Hospital

Texas County Memorial Hospital

Texas County Memorial Hospital in Houston, MO publishes cash prices for 244 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the Missouri median for 167 of 240 procedures and above it for 72. By typical cash price it ranks #14 of 60 Missouri hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1333 S Sam Houston Blvd, Houston, MO, 654832046 Collected Sep 27, 2026 Source price file (417) 967-3311

Acute care hospital Emergency department CMS star rating 2 of 5 CCN 260024 · 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 2 actions for a hospital named Texas County Memorial Hospital in Houston, MO:

Jun 10, 2026 Corrective action plan requested
Jul 29, 2026 Corrective action plan requested

Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 CL-X-RAY ANKLE 3 VIEWS	$90.00	$90.00	$91.04	70% below	—
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABI	$355.60	$508.00	$139.18	4% above	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ABI	$355.60	$508.00	$139.18	—	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGRAM	$214.90	$307.00	$183.49	51% below	30%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGRAM	$214.90	$307.00	$183.49	—	30%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE SCAN WHOLE BODY	$1,041.60	$1,488.00	$418.22	30% below	30%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE SCAN WHOLE BODY	$1,041.60	$1,488.00	$418.22	—	30%
Breast ultrasound, complete, one breast CPT 76641 US BREAST SMHW COMPLETE UNI PROF/TECH	$68.06	$97.23	$109.36	82% below	30%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST UNILAT; COMPLETE	$401.80	$574.00	$109.36	5% above	30%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST SMHW COMPLETE UNI PROF/TECH	$68.06	$97.23	$109.36	—	30%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST UNILAT; COMPLETE	$401.80	$574.00	$109.36	—	30%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST SMHW LIMITED UNI PROF/TECH	$56.44	$80.63	$91.04	81% below	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST UNILAT; LIMITED	$366.10	$523.00	$91.04	24% above	30%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST SMHW LIMITED UNI PROF/TECH	$56.44	$80.63	$91.04	—	30%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST UNILAT; LIMITED	$366.10	$523.00	$91.04	—	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT CTA CHEST WITH CONTRAST	$2,746.10	$3,923.00	$183.49	41% above	30%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT CTA CHEST WITH CONTRAST	$2,746.10	$3,923.00	$183.49	—	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PELVIS W/O CONTRAST	$2,482.20	$3,546.00	$249.62	17% above	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PELVIS W/O CONTRAST	$2,482.20	$3,546.00	$249.62	—	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELVIS W/ CONTRAST	$2,937.20	$4,196.00	$364.97	24% above	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELVIS W/ CONTRAST	$2,937.20	$4,196.00	$364.97	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PELVIS W/O & W/ CONTRAST	$3,392.20	$4,846.00	$364.97	16% above	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD/PELVIS W/O & W/ CONTRAST	$3,392.20	$4,846.00	$364.97	—	30%
CT scan of the abdomen with contrast CPT 74160 CT ABD W/ CONTRAST	$1,961.40	$2,802.00	$183.49	25% above	30%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABD W/ CONTRAST	$1,961.40	$2,802.00	$183.49	—	30%
CT scan of the abdomen without contrast CPT 74150 CT ABD W/O CONTRAST	$1,654.80	$2,364.00	$109.36	54% above	30%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD W/O CONTRAST	$1,654.80	$2,364.00	$109.36	—	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLA FAC W/O CONTR	$1,809.50	$2,585.00	$109.36	68% above	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUSES	$1,809.50	$2,585.00	$109.36	68% above	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT FACIAL BONES	$1,809.50	$2,585.00	$109.36	68% above	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT FACIAL BONES	$1,809.50	$2,585.00	$109.36	—	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLA FAC W/O CONTR	$1,809.50	$2,585.00	$109.36	—	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUSES	$1,809.50	$2,585.00	$109.36	—	30%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST	$1,654.80	$2,364.00	$109.36	32% above	30%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD STROKE PROTOCOL W/O CONTR	$1,654.80	$2,364.00	$109.36	32% above	30%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD STROKE PROTOCOL W/O CONTR	$1,654.80	$2,364.00	$109.36	—	30%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST	$1,654.80	$2,364.00	$109.36	—	30%
CT scan of the head with contrast CPT 70460 CT HEAD CONTR	$1,961.40	$2,802.00	$183.49	36% above	30%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD CONTR	$1,961.40	$2,802.00	$183.49	—	30%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/O & W/ CONT	$2,262.40	$3,232.00	$183.49	27% above	30%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/O & W/ CONT	$2,262.40	$3,232.00	$183.49	—	30%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L-SPINE	$1,961.40	$2,802.00	$109.36	42% above	30%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L-SPINE	$1,961.40	$2,802.00	$109.36	—	30%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C-SPINE W/O CONTRAST	$1,961.40	$2,802.00	$109.36	21% above	30%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C-SPINE W/O CONTRAST	$1,961.40	$2,802.00	$109.36	—	30%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS CONTR	$1,961.40	$2,802.00	$183.49	20% above	30%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS CONTR	$1,961.40	$2,802.00	$183.49	—	30%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US CAROTID	$455.00	$650.00	$249.62	45% below	30%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US CAROTID	$455.00	$650.00	$249.62	—	30%
Chest X-ray, 2 views CPT 71046 CL-X-RAY CHEST 2 VIEWS FRNT&LAT	$100.00	$100.00	$91.04	60% below	—
Chest X-ray, 2 views CPT 71046 RHC CHEST 2VW	$147.00	$210.00	$91.04	42% below	30%
Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS	$205.80	$294.00	$91.04	18% below	30%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS	$205.80	$294.00	$91.04	—	30%
Chest X-ray, single view CPT 71045 CL-X-RAY CHEST CHILD PA ONLY	$90.00	$90.00	$91.04	57% below	—
Chest X-ray, single view CPT 71045 CHEST (NON PORTABLE) 1VIEW	$122.50	$175.00	$91.04	42% below	30%
Chest X-ray, single view CPT 71045 RHC CHEST 1VW	$122.50	$175.00	$91.04	42% below	30%
Chest X-ray, single view CPT 71045 CHEST PORTABLE (1 VW)	$141.40	$202.00	$91.04	33% below	30%
Chest X-ray, single view inpatient CPT 71045 CHEST (NON PORTABLE) 1VIEW	$122.50	$175.00	$91.04	—	30%
Chest X-ray, single view inpatient CPT 71045 CHEST PORTABLE (1 VW)	$141.40	$202.00	$91.04	—	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 CL-US RETROPERITONEAL COMPLETE	$155.00	$155.00	$109.36	73% below	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMPLETE	$454.30	$649.00	$109.36	20% below	30%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL COMPLETE	$454.30	$649.00	$109.36	—	30%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD DEXA BONE DENSITY	$296.10	$423.00	$109.36	13% below	30%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD DEXA BONE DENSITY	$296.10	$423.00	$109.36	—	30%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD BONE DENSITY PERIPHERAL	$158.90	$227.00	$91.04	13% below	30%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD BONE DENSITY PERIPHERAL	$158.90	$227.00	$91.04	—	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTR HIGH RESOLUTION	$1,961.40	$2,802.00	$109.36	53% above	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST	$1,961.40	$2,802.00	$109.36	53% above	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTR HIGH RESOLUTION	$1,961.40	$2,802.00	$109.36	—	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTRAST	$1,961.40	$2,802.00	$109.36	—	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST CONTR	$2,262.40	$3,232.00	$183.49	38% above	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST CONTR	$2,262.40	$3,232.00	$183.49	—	30%
Diagnostic mammogram, both breasts both sides CPT 77066 MM SMHW DIGITAL MAMMO DIAG BILAT ALL VWS	$105.04	$150.05	$93.00	—	30%
Diagnostic mammogram, both breasts both sides CPT 77066 MM DIGITAL MAMMO DIAG BILAT ALL VWS	$217.70	$311.00	$93.00	—	30%
Diagnostic mammogram, one breast CPT 77065 MM SMHW DIGITAL MAMMO DIAG UNI ALL VWS	$82.99	$118.55	$72.48	64% below	30%
Diagnostic mammogram, one breast one side CPT 77065 MM DIGITAL MAMMO DIAG UNILAT ALL VWS	$170.80	$244.00	$72.48	27% below	30%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US DOPPLER ARTERIAL LOW EXT BILAT	$837.20	$1,196.00	$249.62	—	30%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US DOPPLER ARTERIAL LOW EXT BILAT	$837.20	$1,196.00	$249.62	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US DOPPLER VENOUS FLOW BILAT	$604.10	$863.00	$249.62	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US DOPPLER VENOUS BILAT LOW EXT	$604.10	$863.00	$249.62	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US DOPPLER VENOUS BILAT UPR EXT	$604.10	$863.00	$249.62	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US DOPPLER VENOUS FLOW BILAT	$604.10	$863.00	$249.62	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US DOPPLER VENOUS BILAT UPR EXT	$604.10	$863.00	$249.62	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US DOPPLER VENOUS BILAT LOW EXT	$604.10	$863.00	$249.62	—	30%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHO W/ DOPPLER & COLOR DOP	$1,066.80	$1,524.00	$571.62	29% below	30%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHO W/ DOPPLER & COLOR DOP	$1,066.80	$1,524.00	$571.62	—	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HIDA SCAN W/O EF	$1,379.00	$1,970.00	$418.22	at median	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HIDA SCAN W/O EF	$1,379.00	$1,970.00	$418.22	—	30%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY, HOME (CPT 95806)	$231.00	$330.00	$225.89	65% below	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 TITRATION STUDY (CPT 95811)	$3,027.50	$4,325.00	$898.36	15% above	30%
Knee X-ray, 3 views CPT 73562 CL-X-RAY KNEE 3 VIEWS	$100.00	$100.00	$91.04	63% below	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PANCREAS	$688.80	$984.00	$109.36	37% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US GB	$688.80	$984.00	$109.36	37% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED SINGLE/ORGAN	$688.80	$984.00	$109.36	37% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SPLEEN	$688.80	$984.00	$109.36	37% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US HEPATIC	$688.80	$984.00	$109.36	37% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US SPLEEN	$688.80	$984.00	$109.36	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US HEPATIC	$688.80	$984.00	$109.36	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LIMITED SINGLE/ORGAN	$688.80	$984.00	$109.36	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US PANCREAS	$688.80	$984.00	$109.36	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US GB	$688.80	$984.00	$109.36	—	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT CHEST LOW DOSE LUNG CA SCREENING	$1,961.40	$2,802.00	$120.16	351% above	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT CHEST LOW DOSE LUNG CA SCREENING	$1,961.40	$2,802.00	$120.16	—	30%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW EXT ANY JT W/O CONTRAST	$2,884.00	$4,120.00	$249.62	55% above	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOW EXT ANY JT W/O CONTRAST	$2,884.00	$4,120.00	$249.62	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOW EXT ANY JT W/O & W/ CONT	$3,591.00	$5,130.00	$364.97	61% above	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOW EXT ANY JT W/O & W/ CONT	$3,591.00	$5,130.00	$364.97	—	30%
MRI of the abdomen without contrast CPT 74181 MRI MRCP (MRI ABD W/O CONTR)	$2,884.00	$4,120.00	$249.62	74% above	30%
MRI of the abdomen without contrast CPT 74181 MRI ABD W/O CONTRAST	$2,884.00	$4,120.00	$249.62	74% above	30%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABD W/O CONTRAST	$2,884.00	$4,120.00	$249.62	—	30%
MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP (MRI ABD W/O CONTR)	$2,884.00	$4,120.00	$249.62	—	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABD W/O & W/ CONT	$3,591.00	$5,130.00	$364.97	48% above	30%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABD W/O & W/ CONT	$3,591.00	$5,130.00	$364.97	—	30%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W O CONTRAST	$2,884.00	$4,120.00	$249.62	78% above	30%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W O CONTRAST	$2,884.00	$4,120.00	$249.62	—	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/O & W CONT	$3,591.00	$5,130.00	$364.97	41% above	30%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/O & W CONT	$3,591.00	$5,130.00	$364.97	—	30%
MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE W O CONTRAST	$2,884.00	$4,120.00	$249.62	55% above	30%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE W O CONTRAST	$2,884.00	$4,120.00	$249.62	—	30%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE W/O & W/ CONT	$3,591.00	$5,130.00	$364.97	44% above	30%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L SPINE W/O & W/ CONT	$3,591.00	$5,130.00	$364.97	—	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T SPINE W O CONTRAST	$2,884.00	$4,120.00	$249.62	64% above	30%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T SPINE W O CONTRAST	$2,884.00	$4,120.00	$249.62	—	30%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE W/O & W CONT	$3,591.00	$5,130.00	$364.97	44% above	30%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE W/O & W CONT	$3,591.00	$5,130.00	$364.97	—	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C SPINE W O CONTRAST	$2,884.00	$4,120.00	$249.62	46% above	30%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C SPINE W O CONTRAST	$2,884.00	$4,120.00	$249.62	—	30%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/O & W/ CONT	$3,591.00	$5,130.00	$364.97	40% above	30%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/O & W/ CONT	$3,591.00	$5,130.00	$364.97	—	30%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$2,884.00	$4,120.00	$249.62	53% above	30%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$2,884.00	$4,120.00	$249.62	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UP EXT ANY JT W/O CONTRAST	$2,884.00	$4,120.00	$249.62	55% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UP EXT ANY JT W/O CONTRAST	$2,884.00	$4,120.00	$249.62	—	30%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCARDIAL SPECT MULTI	$2,792.30	$3,989.00	$1,354.36	32% below	30%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOCARDIAL SPECT MULTI	$2,792.30	$3,989.00	$1,354.36	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIMITED	$347.20	$496.00	$109.36	14% below	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LIMITED	$347.20	$496.00	$109.36	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS	$688.80	$984.00	$109.36	6% above	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS	$688.80	$984.00	$109.36	—	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG >OR= 14 WKS GEST	$662.90	$947.00	$109.36	17% above	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG >OR= 14 WKS GEST	$662.90	$947.00	$109.36	—	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG 1ST TRIMESTER <14 WKS	$574.00	$820.00	$109.36	12% above	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG 1ST TRIMESTER <14 WKS	$574.00	$820.00	$109.36	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 LIMITED OB ULTRASOUND	$205.00	$205.00	$109.36	43% below	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANCY LIMITED	$574.00	$820.00	$109.36	60% above	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREGNANCY LIMITED	$574.00	$820.00	$109.36	—	30%
Screening mammogram, both breasts both sides CPT 77067 MM BCFO DIGITAL MAMMO SCR BILAT ALL VWS	$78.70	$112.43	$76.68	—	30%
Screening mammogram, both breasts both sides CPT 77067 MM SMHW DIGITAL MAMMO SCR BILAT ALL VWS	$84.68	$120.97	$76.68	—	30%
Screening mammogram, both breasts both sides CPT 77067 MM DIGITAL MAMMO SCR BILAT 2 VW	$177.80	$254.00	$76.68	—	30%
Shoulder X-ray, complete, 2 or more views CPT 73030 CL-X-RAY SHOULDER COMPL MINIMUM 2 VIEWS	$125.00	$125.00	$91.04	54% below	—
Sleep study in a lab (polysomnography) CPT 95810 SLEEP STUDY (CPT 95810)	$2,604.00	$3,720.00	$898.36	3% above	30%
Swallow study (modified barium swallow, video X-ray) CPT 74230 SWALLOWING EVAL W/CINE/VIDEO	$355.60	$508.00	$183.49	20% below	30%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 SWALLOWING EVAL W/CINE/VIDEO	$355.60	$508.00	$183.49	—	30%
Transvaginal pelvic ultrasound CPT 76830 US TRANS VAGINAL	$644.00	$920.00	$109.36	11% above	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANS VAGINAL	$644.00	$920.00	$109.36	—	30%
Transvaginal ultrasound during pregnancy CPT 76817 US PREGNANCY TRANS VAG	$644.00	$920.00	$109.36	38% above	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREGNANCY TRANS VAG	$644.00	$920.00	$109.36	—	30%
Ultrasound of the abdomen, complete CPT 76700 US ABD COMP	$921.90	$1,317.00	$109.36	17% above	30%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMP	$921.90	$1,317.00	$109.36	—	30%
Ultrasound of the scrotum and testicles CPT 76870 US TESTICLE	$651.70	$931.00	$109.36	12% above	30%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US TESTICLE	$651.70	$931.00	$109.36	—	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE NECK/HEAD	$620.90	$887.00	$109.36	10% above	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID	$653.80	$934.00	$109.36	16% above	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE NECK/HEAD	$620.90	$887.00	$109.36	—	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID	$653.80	$934.00	$109.36	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US DOPPLER VENOUS UNILAT	$476.70	$681.00	$109.36	15% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US DOPPLER VENOUS UNILAT	$476.70	$681.00	$109.36	—	30%
Wrist X-ray, complete, 3 or more views CPT 73110 CL-X-RAY WRIST 3VIEW MINIMUM	$90.00	$90.00	$91.04	66% below	—
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 CL-X-RAY HIP/PELVIS 2-3 VIEWS	$100.00	$100.00	$91.04	58% below	—
X-ray of the abdomen, 1 view CPT 74018 CL-X-RAY ABDOMEN 1 VIEW	$90.00	$90.00	$91.04	59% below	—
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW	$220.50	$315.00	$91.04	1% above	30%
X-ray of the abdomen, 1 view CPT 74018 RHC ABDOMEN 1 VIEW	$220.50	$315.00	$91.04	1% above	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 VIEW	$220.50	$315.00	$91.04	—	30%
X-ray of the ankle, 2 views CPT 73600 CL-X-RAY ANKLE 2 VIEWS	$80.00	$80.00	$91.04	58% below	—
X-ray of the finger(s), 2 or more views CPT 73140 CL-X-RAY FINGER MINIMUM 2 VIEWS	$70.00	$70.00	$91.04	66% below	—
X-ray of the foot, 2 views CPT 73620 CL-X-RAY FOOT 2 VIEWS	$90.00	$90.00	$91.04	55% below	—
X-ray of the foot, complete, 3 or more views CPT 73630 CL-X-RAY FOOT 3 VIEWS	$100.00	$100.00	$91.04	64% below	—
X-ray of the hand, 3 or more views CPT 73130 CL-X-RAY HAND 3 VIEW MINIMUM	$85.00	$85.00	$91.04	66% below	—
X-ray of the knee, 1 or 2 views CPT 73560 CL-X-RAY KNEE 1-2 VIEWS	$90.00	$90.00	$91.04	61% below	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 CL-X-RAY L SPINE 2-3 VIEWS	$155.00	$155.00	$109.36	47% below	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RHC L-SPINE 2-3 VIEWS	$329.70	$471.00	$109.36	12% above	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 L-SPINE 2-3 VIEWS	$329.70	$471.00	$109.36	12% above	30%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 L-SPINE 2-3 VIEWS	$329.70	$471.00	$109.36	—	30%
X-ray of the lower back, 4 or more views CPT 72110 CL-X-RAY L SPINE 4 VIEW MINIMUM	$175.00	$175.00	$109.36	59% below	—
X-ray of the lower back, 4 or more views CPT 72110 L-SPINE 5VW MINIMUM 4VW	$415.10	$593.00	$109.36	3% below	30%
X-ray of the lower back, 4 or more views inpatient CPT 72110 L-SPINE 5VW MINIMUM 4VW	$415.10	$593.00	$109.36	—	30%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 CL-X-RAY T SPINE 2 VIEW	$120.00	$120.00	$109.36	54% below	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 T-SPINE 2VW	$291.90	$417.00	$109.36	11% above	30%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 RHC T-SPINE 2VW	$291.90	$417.00	$109.36	11% above	30%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 T-SPINE 2VW	$291.90	$417.00	$109.36	—	30%
X-ray of the nasal bones, 3 or more views CPT 70160 CL-X-RAY NASAL 3 VIEWS	$85.00	$85.00	$91.04	66% below	—
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES 3VW MINIMUM	$233.80	$334.00	$91.04	6% below	30%
X-ray of the nasal bones, 3 or more views CPT 70160 RHC NASAL BONES 3VW MINIMUM	$233.80	$334.00	$91.04	6% below	30%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES 3VW MINIMUM	$233.80	$334.00	$91.04	—	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CL-X-RAY C SPINE 2-3 VIEWS	$120.00	$120.00	$91.04	60% below	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 C-SPINE 3 VIEWS OR LESS	$306.60	$438.00	$91.04	2% above	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RHC C-SPINE UP TO 3VWS	$306.60	$438.00	$91.04	2% above	30%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 C-SPINE 3 VIEWS OR LESS	$306.60	$438.00	$91.04	—	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 CL-X-RAY PELVIS 1-2 VIEWS	$115.00	$115.00	$109.36	49% below	—
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS/FROG	$140.00	$200.00	$109.36	38% below	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1-2 VIEWS	$239.40	$342.00	$109.36	6% above	30%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS/FROG	$140.00	$200.00	$109.36	—	30%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1-2 VIEWS	$239.40	$342.00	$109.36	—	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 CL-X-RAY SACRUM & COCCYX 2VW MINIMUM	$120.00	$120.00	$91.04	54% below	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SAC COCCYX MINIMUM 2VW	$329.70	$471.00	$91.04	25% above	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SAC COCCYX MINIMUM 2VW	$329.70	$471.00	$91.04	—	30%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALTV (TCMH)	$73.33	$104.75	$5.19	52% above	30%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALTV (TCMH)	$73.33	$104.75	$5.19	—	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST	$34.76	$49.65	$5.08	25% below	30%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST	$34.76	$49.65	$5.08	—	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 12***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 8***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 13***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 3***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 14***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 6***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 10***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 7***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 11***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 4***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 2***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 1***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 19***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 18***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 17***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 9***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 5***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 16***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 z PERENNIAL ALLERGENS 15***	$16.91	$24.15	$5.12	23% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 zz RESPIRATORY ALLERGENS 20***	$51.21	$73.15	$5.12	132% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 zz RESPIRATORY ALLERGENS 23***	$51.21	$73.15	$5.12	132% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 zz RESPIRATORY ALLERGENS 19***	$51.21	$73.15	$5.12	132% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 zz RESPIRATORY ALLERGENS 17***	$51.21	$73.15	$5.12	132% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 zz RESPIRATORY ALLERGENS 16***	$51.21	$73.15	$5.12	132% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 zz RESPIRATORY ALLERGENS 21***	$51.21	$73.15	$5.12	132% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 zz RESPIRATORY ALLERGENS 26***	$51.21	$73.15	$5.12	132% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 zz RESPIRATORY ALLERGENS 18***	$51.21	$73.15	$5.12	132% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 zz RESPIRATORY ALLERGENS 25***	$51.21	$73.15	$5.12	132% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 zz RESPIRATORY ALLERGENS 22***	$51.21	$73.15	$5.12	132% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 zz RESPIRATORY ALLERGENS 24***	$51.21	$73.15	$5.12	132% above	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 16***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 7***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 8***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 6***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 5***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 4***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 3***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 2***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 1***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 9***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 10***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 11***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 12***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 13***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 14***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 15***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 17***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 18***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 z PERENNIAL ALLERGENS 19***	$16.91	$24.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 zz RESPIRATORY ALLERGENS 25***	$51.21	$73.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 zz RESPIRATORY ALLERGENS 21***	$51.21	$73.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 zz RESPIRATORY ALLERGENS 22***	$51.21	$73.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 zz RESPIRATORY ALLERGENS 23***	$51.21	$73.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 zz RESPIRATORY ALLERGENS 16***	$51.21	$73.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 zz RESPIRATORY ALLERGENS 24***	$51.21	$73.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 zz RESPIRATORY ALLERGENS 26***	$51.21	$73.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 zz RESPIRATORY ALLERGENS 18***	$51.21	$73.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 zz RESPIRATORY ALLERGENS 19***	$51.21	$73.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 zz RESPIRATORY ALLERGENS 17***	$51.21	$73.15	$5.12	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 zz RESPIRATORY ALLERGENS 20***	$51.21	$73.15	$5.12	—	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT proBNP (TCMH)	$161.11	$230.15	$38.47	32% above	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT proBNP (TCMH)	$161.11	$230.15	$38.47	—	30%
Basic metabolic panel (blood test) CPT 80048 BASIC METAB PANEL	$49.63	$70.90	$8.29	60% below	30%
Basic metabolic panel (blood test) CPT 80048 BASIC METAB PANEL* PHARMACY REFLEX	$49.63	$70.90	$8.29	60% below	30%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METAB PANEL* PHARMACY REFLEX	$49.63	$70.90	$8.29	—	30%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METAB PANEL	$49.63	$70.90	$8.29	—	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 BBPL LEVEL IV - SURG PATH, GROSS/MICRO	$89.22	$127.45	$54.53	56% below	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 zzBBPL-CL SURG PATH LEVEL IV	$91.35	$91.35	$54.53	55% below	—
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 BBPL LEVEL IV - SURG PATH, GROSS/MICRO	$89.22	$127.45	$54.53	—	30%
Blood culture for bacteria CPT 87040 BACTERIAL ID CULTURE	$33.71	$48.15	$10.11	70% below	30%
Blood culture for bacteria CPT 87040 zz_BLOOD CULTURE BBPL	$33.71	$48.15	$10.11	70% below	30%
Blood culture for bacteria CPT 87040 BLOOD CULT - TCMH	$33.71	$48.15	$10.11	70% below	30%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULT - TCMH	$33.71	$48.15	$10.11	—	30%
Blood culture for bacteria inpatient CPT 87040 zz_BLOOD CULTURE BBPL	$33.71	$48.15	$10.11	—	30%
Blood culture for bacteria inpatient CPT 87040 BACTERIAL ID CULTURE	$33.71	$48.15	$10.11	—	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$20.00	$20.00	$8.94	19% above	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$20.00	$20.00	$9.15	19% above	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 SPEC COLL VENI	$31.50	$45.00	$9.15	88% above	30%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$20.00	$20.00	$8.94	—	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 SPEC COLL VENI	$31.50	$45.00	$9.15	—	30%
Blood glucose (sugar) test CPT 82947 CSF GLUCOSE	$79.59	$113.70	$3.85	144% above	30%
Blood glucose (sugar) test inpatient CPT 82947 CSF GLUCOSE	$79.59	$113.70	$3.85	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREG TEST SERUM QUAL	$79.59	$113.70	$7.37	49% above	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREG TEST URINE QUAL	$79.59	$113.70	$7.37	49% above	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREG TEST URINE QUAL	$79.59	$113.70	$7.37	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREG TEST SERUM QUAL	$79.59	$113.70	$7.37	—	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB BLOOD TYPING ABO	$26.39	$37.70	$139.18	63% below	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB BLOOD TYPING ABO - GEL	$26.39	$37.70	$139.18	63% below	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB BLOOD TYPING ABO - GEL	$26.39	$37.70	$139.18	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB BLOOD TYPING ABO	$26.39	$37.70	$139.18	—	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACT PROT	$116.03	$165.75	$5.08	95% above	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACT PROT	$116.03	$165.75	$5.08	—	30%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF TOXIN PCR (TCMH)	$113.79	$162.55	$36.52	19% below	30%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF TOXIN PCR (TCMH)	$113.79	$162.55	$36.52	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 by NAA (PCR) (ABBOTT-IDNOW)	$58.52	$83.60	$50.28	41% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 X SARS-COV2	$67.87	$96.95	$50.28	32% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 by NAA (PCR) (ABBOTT-IDNOW)	$58.52	$83.60	$50.28	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 X SARS-COV2	$67.87	$96.95	$50.28	—	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL, NON-FASTING	$97.62	$139.45	$13.12	5% below	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL, FASTING	$97.62	$139.45	$13.12	5% below	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL - 80061	$120.79	$172.55	$13.12	17% above	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL, NON-FASTING	$97.62	$139.45	$13.12	—	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL, FASTING	$97.62	$139.45	$13.12	—	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL - 80061	$120.79	$172.55	$13.12	—	30%
Complete blood count (CBC) with differential CPT 85025 X CBC/AUTO DIFF	$49.42	$70.60	$7.61	7% below	30%
Complete blood count (CBC) with differential inpatient CPT 85025 X CBC/AUTO DIFF	$49.42	$70.60	$7.61	—	30%
Complete blood count (CBC), no differential CPT 85027 CBC without DIFF	$24.71	$35.30	$6.34	50% below	30%
Complete blood count (CBC), no differential CPT 85027 X CBC/HEMOGRAM	$24.71	$35.30	$6.34	50% below	30%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC without DIFF	$24.71	$35.30	$6.34	—	30%
Complete blood count (CBC), no differential inpatient CPT 85027 X CBC/HEMOGRAM	$24.71	$35.30	$6.34	—	30%
Comprehensive metabolic panel (blood test) CPT 80053 .COMP METABOLIC PANEL	$77.39	$110.55	$10.35	39% below	30%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL	$81.66	$116.65	$10.35	35% below	30%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL *PHARMACY REFLEX	$81.66	$116.65	$10.35	35% below	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 .COMP METABOLIC PANEL	$77.39	$110.55	$10.35	—	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL *PHARMACY REFLEX	$81.66	$116.65	$10.35	—	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL	$81.66	$116.65	$10.35	—	30%
D-dimer blood test (blood clot marker) CPT 85379 D DIMER	$75.92	$108.45	$9.98	39% below	30%
D-dimer blood test (blood clot marker) CPT 85379 *D DIMER	$75.92	$108.45	$9.98	39% below	30%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D DIMER	$75.92	$108.45	$9.98	—	30%
D-dimer blood test (blood clot marker) inpatient CPT 85379 *D DIMER	$75.92	$108.45	$9.98	—	30%
Ferritin blood test (iron stores) CPT 82728 FERRITIN (TCMH)	$73.71	$105.30	$13.36	12% below	30%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN (TCMH)	$73.71	$105.30	$13.36	—	30%
Folate (folic acid) blood test CPT 82746 FOLATE SERUM/PLASMA (TCMH)	$112.88	$161.25	$14.41	48% above	30%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE SERUM/PLASMA (TCMH)	$112.88	$161.25	$14.41	—	30%
Free T3 thyroid hormone test CPT 84481 FREE T3 (TCMH)	$362.29	$517.55	$16.60	265% above	30%
Free T3 thyroid hormone test inpatient CPT 84481 FREE T3 (TCMH)	$362.29	$517.55	$16.60	—	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4	$149.77	$213.95	$8.84	102% above	30%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4	$149.77	$213.95	$8.84	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE BLOOD QUANT	$35.39	$50.55	$4.66	17% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUC, GEST, 75GM, 2HR QUEST	$48.76	$69.65	$4.66	15% above	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE BLOOD QUANT	$35.39	$50.55	$4.66	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUC, GEST, 75GM, 2HR QUEST	$48.76	$69.65	$4.66	—	30%
Glucose tolerance test, 3 samples CPT 82951 GLUC, GEST, 50GM, 1HR	$48.76	$69.65	$12.61	46% below	30%
Glucose tolerance test, 3 samples CPT 82951 GLUC TOL/2 HR, 75gm LOAD, NON-GEST	$105.42	$150.60	$12.61	16% above	30%
Glucose tolerance test, 3 samples CPT 82951 GLUC TOL/2 HR, 75gm LOAD, GESTATIONAL	$105.42	$150.60	$12.61	16% above	30%
Glucose tolerance test, 3 samples CPT 82951 GLUC TOL/5 HR, 75gm LOAD	$158.94	$227.05	$12.61	75% above	30%
Glucose tolerance test, 3 samples CPT 82951 GLUC TOL/3 HR, 100gm LOAD, GESTATIONAL	$158.94	$227.05	$12.61	75% above	30%
Glucose tolerance test, 3 samples CPT 82951 GLUC TOL/3 HR, 75gm LOAD	$158.94	$227.05	$12.61	75% above	30%
Glucose tolerance test, 3 samples CPT 82951 GLUC TOL/4 HR, 75gm LOAD	$158.94	$227.05	$12.61	75% above	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC, GEST, 50GM, 1HR	$48.76	$69.65	$12.61	—	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC TOL/2 HR, 75gm LOAD, NON-GEST	$105.42	$150.60	$12.61	—	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC TOL/2 HR, 75gm LOAD, GESTATIONAL	$105.42	$150.60	$12.61	—	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC TOL/3 HR, 100gm LOAD, GESTATIONAL	$158.94	$227.05	$12.61	—	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC TOL/4 HR, 75gm LOAD	$158.94	$227.05	$12.61	—	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC TOL/5 HR, 75gm LOAD	$158.94	$227.05	$12.61	—	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC TOL/3 HR, 75gm LOAD	$158.94	$227.05	$12.61	—	30%
HIV-1 and HIV-2 antibody test CPT 86703 zz_HIV 1/2 ANTIBODIES	$37.91	$54.15	$13.44	67% below	30%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 zz_HIV 1/2 ANTIBODIES	$37.91	$54.15	$13.44	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 z HGB A 1 C	$61.39	$87.70	$9.52	at median	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HGB A1C (TCMH)	$61.39	$87.70	$9.52	at median	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HGB A1C (TCMH)	$61.39	$87.70	$9.52	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 z HGB A 1 C	$61.39	$87.70	$9.52	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 *HEP B SURF AB (TCMH)	$61.81	$88.30	$10.53	10% below	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 *HEP B SURF AB (TCMH)	$61.81	$88.30	$10.53	—	30%
Iron blood test (serum iron) CPT 83540 IRON/TIBC(TCMH)	$75.04	$107.20	$6.34	63% above	30%
Iron blood test (serum iron) CPT 83540 IRON (TCMH)	$75.04	$107.20	$6.34	63% above	30%
Iron blood test (serum iron) inpatient CPT 83540 IRON (TCMH)	$75.04	$107.20	$6.34	—	30%
Iron blood test (serum iron) inpatient CPT 83540 IRON/TIBC(TCMH)	$75.04	$107.20	$6.34	—	30%
Kidney function blood test panel CPT 80069 RENAL PANEL	$57.51	$82.15	$8.51	46% below	30%
Kidney function blood test panel inpatient CPT 80069 RENAL PANEL	$57.51	$82.15	$8.51	—	30%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$122.22	$174.60	$6.75	94% above	30%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$122.22	$174.60	$6.75	—	30%
Liver function blood test panel CPT 80076 .LIVER PANEL	$70.88	$101.25	$8.01	47% below	30%
Liver function blood test panel CPT 80076 LIVER PANEL	$124.08	$177.25	$8.01	7% below	30%
Liver function blood test panel inpatient CPT 80076 .LIVER PANEL	$70.88	$101.25	$8.01	—	30%
Liver function blood test panel inpatient CPT 80076 LIVER PANEL	$124.08	$177.25	$8.01	—	30%
Magnesium blood test CPT 83735 MAGNESIUM	$35.39	$50.55	$6.57	25% below	30%
Magnesium blood test CPT 83735 MAGNESIUM 24 HR URINE	$43.33	$61.90	$6.57	8% below	30%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$35.39	$50.55	$6.57	—	30%
Magnesium blood test inpatient CPT 83735 MAGNESIUM 24 HR URINE	$43.33	$61.90	$6.57	—	30%
Mono test (heterophile antibody, Monospot) CPT 86308 MONOSPOT	$89.01	$127.15	$5.08	117% above	30%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSPOT	$89.01	$127.15	$5.08	—	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL	$181.34	$259.05	$18.02	135% above	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL	$181.34	$259.05	$18.02	—	30%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT (TCMH)	$149.77	$213.95	$40.45	12% below	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT (TCMH)	$149.77	$213.95	$40.45	—	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$81.31	$116.15	$5.89	55% above	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$81.31	$116.15	$5.89	—	30%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME/INR	$29.93	$42.75	$4.20	7% above	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME/INR	$29.93	$42.75	$4.20	—	30%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 FENTANYL QUAL URINE	$9.66	$13.80	$12.35	86% below	30%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 EMPLOYEE DRUG SCREEN (TCMH)	$12.08	$17.25	$12.35	82% below	30%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN - CONTRACT PRE-EMPLOY	$21.00	$30.00	$12.35	69% below	30%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN PROCEDURE/TRIAGE QUAL (TCMH)	$222.25	$317.50	$12.35	227% above	30%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 OB DRUG SCREEN W/ REFLEX CONF IF POS	$222.25	$317.50	$12.35	227% above	30%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 FENTANYL QUAL URINE	$9.66	$13.80	$12.35	—	30%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 EMPLOYEE DRUG SCREEN (TCMH)	$12.08	$17.25	$12.35	—	30%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN - CONTRACT PRE-EMPLOY	$21.00	$30.00	$12.35	—	30%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN PROCEDURE/TRIAGE QUAL (TCMH)	$222.25	$317.50	$12.35	—	30%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 OB DRUG SCREEN W/ REFLEX CONF IF POS	$222.25	$317.50	$12.35	—	30%
Rapid flu test (influenza antigen) CPT 87804 *FLU A ANTIGEN	$60.94	$87.05	$16.22	2% above	30%
Rapid flu test (influenza antigen) inpatient CPT 87804 *FLU A ANTIGEN	$60.94	$87.05	$16.22	—	30%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB IgG (TCMH)	$73.85	$105.50	$14.10	40% above	30%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB IgG (TCMH)	$73.85	$105.50	$14.10	—	30%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE	$6.16	$8.80	$2.65	82% below	30%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE	$6.16	$8.80	$2.65	—	30%
Stool test for hidden blood (guaiac FOBT) CPT 82270 CL-HEMOCCULT	$22.00	$22.00	$4.29	3% above	—
Testosterone blood test, total (not free testosterone) CPT 84403 Z TESTOSTERONE (TCMH)	$240.77	$343.95	$25.29	102% above	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Z TESTOSTERONE (TCMH)	$240.77	$343.95	$25.29	—	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$92.58	$132.25	$16.46	102% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH with FREE T4 IF INDICATED	$92.58	$132.25	$16.46	102% above	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH with FREE T4 IF INDICATED	$92.58	$132.25	$16.46	—	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$92.58	$132.25	$16.46	—	30%
Uric acid blood test CPT 84550 URIC ACID	$71.75	$102.50	$4.43	70% above	30%
Uric acid blood test inpatient CPT 84550 URIC ACID	$71.75	$102.50	$4.43	—	30%
Urinalysis with microscope exam, automated CPT 81001 X URINALYSIS WITH MICRO	$39.97	$57.10	$3.11	7% above	30%
Urinalysis with microscope exam, automated inpatient CPT 81001 X URINALYSIS WITH MICRO	$39.97	$57.10	$3.11	—	30%
Urinalysis without microscope exam, automated CPT 81003 X URINALYSIS W O MICRO	$39.97	$57.10	$2.20	99% above	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 X URINALYSIS W O MICRO	$39.97	$57.10	$2.20	—	30%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE	$33.71	$48.15	$7.91	48% below	30%
Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE	$33.71	$48.15	$7.91	—	30%
Vitamin B12 (cobalamin) blood test CPT 82607 VIT B12 LEVEL (TCMH)	$94.85	$135.50	$14.78	23% above	30%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VIT B12 LEVEL (TCMH)	$94.85	$135.50	$14.78	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 zz CL VitD_25-OH	$111.62	$159.45	$29.01	18% below	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25-OH(TCMH)	$111.62	$159.45	$29.01	18% below	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 zz VitD_25-OH	$111.62	$159.45	$29.01	18% below	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 zz CL VitD_25-OH	$111.62	$159.45	$29.01	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 zz VitD_25-OH	$111.62	$159.45	$29.01	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25-OH(TCMH)	$111.62	$159.45	$29.01	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG QUANT	$166.53	$237.90	$14.75	96% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG QUANT	$166.53	$237.90	$14.75	—	30%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Appendectomy, open surgery CPT 44950 CL-APPENDECTOMY OPEN	$1,785.00	$1,785.00	$6,772.41	43% above	—
Appendectomy, open surgery inpatient CPT 44950 CL-APPENDECTOMY OPEN	$1,785.00	$1,785.00	$6,772.41	—	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 CL-BX BREAST W/DEVICE 1ST LESION	$1,050.00	$1,050.00	$1,727.77	59% below	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 CL-BX BREAST W/DEVICE 1ST LESION	$1,050.00	$1,050.00	$1,727.77	—	—
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 ED CLO TX DIST FIB FX W/O MAN	$336.00	$480.00	$258.04	31% below	30%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLO TX DIST FIB FX W/O MAN	$658.70	$941.00	$258.04	35% above	30%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 ED CLO TX DIST FIB FX W/O MAN	$336.00	$480.00	$258.04	—	30%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLO TX DIST FIB FX W/O MAN	$658.70	$941.00	$258.04	—	30%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 ED CLO TX METATARSAL FX W/O MAN EACH	$336.00	$480.00	$258.04	14% below	30%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLO TX METATARSAL FX W/O MAN EACH	$462.00	$660.00	$258.04	18% above	30%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 ED CLO TX METATARSAL FX W/O MAN EACH	$336.00	$480.00	$258.04	—	30%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLO TX METATARSAL FX W/O MAN EACH	$462.00	$660.00	$258.04	—	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CL-CARDIOVERSION ELECTIVE	$170.00	$170.00	$691.43	79% below	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE EXTERNAL	$246.40	$352.00	$691.43	70% below	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE	$797.30	$1,139.00	$691.43	3% below	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 ED CARDIOVERSION ELECTIVE EXTERNAL	$833.00	$1,190.00	$691.43	1% above	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTIVE EXTERNAL	$246.40	$352.00	$691.43	—	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ED CARDIOVERSION ELECTIVE EXTERNAL	$833.00	$1,190.00	$691.43	—	30%
Cataract surgery with lens implant CPT 66984 CATARACT REMOVAL	$5,116.30	$7,309.00	$2,414.27	1% below	30%
Cervical biopsy CPT 57500 CERVIX BX SNGL/MULTI/EXC OF LES SEPPROC	$325.00	$325.00	$963.54	69% below	—
Cervical biopsy inpatient CPT 57500 CERVIX BX SNGL/MULTI/EXC OF LES SEPPROC	$325.00	$325.00	$963.54	—	—
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMCISION >=28 DAYS OLD	$1,185.00	$1,185.00	$2,186.80	63% below	—
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUMCISION >=28 DAYS OLD	$1,185.00	$1,185.00	$2,186.80	—	—
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HSPTLST CIRCUMCISION NEWBORN	$170.80	$244.00	$2,186.80	49% below	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/CLAMP NEWBORN	$250.00	$250.00	$2,186.80	25% below	—
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HSPTLST CIRCUMCISION NEWBORN	$170.80	$244.00	$2,186.80	—	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/CLAMP NEWBORN	$250.00	$250.00	$2,186.80	—	—
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/CLAMP NEWBORN	$250.00	$250.00	$2,186.80	—	—
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION <=28 DAYS OLD	$250.00	$250.00	$729.45	52% below	—
Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUMCISION <=28 DAYS OLD	$250.00	$250.00	$729.45	—	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 ED TX DISTAL RADIAL FX W/O MAN	$336.00	$480.00	$258.04	43% below	30%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLO TX DISTAL RADIAL FX W/O MAN	$599.90	$857.00	$258.04	2% above	30%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 ED TX DISTAL RADIAL FX W/O MAN	$336.00	$480.00	$258.04	—	30%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLO TX DISTAL RADIAL FX W/O MAN	$599.90	$857.00	$258.04	—	30%
Colonoscopy with polyp removal CPT 45385 CL-COLONOSCOPY FLEXIBLE W/REM OF POLYPS	$1,465.00	$1,465.00	$1,251.83	14% below	—
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY LESION REM	$3,622.50	$5,175.00	$1,251.83	113% above	30%
Colonoscopy with polyp removal inpatient CPT 45385 CL-COLONOSCOPY FLEXIBLE W/REM OF POLYPS	$1,465.00	$1,465.00	$1,251.83	—	—
Colonoscopy with tissue sample CPT 45380 CL-COLONOSCOPY FLEXIBLE W/BX REM OF LES	$1,140.00	$1,140.00	$1,251.83	36% below	—
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY BIOPSY	$3,577.70	$5,111.00	$1,251.83	100% above	30%
Colonoscopy with tissue sample inpatient CPT 45380 CL-COLONOSCOPY FLEXIBLE W/BX REM OF LES	$1,140.00	$1,140.00	$1,251.83	—	—
Colonoscopy, diagnostic CPT 45378 CL-COLONOSCOPY SCREENING/DX FLEXIBLE	$1,035.00	$1,035.00	$972.85	18% below	—
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY	$3,229.80	$4,614.00	$972.85	155% above	30%
Colonoscopy, diagnostic inpatient CPT 45378 CL-COLONOSCOPY SCREENING/DX FLEXIBLE	$1,035.00	$1,035.00	$972.85	—	—
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 LEEP & COLPOSCOPY	$1,085.00	$1,085.00	$3,386.43	47% below	—
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 LEEP & COLPOSCOPY	$1,085.00	$1,085.00	$3,386.43	—	—
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 CL-COLPOSCOPY W/ BIOPSY OF THE CERVIX	$435.00	$435.00	$318.78	3% below	—
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 CL-COLPOSCOPY W/ BIOPSY OF THE CERVIX	$435.00	$435.00	$318.78	—	—
D&C (dilation and curettage), not related to pregnancy CPT 58120 CL-D&C DIAGNOSTIC/THERAPEUTIC NON-OB	$715.00	$715.00	$3,386.43	77% below	—
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 CL-D&C DIAGNOSTIC/THERAPEUTIC NON-OB	$715.00	$715.00	$3,386.43	—	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION/CRYO PREMLGNT LES 1ST LES	$115.00	$115.00	$209.90	2% below	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION/CRYO PREMLGNT LES 1ST LES	$115.00	$115.00	$209.90	—	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPACTED CERUMEN W/IRRIGATION UNI	$23.10	$33.00	$61.72	69% below	30%
Earwax removal by irrigation (rinsing), one ear CPT 69209 EAR WAX REMOVAL W/LAVAGE	$55.00	$55.00	$61.72	26% below	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 ED REM IMPACTED CERUMEN W/IRRIG UNI	$87.50	$125.00	$61.72	18% above	30%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REM IMPACTED CERUMEN W/IRRIGATION UNI	$23.10	$33.00	$61.72	—	30%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ED REM IMPACTED CERUMEN W/IRRIG UNI	$87.50	$125.00	$61.72	—	30%
Earwax removal with instruments, one ear CPT 69210 ED REM IMPACTED CERUMEN W/INSTRUM UNI	$87.50	$125.00	$61.72	5% below	30%
Earwax removal with instruments, one ear CPT 69210 REM IMPACTED CERUMEN W/INSTRUM UNI	$88.90	$127.00	$61.72	3% below	30%
Earwax removal with instruments, one ear CPT 69210 EAR WAX REMOVAL	$135.00	$135.00	$61.72	47% above	—
Earwax removal with instruments, one ear inpatient CPT 69210 ED REM IMPACTED CERUMEN W/INSTRUM UNI	$87.50	$125.00	$61.72	—	30%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMPACTED CERUMEN W/INSTRUM UNI	$88.90	$127.00	$61.72	—	30%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 CL-ENDOMETRIAL BX W/O CERVICAL DILATION	$240.00	$240.00	$211.50	8% below	—
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL SAMPLING (BX) W/O CERV DILTN	$240.00	$240.00	$211.50	8% below	—
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 CL-ENDOMETRIAL BX W/O CERVICAL DILATION	$240.00	$240.00	$211.50	—	—
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL SAMPLING (BX) W/O CERV DILTN	$240.00	$240.00	$211.50	—	—
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 CERV/THOR EPID/SUBRCHND INJ W/IMG	$475.00	$475.00	$738.44	53% below	—
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 CERV/THOR EPID/SUBRCHND INJ W/IMG	$475.00	$475.00	$738.44	—	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ FACET LUMB/SACRAL SINGLE LVL W IMAG	$201.60	$288.00	$925.27	81% below	30%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 ED INJ FACET LUMB/SACRAL SINGL LVL W/IMA	$1,260.00	$1,800.00	$925.27	22% above	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ FACET LUMB/SACRAL SINGLE LVL W IMAG	$201.60	$288.00	$925.27	—	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 ED INJ FACET LUMB/SACRAL SINGL LVL W/IMA	$1,260.00	$1,800.00	$925.27	—	30%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 CL-ABD HERNIA INITIAL 3-10CM REDUCIBLE	$870.00	$870.00	$6,323.45	87% below	—
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 HERNIA REPAIR	$9,356.20	$13,366.00	$6,323.45	45% above	30%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 CL-ABD HERNIA INITIAL 3-10CM REDUCIBLE	$870.00	$870.00	$6,323.45	—	—
First repair of a front abdominal hernia larger than 10 cm CPT 49595 CL-ABD HERNIA INITIAL >10CM REDUCIBLE	$1,165.00	$1,165.00	$6,323.45	38% below	—
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 CL-ABD HERNIA INITIAL >10CM REDUCIBLE	$1,165.00	$1,165.00	$6,323.45	—	—
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 CL-ABD HERNIA INITIAL <3CM REDUCIBLE	$515.00	$515.00	$3,497.24	89% below	—
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 HERNIA REPAIR	$7,694.40	$10,992.00	$3,497.24	63% above	30%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 CL-ABD HERNIA INITIAL <3CM REDUCIBLE	$515.00	$515.00	$3,497.24	—	—
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 CL-SIGMOIDOSCOPY DX	$250.00	$250.00	$972.85	78% below	—
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 CL-SIGMOIDOSCOPY DX	$250.00	$250.00	$972.85	—	—
Gallbladder removal, laparoscopic CPT 47562 CL-LAPAROSCOPY CHOLECYSTECTOMY	$2,945.00	$2,945.00	$6,324.37	51% below	—
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPY CHOLECYSTECTOMY	$14,004.20	$20,006.00	$6,324.37	132% above	30%
Gallbladder removal, laparoscopic inpatient CPT 47562 CL-LAPAROSCOPY CHOLECYSTECTOMY	$2,945.00	$2,945.00	$6,324.37	—	—
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 CL-LAP CHOLECYSTECTOMY W/CHOLANGIOGRAM	$3,140.00	$3,140.00	$6,324.37	50% below	—
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPAROSCOPY CHOLECYSTECTOMY WITH CHLOANGIOGRAPHY	$14,909.30	$21,299.00	$6,324.37	139% above	30%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 CL-LAP CHOLECYSTECTOMY W/CHOLANGIOGRAM	$3,140.00	$3,140.00	$6,324.37	—	—
Hemorrhoid banding (rubber band ligation) CPT 46221 CL-HEMORRHOIDECTOMY INTRNL RUBBER BAND	$410.00	$410.00	$972.85	70% below	—
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 CL-HEMORRHOIDECTOMY INTRNL RUBBER BAND	$410.00	$410.00	$972.85	—	—
Hemorrhoidectomy (internal and external), one area CPT 46255 CL-HEMORROIDECTOMY INT/EXT SING COL/GRP	$765.00	$765.00	$2,903.68	82% below	—
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 CL-HEMORROIDECTOMY INT/EXT SING COL/GRP	$765.00	$765.00	$2,903.68	—	—
Hysteroscopy with endometrial ablation CPT 58563 CL-HYSTEROSCOPY SURG W/ENDO ABLATION	$950.00	$950.00	$5,233.19	87% below	—
Hysteroscopy with endometrial ablation inpatient CPT 58563 CL-HYSTEROSCOPY SURG W/ENDO ABLATION	$950.00	$950.00	$5,233.19	—	—
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 CL-LAP/HYSTEROSCOPIC OF CORPUS UTERI	$1,795.00	$1,795.00	$3,386.43	57% below	—
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 CL-LAP/HYSTEROSCOPIC OF CORPUS UTERI	$1,795.00	$1,795.00	$3,386.43	—	—
Incision and drainage of a simple or single skin abscess CPT 10060 I&D SIMPLE	$185.00	$185.00	$209.90	18% below	—
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE OR SINGLE	$225.40	$322.00	$209.90	at median	30%
Incision and drainage of a simple or single skin abscess CPT 10060 ED I&D ABSCESS SIMPLE OR SINGLE	$273.00	$390.00	$209.90	21% above	30%
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION AND DRAINAGE ABSCESS	$5,380.90	$7,687.00	$209.90	2292% above	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D SIMPLE	$185.00	$185.00	$209.90	—	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE OR SINGLE	$225.40	$322.00	$209.90	—	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ED I&D ABSCESS SIMPLE OR SINGLE	$273.00	$390.00	$209.90	—	30%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 CL-REPAIR INGUINAL HERNIA REDUCIBLE >=5Y	$1,855.00	$1,855.00	$3,745.54	70% below	—
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HERNIA REPAIR	$8,477.00	$12,110.00	$3,745.54	35% above	30%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 CL-REPAIR INGUINAL HERNIA REDUCIBLE >=5Y	$1,855.00	$1,855.00	$3,745.54	—	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ SGL TENDON SHTH/LIGAMNT APONEUROSIS	$108.50	$155.00	$321.12	45% below	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 CL-INJECTION SNGL TENDON SHEATH/LIGAMENT	$130.00	$130.00	$321.12	34% below	—
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ SGL TENDON SHTH/LIGAMNT APONEUROSIS	$108.50	$155.00	$321.12	—	30%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 CL-INJECTION SNGL TENDON SHEATH/LIGAMENT	$130.00	$130.00	$321.12	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHRO/ASPIR/INJ MAJOR JNT W/O US	$130.90	$187.00	$321.12	39% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HSPTLST INJ MAJOR JOINT W/O US	$139.30	$199.00	$321.12	35% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 CL-INJECTION MAJOR JOINT W/O US	$210.00	$210.00	$321.12	2% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ED ARTHR/ASP/INJ MAJOR JOINT OR BURSA	$406.00	$580.00	$321.12	90% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHRO/ASPIR/INJ MAJOR JNT W/O US	$130.90	$187.00	$321.12	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HSPTLST INJ MAJOR JOINT W/O US	$139.30	$199.00	$321.12	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 CL-INJECTION MAJOR JOINT W/O US	$210.00	$210.00	$321.12	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ED ARTHR/ASP/INJ MAJOR JOINT OR BURSA	$406.00	$580.00	$321.12	—	30%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 NEXPLANON INSERTION	$395.00	$395.00	$139.18	119% above	—
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 NEXPLANON INSERTION	$395.00	$395.00	$139.18	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHRO/ASPIR/INJ INTER JNT W/O US	$109.90	$157.00	$321.12	45% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 CL-INJ/ASPIRATION INTERMED JNT/BURSA	$130.00	$130.00	$321.12	35% below	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ED ARTHR/ASP/INJ INTER JOINT W/O US	$406.00	$580.00	$321.12	103% above	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 OP ARTHR/ASP/INJ INTER JOINT W/O US	$406.00	$580.00	$321.12	103% above	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHRO/ASPIR/INJ INTER JNT W/O US	$109.90	$157.00	$321.12	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 CL-INJ/ASPIRATION INTERMED JNT/BURSA	$130.00	$130.00	$321.12	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 OP ARTHR/ASP/INJ INTER JOINT W/O US	$406.00	$580.00	$321.12	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ED ARTHR/ASP/INJ INTER JOINT W/O US	$406.00	$580.00	$321.12	—	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHRO/ASPIR/INJ SMALL JOINT W/O US	$107.10	$153.00	$321.12	47% below	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 CL-INJECTION/ASPIRATION SMALL JNT/BURSA	$120.00	$120.00	$321.12	40% below	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ED ARTHR/ASP/INJ SMALL JOINT W/O US	$406.00	$580.00	$321.12	102% above	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHRO/ASPIR/INJ SMALL JOINT W/O US	$107.10	$153.00	$321.12	—	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 CL-INJECTION/ASPIRATION SMALL JNT/BURSA	$120.00	$120.00	$321.12	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ED ARTHR/ASP/INJ SMALL JOINT W/O US	$406.00	$580.00	$321.12	—	30%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 CL-LAPAROSCOPY, SURGICAL, APPENDECTOMY	$1,840.00	$1,840.00	$6,324.37	77% below	—
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY APPENDECTOMY	$16,959.60	$24,228.00	$6,324.37	113% above	30%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 CL-LAPAROSCOPY, SURGICAL, APPENDECTOMY	$1,840.00	$1,840.00	$6,324.37	—	—
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 CL-ESOPHAGOGASTRIC FUNDOPLASTY	$2,975.00	$2,975.00	$11,120.13	71% below	—
Laparoscopic fundoplication (anti-reflux surgery) inpatient CPT 43280 CL-ESOPHAGOGASTRIC FUNDOPLASTY	$2,975.00	$2,975.00	$11,120.13	—	—
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 CL-LAP REPAIR INITIAL INGUINAL HERNIA	$655.00	$655.00	$6,324.37	91% below	—
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAPAROSCOPY INGUINAL HERNIA REPAIR	$13,847.40	$19,782.00	$6,324.37	88% above	30%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 CL-LAP REPAIR INITIAL INGUINAL HERNIA	$655.00	$655.00	$6,324.37	—	—
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 CL-LAP REPAIR RECUR INGUINAL HERNIA	$850.00	$850.00	$6,324.37	92% below	—
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 CL-LAP REPAIR RECUR INGUINAL HERNIA	$850.00	$850.00	$6,324.37	—	—
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 CL-LAP W/FULGURATION OR EXC OF LESIONS	$1,550.00	$1,550.00	$6,324.37	86% below	—
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 CL-LAPAROSCOPIC OOPHORECTOMY/SALPINGECT	$2,745.00	$2,745.00	$6,324.37	74% below	—
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 CL-LAP W/FULGURATION OR EXC OF LESIONS	$1,550.00	$1,550.00	$6,324.37	—	—
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 CL-LAPAROSCOPIC OOPHORECTOMY/SALPINGECT	$2,745.00	$2,745.00	$6,324.37	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 RPR INT <2.5CM SCLP/TRNK/EXT-EXC HND/FT	$350.70	$501.00	$425.26	8% below	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 CL-REP INT SCALP AXIL TRUNK EXTR <=2.5CM	$480.00	$480.00	$425.26	26% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ED RPR INT <2.5CM SC/TR/EXT EXC HD/FT	$497.00	$710.00	$425.26	31% above	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 RPR INT <2.5CM SCLP/TRNK/EXT-EXC HND/FT	$350.70	$501.00	$425.26	—	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 CL-REP INT SCALP AXIL TRUNK EXTR <=2.5CM	$480.00	$480.00	$425.26	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 ED RPR INT <2.5CM SC/TR/EXT EXC HD/FT	$497.00	$710.00	$425.26	—	30%
Lower-back epidural injection, with imaging guidance CPT 62323 LMBR/SACRAL EPID/SUBRCHND INJ W/IMG	$475.00	$475.00	$738.44	51% below	—
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 LMBR/SACRAL EPID/SUBRCHND INJ W/IMG	$475.00	$475.00	$738.44	—	—
Lower-back epidural injection, without imaging guidance CPT 62322 LMBR/SACRAL EPID/SUBRCHND INJ W/O IMG	$420.00	$420.00	$925.27	62% below	—
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 LMBR/SACRAL EPID/SUBRCHND INJ W/O IMG	$420.00	$420.00	$925.27	—	—
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CL-INJ EPID LUMB/SACRAL W/GUID SNGL LVL	$845.00	$845.00	$925.27	43% below	—
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 CL-INJ EPID LUMB/SACRAL W/GUID SNGL LVL	$845.00	$845.00	$925.27	—	—
Lumpectomy (partial mastectomy) CPT 19301 CL-MASTECTOMY PARTIAL	$1,020.00	$1,020.00	$4,096.03	20% below	—
Lumpectomy (partial mastectomy) inpatient CPT 19301 CL-MASTECTOMY PARTIAL	$1,020.00	$1,020.00	$4,096.03	—	—
Miscarriage treatment with D&C, first trimester CPT 59820 CL-MISSED ABORTION, COMPL SURG 1ST TRI	$1,135.00	$1,135.00	$3,386.43	77% below	—
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 CL-MISSED ABORTION, COMPL SURG 1ST TRI	$1,135.00	$1,135.00	$3,386.43	—	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BEN LES TRNK/ARM/LG 0.5 CM OR LESS	$150.00	$150.00	$740.80	39% below	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BENIGN LES;TRUNK/ARMS/LEGS 0.5CM	$173.60	$248.00	$740.80	30% below	30%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BEN LES TRNK/ARM/LG 0.5 CM OR LESS	$150.00	$150.00	$740.80	—	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BENIGN LES;TRUNK/ARMS/LEGS 0.5CM	$173.60	$248.00	$740.80	—	30%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC BEN LES FC/ER/EY/NS/LP/MUCM 0.5 CM/<	$190.00	$190.00	$740.80	34% below	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC BEN LES FC/ER/EY/NS/LP/MUCM 0.5 CM/<	$190.00	$190.00	$740.80	—	—
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SIMPLE SINGLE	$150.00	$150.00	$209.90	9% below	—
Nail removal (partial or complete), one nail CPT 11730 AVULSN NAIL PLATE PART/COMPLT SIMPL SING	$164.50	$235.00	$209.90	at median	30%
Nail removal (partial or complete), one nail CPT 11730 ED AVULSN NAIL PLATE SIMPLE SINGLE	$273.00	$390.00	$209.90	66% above	30%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SIMPLE SINGLE	$150.00	$150.00	$209.90	—	—
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSN NAIL PLATE PART/COMPLT SIMPL SING	$164.50	$235.00	$209.90	—	30%
Nail removal (partial or complete), one nail inpatient CPT 11730 ED AVULSN NAIL PLATE SIMPLE SINGLE	$273.00	$390.00	$209.90	—	30%
Occipital nerve block (injection for headaches) CPT 64405 CL-INJ ANES AGENT GREATER OCCIPITAL NRV	$115.00	$115.00	$321.12	62% below	—
Occipital nerve block (injection for headaches) CPT 64405 INJ ANES AGENT OCCIPITAL NERVE	$122.50	$175.00	$321.12	60% below	30%
Occipital nerve block (injection for headaches) CPT 64405 ED INJ ANES AGENT OCCIPITAL NERVE	$406.00	$580.00	$321.12	33% above	30%
Occipital nerve block (injection for headaches) inpatient CPT 64405 CL-INJ ANES AGENT GREATER OCCIPITAL NRV	$115.00	$115.00	$321.12	—	—
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJ ANES AGENT OCCIPITAL NERVE	$122.50	$175.00	$321.12	—	30%
Occipital nerve block (injection for headaches) inpatient CPT 64405 ED INJ ANES AGENT OCCIPITAL NERVE	$406.00	$580.00	$321.12	—	30%
Paracentesis with imaging guidance CPT 49083 ABDOMINAL PARACENTESIS W/ IMAGING GUIDE	$245.70	$351.00	$948.82	72% below	30%
Paracentesis with imaging guidance CPT 49083 CL-ABDOMINAL PARACENTESIS	$475.00	$475.00	$948.82	45% below	—
Paracentesis with imaging guidance CPT 49083 ED ABDOMINAL PARACENTESIS WITH GUIDANCE	$1,218.00	$1,740.00	$948.82	41% above	30%
Paracentesis with imaging guidance inpatient CPT 49083 ABDOMINAL PARACENTESIS W/ IMAGING GUIDE	$245.70	$351.00	$948.82	—	30%
Paracentesis with imaging guidance inpatient CPT 49083 CL-ABDOMINAL PARACENTESIS	$475.00	$475.00	$948.82	—	—
Paracentesis with imaging guidance inpatient CPT 49083 ED ABDOMINAL PARACENTESIS WITH GUIDANCE	$1,218.00	$1,740.00	$948.82	—	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL/NAIL MATRIX PERM REMOVAL	$370.00	$370.00	$425.26	7% below	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL/MATRIX PART/COMPLT PERM	$387.80	$554.00	$425.26	2% below	30%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL/NAIL MATRIX PERM REMOVAL	$370.00	$370.00	$425.26	—	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL/MATRIX PART/COMPLT PERM	$387.80	$554.00	$425.26	—	30%
Removal of a breast lump, open surgery CPT 19120 EXC BREAST LESION OPEN 1 OR MORE LESIONS	$1,010.00	$1,010.00	$4,096.03	2% above	—
Removal of a breast lump, open surgery inpatient CPT 19120 EXC BREAST LESION OPEN 1 OR MORE LESIONS	$1,010.00	$1,010.00	$4,096.03	—	—
Removal of a foreign object under the skin, simple CPT 10120 INCISION/REMOVAL FB SIMPLE	$200.00	$200.00	$425.26	34% below	—
Removal of a foreign object under the skin, simple CPT 10120 FB INCS & REM SQ; SIMPLE	$229.60	$328.00	$425.26	25% below	30%
Removal of a foreign object under the skin, simple CPT 10120 ED FB REMOVAL SQ SIMPLE	$497.00	$710.00	$425.26	63% above	30%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION/REMOVAL FB SIMPLE	$200.00	$200.00	$425.26	—	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 FB INCS & REM SQ; SIMPLE	$229.60	$328.00	$425.26	—	30%
Removal of a foreign object under the skin, simple inpatient CPT 10120 ED FB REMOVAL SQ SIMPLE	$497.00	$710.00	$425.26	—	30%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLONOSCOPY SCREENING LOW RISK	$725.00	$725.00	$972.85	5% below	—
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CA SCREENING NON HIGH RISK INDV	$3,195.50	$4,565.00	$972.85	318% above	30%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY SCR HIGH RISK	$725.00	$725.00	$972.85	4% below	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLON CA SCREENING HIGH RISK INDV	$3,236.10	$4,623.00	$972.85	329% above	30%
Shock-wave lithotripsy to break up kidney stones (from outside the body) one side CPT 50590 LITHOTRIPSY UNILATERAL	$6,286.00	$8,980.00	$3,687.56	35% below	30%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient one side CPT 50590 LITHOTRIPSY UNILATERAL	$6,286.00	$8,980.00	$3,687.56	—	30%
Short arm cast (elbow to hand) CPT 29075 CAST APPL, SHORT ARM, ELBOW-FINGER	$152.60	$218.00	$292.59	36% below	30%
Short arm cast (elbow to hand) CPT 29075 CL-APPL CAST ELBOW FINGER SHORT ARM	$165.00	$165.00	$292.59	31% below	—
Short arm cast (elbow to hand) CPT 29075 ED CAST APPL SHORT ARM ELBOW-FINGER	$357.00	$510.00	$292.59	49% above	30%
Short arm cast (elbow to hand) inpatient CPT 29075 CAST APPL, SHORT ARM, ELBOW-FINGER	$152.60	$218.00	$292.59	—	30%
Short arm cast (elbow to hand) inpatient CPT 29075 CL-APPL CAST ELBOW FINGER SHORT ARM	$165.00	$165.00	$292.59	—	—
Short arm cast (elbow to hand) inpatient CPT 29075 ED CAST APPL SHORT ARM ELBOW-FINGER	$357.00	$510.00	$292.59	—	30%
Short arm splint (forearm and hand) CPT 29125 CL-APPL SHORT ARM SPLINT STATIC	$95.00	$95.00	$139.18	36% below	—
Short arm splint (forearm and hand) CPT 29125 SPLINT APPL, SHORT ARM, STATIC	$105.00	$150.00	$139.18	29% below	30%
Short arm splint (forearm and hand) CPT 29125 ED SPLINT APPL SHORT ARM STATIC	$171.50	$245.00	$139.18	16% above	30%
Short arm splint (forearm and hand) inpatient CPT 29125 CL-APPL SHORT ARM SPLINT STATIC	$95.00	$95.00	$139.18	—	—
Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT APPL, SHORT ARM, STATIC	$105.00	$150.00	$139.18	—	30%
Short arm splint (forearm and hand) inpatient CPT 29125 ED SPLINT APPL SHORT ARM STATIC	$171.50	$245.00	$139.18	—	30%
Short leg cast (below the knee) CPT 29405 CL-APPL SHORT LEG CAST BELOW KNEE-TOE	$120.00	$120.00	$292.59	57% below	—
Short leg cast (below the knee) CPT 29405 CAST APPL, SHORT LEG, BELOW KNEES-TOES	$166.60	$238.00	$292.59	41% below	30%
Short leg cast (below the knee) CPT 29405 ED CAST APPL SHORT LEG BELOW KNEE-TOES	$357.00	$510.00	$292.59	27% above	30%
Short leg cast (below the knee) inpatient CPT 29405 CL-APPL SHORT LEG CAST BELOW KNEE-TOE	$120.00	$120.00	$292.59	—	—
Short leg cast (below the knee) inpatient CPT 29405 CAST APPL, SHORT LEG, BELOW KNEES-TOES	$166.60	$238.00	$292.59	—	30%
Short leg cast (below the knee) inpatient CPT 29405 ED CAST APPL SHORT LEG BELOW KNEE-TOES	$357.00	$510.00	$292.59	—	30%
Short leg splint (calf to foot) CPT 29515 CL-SHORT LEG SPLINT APPLICATION	$105.00	$105.00	$170.00	36% below	—
Short leg splint (calf to foot) CPT 29515 SPLINT APPL, SHORT LEG, CALF-FOOT	$127.40	$182.00	$170.00	23% below	30%
Short leg splint (calf to foot) CPT 29515 ED SPLINT APPL SHORT LEG CALF-FOOT	$210.00	$300.00	$170.00	27% above	30%
Short leg splint (calf to foot) inpatient CPT 29515 CL-SHORT LEG SPLINT APPLICATION	$105.00	$105.00	$170.00	—	—
Short leg splint (calf to foot) inpatient CPT 29515 SPLINT APPL, SHORT LEG, CALF-FOOT	$127.40	$182.00	$170.00	—	30%
Short leg splint (calf to foot) inpatient CPT 29515 ED SPLINT APPL SHORT LEG CALF-FOOT	$210.00	$300.00	$170.00	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HSPTLST INPT RPR <2.5CM SCLP/NK/TR/EXT	$147.00	$210.00	$209.90	34% below	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HSPTLST OBSV RPR <2.5CM SCLP/NK/TR/EXT	$147.00	$210.00	$209.90	34% below	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REP SIM SCLP/NK/AX/GEN/TR/EXT 2.5CM/<	$225.00	$225.00	$209.90	2% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR SIM <2.5CM SCALP/NECK/TRUNK/EXTRM	$266.00	$380.00	$209.90	20% above	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ED RPR SIM <2.5CM SCLP/NCK/TRNK/EXTR	$273.00	$390.00	$209.90	23% above	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HSPTLST INPT RPR <2.5CM SCLP/NK/TR/EXT	$147.00	$210.00	$209.90	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HSPTLST OBSV RPR <2.5CM SCLP/NK/TR/EXT	$147.00	$210.00	$209.90	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REP SIM SCLP/NK/AX/GEN/TR/EXT 2.5CM/<	$225.00	$225.00	$209.90	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR SIM <2.5CM SCALP/NECK/TRUNK/EXTRM	$266.00	$380.00	$209.90	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 ED RPR SIM <2.5CM SCLP/NCK/TRNK/EXTR	$273.00	$390.00	$209.90	—	30%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY,SKIN SINGLE LESIO CPT-11104	$155.00	$155.00	$425.26	41% below	—
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY,SKIN SINGLE LESIO CPT-11104	$155.00	$155.00	$425.26	—	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC MALG LES TRNK/ARM/LG 0.5 CM/<	$210.00	$210.00	$740.80	39% below	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC MALG LES TRNK/ARM/LG 0.5 CM/<	$210.00	$210.00	$740.80	—	—
Skin tag removal, up to 15 tags CPT 11200 REM/DESTR SKIN TAGS UP TO15 LESIONS	$130.00	$130.00	$209.90	12% below	—
Skin tag removal, up to 15 tags CPT 11200 REM SKIN TAG, MULT FIBRO TAGS, UP TO 15	$164.50	$235.00	$209.90	12% above	30%
Skin tag removal, up to 15 tags CPT 11200 SKIN TAG REMOVAL	$7,490.70	$10,701.00	$209.90	4990% above	30%
Skin tag removal, up to 15 tags inpatient CPT 11200 REM/DESTR SKIN TAGS UP TO15 LESIONS	$130.00	$130.00	$209.90	—	—
Skin tag removal, up to 15 tags inpatient CPT 11200 REM SKIN TAG, MULT FIBRO TAGS, UP TO 15	$164.50	$235.00	$209.90	—	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LUMBAR BY CRNA	$173.60	$248.00	$738.44	66% below	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC	$200.90	$287.00	$738.44	60% below	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 CL-SPINAL PUNCTURE, LUMBAR, DX	$295.00	$295.00	$738.44	41% below	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 ED SPINAL PUNCTURE LUMBAR DIAG	$969.50	$1,385.00	$738.44	93% above	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE LUMBAR BY CRNA	$173.60	$248.00	$738.44	—	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC	$200.90	$287.00	$738.44	—	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 CL-SPINAL PUNCTURE, LUMBAR, DX	$295.00	$295.00	$738.44	—	—
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ED SPINAL PUNCTURE LUMBAR DIAG	$969.50	$1,385.00	$738.44	—	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REP SIM SCLP/NK/AX/GEN/TR/EXT 2.6-7.5CM	$265.00	$265.00	$209.90	8% below	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ED RPR SIM 2.6-7.5CM SCLP/NCK/TRNK/EXTR	$273.00	$390.00	$209.90	5% below	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR SIM 2.6-7.5CM SCALP/NECK/TRUNK/EXTRM	$295.40	$422.00	$209.90	2% above	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 REP SIM SCLP/NK/AX/GEN/TR/EXT 2.6-7.5CM	$265.00	$265.00	$209.90	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 ED RPR SIM 2.6-7.5CM SCLP/NCK/TRNK/EXTR	$273.00	$390.00	$209.90	—	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR SIM 2.6-7.5CM SCALP/NECK/TRUNK/EXTRM	$295.40	$422.00	$209.90	—	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REP SIM FACE EAR EYE NOSE LIP MM <= 2.5	$170.00	$170.00	$209.90	36% below	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR SIM <2.5CM FACE/EAR/MUCOUS MEMBRN	$270.90	$387.00	$209.90	2% above	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ED RPR SIM <2.5CM FACE/EAR/MM	$273.00	$390.00	$209.90	3% above	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REP SIM FACE EAR EYE NOSE LIP MM <= 2.5	$170.00	$170.00	$209.90	—	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR SIM <2.5CM FACE/EAR/MUCOUS MEMBRN	$270.90	$387.00	$209.90	—	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 ED RPR SIM <2.5CM FACE/EAR/MM	$273.00	$390.00	$209.90	—	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY OF SKIN CPT-11102	$125.00	$125.00	$425.26	35% below	—
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENTIAL BIOPSY OF SKIN CPT-11102	$125.00	$125.00	$425.26	—	—
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/IMAGING GUIDANCE	$256.90	$367.00	$656.24	71% below	30%
Thoracentesis with imaging guidance CPT 32555 HSPTLST THORACENTESIS WITH GUIDANCE	$576.10	$823.00	$656.24	36% below	30%
Thoracentesis with imaging guidance CPT 32555 CL-THORACENTESIS W/IMAGING	$815.00	$815.00	$656.24	9% below	—
Thoracentesis with imaging guidance CPT 32555 ED THORACENTESIS WITH IMAGING GUIDANCE	$976.50	$1,395.00	$656.24	9% above	30%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/IMAGING GUIDANCE	$256.90	$367.00	$656.24	—	30%
Thoracentesis with imaging guidance inpatient CPT 32555 HSPTLST THORACENTESIS WITH GUIDANCE	$576.10	$823.00	$656.24	—	30%
Thoracentesis with imaging guidance inpatient CPT 32555 CL-THORACENTESIS W/IMAGING	$815.00	$815.00	$656.24	—	—
Thoracentesis with imaging guidance inpatient CPT 32555 ED THORACENTESIS WITH IMAGING GUIDANCE	$976.50	$1,395.00	$656.24	—	30%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIG POINT(S) 1-2 MUSCLES	$93.80	$134.00	$321.12	54% below	30%
Trigger point injections, 1 or 2 muscles CPT 20552 CL-TRIGGER POINT INJECTION 1-2 MUSCLES	$120.00	$120.00	$321.12	41% below	—
Trigger point injections, 1 or 2 muscles CPT 20552 ED INJ TRIGGER POINT(S) 1-2 MUSCLES	$406.00	$580.00	$321.12	98% above	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIG POINT(S) 1-2 MUSCLES	$93.80	$134.00	$321.12	—	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 CL-TRIGGER POINT INJECTION 1-2 MUSCLES	$120.00	$120.00	$321.12	—	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ED INJ TRIGGER POINT(S) 1-2 MUSCLES	$406.00	$580.00	$321.12	—	30%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 CL-BIL TUBAL LAP W/FULGURATION OVIDUCTS	$1,280.00	$1,280.00	$6,324.37	44% below	—
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 CL-BIL TUBAL LAP W/FULGURATION OVIDUCTS	$1,280.00	$1,280.00	$6,324.37	—	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 CL-BX BREAST W/ULTRASOUND 1ST LESION	$765.00	$765.00	$1,727.77	57% below	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 CL-BX BREAST W/ULTRASOUND 1ST LESION	$765.00	$765.00	$1,727.77	—	—
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD WITH BALOON DILATION LESS 30MM	$955.00	$955.00	$2,007.41	61% below	—
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 EGD WITH BALOON DILATION LESS 30MM	$955.00	$955.00	$2,007.41	—	—
Upper endoscopy (EGD) with biopsy CPT 43239 EGD W/BX	$835.00	$835.00	$948.82	51% below	—
Upper endoscopy (EGD) with biopsy CPT 43239 EGD	$3,453.80	$4,934.00	$948.82	103% above	30%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD W/BX	$835.00	$835.00	$948.82	—	—
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD W/REMOVAL POLPY (S) LESION	$925.00	$925.00	$2,007.41	53% below	—
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD W/REMOVAL POLPY (S) LESION	$925.00	$925.00	$2,007.41	—	—
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 CL-EGD W/WIRE DILATION	$610.00	$610.00	$948.82	47% below	—
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 CL-EGD W/WIRE DILATION	$610.00	$610.00	$948.82	—	—
Upper endoscopy (EGD), diagnostic CPT 43235 EGD INCLUDING ESPHOG. AND STOMACH	$725.00	$725.00	$948.82	33% below	—
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD INCLUDING ESPHOG. AND STOMACH	$725.00	$725.00	$948.82	—	—
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 CL-VASECTOMY	$820.00	$820.00	$2,186.80	2% below	—
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 CL-VASECTOMY	$820.00	$820.00	$2,186.80	—	—
Wart removal, up to 14 warts CPT 17110 DESTRUCTION/CRYO BEN LES UP TO 14 LES	$115.00	$115.00	$209.90	27% below	—
Wart removal, up to 14 warts CPT 17110 DESTR/CRYO, BENIGN LESIONS, UP TO 14	$163.10	$233.00	$209.90	3% above	30%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION/CRYO BEN LES UP TO 14 LES	$115.00	$115.00	$209.90	—	—
Wart removal, up to 14 warts inpatient CPT 17110 DESTR/CRYO, BENIGN LESIONS, UP TO 14	$163.10	$233.00	$209.90	—	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRID SKIN & SQ TISSUE	$137.90	$197.00	$425.26	64% below	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SKIN AND SUBQ TISSUE 1ST 20 SQ CM	$330.00	$330.00	$425.26	14% below	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 ED DEBRID SKIN/SQ TISSUE	$497.00	$710.00	$425.26	29% above	30%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRID SKIN & SQ TISSUE	$137.90	$197.00	$425.26	—	30%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DBRDMT SKIN AND SUBQ TISSUE 1ST 20 SQ CM	$330.00	$330.00	$425.26	—	—
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 ED DEBRID SKIN/SQ TISSUE	$497.00	$710.00	$425.26	—	30%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM COLLECTION BY STERILE TRAP	$19.08	$27.25	$229.08	88% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM COLLECTION	$19.08	$27.25	$229.08	88% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 BREATHING TX FOR DUONEB/ALBUTEROL W/NEB	$40.00	$40.00	$229.08	75% below	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 OXYGEN W/COOL AEROSOL SUBSQ HOUR	$43.93	$62.75	$229.08	72% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 OXYGEN W/HEATED AEROSOL SUBSQ HOUR	$43.93	$62.75	$229.08	72% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 OXYGEN W/COOL AEROSOL INITIAL HOUR	$45.50	$65.00	$229.08	71% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 OXYGEN W/HEATED AEROSOL INITIAL HOUR	$45.50	$65.00	$229.08	71% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI THERAPY SUBSEQUENT	$88.55	$126.50	$229.08	44% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER THERAPY SUBSEQUENT	$88.55	$126.50	$229.08	44% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI THERAPY INITIAL	$176.05	$251.50	$229.08	11% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER THERAPY INITIAL	$176.05	$251.50	$229.08	11% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM COLLECTION	$19.08	$27.25	$229.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM COLLECTION BY STERILE TRAP	$19.08	$27.25	$229.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 OXYGEN W/COOL AEROSOL SUBSQ HOUR	$43.93	$62.75	$229.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 OXYGEN W/HEATED AEROSOL SUBSQ HOUR	$43.93	$62.75	$229.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 OXYGEN W/HEATED AEROSOL INITIAL HOUR	$45.50	$65.00	$229.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 OXYGEN W/COOL AEROSOL INITIAL HOUR	$45.50	$65.00	$229.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI THERAPY SUBSEQUENT	$88.55	$126.50	$229.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER THERAPY SUBSEQUENT	$88.55	$126.50	$229.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI THERAPY INITIAL	$176.05	$251.50	$229.08	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER THERAPY INITIAL	$176.05	$251.50	$229.08	—	30%
Chemotherapy IV infusion, first hour CPT 96413 ED INF THER INITIAL-BRM/MA DRUG 1ST HR	$353.50	$505.00	$345.54	18% below	30%
Chemotherapy IV infusion, first hour CPT 96413 OP INF THER INITIAL-BRM/MA DRUG 1ST HR	$353.50	$505.00	$345.54	18% below	30%
Chemotherapy IV infusion, first hour inpatient CPT 96413 ED INF THER INITIAL-BRM/MA DRUG 1ST HR	$353.50	$505.00	$345.54	—	30%
Chemotherapy IV infusion, first hour inpatient CPT 96413 OP INF THER INITIAL-BRM/MA DRUG 1ST HR	$353.50	$505.00	$345.54	—	30%
Critical care, first 30 to 74 minutes CPT 99291 HSPTLST CRITICAL CARE 30-74 MIN	$374.50	$535.00	$864.12	72% below	30%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE E&M 30-74 MINUTES	$565.00	$565.00	$864.12	58% below	—
Critical care, first 30 to 74 minutes CPT 99291 ED CRITICAL CARE E&M	$1,032.50	$1,475.00	$864.12	23% below	30%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE E&M 1ST 30-74 MIN	$1,094.10	$1,563.00	$864.12	19% below	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HSPTLST CRITICAL CARE 30-74 MIN	$374.50	$535.00	$864.12	—	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE E&M 30-74 MINUTES	$565.00	$565.00	$864.12	—	—
Critical care, first 30 to 74 minutes inpatient CPT 99291 ED CRITICAL CARE E&M	$1,032.50	$1,475.00	$864.12	—	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE E&M 1ST 30-74 MIN	$1,094.10	$1,563.00	$864.12	—	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG W/O INTERPRETATION	$55.00	$55.00	$61.72	71% below	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING ONLY	$107.10	$153.00	$61.72	44% below	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 RHC EKG TRACING ONLY	$107.10	$153.00	$61.72	44% below	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING ONLY	$107.10	$153.00	$61.72	—	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED SERV I MINOR	$108.50	$155.00	$88.22	22% below	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 CL-EMERGENCY DEPT E&M LIMITED	$130.00	$130.00	$88.22	7% below	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 CL-EMERGENCY DEPT E&M LIMITED	$130.00	$130.00	$88.22	7% below	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER PRO FEE I MINOR	$175.00	$250.00	$88.22	25% above	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED SERV I MINOR	$108.50	$155.00	$88.22	—	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 CL-EMERGENCY DEPT E&M LIMITED	$130.00	$130.00	$88.22	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER PRO FEE I MINOR	$175.00	$250.00	$88.22	—	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 CRNA CONSULT ER PT STRTFORWARD	$44.80	$64.00	$160.62	81% below	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 CL-EMERGENCY DEPT E&M LOW SEVERITY	$170.00	$170.00	$160.62	28% below	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 CL-EMERGENCY DEPT E&M LOW SEVERITY	$170.00	$170.00	$160.62	28% below	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED SERV II INTER	$199.50	$285.00	$160.62	16% below	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER PRO FEE II INTER	$245.00	$350.00	$160.62	3% above	30%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 CRNA CONSULT ER PT STRTFORWARD	$44.80	$64.00	$160.62	—	30%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 CL-EMERGENCY DEPT E&M LOW SEVERITY	$170.00	$170.00	$160.62	—	—
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED SERV II INTER	$199.50	$285.00	$160.62	—	30%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER PRO FEE II INTER	$245.00	$350.00	$160.62	—	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 CRNA CONSULT ER PT LOW	$77.70	$111.00	$285.57	82% below	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HSPTLST EMERGENCY ROOM E&M LOW	$168.00	$240.00	$285.57	62% below	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 CL-EMERGENCY DEPT E&M MODERATE SEVERITY	$255.00	$255.00	$285.57	42% below	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 CL-EMERGENCY DEPT E&M MODERATE SEVERITY	$255.00	$255.00	$285.57	42% below	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED SERV III URGENT	$350.00	$500.00	$285.57	20% below	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER PRO FEE III URGNT	$375.20	$536.00	$285.57	14% below	30%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 CRNA CONSULT ER PT LOW	$77.70	$111.00	$285.57	—	30%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HSPTLST EMERGENCY ROOM E&M LOW	$168.00	$240.00	$285.57	—	30%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 CL-EMERGENCY DEPT E&M MODERATE SEVERITY	$255.00	$255.00	$285.57	—	—
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED SERV III URGENT	$350.00	$500.00	$285.57	—	30%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER PRO FEE III URGNT	$375.20	$536.00	$285.57	—	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HSPTLST EMERGENCY ROOM E&M MOD	$248.50	$355.00	$436.51	63% below	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 CL-EMERGENCY DEPT E&M HIGH SEVERITY	$375.00	$375.00	$436.51	44% below	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 CL-EMERGENCY DEPT E&M HIGH SEVERITY	$375.00	$375.00	$436.51	44% below	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED SERV IV INTENS	$546.00	$780.00	$436.51	19% below	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER PRO FEE IV INTENS	$595.00	$850.00	$436.51	11% below	30%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HSPTLST EMERGENCY ROOM E&M MOD	$248.50	$355.00	$436.51	—	30%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 CL-EMERGENCY DEPT E&M HIGH SEVERITY	$375.00	$375.00	$436.51	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED SERV IV INTENS	$546.00	$780.00	$436.51	—	30%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER PRO FEE IV INTENS	$595.00	$850.00	$436.51	—	30%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 CL-EMERGENCY DEPT E&M HIGH/IMMEDIATE	$555.00	$555.00	$623.00	48% below	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 CL-EMERGENCY DEPT E&M HIGH/IMMEDIATE	$555.00	$555.00	$623.00	48% below	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED SERV V MAJOR	$784.00	$1,120.00	$623.00	26% below	30%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER PRO FEE V MAJOR	$1,012.90	$1,447.00	$623.00	4% below	30%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 CL-EMERGENCY DEPT E&M HIGH/IMMEDIATE	$555.00	$555.00	$623.00	—	—
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED SERV V MAJOR	$784.00	$1,120.00	$623.00	—	30%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER PRO FEE V MAJOR	$1,012.90	$1,447.00	$623.00	—	30%
Exercise stress test, tracing only, the hospital charge CPT 93017 NUCLEAR STRESS 93017	$630.00	$900.00	$225.89	23% below	30%
Exercise stress test, tracing only, the hospital charge CPT 93017 EXERCISE STRESS 93017	$630.00	$900.00	$225.89	23% below	30%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 NUCLEAR STRESS 93017	$630.00	$900.00	$225.89	—	30%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 EXERCISE STRESS 93017	$630.00	$900.00	$225.89	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 CL-IV INF HYDRATION INITIAL 31MIN-1HR	$85.00	$85.00	$222.52	66% below	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OP INFSN HYDR INITIAL 31 MIN TO 1 HR	$255.50	$365.00	$222.52	3% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ED INFSN HYDR INITIAL 31 MIN TO 1 HR	$287.00	$410.00	$222.52	16% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 OP INFSN HYDR INITIAL 31 MIN TO 1 HR	$255.50	$365.00	$222.52	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ED INFSN HYDR INITIAL 31 MIN TO 1 HR	$287.00	$410.00	$222.52	—	30%
IV infusion of a medicine, first hour CPT 96365 OP INFSN THER INITIAL UP TO ONE HR	$255.50	$365.00	$222.52	16% below	30%
IV infusion of a medicine, first hour CPT 96365 ED INFSN THER INITIAL UP TO 1 HR	$287.00	$410.00	$222.52	5% below	30%
IV infusion of a medicine, first hour inpatient CPT 96365 OP INFSN THER INITIAL UP TO ONE HR	$255.50	$365.00	$222.52	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 ED INFSN THER INITIAL UP TO 1 HR	$287.00	$410.00	$222.52	—	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 CL-ADMINISTRATION INJECTION	$35.00	$35.00	$75.32	64% below	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 OP THER/PRO/DIAG INJ SQ/IM EACH INJ	$56.00	$80.00	$75.32	42% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ED THER/PRO/DIAG INJ SQ/IM EACH INJ	$94.50	$135.00	$75.32	3% below	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 OP THER/PRO/DIAG INJ SQ/IM EACH INJ	$56.00	$80.00	$75.32	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ED THER/PRO/DIAG INJ SQ/IM EACH INJ	$94.50	$135.00	$75.32	—	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 DIET MNT INITIAL (15 MIN)	$24.50	$35.00	$30.10	44% below	30%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 TOBACCO USE CESSATION INTERMEDIATE 3-10	$50.00	$50.00	$39.19	126% above	—
Spirometry (breathing test) CPT 94010 SPIROMETRY	$100.00	$100.00	$225.89	53% below	—
Spirometry (breathing test) CPT 94010 BEDSIDE PFT	$126.70	$181.00	$225.89	41% below	30%
Spirometry (breathing test) CPT 94010 SMI (SPIROMETRY) TREATMENT	$126.70	$181.00	$225.89	41% below	30%
Spirometry (breathing test) CPT 94010 PFT COMPLETE	$195.13	$278.75	$225.89	9% below	30%
Spirometry (breathing test) CPT 94010 PFT PRE & POST/DISABILITY	$195.13	$278.75	$225.89	9% below	30%
Spirometry (breathing test) CPT 94010 PFT SCREEN	$241.50	$345.00	$225.89	12% above	30%
Spirometry (breathing test) CPT 94010 PFT COMPLETE WITH INTERP	$241.50	$345.00	$225.89	12% above	30%
Spirometry (breathing test) inpatient CPT 94010 SMI (SPIROMETRY) TREATMENT	$126.70	$181.00	$225.89	—	30%
Spirometry (breathing test) inpatient CPT 94010 BEDSIDE PFT	$126.70	$181.00	$225.89	—	30%
Spirometry (breathing test) inpatient CPT 94010 PFT COMPLETE	$195.13	$278.75	$225.89	—	30%
Spirometry (breathing test) inpatient CPT 94010 PFT PRE & POST/DISABILITY	$195.13	$278.75	$225.89	—	30%
Spirometry (breathing test) inpatient CPT 94010 PFT COMPLETE WITH INTERP	$241.50	$345.00	$225.89	—	30%
Spirometry (breathing test) inpatient CPT 94010 PFT SCREEN	$241.50	$345.00	$225.89	—	30%
Spirometry before and after a bronchodilator CPT 94060 zz BRONCHOSPASM EVAL	$221.90	$317.00	$390.37	51% below	30%
Spirometry before and after a bronchodilator inpatient CPT 94060 zz BRONCHOSPASM EVAL	$221.90	$317.00	$390.37	—	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 CL-PHLEBOTOMY THERAPEUTIC	$95.00	$95.00	$139.18	49% below	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 CL-PHLEBOTOMY THERAPEUTIC	$95.00	$95.00	$139.18	49% below	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUT	$142.87	$204.10	$139.18	24% below	30%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 CL-PHLEBOTOMY THERAPEUTIC	$95.00	$95.00	$139.18	—	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUT	$142.87	$204.10	$139.18	—	30%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 CL-FLULAVAL .5ML	$25.00	$25.00	$19.37	58% below	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 CL-FLUARIX TRIVALENT 0.5ML GLXOSMTHKL	$25.00	$25.00	$19.37	58% below	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUARIX 0.5ML INJ	$43.44	$62.06	$19.37	27% below	30%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUARIX 0.5ML INJ	$43.44	$62.06	$19.37	—	30%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HIBERIX 0.5ML INJ	$24.94	$35.63	$119.87	87% below	30%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 CL-PNEUMOVAX23	$110.00	$110.00	$119.87	41% below	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOVAX-23 0.5ML INJ [PPV23]	$196.70	$281.00	$119.87	6% above	30%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 MENVEO 0.5ML INJ	$235.00	$335.72	$119.87	26% above	30%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HIBERIX 0.5ML INJ	$24.94	$35.63	$119.87	—	30%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOVAX-23 0.5ML INJ [PPV23]	$196.70	$281.00	$119.87	—	30%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 MENVEO 0.5ML INJ	$235.00	$335.72	$119.87	—	30%
Rabies vaccine, one dose CPT 90675 RABAVERT 2.5U/1ML INJ	$730.14	$1,043.06	$329.23	16% below	30%
Rabies vaccine, one dose inpatient CPT 90675 RABAVERT 2.5U/1ML INJ	$730.14	$1,043.06	$329.23	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 CL-IMMUNIZATION ADMIN 1ST ADULT OVER 18	$30.00	$30.00	$75.32	49% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 OP IMMUN ADMIN SINGLE/FIRST	$56.00	$80.00	$75.32	5% below	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED IMMUN ADMIN SINGLE/FIRST	$94.50	$135.00	$75.32	60% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 OP IMMUN ADMIN SINGLE/FIRST	$56.00	$80.00	$75.32	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED IMMUN ADMIN SINGLE/FIRST	$94.50	$135.00	$75.32	—	30%

Source file: https://www.tcmh.org/wp-content/uploads/2026/07/430887928_texas-county-memorial-hospital_standardcharges.csv