Scotland County Memorial Hospital
Scotland County Memorial Hospital in Memphis, MO publishes cash prices for 306 common procedures listed here, from its own machine-readable price file updated Oct 24, 2025. Compared with other hospitals in the state, its outpatient cash prices are below the Missouri median for 179 of 305 procedures and above it for 123. By typical cash price it ranks #18 of 61 Missouri hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
450 East Sigler, Memphis, MO 63555 Collected Sep 28, 2026 Source price file (660) 465-8511
Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 2 of 5 CCN 261310 · CMS hospital register
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Missouri | Off list |
|---|---|---|---|---|---|
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTRMITY ART 2 LEVELS-OFC | $175.00 | $250.00 | $62.50–$212.50 | 48% below | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTRMITY ART 2 LEVEL-VASC | $238.00 | $340.00 | $85.00–$289.00 | 30% below | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 EXTRACRANIAL BILAT STUDY-VASC | $615.30 | $879.00 | $219.75–$747.15 | — | 30% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 DUPLEX SCAN LOWER EXT COMP BIL | $655.20 | $936.00 | $234.00–$795.60 | 11% below | 30% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VENOUS DOPPLER LE BILATERAL | $514.50 | $735.00 | $183.75–$624.75 | — | 30% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 B US VENOUS DOPPLER UE BILATERAL | $514.50 | $735.00 | $183.75–$624.75 | — | 30% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY VEINS BIL STUDY-OFC | $388.50 | $555.00 | $138.75–$471.75 | 51% below | 30% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER COMPLETE | $2,175.60 | $3,108.00 | $777.00–$2,641.80 | 26% above | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY VEINS UNI/LIMIT-OFC | $252.00 | $360.00 | $90.00–$306.00 | 56% below | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 R US VENOUS DOPPLER LE RIGHT | $514.50 | $735.00 | $183.75–$624.75 | 10% below | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 L US VENOUS DOPPLER LE LEFT | $514.50 | $735.00 | $183.75–$624.75 | 10% below | 30% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Missouri | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT) | $59.50 | $85.00 | $1.30–$6.89 | 20% above | 30% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT) | $60.20 | $86.00 | $1.30–$6.73 | 29% above | 30% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $245.00 | $350.00 | $1.30–$61.92 | 4% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Specific Allergy Testing | $16.10 | $23.00 | $1.30–$6.79 | 27% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALPHA GAL | $67.90 | $97.00 | $1.30–$6.79 | 209% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 RESP ALLERGY PANEL | $203.70 | $291.00 | $1.30–$6.79 | 827% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CHILDHOOD & TREE NUT ALLER PNL | $203.70 | $291.00 | $1.30–$6.79 | 827% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 FOOD & TREE NUT ALLER PNL | $203.70 | $291.00 | $1.30–$6.79 | 827% above | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY | $70.00 | $100.00 | $1.30–$16.84 | 11% below | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA | $72.10 | $103.00 | $1.30–$15.72 | 3% above | 30% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP | $352.80 | $504.00 | $1.30–$51.04 | 185% above | 30% |
| Basic metabolic panel (blood test) CPT 80048 BMP | $121.80 | $174.00 | $1.30–$11.00 | 1% below | 30% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA | $154.70 | $221.00 | $1.30–$13.42 | 34% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE | $18.20 | $26.00 | $6.50–$22.10 | 8% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE-LAB | $18.20 | $26.00 | $6.50–$22.10 | 8% above | 30% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE | $49.70 | $71.00 | $1.30–$5.11 | 46% above | 30% |
| Blood lead test CPT 83655 LEAD | $51.80 | $74.00 | $1.30–$15.74 | 5% below | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG (QUALITATIVE) SERUM ROUTIN | $101.50 | $145.00 | $1.30–$9.78 | 90% above | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO | $39.90 | $57.00 | $1.30–$120.88 | 41% below | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $79.10 | $113.00 | $1.30–$6.73 | 33% above | 30% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED PROBE | $161.70 | $231.00 | $1.30–$48.45 | 15% above | 30% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR CA 19-9 | $71.40 | $102.00 | $1.30–$27.05 | 32% below | 30% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125 | $72.80 | $104.00 | $1.30–$27.05 | 31% below | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB | $262.15 | $374.50 | $1.30–$66.70 | 142% above | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE | $48.30 | $69.00 | $1.30–$45.62 | 46% below | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $193.20 | $276.00 | $1.30–$17.41 | 86% above | 30% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $189.00 | $270.00 | $1.30–$10.10 | 242% above | 30% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED | $74.20 | $106.00 | $1.30–$8.41 | 39% above | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL | $135.80 | $194.00 | $1.30–$13.73 | 7% above | 30% |
| D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION QUANT | $249.20 | $356.00 | $1.30–$13.23 | 94% above | 30% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE SULFATE | $79.10 | $113.00 | $1.30–$28.90 | 42% below | 30% |
| Estradiol blood test CPT 82670 TOTAL ESTRADIOL | $85.40 | $122.00 | $1.30–$36.32 | 40% below | 30% |
| FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN (FSH) | $70.70 | $101.00 | $1.30–$24.15 | 31% below | 30% |
| Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL | $280.97 | $401.38 | $1.30–$25.52 | 51% above | 30% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $145.60 | $208.00 | $1.30–$17.72 | 71% above | 30% |
| Folate (folic acid) blood test CPT 82746 FOLATE | $143.50 | $205.00 | $1.30–$19.11 | 84% above | 30% |
| Free T3 thyroid hormone test CPT 84481 FREE T3 | $124.60 | $178.00 | $1.30–$22.02 | 23% above | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 | $112.70 | $161.00 | $1.30–$11.73 | 46% above | 30% |
| Free testosterone test CPT 84402 FREE TESTOSTERONE | $67.20 | $96.00 | $1.30–$33.11 | 45% below | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TEST | $83.30 | $119.00 | $1.30–$6.18 | 96% above | 30% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT) | $140.00 | $200.00 | $1.30–$16.73 | 54% above | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA AMP PROB | $48.30 | $69.00 | $1.30–$45.62 | 41% below | 30% |
| H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI ANTIBODY | $121.80 | $174.00 | $1.30–$21.91 | 60% above | 30% |
| H. pylori stool antigen test CPT 87338 HPYLORI STOOL AG IA | $252.00 | $360.00 | $1.30–$18.69 | 108% above | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ | $434.00 | $620.00 | $1.30–$110.63 | 24% above | 30% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 1 RESULT ANTBDY | $25.90 | $37.00 | $1.30–$17.82 | 77% below | 30% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA | $148.75 | $212.50 | $1.30–$31.30 | 77% above | 30% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH-RISK TYPES | $152.95 | $218.50 | $1.30–$45.62 | 36% above | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $99.40 | $142.00 | $1.30–$12.62 | 61% above | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY | $65.10 | $93.00 | $1.30–$13.96 | 5% below | 30% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA | $35.00 | $50.00 | $1.30–$13.43 | 45% below | 30% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB TEST | $77.70 | $111.00 | $1.30–$18.55 | 6% below | 30% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ | $530.01 | $757.15 | $1.30–$55.69 | 78% above | 30% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 TEST | $51.10 | $73.00 | $1.30–$17.15 | 20% below | 30% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST | $46.20 | $66.00 | $1.30–$25.16 | 24% below | 30% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS | $105.00 | $150.00 | $1.30–$16.84 | 47% above | 30% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE | $233.10 | $333.00 | $1.30–$23.30 | 113% above | 30% |
| Insulin blood test CPT 83525 INSULIN TOTAL | $98.70 | $141.00 | $1.30–$14.86 | 66% above | 30% |
| Iron blood test (serum iron) CPT 83540 IRON | $81.90 | $117.00 | $1.30–$8.41 | 77% above | 30% |
| Iron-binding capacity (TIBC) test CPT 83550 TIBC | $92.40 | $132.00 | $1.30–$11.36 | 36% above | 30% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $124.60 | $178.00 | $1.30–$11.28 | 16% above | 30% |
| LH (luteinizing hormone) test CPT 83002 LH | $70.00 | $100.00 | $1.30–$24.08 | 31% below | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE | $106.40 | $152.00 | $1.30–$8.96 | 65% above | 30% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $135.10 | $193.00 | $1.30–$10.62 | 1% above | 30% |
| Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY | $114.80 | $164.00 | $1.30–$22.14 | 24% above | 30% |
| Magnesium blood test CPT 83735 MAGNESIUM | $79.10 | $113.00 | $1.30–$8.71 | 66% above | 30% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY | $70.00 | $100.00 | $1.30–$16.74 | 17% above | 30% |
| Mono test (heterophile antibody, Monospot) CPT 86308 MONOSPOT TEST | $41.30 | $59.00 | $1.30–$6.73 | at median | 30% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $292.60 | $418.00 | $1.30–$62.15 | 6% below | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PSA FREE | $148.40 | $212.00 | $1.30–$23.91 | 91% above | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL | $148.40 | $212.00 | $1.30–$23.91 | 91% above | 30% |
| Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATH C/V AUTO FLUID REDO | $191.10 | $273.00 | $1.30–$34.59 | 151% above | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH C/V THIN LAYER | $86.45 | $123.50 | $1.30–$26.34 | 10% above | 30% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE (PTH) | $65.10 | $93.00 | $1.30–$53.66 | 62% below | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $112.00 | $160.00 | $1.30–$7.81 | 102% above | 30% |
| Progesterone blood test CPT 84144 PROGESTERONE | $53.90 | $77.00 | $1.30–$27.12 | 51% below | 30% |
| Prolactin blood test CPT 84146 PROLACTIN | $31.50 | $45.00 | $1.30–$25.19 | 73% below | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $53.90 | $77.00 | $1.30–$5.58 | 89% above | 30% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRSMV DIR OPT OBS | $105.00 | $150.00 | $1.30–$16.38 | 54% above | 30% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/OPTIC | $66.50 | $95.00 | $1.30–$21.52 | 10% above | 30% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ASSAY W/OPTIC | $58.10 | $83.00 | $1.30–$21.49 | 38% above | 30% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT | $49.00 | $70.00 | $1.30–$7.37 | 5% above | 30% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY | $16.10 | $23.00 | $1.30–$18.71 | 69% below | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE AUTOMATED | $18.20 | $26.00 | $1.30–$3.51 | 45% below | 30% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANAL VOL/COUNT/MOT | $301.00 | $430.00 | $1.30–$16.00 | 125% above | 30% |
| Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS | $31.50 | $45.00 | $1.30–$11.57 | 44% below | 30% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECES | $84.00 | $120.00 | $1.30–$5.69 | 287% above | 30% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 ASSAY TEST FOR BLOOD FECAL | $59.50 | $85.00 | $1.30–$20.70 | 17% above | 30% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 ASSAY TEST FOR BLOOD FECAL CL | $67.20 | $96.00 | $1.30–$20.70 | 32% above | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP (RPR) | $28.00 | $40.00 | $1.30–$5.55 | at median | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUN MEASURE | $259.00 | $370.00 | $1.30–$80.57 | 36% above | 30% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TOTAL TESTOSTERONE | $28.00 | $40.00 | $1.30–$33.55 | 76% below | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB | $116.90 | $167.00 | $1.30–$18.92 | 52% above | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $154.00 | $220.00 | $1.30–$21.84 | 213% above | 30% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $261.63 | $373.75 | $1.30–$45.62 | 90% above | 30% |
| Uric acid blood test CPT 84550 URIC ACID | $56.70 | $81.00 | $1.30–$5.88 | 32% above | 30% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE | $53.90 | $77.00 | $1.30–$4.12 | 43% above | 30% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE | $45.50 | $65.00 | $1.30–$2.93 | 126% above | 30% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE | $16.10 | $23.00 | $1.30–$4.52 | 14% above | 30% |
| Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE QUANTITATIVE | $106.40 | $152.00 | $1.30–$10.49 | 60% above | 30% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST | $58.10 | $83.00 | $1.30–$11.19 | 15% above | 30% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 | $25.20 | $36.00 | $1.30–$19.60 | 67% below | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY | $145.60 | $208.00 | $1.30–$38.48 | 3% above | 30% |
| Zinc blood test CPT 84630 ZINC | $36.40 | $52.00 | $1.30–$14.81 | 40% below | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST | $143.50 | $205.00 | $1.30–$19.57 | 68% above | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Missouri | Off list |
|---|---|---|---|---|---|
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 ADENOIDECTOMY LESS 12 YRS | $249.90 | $357.00 | $89.25–$303.45 | 93% below | 30% |
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 REMOVAL OF ADENOIDS | $458.50 | $655.00 | $163.75–$556.75 | 88% below | 30% |
| Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 APPENDECTOMY FOR RUPTURED-OFC | $1,361.50 | $1,945.00 | $486.25–$1,653.25 | 8% below | 30% |
| Appendectomy, open surgery CPT 44950 APPENDECTOMY | $766.50 | $1,095.00 | $273.75–$930.75 | 38% below | 30% |
| Appendectomy, open surgery CPT 44950 APPENDECTOMY-OFC | $1,127.00 | $1,610.00 | $402.50–$1,368.50 | 9% below | 30% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 ARTHRO ANT CRUC LIG RPR | $2,415.00 | $3,450.00 | $862.50–$2,932.50 | 88% below | 30% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 ARTHRO ANT CRUC LIG RPR-OFC | $2,555.00 | $3,650.00 | $912.50–$3,102.50 | 87% below | 30% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHRO ROTATOR CUFF REPAIR | $2,552.90 | $3,647.00 | $911.75–$3,099.95 | 79% below | 30% |
| Botox injections for chronic migraine CPT 64615 TMJ PROCEDURE | $990.50 | $1,415.00 | $353.75–$1,202.75 | 259% above | 30% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT ANKLE FRACTURE-ER | $169.40 | $242.00 | $60.50–$205.70 | 66% below | 30% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT ANKLE FRACTURE-OFC | $444.50 | $635.00 | $158.75–$539.75 | 11% below | 30% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE-ER | $151.20 | $216.00 | $54.00–$183.60 | 60% below | 30% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE-OFC | $332.50 | $475.00 | $118.75–$403.75 | 12% below | 30% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 CORRECT HALLUX VALGUS DIS MET | $2,065.00 | $2,950.00 | $737.50–$2,507.50 | 13% below | 30% |
| Bunion correction with removal of part of the big toe joint CPT 28292 BUNIONECTOMY | $799.40 | $1,142.00 | $285.50–$970.70 | 35% below | 30% |
| Bunion correction with removal of part of the big toe joint CPT 28292 CORRECTION HALLUX VALGUS-OFC | $1,484.00 | $2,120.00 | $530.00–$1,802.00 | 20% above | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERS ELECTRIC EXT ER | $136.50 | $195.00 | $48.75–$165.75 | 83% below | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERS ELECTRIC EXT CL | $290.50 | $415.00 | $103.75–$352.75 | 64% below | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERS ELECTRIC EXT OR | $454.30 | $649.00 | $162.25–$551.65 | 44% below | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERS ELECTRIC EXT CARDO | $1,050.00 | $1,500.00 | $375.00–$1,275.00 | 30% above | 30% |
| Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNELL RELEASE | $520.80 | $744.00 | $186.00–$632.40 | 85% below | 30% |
| Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURGERY CL | $966.00 | $1,380.00 | $345.00–$1,173.00 | 71% below | 30% |
| Cervical biopsy CPT 57500 BIOPSY OF CERVIX | $161.00 | $230.00 | $57.50–$195.50 | 84% below | 30% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 CESAREAN DEL W/ANTE&POST CARE | $2,628.50 | $3,755.00 | $938.75–$3,191.75 | 32% below | 30% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUM 28 DAYS OR OLDER CL | $465.50 | $665.00 | $166.25–$565.25 | 85% below | 30% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 SURGICAL CIRCUMCISION 28+DAYS | $485.80 | $694.00 | $173.50–$589.90 | 85% below | 30% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REG BLOCK CL | $304.50 | $435.00 | $108.75–$369.75 | 16% below | 30% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 NEWBORN CIRC CLAMP | $354.20 | $506.00 | $126.50–$430.10 | 2% below | 30% |
| Circumcision, surgical, older than a newborn CPT 54160 CIRC SURG EXC NEONAT<28 DA CL | $245.00 | $350.00 | $87.50–$297.50 | 53% below | 30% |
| Circumcision, surgical, older than a newborn CPT 54160 NEWBORN CIRC SURGICAL | $523.60 | $748.00 | $187.00–$635.80 | 1% above | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TREAT FRACTURE RADIUS/ULNA-ER | $233.80 | $334.00 | $83.50–$283.90 | 60% below | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TREAT FRACTURE RADIUS/ULNA-OFC | $441.00 | $630.00 | $157.50–$535.50 | 24% below | 30% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION SNARE-OFC | $805.00 | $1,150.00 | $287.50–$977.50 | 53% below | 30% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION SNARE-OR | $1,877.40 | $2,682.00 | $670.50–$2,279.70 | 10% above | 30% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY-OFC | $672.00 | $960.00 | $240.00–$816.00 | 62% below | 30% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY-OR | $1,676.50 | $2,395.00 | $598.75–$2,035.75 | 6% below | 30% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY-DIAG | $567.00 | $810.00 | $202.50–$688.50 | 55% below | 30% |
| Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY-OFC | $609.00 | $870.00 | $217.50–$739.50 | 52% below | 30% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 LEEP | $357.00 | $510.00 | $127.50–$433.50 | 83% below | 30% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX OF CERVIX LEEP-OFC | $570.50 | $815.00 | $203.75–$692.75 | 73% below | 30% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT CERVIX W/SCOPE-OFC | $252.00 | $360.00 | $90.00–$306.00 | 43% below | 30% |
| Complex cataract surgery with lens implant CPT 66982 CATARACT EXTRACTION | $855.40 | $1,222.00 | $305.50–$1,038.70 | 79% below | 30% |
| Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY AND TREATMENT | $913.50 | $1,305.00 | $326.25–$1,109.25 | 83% below | 30% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY-OFC | $280.00 | $400.00 | $100.00–$340.00 | 75% below | 30% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION & CURETTAGE | $347.20 | $496.00 | $124.00–$421.60 | 89% below | 30% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTAGE-OFC | $574.00 | $820.00 | $205.00–$697.00 | 81% below | 30% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION | $115.50 | $165.00 | $41.25–$140.25 | 1% below | 30% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM OPENING | $465.50 | $665.00 | $166.25–$565.25 | 86% below | 30% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMVE IMPACTED EAR WAX UNI-OFC | $28.00 | $40.00 | $10.00–$34.00 | 62% below | 30% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI-ER | $214.20 | $306.00 | $76.50–$260.10 | 194% above | 30% |
| Earwax removal with instruments, one ear CPT 69210 RMOVE IMPACTED EAR WAX UNI-OFC | $91.00 | $130.00 | $32.50–$110.50 | 2% below | 30% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI-ER | $100.80 | $144.00 | $36.00–$122.40 | 8% above | 30% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING | $164.50 | $235.00 | $58.75–$199.75 | 37% below | 30% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC | $294.70 | $421.00 | $105.25–$357.85 | 75% below | 30% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC-OFC | $560.00 | $800.00 | $200.00–$680.00 | 52% below | 30% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC-SPEC | $1,514.10 | $2,163.00 | $540.75–$1,838.55 | 31% above | 30% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PRVRT F JNT L/S 1 LEV-OR | $200.20 | $286.00 | $71.50–$243.10 | 81% below | 30% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PRVRT F JNT L/S 1 LEV-OFC | $602.00 | $860.00 | $215.00–$731.00 | 42% below | 30% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PRVRT F JNT L/S 1 LEV-SPEC | $1,818.60 | $2,598.00 | $649.50–$2,208.30 | 75% above | 30% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 RPR AA HRN 1ST 3-10 RDC-OR | $3,185.70 | $4,551.00 | $1,137.75–$3,868.35 | 54% below | 30% |
| First repair of a front abdominal hernia larger than 10 cm CPT 49595 RPR AA HRN 1ST > 10 RDC-OR | $4,282.60 | $6,118.00 | $1,529.50–$5,200.30 | 22% above | 30% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST < 3 CM RDC-OFC | $980.00 | $1,400.00 | $350.00–$1,190.00 | 81% below | 30% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST < 3 CM RDC-OR | $1,900.50 | $2,715.00 | $678.75–$2,307.75 | 64% below | 30% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY-OFC | $227.50 | $325.00 | $81.25–$276.25 | 80% below | 30% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY-OR | $504.00 | $720.00 | $180.00–$612.00 | 55% below | 30% |
| Gallbladder removal, laparoscopic CPT 47562 LAPROSCOPIC CHOLECYSTECTOMY | $787.50 | $1,125.00 | $281.25–$956.25 | 89% below | 30% |
| Gallbladder removal, laparoscopic CPT 47562 LAPARO CHOLECYSTECTOMY-OFC | $1,785.00 | $2,550.00 | $637.50–$2,167.50 | 74% below | 30% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPARO CHOLECYSTCTMY/GRAPH-OFC | $1,900.50 | $2,715.00 | $678.75–$2,307.75 | 74% below | 30% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 CHOLECYSTECTOMY | $1,275.40 | $1,822.00 | $455.50–$1,548.70 | 31% below | 30% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 REMOVAL OF GALLBLADDER | $1,582.00 | $2,260.00 | $565.00–$1,921.00 | 15% below | 30% |
| Hammertoe correction surgery CPT 28285 HAMMERTOE REPAIR | $616.70 | $881.00 | $220.25–$748.85 | 74% below | 30% |
| Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE-OFC | $1,001.00 | $1,430.00 | $357.50–$1,215.50 | 58% below | 30% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S) | $203.00 | $290.00 | $72.50–$246.50 | 85% below | 30% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 HEMORRHOIDECTOMY INT-LIGATION | $320.60 | $458.00 | $114.50–$389.30 | 76% below | 30% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVE INT/EXT HEM 1 GROUP | $822.50 | $1,175.00 | $293.75–$998.75 | 81% below | 30% |
| Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL ABD HYSTERECTOMY | $1,211.70 | $1,731.00 | $432.75–$1,471.35 | 92% below | 30% |
| Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL HYSTERECTOMY-OFC | $2,128.00 | $3,040.00 | $760.00–$2,584.00 | 85% below | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER HYSTEROGRAPHY CL | $339.50 | $485.00 | $121.25–$412.25 | 9% above | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER HYSTEROGRAPHY SPECSER | $390.60 | $558.00 | $139.50–$474.30 | 26% above | 30% |
| Hysteroscopy with endometrial ablation CPT 58563 HYSTEROSCOPY ABLATION-OFC | $1,792.00 | $2,560.00 | $640.00–$2,176.00 | 77% below | 30% |
| Hysteroscopy with endometrial ablation CPT 58563 HYSTERSCOPY/ABLATION | $2,272.90 | $3,247.00 | $811.75–$2,759.95 | 70% below | 30% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY BIOPSY-OFC | $822.50 | $1,175.00 | $293.75–$998.75 | 81% below | 30% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTERSCOPE W-W/O D&C | $1,443.40 | $2,062.00 | $515.50–$1,752.70 | 67% below | 30% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE | $154.00 | $220.00 | $55.00–$187.00 | 75% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS | $161.70 | $231.00 | $57.75–$196.35 | 29% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS-OFC | $178.50 | $255.00 | $63.75–$216.75 | 21% below | 30% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDUC >5 YR-OF | $994.00 | $1,420.00 | $355.00–$1,207.00 | 84% below | 30% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDUC >5 YR-OR | $2,627.80 | $3,754.00 | $938.50–$3,190.90 | 59% below | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT | $67.20 | $96.00 | $24.00–$81.60 | 66% below | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT-OFC | $87.50 | $125.00 | $31.25–$106.25 | 56% below | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT-ER | $140.00 | $200.00 | $50.00–$170.00 | 30% below | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JNT/BURSA W/O US-ER | $127.02 | $181.45 | $45.36–$154.23 | 41% below | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JNT/BURSA W/O US-OFC | $175.00 | $250.00 | $62.50–$212.50 | 19% below | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASP/INJ MAJOR JNT/BURSA | $284.20 | $406.00 | $101.50–$345.10 | 32% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JNT/BRSA W/O US-SPEC | $301.00 | $430.00 | $107.50–$365.50 | 40% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JNT/BURSA W/O US-OP | $493.50 | $705.00 | $176.25–$599.25 | 130% above | 30% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION DRUG DLVR IMPLANT | $182.00 | $260.00 | $65.00–$221.00 | at median | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JNT/BURSA W/O US-OFC | $94.50 | $135.00 | $33.75–$114.75 | 54% below | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US | $233.10 | $333.00 | $83.25–$283.05 | 14% above | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JNT/BURSA W/O US-OFC | $77.00 | $110.00 | $27.50–$93.50 | 62% below | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $216.30 | $309.00 | $77.25–$262.65 | 7% above | 30% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 KNEE ARTHR MENI RPR MED/LA-OFC | $1,879.50 | $2,685.00 | $671.25–$2,282.25 | 85% below | 30% |
| Knee arthroscopy with meniscus trim CPT 29881 KNEE ARTHRO MENI MED OR LAT-OF | $1,722.00 | $2,460.00 | $615.00–$2,091.00 | 75% below | 30% |
| Knee arthroscopy with meniscus trim CPT 29881 KNEE ARTHRO MENI MED OR LAT | $3,581.20 | $5,116.00 | $1,279.00–$4,348.60 | 48% below | 30% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 KNEE ARTHRO MENIS MED&LAT-OFC | $2,026.50 | $2,895.00 | $723.75–$2,460.75 | 71% below | 30% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 KNEE ARTHRO MENIS MED&LAT | $3,631.60 | $5,188.00 | $1,297.00–$4,409.80 | 48% below | 30% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 KNEE ARTHROSCOPY/SURGERY-OFC | $1,977.50 | $2,825.00 | $706.25–$2,401.25 | 68% below | 30% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPROSCOPIC APPENDECTOMY | $717.50 | $1,025.00 | $256.25–$871.25 | 91% below | 30% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY APPENDECTOMY-OFC | $1,144.50 | $1,635.00 | $408.75–$1,389.75 | 86% below | 30% |
| Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 LAPAROSCOPY | $1,285.20 | $1,836.00 | $459.00–$1,560.60 | 87% below | 30% |
| Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 LAPAROSCOPY FUNDOPLASTY | $2,138.50 | $3,055.00 | $763.75–$2,596.75 | 79% below | 30% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP ING HERNIA REPAIR INIT-OFC | $1,060.50 | $1,515.00 | $378.75–$1,287.75 | 82% below | 30% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP ING HERNIA REPAIR INIT-OR | $2,415.00 | $3,450.00 | $862.50–$2,932.50 | 60% below | 30% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP ING HERNIA RPR RECUR-OFC | $1,095.50 | $1,565.00 | $391.25–$1,330.25 | 89% below | 30% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP ING HERNIA REPAIR RECUR-OR | $3,154.20 | $4,506.00 | $1,126.50–$3,830.10 | 69% below | 30% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY REMOVE ADNEXA-OFC | $1,417.50 | $2,025.00 | $506.25–$1,721.25 | 87% below | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5CM/<-OF | $189.00 | $270.00 | $67.50–$229.50 | 49% below | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/< | $208.60 | $298.00 | $74.50–$253.30 | 44% below | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAM LMBR/SAC W/IMG-OF | $584.50 | $835.00 | $208.75–$709.75 | 50% below | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTER LMBR/SAC W/IMG-SPEC | $1,486.80 | $2,124.00 | $531.00–$1,805.40 | 28% above | 30% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC-SPEC | $1,250.20 | $1,786.00 | $446.50–$1,518.10 | 4% above | 30% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC-OFC | $1,277.50 | $1,825.00 | $456.25–$1,551.25 | 6% above | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA/STRD TFRM EPI L/S 1-OFC | $658.00 | $940.00 | $235.00–$799.00 | 56% below | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA/STRD TFRM EPI L/S 1-SPE | $1,514.10 | $2,163.00 | $540.75–$1,838.55 | 1% above | 30% |
| Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 LOW BACK DISC SURGERY-OFC | $2,660.70 | $3,801.00 | $950.25–$3,230.85 | 78% below | 30% |
| Lumpectomy (partial mastectomy) CPT 19301 PARTIAL MASTECTOMY-OFC | $568.40 | $812.00 | $203.00–$690.20 | 55% below | 30% |
| Lumpectomy (partial mastectomy) CPT 19301 PARTIAL MASTECTOMY | $785.40 | $1,122.00 | $280.50–$953.70 | 38% below | 30% |
| Mastectomy (total removal of the breast) CPT 19303 MAST SIMPLE COMPLETE-OFC | $1,022.00 | $1,460.00 | $365.00–$1,241.00 | 27% below | 30% |
| Mastectomy (total removal of the breast) CPT 19303 SIMPLE MASTECTOMY | $1,140.30 | $1,629.00 | $407.25–$1,384.65 | 19% below | 30% |
| Miscarriage treatment with D&C, first trimester CPT 59820 CARE OF MISCARRIAGE CL | $738.50 | $1,055.00 | $263.75–$896.75 | 85% below | 30% |
| Miscarriage treatment with D&C, first trimester CPT 59820 TREATMENT OF MISSED ABORTION | $1,025.50 | $1,465.00 | $366.25–$1,245.25 | 79% below | 30% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM< | $54.60 | $78.00 | $19.50–$66.30 | 76% below | 30% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<-OFC | $115.50 | $165.00 | $41.25–$140.25 | 50% below | 30% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FCE-MM B9+MARG 0.5 CM/<-OF | $203.00 | $290.00 | $72.50–$246.50 | 33% below | 30% |
| Nail removal (partial or complete), one nail CPT 11730 RMVL NAIL PLATE PART/COMP-SWB | $70.49 | $100.70 | $25.18–$85.60 | 62% below | 30% |
| Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE-ER | $79.80 | $114.00 | $28.50–$96.90 | 57% below | 30% |
| Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE-OFFICE | $91.00 | $130.00 | $32.50–$110.50 | 51% below | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV-OFC | $87.50 | $125.00 | $31.25–$106.25 | 74% below | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV-SPEC | $1,050.00 | $1,500.00 | $375.00–$1,275.00 | 216% above | 30% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING CL | $364.00 | $520.00 | $130.00–$442.00 | 57% below | 30% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING SWB | $396.90 | $567.00 | $141.75–$481.95 | 53% below | 30% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTIS W/IMAG SPEC SER | $579.60 | $828.00 | $207.00–$703.80 | 31% below | 30% |
| Partial knee replacement (one compartment) CPT 27446 HEMIARTHROPLASTY KNEE | $1,355.90 | $1,937.00 | $484.25–$1,646.45 | 81% below | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED-OFFICE | $252.00 | $360.00 | $90.00–$306.00 | 41% below | 30% |
| Prostate biopsy CPT 55700 BIOPSY OF PROSTATE CL | $462.00 | $660.00 | $165.00–$561.00 | 83% below | 30% |
| Prostate biopsy CPT 55700 BIOPSY OF PROSTATE LPATHIST | $476.00 | $680.00 | $170.00–$578.00 | 83% below | 30% |
| Prostate biopsy CPT 55700 BIOPSY PROSTATE | $532.00 | $760.00 | $190.00–$646.00 | 81% below | 30% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JNT-OFC | $948.50 | $1,355.00 | $338.75–$1,151.75 | 34% below | 30% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LMB/SAC FACET JNT-SPEC | $2,800.00 | $4,000.00 | $1,000.00–$3,400.00 | 95% above | 30% |
| Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION-OFC | $526.40 | $752.00 | $188.00–$639.20 | 48% below | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY | $105.00 | $150.00 | $37.50–$127.50 | 65% below | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY-OFC | $119.00 | $170.00 | $42.50–$144.50 | 60% below | 30% |
| Removal of one lobe of the thyroid (lobectomy) CPT 60220 PARTIAL REMOVAL OF THYROID | $1,634.50 | $2,335.00 | $583.75–$1,984.75 | 86% below | 30% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 SCREEN COLONOSCOPY, NOT HIGH R | $609.00 | $870.00 | $217.50–$739.50 | 25% below | 30% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLONOSCOPY SCREENING | $1,366.40 | $1,952.00 | $488.00–$1,659.20 | 69% above | 30% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY,HIGH RISK | $609.00 | $870.00 | $217.50–$739.50 | 20% below | 30% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY SCREEN HIGH RISK | $1,366.40 | $1,952.00 | $488.00–$1,659.20 | 79% above | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 FRAGMENTING KIDNEY STONE-LITH | $1,820.00 | $2,600.00 | $650.00–$2,210.00 | 81% below | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 FRAGMENTING KIDNEY STONE-OFC | $1,820.00 | $2,600.00 | $650.00–$2,210.00 | 81% below | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 FRAGMENTING KIDNEY STONE-OR | $5,819.80 | $8,314.00 | $2,078.50–$7,066.90 | 40% below | 30% |
| Short arm cast (elbow to hand) CPT 29075 APPLICATION FOREARM CAST CL | $122.50 | $175.00 | $43.75–$148.75 | 54% below | 30% |
| Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT STATIC CL | $80.50 | $115.00 | $28.75–$97.75 | 45% below | 30% |
| Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT STATIC ER | $90.80 | $129.72 | $32.43–$110.26 | 38% below | 30% |
| Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST ER | $51.80 | $74.00 | $18.50–$62.90 | 82% below | 30% |
| Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST CL | $147.00 | $210.00 | $52.50–$178.50 | 48% below | 30% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLNT CL | $147.00 | $210.00 | $52.50–$178.50 | 11% below | 30% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLNT ER | $170.80 | $244.00 | $61.00–$207.40 | 3% above | 30% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 SHO ARTHRS SRG DSTL CLAVI-OFC | $1,375.50 | $1,965.00 | $491.25–$1,670.25 | 87% below | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHO ARTHRS SRG DECOMPRESS-OFC | $1,295.00 | $1,850.00 | $462.50–$1,572.50 | 91% below | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/<-OF | $210.00 | $300.00 | $75.00–$255.00 | 5% below | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< | $245.70 | $351.00 | $87.75–$298.35 | 12% above | 30% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SIN LESION-OFC | $112.00 | $160.00 | $40.00–$136.00 | 55% below | 30% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SING LESION-SPEC | $436.10 | $623.00 | $155.75–$529.55 | 73% above | 30% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC TR-EXT MAL+MARG 0.5 CM/< | $168.00 | $240.00 | $60.00–$204.00 | 51% below | 30% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS <W/15-OFC | $80.50 | $115.00 | $28.75–$97.75 | 46% below | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR | $165.90 | $237.00 | $59.25–$201.45 | 68% below | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR-OFC | $303.10 | $433.00 | $108.25–$368.05 | 42% below | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR-ER | $337.40 | $482.00 | $120.50–$409.70 | 36% 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 S/N/AX/GN/TRNK2.6-7.5CM-OF | $248.50 | $355.00 | $88.75–$301.75 | 14% 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 S/N/AX/GEN/TRNK2.6-7.5CM | $277.20 | $396.00 | $99.00–$336.60 | 4% below | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5 CM/< | $275.10 | $393.00 | $98.25–$334.05 | at median | 30% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES-OFC | $91.00 | $130.00 | $32.50–$110.50 | 53% below | 30% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES | $484.40 | $692.00 | $173.00–$588.20 | 148% above | 30% |
| Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING | $693.00 | $990.00 | $247.50–$841.50 | 18% below | 30% |
| Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING OR | $983.50 | $1,405.00 | $351.25–$1,194.25 | 16% above | 30% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 REMOVE TONSILS AND ADENOIDS | $672.00 | $960.00 | $240.00–$816.00 | 86% below | 30% |
| Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS AND ADENOIDS | $623.00 | $890.00 | $222.50–$756.50 | 86% below | 30% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS | $567.00 | $810.00 | $202.50–$688.50 | 85% below | 30% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 TONSILLECTOMY LESS 12 YRS OLD | $315.70 | $451.00 | $112.75–$383.35 | 91% below | 30% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 REMOVAL OF TONSILS | $598.50 | $855.00 | $213.75–$726.75 | 83% below | 30% |
| Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY | $1,517.60 | $2,168.00 | $542.00–$1,842.80 | 56% below | 30% |
| Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY-OFC | $1,785.00 | $2,550.00 | $637.50–$2,167.50 | 49% below | 30% |
| Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY-OR | $1,514.80 | $2,164.00 | $541.00–$1,839.40 | 66% below | 30% |
| Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY-OFC | $1,575.00 | $2,250.00 | $562.50–$1,912.50 | 65% below | 30% |
| Total shoulder replacement CPT 23472 ARTHROPLASTY TOTAL SHOULDER | $1,705.90 | $2,437.00 | $609.25–$2,071.45 | 82% below | 30% |
| Trigger finger release surgery CPT 26055 TRIGGER FINGER RELEASE | $658.70 | $941.00 | $235.25–$799.85 | 59% below | 30% |
| Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH-OF | $1,088.50 | $1,555.00 | $388.75–$1,321.75 | 32% below | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL | $60.90 | $87.00 | $21.75–$73.95 | 70% below | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSC-OFC | $87.50 | $125.00 | $31.25–$106.25 | 56% below | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL-ER | $122.50 | $175.00 | $43.75–$148.75 | 39% below | 30% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAPAROSCOPY TUBAL CAUTERY-OFC | $1,043.00 | $1,490.00 | $372.50–$1,266.50 | 33% below | 30% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAP BIL TUBAL LIGATION | $2,396.80 | $3,424.00 | $856.00–$2,910.40 | 54% above | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG | $560.00 | $800.00 | $200.00–$680.00 | 70% below | 30% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30 MM-OFC | $1,151.50 | $1,645.00 | $411.25–$1,398.25 | 53% below | 30% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30 MM-OR | $2,340.80 | $3,344.00 | $836.00–$2,842.40 | 5% below | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE-OFC | $511.00 | $730.00 | $182.50–$620.50 | 70% below | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE-OR | $1,381.80 | $1,974.00 | $493.50–$1,677.90 | 19% below | 30% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPR GI SCOPE W/SUBMUC INJ | $2,730.00 | $3,900.00 | $975.00–$3,315.00 | 34% above | 30% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVE LESION SNARE-OFC | $598.50 | $855.00 | $213.75–$726.75 | 71% below | 30% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVE LESION SNARE-OR | $1,620.50 | $2,315.00 | $578.75–$1,967.75 | 21% below | 30% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 EGD GUIDE WIRE INSERTION-OFC | $504.00 | $720.00 | $180.00–$612.00 | 60% below | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH-OFC | $427.00 | $610.00 | $152.50–$518.50 | 66% below | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH-OR | $1,127.70 | $1,611.00 | $402.75–$1,369.35 | 9% below | 30% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URETERO W/LITHOTRIPSY-OF | $920.50 | $1,315.00 | $328.75–$1,117.75 | 92% below | 30% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 OBSTETRICAL CARE | $2,152.50 | $3,075.00 | $768.75–$2,613.75 | 17% below | 30% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT(S)-OFC | $507.50 | $725.00 | $181.25–$616.25 | 40% below | 30% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT(S)-OR | $1,170.40 | $1,672.00 | $418.00–$1,421.20 | 39% above | 30% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESION 1-14-OFFICE | $171.50 | $245.00 | $61.25–$208.25 | 5% above | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<-SWB | $148.40 | $212.00 | $53.00–$180.20 | 62% below | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<-OFC | $154.00 | $220.00 | $55.00–$187.00 | 60% below | 30% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 ORIF DIST RADIUS-OR PRO | $874.30 | $1,249.00 | $312.25–$1,061.65 | 83% below | 30% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 TREAT FX RAD EXTRA-ARTICUL-OFC | $1,452.50 | $2,075.00 | $518.75–$1,763.75 | 71% below | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Missouri | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION SERVICE | $788.20 | $1,126.00 | $281.50–$957.10 | 20% above | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INH TREATMENT-OFFICE | $28.00 | $40.00 | $10.00–$34.00 | 81% below | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SUB INCENTIVE SPIROMETER | $81.90 | $117.00 | $29.25–$99.45 | 45% below | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT-PU | $84.00 | $120.00 | $30.00–$102.00 | 44% below | 30% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR | $524.30 | $749.00 | $187.25–$636.65 | 21% above | 30% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR-PHYS | $283.50 | $405.00 | $101.25–$344.25 | 79% below | 30% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR-ER | $1,788.50 | $2,555.00 | $638.75–$2,171.75 | 33% above | 30% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG COMPLETE | $175.00 | $250.00 | $62.50–$212.50 | 144% above | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING-OFFI | $175.00 | $250.00 | $62.50–$212.50 | 8% below | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING-CARD | $239.40 | $342.00 | $85.50–$290.70 | 25% above | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMR DPT VST MAYX REQ PHY/QHP | $156.10 | $223.00 | $55.75–$189.55 | 12% above | 30% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT SF MDM | $269.50 | $385.00 | $96.25–$327.25 | 5% above | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LOW MDM | $396.90 | $567.00 | $141.75–$481.95 | 11% below | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM | $589.40 | $842.00 | $210.50–$715.70 | 14% below | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT HI MDM | $727.30 | $1,039.00 | $259.75–$883.15 | 31% below | 30% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST NUCLEAR STUDY | $793.10 | $1,133.00 | $283.25–$963.05 | 3% below | 30% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYTX W/PT 50 MIN | $609.00 | $870.00 | $217.50–$739.50 | 256% above | 30% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PT 50 MIN | $556.50 | $795.00 | $198.75–$675.75 | 132% above | 30% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY | $667.10 | $953.00 | $238.25–$810.05 | 216% above | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION INF INI 31 MIN-1 HR | $329.10 | $470.14 | $117.54–$399.62 | 32% above | 30% |
| IV infusion of a medicine, first hour CPT 96365 IV INF THERAPY INT UP TO 1 HR | $324.98 | $464.26 | $116.07–$394.62 | 2% above | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM-OFC | $28.00 | $40.00 | $10.00–$34.00 | 71% below | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM | $122.50 | $175.00 | $43.75–$148.75 | 27% above | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ INJ | $122.50 | $175.00 | $43.75–$148.75 | 27% above | 30% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 NRV CNDJ TEST 7-8 STUDIES-EMG | $389.90 | $557.00 | $139.25–$473.45 | 25% below | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION-OT | $109.90 | $157.00 | $39.25–$133.45 | 22% above | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION-PT | $116.90 | $167.00 | $41.75–$141.95 | 30% above | 30% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30+MINS | $201.60 | $288.00 | $72.00–$244.80 | 49% above | 30% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45+ MINS | $301.70 | $431.00 | $107.75–$366.35 | 71% above | 30% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60+ MINS | $350.00 | $500.00 | $125.00–$425.00 | 35% above | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE O/P NEW SF 15 MINS+ | $140.00 | $200.00 | $50.00–$170.00 | 47% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION INDIV IN | $38.50 | $55.00 | $13.75–$46.75 | 12% below | 30% |
| Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEX 30 MIN | $186.90 | $267.00 | $66.75–$226.95 | 32% above | 30% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEX 45 MIN | $332.50 | $475.00 | $118.75–$403.75 | 91% above | 30% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEX 20 MIN | $182.70 | $261.00 | $65.25–$221.85 | 41% above | 30% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD COMPLEX 30 MIN | $205.75 | $293.93 | $73.48–$249.84 | 29% above | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 1/> REGIONS-OT | $91.00 | $130.00 | $32.50–$110.50 | 10% above | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 1/> REGIONS-PT | $100.10 | $143.00 | $35.75–$121.55 | 21% above | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES-PT | $114.80 | $164.00 | $41.00–$139.40 | 47% above | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES-OT | $122.50 | $175.00 | $43.75–$148.75 | 56% above | 30% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PREV VISIT NEW AGE 18-39 | $87.50 | $125.00 | $31.25–$106.25 | 37% below | 30% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PREV VISIT NEW AGE 40-64 | $87.50 | $125.00 | $31.25–$106.25 | 48% below | 30% |
| Preventive checkup, new patient aged 65 or older CPT 99387 INIT PM E/M NEW PAT 65+ YRS | $87.50 | $125.00 | $31.25–$106.25 | 47% below | 30% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 PREV VISIT EST AGE 18-39 | $87.50 | $125.00 | $31.25–$106.25 | 30% below | 30% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 PREV VISIT EST AGE 40-64 | $87.50 | $125.00 | $31.25–$106.25 | 32% below | 30% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 PER PM REEVAL EST PAT 65+ YR | $87.50 | $125.00 | $31.25–$106.25 | 40% below | 30% |
| Psychotherapy session, 30 minutes CPT 90832 PSYTX W PT 30 MINUTES | $407.40 | $582.00 | $145.50–$494.70 | 204% above | 30% |
| Psychotherapy session, 45 minutes CPT 90834 PSYTX W PT 45 MINUTES | $576.80 | $824.00 | $206.00–$700.40 | 239% above | 30% |
| Psychotherapy session, 60 minutes CPT 90837 PSYTX W PT 60 MINUTES | $613.20 | $876.00 | $219.00–$744.60 | 197% above | 30% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN CL | $24.50 | $35.00 | $8.75–$29.75 | 11% above | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 E&M EST 40+ MINS-SPEC | $137.20 | $196.00 | $49.00–$166.60 | 26% below | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40+ MIN-OFC | $342.30 | $489.00 | $122.25–$415.65 | 85% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M EST 20+ MINS-SPEC | $177.10 | $253.00 | $63.25–$215.05 | 58% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20+ MINS-OF | $189.00 | $270.00 | $67.50–$229.50 | 69% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E&M EST 30+ MINS-SPEC | $250.60 | $358.00 | $89.50–$304.30 | 66% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30+ MIN-OFC | $252.00 | $360.00 | $90.00–$306.00 | 67% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M EST 10+ MINS-SPEC | $113.40 | $162.00 | $40.50–$137.70 | 60% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10+ MINS | $117.60 | $168.00 | $42.00–$142.80 | 66% above | 30% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 OFF/OP CNSLTJ NEW/EST LOW 30 | $191.10 | $273.00 | $68.25–$232.05 | 1% above | 30% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFF/OP CNSLTJ NEW/EST MOD 40 | $272.30 | $389.00 | $97.25–$330.65 | 11% above | 30% |
| Speech and language evaluation CPT 92523 SPEECH SOUND LANG COMPREHEN | $360.50 | $515.00 | $128.75–$437.75 | 26% above | 30% |
| Speech therapy session, individual CPT 92507 SPEECH/HEARING THERAPY | $140.00 | $200.00 | $50.00–$170.00 | 11% below | 30% |
| Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST CL | $56.00 | $80.00 | $20.00–$68.00 | 75% below | 30% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY | $331.80 | $474.00 | $118.50–$402.90 | 50% above | 30% |
| Spirometry before and after a bronchodilator CPT 94060 EVALUATION OF WHEEZING-OFC | $91.00 | $130.00 | $32.50–$110.50 | 79% below | 30% |
| Spirometry before and after a bronchodilator CPT 94060 EVALUATION OF WHEEZING-PULM | $422.80 | $604.00 | $151.00–$513.40 | 4% below | 30% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES-PT | $73.50 | $105.00 | $26.25–$89.25 | 11% below | 30% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES-OT | $135.80 | $194.00 | $48.50–$164.90 | 65% above | 30% |
| Therapeutic activities (functional training), 15 minutes one side CPT 97530 THERAPEUTIC ACTIVITIES-RT | $74.20 | $106.00 | $26.50–$90.10 | 10% below | 30% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC | $54.60 | $78.00 | $19.50–$66.30 | 71% below | 30% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 CARDIOV ST MAXW/SUP,I/R CL | $227.50 | $325.00 | $81.25–$276.25 | 42% above | 30% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 CARDIOV ST MAXW/SUP,I/R CARDST | $813.40 | $1,162.00 | $290.50–$987.70 | 408% above | 30% |
| Visual field test, extended CPT 92083 VISUAL FIELD EXAMINATION(S) | $156.32 | $223.32 | $55.83–$189.82 | 28% above | 30% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Missouri | Off list |
|---|---|---|---|---|---|
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 FLUAD TRIVALENT 24-25 (65+) | $279.65 | $399.50 | $99.88–$339.58 | 273% above | 30% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 FLUAD TRIVALENT 24-25 (65+) | $279.65 | $399.50 | $99.88–$339.58 | 273% above | 30% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 FLUAD TRIVALENT 24-25 (65+) | $279.65 | $399.50 | $99.88–$339.58 | — | 30% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SPIKEVAX | $122.50 | $175.00 | $43.75–$148.75 | 29% below | 30% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SPIKEVAX | $122.50 | $175.00 | $43.75–$148.75 | 29% below | 30% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SPIKEVAX 24-25 (12+) | $655.20 | $936.00 | $234.00–$795.60 | 282% above | 30% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SPIKEVAX 24-25 (12+) | $655.20 | $936.00 | $234.00–$795.60 | 282% above | 30% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SPIKEVAX | $122.50 | $175.00 | $43.75–$148.75 | — | 30% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SPIKEVAX 24-25 (12+) | $655.20 | $936.00 | $234.00–$795.60 | — | 30% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VAR VACCINE LIVE SUBQ | $844.90 | $1,207.00 | $301.75–$1,025.95 | 301% above | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUZONE TRIVALENT 24-25 (6M+) | $76.73 | $109.62 | $27.41–$93.18 | 29% above | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUZONE TRIVALENT 24-25 (6M+) | $76.73 | $109.62 | $27.41–$93.18 | 29% above | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUZONE TRIVALENT 24-25 (6M+) | $76.73 | $109.62 | $27.41–$93.18 | — | 30% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 9VHPV VACCINE 2/3 DOSE IM CL | $1,420.65 | $2,029.50 | $507.38–$1,725.08 | 332% above | 30% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 9VHPV VACCINE 2/3 DOSE IM | $1,420.65 | $2,029.50 | $507.38–$1,725.08 | 332% above | 30% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 9VHPV VACCINE 2/3 DOSE IM | $1,420.65 | $2,029.50 | $507.38–$1,725.08 | 332% above | 30% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 9VHPV VACCINE 2/3 DOSE IM | $1,420.65 | $2,029.50 | $507.38–$1,725.08 | — | 30% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPA VACCINE ADULT IM | $131.25 | $187.50 | $46.88–$159.38 | 48% above | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPB VACCINE 3 DOSE ADULT IM | $66.50 | $95.00 | $23.75–$80.75 | 15% below | 30% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 IIV NO PRSV INCREASED AG IM | $220.50 | $315.00 | $78.75–$267.75 | 115% above | 30% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Flu Vacc 23-24 High dose syr 6 | $220.50 | $315.00 | $78.75–$267.75 | 115% above | 30% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Flu Vacc 23-24 High dose syr 6 | $220.50 | $315.00 | $78.75–$267.75 | 115% above | 30% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Flu Vacc 23-24 High dose syr 6 | $220.50 | $315.00 | $78.75–$267.75 | — | 30% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE SC-OFFICE | $438.20 | $626.00 | $156.50–$532.10 | 153% above | 30% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACWYD/MENACWYCRM VACC IM | $94.50 | $135.00 | $33.75–$114.75 | 26% below | 30% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACWYD/MENACWYCRM VAC IM-OFC | $94.50 | $135.00 | $33.75–$114.75 | 26% below | 30% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACWYD/MENACWYCRM VACC IM | $94.50 | $135.00 | $33.75–$114.75 | 26% below | 30% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENACWYD/MENACWYCRM VACC IM | $94.50 | $135.00 | $33.75–$114.75 | — | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENB-4C VACC 2 DOSE IM | $1,095.15 | $1,564.50 | $391.13–$1,329.83 | 255% above | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENB-4C VACC 2 DOSE IM | $1,095.15 | $1,564.50 | $391.13–$1,329.83 | 255% above | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENB-4C VACC 2 DOSE IM | $1,095.15 | $1,564.50 | $391.13–$1,329.83 | — | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV23 VACC 2 YRS+ SUBQ/IM | $541.10 | $773.00 | $193.25–$657.05 | 188% above | 30% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 BEYFOIRTUS 50 MG SYRINGE | $2,569.35 | $3,670.50 | $917.63–$3,119.93 | 101% above | 30% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 BEYFOIRTUS 50 MG SYRINGE | $2,569.35 | $3,670.50 | $917.63–$3,119.93 | 101% above | 30% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 BEYFOIRTUS 50 MG SYRINGE | $2,569.35 | $3,670.50 | $917.63–$3,119.93 | — | 30% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 ABRYSVO | $1,417.50 | $2,025.00 | $506.25–$1,721.25 | 168% above | 30% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 ABRYSVO | $1,417.50 | $2,025.00 | $506.25–$1,721.25 | 168% above | 30% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 ABRYSVO | $1,417.50 | $2,025.00 | $506.25–$1,721.25 | — | 30% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 AREXVY | $1,176.00 | $1,680.00 | $420.00–$1,428.00 | 151% above | 30% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 AREXVY | $1,176.00 | $1,680.00 | $420.00–$1,428.00 | 151% above | 30% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 AREXVY | $1,176.00 | $1,680.00 | $420.00–$1,428.00 | — | 30% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 SHINGRIX | $995.75 | $1,422.50 | $355.63–$1,209.13 | 290% above | 30% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 SHINGRIX | $995.75 | $1,422.50 | $355.63–$1,209.13 | 290% above | 30% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 SHINGRIX | $995.75 | $1,422.50 | $355.63–$1,209.13 | — | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACC NO PRESV 7 YRS+ IM | $185.15 | $264.50 | $66.13–$224.83 | 156% above | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACC NO PRESV 7 YRS+ IM | $185.15 | $264.50 | $66.13–$224.83 | 156% above | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACC NO PRESV 7 YRS+ IM | $185.15 | $264.50 | $66.13–$224.83 | — | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE 7 YRS/> IM | $225.75 | $322.50 | $80.63–$274.13 | 118% above | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE 7 YRS/> IM | $225.75 | $322.50 | $80.63–$274.13 | 118% above | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE 7 YRS/> IM | $225.75 | $322.50 | $80.63–$274.13 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN | $35.00 | $50.00 | $12.50–$42.50 | 39% below | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-OFC | $35.00 | $50.00 | $12.50–$42.50 | 39% below | 30% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD-OF | $21.00 | $30.00 | $7.50–$25.50 | 56% below | 30% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD | $26.60 | $38.00 | $9.50–$32.30 | 44% below | 30% |
Source file: https://scmohospital.pt.panaceainc.com/MRFDownload/scmohospital/scotlandcounty