% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED	$520.00	$650.00	$104.03–$149.63	—	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 PC XR SHOULDER 2 OR MORE VIEWS RT	$160.00	$200.00	$16.29–$400.00	25% below	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 PC XR SHOULDER 2 OR MORE VIEWS LT	$160.00	$200.00	$16.29–$400.00	25% below	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 2 OR MORE VIEWS LT	$320.00	$400.00	$16.29–$400.00	50% above	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 2 OR MORE VIEWS RT	$320.00	$400.00	$16.29–$400.00	50% above	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 PC XR SHOULDER 2 OR MORE VIEWS RT	$160.00	$200.00	$16.29–$400.00	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 PC XR SHOULDER 2 OR MORE VIEWS LT	$160.00	$200.00	$16.29–$400.00	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 2 OR MORE VIEWS LT	$320.00	$400.00	$16.29–$400.00	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 2 OR MORE VIEWS RT	$320.00	$400.00	$16.29–$400.00	—	20%
Transvaginal pelvic ultrasound CPT 76830 PC US TRANSVAGINAL PELVIC NON OB	$160.00	$200.00	$59.96–$800.00	50% below	20%
Transvaginal pelvic ultrasound CPT 76830 US PELVIC TRANSVAGINAL NON OB	$640.00	$800.00	$59.96–$800.00	100% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 PC US TRANSVAGINAL PELVIC NON OB	$160.00	$200.00	$59.96–$800.00	—	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 US PELVIC TRANSVAGINAL NON OB	$640.00	$800.00	$59.96–$800.00	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 PC US TRANSVAGINAL PELVIC OB	$160.00	$200.00	$59.96–$800.00	55% below	20%
Transvaginal ultrasound during pregnancy CPT 76817 US PELVIC TRANSVAGINAL OB	$640.00	$800.00	$59.96–$800.00	79% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 PC US TRANSVAGINAL PELVIC OB	$160.00	$200.00	$59.96–$800.00	—	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PELVIC TRANSVAGINAL OB	$640.00	$800.00	$59.96–$800.00	—	20%
Ultrasound of the abdomen, complete CPT 76700 PC US ABDOMEN COMPLETE	$160.00	$200.00	—	63% below	20%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$960.00	$1,200.00	—	123% above	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 PC US ABDOMEN COMPLETE	$160.00	$200.00	—	—	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$960.00	$1,200.00	—	—	20%
Ultrasound of the scrotum and testicles CPT 76870 PC US TESTICULAR SCROTAL	$160.00	$200.00	$99.05	59% below	20%
Ultrasound of the scrotum and testicles CPT 76870 US TESTICULAR SCROTAL	$640.00	$800.00	$99.05	65% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 PC US TESTICULAR SCROTAL	$160.00	$200.00	$99.05	—	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US TESTICULAR SCROTAL	$640.00	$800.00	$99.05	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 PC US SOFT TISSUES OF HEAD NECK	$160.00	$200.00	$468.12	73% below	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD NECK	$640.00	$800.00	$468.12	7% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 PC US SOFT TISSUES OF HEAD NECK	$160.00	$200.00	$468.12	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD NECK	$640.00	$800.00	$468.12	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 **X-RAY EXAM UPPER GI TRACT	$440.00	$550.00	—	19% below	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 **X-RAY EXAM UPPER GI TRACT	$440.00	$550.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 PC US VENOUS DOPPLER UNILATERAL RT	$160.00	$200.00	—	75% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 PC US VENOUS DOPPLER UNILATERAL LT	$160.00	$200.00	—	75% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS DOPPLER UNILAT LT	$960.00	$1,200.00	—	48% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS DOPPLER UNILAT RT	$960.00	$1,200.00	—	48% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 PC US VENOUS DOPPLER UNILATERAL RT	$160.00	$200.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 PC US VENOUS DOPPLER UNILATERAL LT	$160.00	$200.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS DOPPLER UNILAT RT	$960.00	$1,200.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS DOPPLER UNILAT LT	$960.00	$1,200.00	—	—	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 **PC XR WRIST 3 VIEWS RT	$160.00	$200.00	$16.29–$400.00	30% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 PC XR WRIST 3 VIEWS LT	$160.00	$200.00	$16.29–$400.00	30% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST 3 VIEWS LT	$320.00	$400.00	$16.29–$400.00	40% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST 3 VIEWS RT	$320.00	$400.00	$16.29–$400.00	40% above	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 **PC XR WRIST 3 VIEWS RT	$160.00	$200.00	$16.29–$400.00	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 PC XR WRIST 3 VIEWS LT	$160.00	$200.00	$16.29–$400.00	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST 3 VIEWS RT	$320.00	$400.00	$16.29–$400.00	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST 3 VIEWS LT	$320.00	$400.00	$16.29–$400.00	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 PC XR OF HIP 2 OR 3 VIEWS LT	$160.00	$200.00	$16.29–$400.00	38% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 PC XR OF HIP 2 OR 3 VIEWS RT	$160.00	$200.00	$16.29–$400.00	38% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP 2 OR 3 VIEWS RT	$320.00	$400.00	$16.29–$400.00	24% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP 2 OR 3 VIEWS LT	$320.00	$400.00	$16.29–$400.00	24% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 PC XR OF HIP 2 OR 3 VIEWS RT	$160.00	$200.00	$16.29–$400.00	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 PC XR OF HIP 2 OR 3 VIEWS LT	$160.00	$200.00	$16.29–$400.00	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP 2 OR 3 VIEWS RT	$320.00	$400.00	$16.29–$400.00	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP 2 OR 3 VIEWS LT	$320.00	$400.00	$16.29–$400.00	—	20%
X-ray of the abdomen, 1 view CPT 74018 PC XR ABDOMEN 1 VIEW	$160.00	$200.00	—	24% below	20%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN KUB	$320.00	$400.00	—	52% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 PC XR ABDOMEN 1 VIEW	$160.00	$200.00	—	—	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN KUB	$320.00	$400.00	—	—	20%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS RT	$320.00	$400.00	—	68% above	20%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS LT	$320.00	$400.00	—	68% above	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 2 VIEWS RT	$320.00	$400.00	—	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 2 VIEWS LT	$320.00	$400.00	—	—	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 PC XR FINGERS 2 OR MORE VIEWS LT	$160.00	$200.00	$16.29–$400.00	4% below	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 PC XR FINGERS 2 OR MORE VIEWS RT	$160.00	$200.00	$16.29–$400.00	4% below	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGERS 2 OR MORE LT	$320.00	$400.00	$16.29–$400.00	92% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGERS 2 OR MORE RT	$320.00	$400.00	$16.29–$400.00	92% above	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 PC XR FINGERS 2 OR MORE VIEWS RT	$160.00	$200.00	$16.29–$400.00	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 PC XR FINGERS 2 OR MORE VIEWS LT	$160.00	$200.00	$16.29–$400.00	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGERS 2 OR MORE LT	$320.00	$400.00	$16.29–$400.00	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGERS 2 OR MORE RT	$320.00	$400.00	$16.29–$400.00	—	20%
X-ray of the foot, 2 views one side CPT 73620 PC XR FOOT 2 VIEWS RT	$160.00	$200.00	$75.69	15% below	20%
X-ray of the foot, 2 views one side CPT 73620 PC XR FOOT 2 VIEWS LT	$160.00	$200.00	$75.69	15% below	20%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS LT	$320.00	$400.00	$75.69	70% above	20%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS RT	$320.00	$400.00	$75.69	70% above	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 PC XR FOOT 2 VIEWS RT	$160.00	$200.00	$75.69	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 PC XR FOOT 2 VIEWS LT	$160.00	$200.00	$75.69	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS RT	$320.00	$400.00	$75.69	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS LT	$320.00	$400.00	$75.69	—	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 PC XR FOOT 3 VIEWS RT	$160.00	$200.00	$47.97–$400.00	27% below	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 PC XR FOOT 3 VIEWS LT	$160.00	$200.00	$47.97–$400.00	27% below	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT 3 VIEWS RT	$320.00	$400.00	$47.97–$400.00	47% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT 3 VIEWS LT	$320.00	$400.00	$47.97–$400.00	47% above	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 PC XR FOOT 3 VIEWS LT	$160.00	$200.00	$47.97–$400.00	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 PC XR FOOT 3 VIEWS RT	$160.00	$200.00	$47.97–$400.00	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT 3 VIEWS LT	$320.00	$400.00	$47.97–$400.00	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT 3 VIEWS RT	$320.00	$400.00	$47.97–$400.00	—	20%
X-ray of the hand, 3 or more views one side CPT 73130 PC XR HAND 3 VIEWS RT	$160.00	$200.00	$16.29–$400.00	25% below	20%
X-ray of the hand, 3 or more views one side CPT 73130 PC XR HAND 3 VIEWS LT	$160.00	$200.00	$16.29–$400.00	25% below	20%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND 3 VIEWS LT	$320.00	$400.00	$16.29–$400.00	49% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND 3 VIEWS RT	$320.00	$400.00	$16.29–$400.00	49% above	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 PC XR HAND 3 VIEWS RT	$160.00	$200.00	$16.29–$400.00	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 PC XR HAND 3 VIEWS LT	$160.00	$200.00	$16.29–$400.00	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND 3 VIEWS RT	$320.00	$400.00	$16.29–$400.00	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND 3 VIEWS LT	$320.00	$400.00	$16.29–$400.00	—	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 PC XR EXAM OF KNEE 1 OR 2 VIEW LT	$160.00	$200.00	$79.64–$400.00	16% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 PC XR EXAM OF KNEE 1 OR 2 VIEW RT	$160.00	$200.00	$79.64–$400.00	16% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1 OR 2 VIEWS RT	$320.00	$400.00	$79.64–$400.00	68% above	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1 OR 2 VIEWS LT	$320.00	$400.00	$79.64–$400.00	68% above	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PC XR EXAM OF KNEE 1 OR 2 VIEW LT	$160.00	$200.00	$79.64–$400.00	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PC XR EXAM OF KNEE 1 OR 2 VIEW RT	$160.00	$200.00	$79.64–$400.00	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE 1 OR 2 VIEWS LT	$320.00	$400.00	$79.64–$400.00	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE 1 OR 2 VIEWS RT	$320.00	$400.00	$79.64–$400.00	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 PC XR L SPINE 2 VIEWS	$160.00	$200.00	$19.67–$400.00	42% below	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR LUMBAR SPINE 2 VIEWS	$320.00	$400.00	$19.67–$400.00	17% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 PC XR L SPINE 2 VIEWS	$160.00	$200.00	$19.67–$400.00	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR LUMBAR SPINE 2 VIEWS	$320.00	$400.00	$19.67–$400.00	—	20%
X-ray of the lower back, 4 or more views CPT 72110 PC XR PC SPINE LUMBAR SPINE 4 VIEWS	$280.00	$350.00	$19.67–$550.00	30% below	20%
X-ray of the lower back, 4 or more views CPT 72110 XR LUMBAR SPINE 4 VIEWS	$440.00	$550.00	$19.67–$550.00	10% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 PC XR PC SPINE LUMBAR SPINE 4 VIEWS	$280.00	$350.00	$19.67–$550.00	—	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR LUMBAR SPINE 4 VIEWS	$440.00	$550.00	$19.67–$550.00	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 PC XR SPINE 2 VIEWS	$160.00	$200.00	$77.82–$400.00	28% below	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR THORACIC SPINE 2 VIEWS	$320.00	$400.00	$77.82–$400.00	44% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 PC XR SPINE 2 VIEWS	$160.00	$200.00	$77.82–$400.00	—	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR THORACIC SPINE 2 VIEWS	$320.00	$400.00	$77.82–$400.00	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 PC XR NASAL BONES	$160.00	$200.00	—	31% below	20%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES	$320.00	$400.00	—	38% above	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 PC XR NASAL BONES	$160.00	$200.00	—	—	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NASAL BONES	$320.00	$400.00	—	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 PC XR C SPINE 2 VIEWS	$160.00	$200.00	$16.29–$400.00	36% below	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR CERVICAL SPINE 2 OR 3 VIEWS	$320.00	$400.00	$16.29–$400.00	28% above	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 PC XR C SPINE 2 VIEWS	$160.00	$200.00	$16.29–$400.00	—	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR CERVICAL SPINE 2 OR 3 VIEWS	$320.00	$400.00	$16.29–$400.00	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 PC XR PELVIS 1 VIEW	$160.00	$200.00	$19.67–$400.00	23% below	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1 VIEW	$320.00	$400.00	$19.67–$400.00	55% above	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PC XR PELVIS 1 VIEW	$160.00	$200.00	$19.67–$400.00	—	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS 1 VIEW	$320.00	$400.00	$19.67–$400.00	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 PC XR SACRUM COCCYX	$160.00	$200.00	—	29% below	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM COCCYX	$320.00	$400.00	—	42% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 PC XR SACRUM COCCYX	$160.00	$200.00	—	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR SACRUM COCCYX	$320.00	$400.00	—	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES ANA (RL)	$139.20	$174.00	—	99% above	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES ANA (RL)	$139.20	$174.00	—	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE REF Lab (RL)	$228.00	$285.00	—	78% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE REF Lab (RL)	$228.00	$285.00	—	—	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL WITH H/H ISTAT	$85.60	$107.00	$8.46–$107.00	5% above	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL (RL)	$85.60	$107.00	$8.46–$107.00	5% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL (RL)	$85.60	$107.00	$8.46–$107.00	—	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL WITH H/H ISTAT	$85.60	$107.00	$8.46–$107.00	—	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATHOLOGY LEVEL 4	$140.00	$175.00	$50.14–$393.75	36% below	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PATHOLOGY LEVEL 4	$140.00	$175.00	$50.14–$393.75	—	20%
Blood culture for bacteria CPT 87040 BLOOD CULTURE (RL)	$140.00	$175.00	—	86% above	20%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE (RL)	$140.00	$175.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$12.80	$16.00	$6.07–$16.00	30% below	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$12.80	$16.00	$6.07–$16.00	—	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE LVL RL	$13.44	$16.80	—	59% below	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE LVL RL	$13.44	$16.80	—	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 SERUM HCG (REF LAB) (RL)	$20.98	$26.23	$3.18–$31.00	63% below	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 INTERNAL HCG URINE	$24.80	$31.00	$3.18–$31.00	57% below	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG URINE (REF LAB) (RL)	$24.80	$31.00	$3.18–$31.00	57% below	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN, CHORIONIC (HCG) SERUM (RL)	$110.40	$138.00	$3.18–$31.00	93% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 SERUM HCG (REF LAB) (RL)	$20.98	$26.23	$3.18–$31.00	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG URINE (REF LAB) (RL)	$24.80	$31.00	$3.18–$31.00	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 INTERNAL HCG URINE	$24.80	$31.00	$3.18–$31.00	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 GONADOTROPIN, CHORIONIC (HCG) SERUM (RL)	$110.40	$138.00	$3.18–$31.00	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB BLOOD TYPE ABO/RH (RL)	$83.20	$104.00	—	5% below	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB BLOOD TYPE ABO/RH (RL)	$83.20	$104.00	—	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE (RL)	$75.60	$94.50	—	13% below	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL (RL)	$136.80	$171.00	—	58% above	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE (RL)	$75.60	$94.50	—	—	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL (RL)	$136.80	$171.00	—	—	20%
Complete blood count (CBC) with differential CPT 85025 CBC W/AUTO DIFF (RL)	$99.20	$124.00	—	144% above	20%
Complete blood count (CBC) with differential CPT 85025 CBC W/O DIFF	$99.20	$124.00	—	144% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/AUTO DIFF (RL)	$99.20	$124.00	—	—	20%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/O DIFF	$99.20	$124.00	—	—	20%
Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT CBC AUTOMATED (RL)	$53.60	$67.00	—	15% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT CBC AUTOMATED (RL)	$53.60	$67.00	—	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL (RL)	$164.80	$206.00	—	57% above	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL (RL)	$164.80	$206.00	—	—	20%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QUANTITATIVE FIBRIN DEGRADATION	$118.40	$148.00	—	2% above	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER QUANTITATIVE FIBRIN DEGRADATION	$118.40	$148.00	—	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE (RL)	$42.40	$53.00	—	30% below	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE (RL)	$42.40	$53.00	—	—	20%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/ 2 AB-RS (RL)	$60.00	$75.00	—	24% below	20%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1/ 2 AB-RS (RL)	$60.00	$75.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP A (RL)	$44.00	$55.00	—	26% below	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 ..TEST HEP B SURF AG W REFLEX (RL)	$44.00	$55.00	—	26% below	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 ..TEST UNDEFINED MISC	$44.00	$55.00	—	26% below	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 ..TEST HEP B CONFIRM (RL)	$44.00	$55.00	—	26% below	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP B SURF AG W/CONF (RL)	$55.20	$69.00	—	7% below	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 ..TEST HEP B SURF AG W REFLEX (RL)	$44.00	$55.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 ..TEST HEP B CONFIRM (RL)	$44.00	$55.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 ..TEST UNDEFINED MISC	$44.00	$55.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEP A (RL)	$44.00	$55.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEP B SURF AG W/CONF (RL)	$55.20	$69.00	—	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEP C AB W/RFX PCR (RL)	$81.60	$102.00	—	8% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEP C AB W/RFX PCR (RL)	$81.60	$102.00	—	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 ..CRP C-REACTIVE PROTEIN: HIGH SENSI(RL)	$96.80	$121.00	—	7% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 ..CRP C-REACTIVE PROTEIN: HIGH SENSI(RL)	$96.80	$121.00	—	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE LEVEL (RL)	$97.60	$122.00	—	56% above	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE LEVEL (RL)	$97.60	$122.00	—	—	20%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL (RL)	$126.40	$158.00	—	37% above	20%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL (RL)	$126.40	$158.00	—	—	20%
Magnesium blood test CPT 83735 MAGNESIUM (RL)	$46.40	$58.00	—	14% below	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM (RL)	$46.40	$58.00	—	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 **AMYLASE	$47.20	$59.00	—	6% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT (RL)	$71.20	$89.00	—	61% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 **AMYLASE	$47.20	$59.00	—	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT (RL)	$71.20	$89.00	—	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR (REF LAB) (RL)	$12.00	$15.00	—	61% below	20%
Prothrombin time (PT/INR) clotting test CPT 85610 **PT/INR	$163.20	$204.00	—	428% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR (REF LAB) (RL)	$12.00	$15.00	—	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 **PT/INR	$163.20	$204.00	—	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH (RL)	$85.60	$107.00	—	4% below	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH (RL)	$85.60	$107.00	—	—	20%
Uric acid blood test CPT 84550 ..CULTURE FLUID REF LAB (RL)	$66.00	$82.50	—	76% above	20%
Uric acid blood test CPT 84550 ..CULTURE URINE REF LAB (RL)	$66.00	$82.50	—	76% above	20%
Uric acid blood test CPT 84550 ..TEST PATHOLOGY MULTI SPECIMEN (RL)	$66.00	$82.50	—	76% above	20%
Uric acid blood test CPT 84550 ..TEST CMP (RL)	$66.00	$82.50	—	76% above	20%
Uric acid blood test CPT 84550 ..TEST PATHOLOGY SINGLE SPECIMEN (RL)	$66.00	$82.50	—	76% above	20%
Uric acid blood test CPT 84550 ..CULTURE WOUND REF LAB (RL)	$66.00	$82.50	—	76% above	20%
Uric acid blood test CPT 84550 ..CULTURE ANAEROBIC REF LAB (RL)	$66.00	$82.50	—	76% above	20%
Uric acid blood test CPT 84550 ..GRAM STAIN REF LAB (RL)	$66.00	$82.50	—	76% above	20%
Uric acid blood test CPT 84550 ..CULTURE TISSUE REF LAB(RL)	$66.00	$82.50	—	76% above	20%
Uric acid blood test CPT 84550 URIC ACID BLOOD (RL)	$66.00	$82.50	—	76% above	20%
Uric acid blood test inpatient CPT 84550 ..TEST CMP (RL)	$66.00	$82.50	—	—	20%
Uric acid blood test inpatient CPT 84550 ..CULTURE TISSUE REF LAB(RL)	$66.00	$82.50	—	—	20%
Uric acid blood test inpatient CPT 84550 ..TEST PATHOLOGY MULTI SPECIMEN (RL)	$66.00	$82.50	—	—	20%
Uric acid blood test inpatient CPT 84550 ..CULTURE URINE REF LAB (RL)	$66.00	$82.50	—	—	20%
Uric acid blood test inpatient CPT 84550 ..TEST PATHOLOGY SINGLE SPECIMEN (RL)	$66.00	$82.50	—	—	20%
Uric acid blood test inpatient CPT 84550 ..CULTURE FLUID REF LAB (RL)	$66.00	$82.50	—	—	20%
Uric acid blood test inpatient CPT 84550 ..CULTURE WOUND REF LAB (RL)	$66.00	$82.50	—	—	20%
Uric acid blood test inpatient CPT 84550 ..CULTURE ANAEROBIC REF LAB (RL)	$66.00	$82.50	—	—	20%
Uric acid blood test inpatient CPT 84550 URIC ACID BLOOD (RL)	$66.00	$82.50	—	—	20%
Uric acid blood test inpatient CPT 84550 ..GRAM STAIN REF LAB (RL)	$66.00	$82.50	—	—	20%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS MICROSCOPIC (RL)	$13.00	$16.25	—	62% below	20%
Urinalysis with microscope exam, automated CPT 81001 UA WITH MICROSCOPIC (RL)	$14.64	$18.30	—	58% below	20%
Urinalysis with microscope exam, automated CPT 81001 UA WITH CULTURE-LAB (RL)	$14.64	$18.30	—	58% below	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS MICROSCOPIC (RL)	$13.00	$16.25	—	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA WITH CULTURE-LAB (RL)	$14.64	$18.30	—	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA WITH MICROSCOPIC (RL)	$14.64	$18.30	—	—	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS (RL)	$9.00	$11.25	—	60% below	20%
Urinalysis without microscope exam, automated CPT 81003 UA ROUTINE-LAB (RL)	$68.00	$85.00	—	201% above	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS (RL)	$9.00	$11.25	—	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA ROUTINE-LAB (RL)	$68.00	$85.00	—	—	20%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE REF LAB (RL)	$54.40	$68.00	—	2% above	20%
Urine culture for bacteria, with colony count CPT 87086 CULTURE BACTE QUANATIVE COLONY COUNT (RL	$121.60	$152.00	—	129% above	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE REF LAB (RL)	$54.40	$68.00	—	—	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE BACTE QUANATIVE COLONY COUNT (RL	$121.60	$152.00	—	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 Neck spine fuse&remov bel c2	$8,944.00	$11,180.00	$1,201.81–$11,807.18	67% above	20%
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 Neck spine fuse&remov bel c2	$8,944.00	$11,180.00	$1,201.81–$11,807.18	—	20%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 KNEE ARTHROSCOPY/SURGERY	$11,040.00	$13,800.00	$4,718.06–$11,292.00	17% above	20%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 KNEE ARTHROSCOPY/SURGERY	$11,040.00	$13,800.00	$4,718.06–$11,292.00	—	20%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHROSCOP ROTATOR CUFF REPR	$5,593.92	$6,992.40	$1,541.60–$9,249.32	25% below	20%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 ARTHROSCOP ROTATOR CUFF REPR	$5,593.92	$6,992.40	$1,541.60–$9,249.32	—	20%
Botox injections for chronic migraine CPT 64615 INJECTION BOTOX FOR MIGRAINE	$260.00	$325.00	$118.49–$232.22	28% below	20%
Botox injections for chronic migraine inpatient CPT 64615 INJECTION BOTOX FOR MIGRAINE	$260.00	$325.00	$118.49–$232.22	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT OF ANKLE FRACTURE	$207.24	$259.05	—	49% below	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TREATMENT OF ANKLE FRACTURE	$207.24	$259.05	—	—	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE	$207.24	$259.05	—	37% below	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 TREAT METATARSAL FRACTURE	$207.24	$259.05	—	—	20%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 CORRECTION OF BUNION	$3,471.08	$4,338.85	—	2% below	20%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 CORRECTION OF BUNION	$3,471.08	$4,338.85	—	—	20%
Bunion correction with removal of part of the big toe joint CPT 28292 CORRECTION OF BUNION	$3,471.08	$4,338.85	—	3% above	20%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 CORRECTION OF BUNION	$3,471.08	$4,338.85	—	—	20%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURGERY	$5,520.00	$6,900.00	$368.10–$6,900.00	250% above	20%
Carpal tunnel release, open surgery inpatient CPT 64721 CARPAL TUNNEL SURGERY	$5,520.00	$6,900.00	$368.10–$6,900.00	—	20%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX	$356.10	$445.13	—	67% below	20%
Cervical biopsy inpatient CPT 57500 BIOPSY OF CERVIX	$356.10	$445.13	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TREAT FRACTURE RADIUS/ULNA	$207.24	$259.05	—	55% below	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 TREAT FRACTURE RADIUS/ULNA	$207.24	$259.05	—	—	20%
Colonoscopy with endoscopic ultrasound CPT 45391 COLONOSCOPY W/ENDOSCOPE US	$800.00	$1,000.00	—	at median	20%
Colonoscopy with endoscopic ultrasound inpatient CPT 45391 COLONOSCOPY W/ENDOSCOPE US	$800.00	$1,000.00	—	—	20%
Colonoscopy with polyp removal CPT 45385 LESION REMOVAL COLONOSCOPY	$1,836.00	$2,295.00	$774.73–$2,295.00	34% above	20%
Colonoscopy with polyp removal inpatient CPT 45385 LESION REMOVAL COLONOSCOPY	$1,836.00	$2,295.00	$774.73–$2,295.00	—	20%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY	$3,672.00	$4,590.00	$735.79–$4,590.00	142% above	20%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY AND BIOPSY	$3,672.00	$4,590.00	$735.79–$4,590.00	—	20%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY	$3,672.00	$4,590.00	$779.14–$4,131.00	243% above	20%
Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONOSCOPY	$3,672.00	$4,590.00	$779.14–$4,131.00	—	20%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX OF CERVIX W/SCOPE LEEP	$1,825.46	$2,281.83	—	145% above	20%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 BX OF CERVIX W/SCOPE LEEP	$1,825.46	$2,281.83	—	—	20%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$356.10	$445.13	—	3% below	20%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$356.10	$445.13	—	—	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTAGE	$2,182.10	$2,727.63	—	51% above	20%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DILATION AND CURETTAGE	$2,182.10	$2,727.63	—	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION	$58.52	$73.15	—	45% below	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALG LESION	$58.52	$73.15	—	—	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING	$158.58	$198.23	—	32% below	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BIOPSY OF UTERUS LINING	$158.58	$198.23	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INTERLAMINAR EPIDURALS CERVICAL/THORACIC	$3,672.00	$4,590.00	$128.10–$4,590.00	202% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 CERVICAL/THORACIC INTRALAMINAL INJECTION	$3,672.00	$4,590.00	$128.10–$4,590.00	202% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INTERLAMINAR EPIDURALS CERVICAL/THORACIC	$3,672.00	$4,590.00	$128.10–$4,590.00	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 CERVICAL/THORACIC INTRALAMINAL INJECTION	$3,672.00	$4,590.00	$128.10–$4,590.00	—	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 NBLOCK MED BRANCH BLOCK L/S W/IMAGE SING	$1,836.00	$2,295.00	$143.67–$2,295.00	87% above	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 MEDIAL BRANCH BLOCK IMAG GUID LUM SACRAL	$1,836.00	$2,295.00	$143.67–$2,295.00	87% above	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 MEDIAL BRANCH BLOCK IMAG GUID LUM SACRAL	$1,836.00	$2,295.00	$143.67–$2,295.00	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 NBLOCK MED BRANCH BLOCK L/S W/IMAGE SING	$1,836.00	$2,295.00	$143.67–$2,295.00	—	20%
Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE	$2,511.12	$3,138.90	—	38% above	20%
Hammertoe correction surgery inpatient CPT 28285 REPAIR OF HAMMERTOE	$2,511.12	$3,138.90	—	—	20%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 TOTAL HIP ARTHROPLASTY	$14,513.00	$18,141.25	—	—	20%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 TOTAL HIP ARTHROPLASTY	$14,513.00	$18,141.25	—	—	20%
Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL HYSTERECTOMY	$5,600.00	$7,000.00	—	75% above	20%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL HYSTERECTOMY	$5,600.00	$7,000.00	—	—	20%
Hysteroscopy with endometrial ablation CPT 58563 HYSTEROSCOPY ABLATION	$8,352.00	$10,440.00	$949.00	133% above	20%
Hysteroscopy with endometrial ablation inpatient CPT 58563 HYSTEROSCOPY ABLATION	$8,352.00	$10,440.00	$949.00	—	20%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY BIOPSY	$8,352.00	$10,440.00	$1,131.14–$10,440.00	162% above	20%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HYSTEROSCOPY BIOPSY	$8,352.00	$10,440.00	$1,131.14–$10,440.00	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS	$176.92	$221.15	—	15% below	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS	$176.92	$221.15	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT	$2,760.00	$3,450.00	$121.23–$2,217.85	1807% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT	$2,760.00	$3,450.00	$121.23–$2,217.85	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 JOINT INJECTION OR ASPIRATION	$3,672.00	$4,590.00	$81.90–$4,590.00	1569% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION/ARTHROCENTESIS INJECTION ANES	$3,672.00	$4,590.00	$81.90–$4,590.00	1569% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 JOINT INJECTION OR ASPIRATION	$3,672.00	$4,590.00	$81.90–$4,590.00	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIRATION/ARTHROCENTESIS INJECTION ANES	$3,672.00	$4,590.00	$81.90–$4,590.00	—	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG IMPLANT DEVICE	$75.02	$93.78	—	53% below	20%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG IMPLANT DEVICE	$75.02	$93.78	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJECT JOINT/BURSA W/O ULTRASOUND	$124.80	$156.00	—	45% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJECT JOINT/BURSA W/O ULTRASOUND	$124.80	$156.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJECT JOINT/BURSA	$1,836.00	$2,295.00	$2,295.00	764% above	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJECT JOINT/BURSA	$1,836.00	$2,295.00	$2,295.00	—	20%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 KNEE ARTHROSCOPY/SURGERY	$4,268.00	$5,335.00	$1,328.42	1% below	20%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 KNEE ARTHROSCOPY/SURGERY	$4,268.00	$5,335.00	$1,328.42	—	20%
Knee arthroscopy with meniscus trim CPT 29881 KNEE ARTHROSCOPY/SURGERY	$3,518.98	$4,398.73	$1,330.36–$6,250.50	7% below	20%
Knee arthroscopy with meniscus trim inpatient CPT 29881 KNEE ARTHROSCOPY/SURGERY	$3,518.98	$4,398.73	$1,330.36–$6,250.50	—	20%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 KNEE ARTHROSCOPY/SURGERY	$5,520.00	$6,900.00	$600.14–$6,900.00	35% above	20%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 KNEE ARTHROSCOPY/SURGERY	$5,520.00	$6,900.00	$600.14–$6,900.00	—	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 KNEE ARTHROSCOPY/SURGERY	$5,520.00	$6,900.00	$2,186.40–$2,616.94	35% above	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 KNEE ARTHROSCOPY/SURGERY	$5,520.00	$6,900.00	$2,186.40–$2,616.94	—	20%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY REMOVE ADNEXA	$7,200.00	$9,000.00	$674.10–$7,344.00	7% above	20%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAPAROSCOPY REMOVE ADNEXA	$7,200.00	$9,000.00	$674.10–$7,344.00	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAYER CLOSURE OF WOUND(S)	$182.48	$228.10	—	47% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAYER CLOSURE OF WOUND(S)	$182.48	$228.10	—	—	20%
Lower-back epidural injection, with imaging guidance CPT 62323 LUMBAR/SACRAL INTRALAMINAR INJ W/IMAGE	$3,672.00	$4,590.00	$128.10–$4,590.00	207% above	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 LUMBAR/SACRAL INTRALAMINAR INJ W/IMAGE	$3,672.00	$4,590.00	$128.10–$4,590.00	—	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN EPIDURAL L/S SINGLE LEVEL	$3,672.00	$4,590.00	$151.54–$4,590.00	254% above	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FORAMEN EPIDURAL L/S SINGLE LEVEL	$3,672.00	$4,590.00	$151.54–$4,590.00	—	20%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 LOW BACK DISK SURGERY	$12,528.00	$15,660.00	$2,317.55–$15,660.00	78% above	20%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 Low back disk surgery	$12,528.00	$15,660.00	$2,317.55–$15,660.00	78% above	20%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 LOW BACK DISK SURGERY	$12,528.00	$15,660.00	$2,317.55–$15,660.00	—	20%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 Low back disk surgery	$12,528.00	$15,660.00	$2,317.55–$15,660.00	—	20%
Lumbar laminectomy (spinal decompression), one level CPT 63047 Remove spine lamina 1 lmbr	$16,560.00	$20,700.00	$1,328.11–$15,660.00	239% above	20%
Lumbar laminectomy (spinal decompression), one level CPT 63047 REMOVAL OF SPINAL LAMINA	$16,560.00	$20,700.00	$1,328.11–$15,660.00	239% above	20%
Lumbar laminectomy (spinal decompression), one level inpatient CPT 63047 Remove spine lamina 1 lmbr	$16,560.00	$20,700.00	$1,328.11–$15,660.00	—	20%
Lumbar laminectomy (spinal decompression), one level inpatient CPT 63047 REMOVAL OF SPINAL LAMINA	$16,560.00	$20,700.00	$1,328.11–$15,660.00	—	20%
Lumbar spinal fusion (posterior), one level CPT 22612 LUMBAR SPINE FUSION	$5,427.48	$6,784.35	$4,651.79	26% above	20%
Lumbar spinal fusion (posterior), one level CPT 22612 POSTEROLATERAL LUMBAR FUSION- 1 LEVEL	$8,135.20	$10,169.00	$4,651.79	89% above	20%
Lumbar spinal fusion (posterior), one level inpatient CPT 22612 LUMBAR SPINE FUSION	$5,427.48	$6,784.35	$4,651.79	—	20%
Lumbar spinal fusion (posterior), one level inpatient CPT 22612 POSTEROLATERAL LUMBAR FUSION- 1 LEVEL	$8,135.20	$10,169.00	$4,651.79	—	20%
Lumpectomy (partial mastectomy) CPT 19301 PARTICAL MASTECTOMY	$2,370.06	$2,962.58	—	30% below	20%
Lumpectomy (partial mastectomy) inpatient CPT 19301 PARTICAL MASTECTOMY	$2,370.06	$2,962.58	—	—	20%
Mastectomy (total removal of the breast) CPT 19303 MAST SIMPLE COMPLETE	$3,444.24	$4,305.30	—	13% below	20%
Mastectomy (total removal of the breast) inpatient CPT 19303 MAST SIMPLE COMPLETE	$3,444.24	$4,305.30	—	—	20%
Miscarriage treatment with D&C, first trimester CPT 59820 CARE OF MISCARRIAGE	$2,276.78	$2,845.98	—	17% above	20%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 CARE OF MISCARRIAGE	$2,276.78	$2,845.98	—	—	20%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 MOHS 1 STAGE H/N/HF/G	$458.46	$573.08	—	—	20%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 MOHS 1 STAGE H/N/HF/G	$458.46	$573.08	—	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 < CM	$503.04	$628.80	$562.00	171% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5 < CM	$503.04	$628.80	$562.00	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 < CM	$503.04	$628.80	—	169% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC FACE-MM B9+MARG 0.5 < CM	$503.04	$628.80	—	—	20%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$134.22	$167.78	—	4% below	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE	$134.22	$167.78	—	—	20%
Occipital nerve block (injection for headaches) CPT 64405 NBLOCK INJ OCCIPITAL	$3,672.00	$4,590.00	$189.38–$4,590.00	882% above	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 NBLOCK INJ OCCIPITAL	$3,672.00	$4,590.00	$189.38–$4,590.00	—	20%
Partial knee replacement (one compartment) CPT 27446 REVISION OF KNEE JOINT	$25,285.66	$31,607.08	—	133% above	20%
Partial knee replacement (one compartment) inpatient CPT 27446 REVISION OF KNEE JOINT	$25,285.66	$31,607.08	—	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$503.04	$628.80	—	32% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF NAIL BED	$503.04	$628.80	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTRUCTION BY NEUROLYTIC AGENT	$2,760.00	$3,450.00	$361.20–$3,450.00	49% above	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 INJECTIONPARVERTEBRAL W/IM L/S, SING LEV	$2,760.00	$3,450.00	$361.20–$3,450.00	49% above	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DESTRUCTION BY NEUROLYTIC AGENT	$2,760.00	$3,450.00	$361.20–$3,450.00	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 INJECTIONPARVERTEBRAL W/IM L/S, SING LEV	$2,760.00	$3,450.00	$361.20–$3,450.00	—	20%
Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION	$2,370.06	$2,962.58	—	at median	20%
Removal of a breast lump, open surgery inpatient CPT 19120 REMOVAL OF BREAST LESION	$2,370.06	$2,962.58	—	—	20%
Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY	$176.92	$221.15	—	25% below	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVE FOREIGN BODY	$176.92	$221.15	—	—	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 SHOULDER ARTHROSCOPY/SURGERY	$3,518.98	$4,398.73	$416.19–$3,955.50	17% below	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 SHOULDER ARTHROSCOPY/SURGERY	$3,518.98	$4,398.73	$416.19–$3,955.50	—	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHOULDER ARTHROSCOPY/SURGERY	$5,593.92	$6,992.40	$770.21–$3,955.50	10% above	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 SHOULDER ARTHROSCOPY/SURGERY	$5,593.92	$6,992.40	$770.21–$3,955.50	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR SUPERFICIAL WOUND(S)	$182.48	$228.10	—	25% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPAIR SUPERFICIAL WOUND(S)	$182.48	$228.10	—	—	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC TR-EXT MLG+MARG 0.5 < CM	$503.04	$628.80	—	115% above	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC TR-EXT MLG+MARG 0.5 < CM	$503.04	$628.80	—	—	20%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS	$134.22	$167.78	—	at median	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS	$134.22	$167.78	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR SUPERFICIAL WOUND(S)	$182.48	$228.10	—	34% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 REPAIR SUPERFICIAL WOUND(S)	$182.48	$228.10	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR SUPERFICIAL WOUND(S)	$182.48	$228.10	—	32% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REPAIR SUPERFICIAL WOUND(S)	$182.48	$228.10	—	—	20%
Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY	$14,513.00	$18,141.25	$1,669.79–$12,420.00	37% above	20%
Total hip replacement inpatient CPT 27130 TOTAL HIP ARTHROPLASTY	$14,513.00	$18,141.25	$1,669.79–$12,420.00	—	20%
Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY	$14,513.00	$18,141.25	$6,147.64–$16,659.29	59% above	20%
Total knee replacement inpatient CPT 27447 TOTAL KNEE ARTHROPLASTY	$14,513.00	$18,141.25	$6,147.64–$16,659.29	—	20%
Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH	$3,672.00	$4,590.00	$296.03–$4,590.00	154% above	20%
Trigger finger release surgery inpatient CPT 26055 INCISE FINGER TENDON SHEATH	$3,672.00	$4,590.00	$296.03–$4,590.00	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$826.53	$1,033.16	$8.15–$382.20	451% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$826.53	$1,033.16	$8.15–$382.20	—	20%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAPAROSCOPY TUBAL CAUTERY	$5,353.72	$6,692.15	—	11% above	20%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 LAPAROSCOPY TUBAL CAUTERY	$5,353.72	$6,692.15	—	—	20%
Upper endoscopy (EGD) with biopsy CPT 43239 ESOPHAGOGASTRODUODENOSCOPY FLEXIBLE TRAN	$1,680.00	$2,100.00	—	25% above	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 ESOPHAGOGASTRODUODENOSCOPY FLEXIBLE TRAN	$1,680.00	$2,100.00	—	—	20%
Upper endoscopy (EGD), diagnostic CPT 43235 DX EXAM OF ESOPHAGUS STOMASH AND OR UPP	$1,680.00	$2,100.00	—	31% above	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 DX EXAM OF ESOPHAGUS STOMASH AND OR UPP	$1,680.00	$2,100.00	—	—	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESION 1-14	$103.66	$129.58	—	37% below	20%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT B9 LESION 1-14	$103.66	$129.58	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN/TISSUE	$328.84	$411.05	—	2% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SKIN/TISSUE	$328.84	$411.05	—	—	20%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 TREAT FX RAD EXTRA-ARTICUL	$7,034.06	$8,792.58	—	62% above	20%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 TREAT FX RAD EXTRA-ARTICUL	$7,034.06	$8,792.58	—	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD INFUSION ROOM	$300.00	$375.00	—	48% below	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD INFUSION ROOM	$300.00	$375.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT HANDHELD NEBULIZER TX	$23.46	$29.32	—	80% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT HANDHELD NEBULIZER TX	$23.46	$29.32	—	—	20%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG 12 LEAD ROUTINE WITH REPORT	$46.58	$58.23	—	48% below	20%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG 12 LEAD ROUTINE WITH REPORT	$46.58	$58.23	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD	$46.58	$58.23	—	75% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD	$46.58	$58.23	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY ROOM LEVEL 3	$164.80	$206.00	—	40% below	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY ROOM LEVEL 3	$164.80	$206.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY ROOM LEVEL 4	$424.80	$531.00	—	8% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY ROOM LEVEL 4	$424.80	$531.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY ROOM LEVEL 5	$535.20	$669.00	—	16% below	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY ROOM LEVEL 5	$535.20	$669.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYDRATION INITIAL 31-60 MINU	$222.40	$278.00	—	9% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION INITIAL HOUR	$222.40	$278.00	—	9% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION THER/PROH/DIAG INITIAL HOUR	$222.40	$278.00	—	9% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION HYDRATION INITIAL 31-60 MINU	$222.40	$278.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION THER/PROH/DIAG INITIAL HOUR	$222.40	$278.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION INITIAL HOUR	$222.40	$278.00	—	—	20%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION THERAPEUTIC, PROPHYLACTIC	$589.93	$737.41	$35.24–$737.41	123% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION THERAPEUTIC, PROPHYLACTIC	$589.93	$737.41	$35.24–$737.41	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC PROPHYLACTIC INJECTION	$64.00	$80.00	$4.95–$80.00	4% below	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC PROPHYLACTIC INJECTION	$64.00	$80.00	$4.95–$80.00	—	20%
Neuromuscular re-education, 15 minutes CPT 97112 1500 PTA 97112 THERAPEUTIC PROCEDURES	$48.00	$60.00	$6.08–$48.00	38% below	20%
Neuromuscular re-education, 15 minutes CPT 97112 PTA 97112 THERAPEUTIC PROCEDURE 1 OR MOR	$48.00	$60.00	$6.08–$48.00	38% below	20%
Neuromuscular re-education, 15 minutes CPT 97112 1500 97112 THERAPEUTIC PROCEDURE 1	$48.00	$60.00	$6.08–$48.00	38% below	20%
Neuromuscular re-education, 15 minutes CPT 97112 PT 97112 THERAPEUTIC PROCEDURE 1 OR MORE	$48.00	$60.00	$6.08–$48.00	38% below	20%
Neuromuscular re-education, 15 minutes CPT 97112 OT 97112 THERAPEUTIC PROCEDURE 1 OR MORE	$52.80	$66.00	$6.08–$48.00	32% below	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 1500 PTA 97112 THERAPEUTIC PROCEDURES	$48.00	$60.00	$6.08–$48.00	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PTA 97112 THERAPEUTIC PROCEDURE 1 OR MOR	$48.00	$60.00	$6.08–$48.00	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 1500 97112 THERAPEUTIC PROCEDURE 1	$48.00	$60.00	$6.08–$48.00	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT 97112 THERAPEUTIC PROCEDURE 1 OR MORE	$48.00	$60.00	$6.08–$48.00	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT 97112 THERAPEUTIC PROCEDURE 1 OR MORE	$52.80	$66.00	$6.08–$48.00	—	20%
New patient office visit, about 30 minutes CPT 99203 OFFICE OP VISIT NEW PT 99203	$254.40	$318.00	$18.58–$139.00	68% above	20%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE OP VISIT NEW PT 99203	$254.40	$318.00	$18.58–$139.00	—	20%
New patient office visit, about 45 minutes CPT 99204 OFFICE OP VISIT NEW PT 99204	$380.80	$476.00	$28.13–$140.64	90% above	20%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE OP VISIT NEW PT 99204	$380.80	$476.00	$28.13–$140.64	—	20%
New patient office visit, about 60 minutes CPT 99205 OFFICE OP VISIT NEW PT 99205	$504.00	$630.00	—	82% above	20%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE OP VISIT NEW PT 99205	$504.00	$630.00	—	—	20%
Occupational therapy evaluation, low complexity CPT 97165 OT 97165 EVAL LOW COMPLEXITY	$136.40	$170.50	$41.26–$95.69	18% below	20%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT 97165 EVAL LOW COMPLEXITY	$136.40	$170.50	$41.26–$95.69	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 1500 PT 97163 EVAL HIGH COMPLEXITY	$136.40	$170.50	$18.65–$130.40	35% below	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT 97163 EVAL HIGH COMPLEXITY	$136.40	$170.50	$18.65–$130.40	35% below	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 1500 PT 97163 EVAL HIGH COMPLEXITY	$136.40	$170.50	$18.65–$130.40	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT 97163 EVAL HIGH COMPLEXITY	$136.40	$170.50	$18.65–$130.40	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 1500 PT 97161 EVAL LOW COMPLEXITY	$136.40	$170.50	$18.60–$136.40	16% below	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT 97161 EVAL LOW COMPLEXITY	$136.40	$170.50	$18.60–$136.40	16% below	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 1500 PT 97161 EVAL LOW COMPLEXITY	$136.40	$170.50	$18.60–$136.40	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT 97161 EVAL LOW COMPLEXITY	$136.40	$170.50	$18.60–$136.40	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 1500 PT 97162 EVAL MODERATE COMPLEXITY	$136.40	$170.50	$18.60–$130.21	26% below	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT 97162 EVAL MODERATE COMPLEXITY	$136.40	$170.50	$18.60–$130.21	26% below	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 1500 PT 97162 EVAL MODERATE COMPLEXITY	$136.40	$170.50	$18.60–$130.21	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT 97162 EVAL MODERATE COMPLEXITY	$136.40	$170.50	$18.60–$130.21	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT 97140 MANUAL THERAPY TECHNIQUES	$56.00	$70.00	$3.99–$61.60	26% below	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 1500 PT 97140 MANUAL THERAPY TECHNIQUES	$61.60	$77.00	$3.99–$61.60	19% below	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT 97140 MANUAL THERAPY TECHNIQUES	$61.60	$77.00	$3.99–$61.60	19% below	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PTA 97140 MANUAL THERAPY TECHNIQUE	$61.60	$77.00	$3.99–$61.60	19% below	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 1500 PTA 97140 MANUAL THERAPY TECHNIQUES	$61.60	$77.00	$3.99–$61.60	19% below	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT 97140 MANUAL THERAPY TECHNIQUES	$56.00	$70.00	$3.99–$61.60	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PTA 97140 MANUAL THERAPY TECHNIQUE	$61.60	$77.00	$3.99–$61.60	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 1500 PT 97140 MANUAL THERAPY TECHNIQUES	$61.60	$77.00	$3.99–$61.60	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 1500 PTA 97140 MANUAL THERAPY TECHNIQUES	$61.60	$77.00	$3.99–$61.60	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT 97140 MANUAL THERAPY TECHNIQUES	$61.60	$77.00	$3.99–$61.60	—	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 1500 PT 97110 THERAPEUTIC EXERCISES	$58.48	$73.10	$8.41–$73.10	25% below	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT 97110 THERAPEUTIC EXERCISES	$58.48	$73.10	$8.41–$73.10	25% below	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 1500 PTA 97110 THERAPEUTIC EXERCISES	$58.48	$73.10	$8.41–$73.10	25% below	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT 97110 OCCUPATIONAL THER EXERCISES	$58.48	$73.10	$8.41–$73.10	25% below	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PTA 97110 THERAPEUTIC EXERCISES	$58.48	$73.10	$8.41–$73.10	25% below	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT 97110 THERAPEUTIC EXERCISES	$58.48	$73.10	$8.41–$73.10	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PTA 97110 THERAPEUTIC EXERCISES	$58.48	$73.10	$8.41–$73.10	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 1500 PT 97110 THERAPEUTIC EXERCISES	$58.48	$73.10	$8.41–$73.10	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT 97110 OCCUPATIONAL THER EXERCISES	$58.48	$73.10	$8.41–$73.10	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 1500 PTA 97110 THERAPEUTIC EXERCISES	$58.48	$73.10	$8.41–$73.10	—	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE OP VISIT EST. PT 99215	$412.80	$516.00	—	98% above	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE OP VISIT EST. PT 99215	$412.80	$516.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE OP VISIT LOW LEVEL 99213	$207.20	$259.00	$15.13–$121.00	53% above	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE OP VISIT LOW LEVEL 99213	$207.20	$259.00	$15.13–$121.00	—	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE OP VISIT MOD LEVEL 99214	$293.60	$367.00	$22.54–$115.58	70% above	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE OP VISIT MOD LEVEL 99214	$293.60	$367.00	$22.54–$115.58	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE OP VISIT EST/OTHER 99212	$128.00	$160.00	$9.38–$74.00	23% above	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE OP VISIT EST/OTHER 99212	$128.00	$160.00	$9.38–$74.00	—	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICE CONSULTATION PT MODERATE 99243	$192.00	$240.00	—	at median	20%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE CONSULTATION PT MODERATE 99243	$192.00	$240.00	—	—	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE CONSULTATION PT MOD/HIGH 99244	$288.00	$360.00	—	17% above	20%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE CONSULTATION PT MOD/HIGH 99244	$288.00	$360.00	—	—	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT 97530 THERAPEUTIC ACTIVITIES 15 MIN	$58.48	$73.10	$6.52–$49.71	26% below	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT 97530 THERAPEUTIC ACTIVITIES 15 MIN	$58.48	$73.10	$6.52–$49.71	26% below	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 1500 97530 THERAPEUTIC ACTIVITIES 15 MIN	$58.48	$73.10	$6.52–$49.71	26% below	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 PTA 97530 THERAPEUTIC ACTIVITIES 15 MIN	$58.48	$73.10	$6.52–$49.71	26% below	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 1500 PTA 97530 THERAP ACTIVITIES 15 MIN	$58.48	$73.10	$6.52–$49.71	26% below	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 1500 PTA 97530 THERAP ACTIVITIES 15 MIN	$58.48	$73.10	$6.52–$49.71	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT 97530 THERAPEUTIC ACTIVITIES 15 MIN	$58.48	$73.10	$6.52–$49.71	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 1500 97530 THERAPEUTIC ACTIVITIES 15 MIN	$58.48	$73.10	$6.52–$49.71	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT 97530 THERAPEUTIC ACTIVITIES 15 MIN	$58.48	$73.10	$6.52–$49.71	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PTA 97530 THERAPEUTIC ACTIVITIES 15 MIN	$58.48	$73.10	$6.52–$49.71	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VACCINE	$35.31	$44.14	—	10% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 AFLURIA TIV PFS	$60.48	$75.60	—	89% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUCELVAX TRI MDV	$90.85	$113.56	—	184% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VACCINE	$35.31	$44.14	—	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 AFLURIA TIV PFS	$60.48	$75.60	—	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUCELVAX TRI MDV	$90.85	$113.56	—	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B	$35.64	$44.55	—	69% below	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B	$35.64	$44.55	—	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOVAX	$193.51	$241.89	—	16% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOVAX	$193.51	$241.89	—	—	20%

Source file: https://summitks.com/wp-content/uploads/203283620_summit-surgical-llc_standardcharges_9.1.26.csv