Hospital Lawrence, KS

Lawrence Memorial Hospital

Lawrence Memorial Hospital in Lawrence, KS publishes cash prices for 267 common procedures listed here, from its own machine-readable price file updated Mar 23, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Kansas median for 205 of 264 procedures and above it for 59. Click a procedure to compare it with other hospitals nearby.

325 MAINE ST, LAWRENCE, KS 660441360 Collected Sep 28, 2026 Source price file

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 Lawrence Memorial Hospital in Lawrence, KS:

Mar 20, 2024 Warning notice
Jun 26, 2024 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$268.63	$1,074.50	$47.37–$999.29	55% below	75%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$268.63	$1,074.50	$47.37–$999.29	—	75%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus	$177.88	$711.50	$102.18–$661.70	61% below	75%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus	$177.88	$711.50	$102.18–$661.70	—	75%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Scan Whole Body	$812.81	$3,251.25	$220.23–$3,023.66	38% below	75%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Scan Whole Body	$812.81	$3,251.25	$220.23–$3,023.66	—	75%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST	$1,003.69	$4,014.75	$102.18–$3,733.72	43% below	75%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY CHEST	$1,003.69	$4,014.75	$102.18–$3,733.72	—	75%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO HRT W/3D IMAGE	$644.25	$2,577.00	$304.45–$2,396.61	29% below	75%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT ANGIO HRT W/3D IMAGE	$644.25	$2,577.00	$304.45–$2,396.61	—	75%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST	$1,376.69	$5,506.75	$132.31–$5,121.28	7% above	75%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ANEURYSM Protocol ABD and Pelvis W/O	$1,376.69	$5,506.75	$132.31–$5,121.28	7% above	75%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CONTRAST	$1,376.69	$5,506.75	$132.31–$5,121.28	—	75%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ANEURYSM Protocol ABD and Pelvis W/O	$1,376.69	$5,506.75	$132.31–$5,121.28	—	75%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CONTRAST	$1,512.94	$6,051.75	$208.76–$5,628.13	12% above	75%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CONTRAST	$1,512.94	$6,051.75	$208.76–$5,628.13	—	75%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR	$1,640.81	$6,563.25	$208.76–$6,103.82	11% below	75%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR	$1,640.81	$6,563.25	$208.76–$6,103.82	—	75%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST	$970.88	$3,883.50	$102.18–$3,611.66	30% below	75%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST	$970.88	$3,883.50	$102.18–$3,611.66	—	75%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$704.44	$2,817.75	$60.56–$2,620.51	42% below	75%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$704.44	$2,817.75	$60.56–$2,620.51	—	75%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O DYE	$154.94	$619.75	$60.56–$619.75	84% below	75%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O DYE	$154.94	$619.75	$60.56–$619.75	—	75%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE	$669.31	$2,677.25	$60.56–$2,489.84	35% below	75%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O DYE	$669.31	$2,677.25	$60.56–$2,489.84	—	75%
CT scan of the head with contrast CPT 70460 CT Head/Brain W/Contrast	$769.88	$3,079.50	$102.18–$2,863.94	33% below	75%
CT scan of the head with contrast inpatient CPT 70460 CT Head/Brain W/Contrast	$769.88	$3,079.50	$102.18–$2,863.94	—	75%
CT scan of the head without and with contrast CPT 70470 CT Head Brain W plus W/O Contrast	$870.75	$3,483.00	$102.18–$3,239.19	30% below	75%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head Brain W plus W/O Contrast	$870.75	$3,483.00	$102.18–$3,239.19	—	75%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O DYE	$905.19	$3,620.75	$60.56–$3,367.30	20% below	75%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O DYE	$905.19	$3,620.75	$60.56–$3,367.30	—	75%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT NECK SPINE W/O DYE	$905.19	$3,620.75	$60.56–$3,367.30	9% below	75%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT NECK SPINE W/O DYE	$905.19	$3,620.75	$60.56–$3,367.30	—	75%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE	$790.19	$3,160.75	$102.18–$2,939.50	31% below	75%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/DYE	$790.19	$3,160.75	$102.18–$2,939.50	—	75%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 EXTRACRANIAL BILAT STUDY	$318.63	$1,274.50	$143.90–$1,185.29	—	75%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 EXTRACRANIAL BILAT STUDY	$318.63	$1,274.50	$143.90–$1,185.29	—	75%
Chest X-ray, 2 views CPT 71046 X-RAY EXAM CHEST 2 VIEWS	$146.88	$587.50	$49.23–$546.38	36% below	75%
Chest X-ray, 2 views inpatient CPT 71046 X-RAY EXAM CHEST 2 VIEWS	$146.88	$587.50	$49.23–$546.38	—	75%
Chest X-ray, single view CPT 71045 XR Chest 1 View	$108.19	$432.75	$49.23–$402.46	44% below	75%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View	$108.19	$432.75	$49.23–$402.46	—	75%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Renal Sono	$318.94	$1,275.75	$60.56–$1,186.45	23% below	75%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Renal Sono	$318.94	$1,275.75	$60.56–$1,186.45	—	75%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 XR Bone Density (Dexa)	$193.38	$773.50	$60.56–$719.36	39% below	75%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 XR Bone Density (Dexa)	$193.38	$773.50	$60.56–$719.36	—	75%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 XR Bone Density (Wrist)	$154.88	$619.50	$18.92–$576.14	3% above	75%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 XR Bone Density (Wrist)	$154.88	$619.50	$18.92–$576.14	—	75%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Aneurysm Protocol Ches ABD Pel WO	$638.31	$2,553.25	$60.56–$2,374.52	33% below	75%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT ANEURYSM Protocol Chest W/O	$745.94	$2,983.75	$60.56–$2,774.89	22% below	75%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DX C-	$745.94	$2,983.75	$60.56–$2,774.89	22% below	75%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Aneurysm Protocol Ches ABD Pel WO	$638.31	$2,553.25	$60.56–$2,374.52	—	75%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX DX C-	$745.94	$2,983.75	$60.56–$2,774.89	—	75%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT ANEURYSM Protocol Chest W/O	$745.94	$2,983.75	$60.56–$2,774.89	—	75%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest W/Contrast	$872.31	$3,489.25	$102.18–$3,245.00	20% below	75%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest W/Contrast	$872.31	$3,489.25	$102.18–$3,245.00	—	75%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US Lower Ext.Art. Sono Bilateral	$385.94	$1,543.75	$80.17–$1,435.69	—	75%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US Lower Ext.Art. Sono Bilateral	$385.94	$1,543.75	$80.17–$1,435.69	—	75%
Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY	$321.44	$1,285.75	$80.17–$1,195.75	56% below	75%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 EXTREMITY STUDY	$321.44	$1,285.75	$80.17–$1,195.75	—	75%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER COMPLETE	$732.88	$2,931.50	$180.05–$2,726.30	61% below	75%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W/DOPPLER COMPLETE	$732.88	$2,931.50	$180.05–$2,726.30	—	75%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary-Liver Function	$540.13	$2,160.50	$220.23–$2,009.27	65% below	75%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary-Liver Function	$540.13	$2,160.50	$220.23–$2,009.27	—	75%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep Test, Unattended	$232.06	$928.25	$59.16–$863.27	36% below	75%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Sleep Test, Unattended	$232.06	$928.25	$59.16–$863.27	—	75%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM	$2,464.44	$9,857.75	$98.66–$9,167.71	25% below	75%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM	$2,464.44	$9,857.75	$98.66–$9,167.71	—	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN	$272.38	$1,089.50	$60.56–$1,013.24	22% below	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ECHO EXAM OF ABDOMEN	$272.38	$1,089.50	$60.56–$1,013.24	—	75%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR C-	$185.88	$743.50	$60.56–$743.50	71% below	75%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCR C-	$185.88	$743.50	$60.56–$743.50	—	75%
MRI of both breasts, without and then with contrast dye CPT 77049 MR Breast W plus W/O Contrast Bil	$1,521.31	$6,085.25	$175.09–$5,659.28	1% above	75%
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 MR Breast W plus W/O Contrast Bil	$1,521.31	$6,085.25	$175.09–$5,659.28	—	75%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MR Hip Bilateral	$2,239.25	$8,957.00	$132.31–$8,330.01	—	75%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MR Hip Bilateral	$2,239.25	$8,957.00	$132.31–$8,330.01	—	75%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$1,025.63	$4,102.50	$132.31–$3,815.33	19% below	75%
MRI of the abdomen without contrast CPT 74181 MR ABD W/O	$1,076.94	$4,307.75	$132.31–$4,006.21	15% below	75%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST	$1,025.63	$4,102.50	$132.31–$3,815.33	—	75%
MRI of the abdomen without contrast inpatient CPT 74181 MR ABD W/O	$1,076.94	$4,307.75	$132.31–$4,006.21	—	75%
MRI of the abdomen, without and then with contrast dye CPT 74183 MR Abdomen W plus WO	$1,265.94	$5,063.75	$208.76–$4,709.29	24% below	75%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR Abdomen W plus WO	$1,265.94	$5,063.75	$208.76–$4,709.29	—	75%
MRI of the brain, no contrast dye CPT 70551 MR Head/Brain W/O Contrast	$1,062.19	$4,248.75	$132.31–$3,951.34	17% below	75%
MRI of the brain, no contrast dye inpatient CPT 70551 MR Head/Brain W/O Contrast	$1,062.19	$4,248.75	$132.31–$3,951.34	—	75%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN STEM W/O & W/DYE	$1,384.75	$5,539.00	$208.76–$5,151.27	19% below	75%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN STEM W/O & W/DYE	$1,384.75	$5,539.00	$208.76–$5,151.27	—	75%
MRI of the lower back, no contrast dye CPT 72148 MR L-Spine W/O Contrast	$1,115.50	$4,462.00	$132.31–$4,149.66	9% below	75%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR L-Spine W/O Contrast	$1,115.50	$4,462.00	$132.31–$4,149.66	—	75%
MRI of the lower back, without and then with contrast dye CPT 72158 MR L-Spine W plus W/O Contrast	$1,480.13	$5,920.50	$208.76–$5,506.07	17% below	75%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR L-Spine W plus W/O Contrast	$1,480.13	$5,920.50	$208.76–$5,506.07	—	75%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR T-Spine W/O Contrast	$1,115.50	$4,462.00	$132.31–$4,149.66	1% below	75%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR T-Spine W/O Contrast	$1,115.50	$4,462.00	$132.31–$4,149.66	—	75%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MR C-Spine W plus W/O Contrast	$1,480.13	$5,920.50	$208.76–$5,506.07	13% below	75%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR C-Spine W plus W/O Contrast	$1,480.13	$5,920.50	$208.76–$5,506.07	—	75%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MR C-Spine W/O Contrast	$1,013.63	$4,054.50	$132.31–$3,770.69	11% below	75%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR C-Spine W/O Contrast	$1,013.63	$4,054.50	$132.31–$3,770.69	—	75%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/O & W/DYE	$1,383.19	$5,532.75	$208.76–$5,145.46	18% below	75%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/O & W/DYE	$1,383.19	$5,532.75	$208.76–$5,145.46	—	75%
MRI of the pelvis, no contrast dye CPT 72195 MR Pelvis W/O Contrast	$951.31	$3,805.25	$132.31–$3,538.88	16% below	75%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MR Pelvis W/O Contrast	$951.31	$3,805.25	$132.31–$3,538.88	—	75%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Perf. Multiple Stud	$1,813.88	$7,255.50	$752.05–$6,747.62	33% below	75%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial Perf. Multiple Stud	$1,813.88	$7,255.50	$752.05–$6,747.62	—	75%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET CT Neuroendocrine	$1,365.06	$5,460.25	$843.89–$5,078.03	73% below	75%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET CT Neuroendocrine	$1,365.06	$5,460.25	$843.89–$5,078.03	—	75%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED	$187.69	$750.75	$60.56–$698.20	44% below	75%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US EXAM PELVIC LIMITED	$187.69	$750.75	$60.56–$698.20	—	75%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM PELVIC COMPLETE	$332.88	$1,331.50	$60.56–$1,238.30	4% below	75%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US EXAM PELVIC COMPLETE	$332.88	$1,331.50	$60.56–$1,238.30	—	75%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB greater14 Wks Single 1st/Gestation	$156.19	$624.75	$60.56–$581.02	59% below	75%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB greater14 Wks Single 1st/Gestation	$156.19	$624.75	$60.56–$581.02	—	75%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB less 14 Wks Single Gestation	$156.19	$624.75	$60.56–$581.02	55% below	75%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB less 14 Wks Single Gestation	$156.19	$624.75	$60.56–$581.02	—	75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US LIMITED FETUS(S)	$142.31	$569.25	$60.56–$529.40	55% below	75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US LIMITED FETUS(S)	$142.31	$569.25	$60.56–$529.40	—	75%
Sleep study in a lab (polysomnography) CPT 95810 Single - Sleep Staging, 4 Or More Prof Fee	$445.50	$1,782.00	$386.85–$1,782.00	86% below	75%
Sleep study in a lab (polysomnography) CPT 95810 Single - Sleep Staging, 4 Or More	$2,373.31	$9,493.25	$386.85–$8,828.72	24% below	75%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Single - Sleep Staging, 4 Or More Prof Fee	$445.50	$1,782.00	$386.85–$1,782.00	—	75%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Single - Sleep Staging, 4 Or More	$2,373.31	$9,493.25	$386.85–$8,828.72	—	75%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Swallowing Function Esoph Video	$154.56	$618.25	$102.18–$574.97	74% below	75%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Swallowing Function Esoph Video	$154.56	$618.25	$102.18–$574.97	—	75%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON-OB	$284.81	$1,139.25	$60.56–$1,059.50	11% below	75%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US NON-OB	$284.81	$1,139.25	$60.56–$1,059.50	—	75%
Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US OBSTETRIC	$168.88	$675.50	$60.56–$628.22	53% below	75%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL US OBSTETRIC	$168.88	$675.50	$60.56–$628.22	—	75%
Ultrasound of the abdomen, complete CPT 76700 US Abdominal Sono	$411.63	$1,646.50	$60.56–$1,531.25	5% below	75%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdominal Sono	$411.63	$1,646.50	$60.56–$1,531.25	—	75%
Ultrasound of the scrotum and testicles CPT 76870 US EXAM SCROTUM	$193.38	$773.50	$60.56–$719.36	50% below	75%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US EXAM SCROTUM	$193.38	$773.50	$60.56–$719.36	—	75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM OF HEAD AND NECK	$230.25	$921.00	$60.56–$856.53	62% below	75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US EXAM OF HEAD AND NECK	$230.25	$921.00	$60.56–$856.53	—	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 X-RAY XM UPR GI TRC 1CNTRST	$390.75	$1,563.00	$102.18–$1,453.59	28% below	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 X-RAY XM UPR GI TRC 1CNTRST	$390.75	$1,563.00	$102.18–$1,453.59	—	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study both sides CPT 93971 US Venous Duplex Limited Bilat With Reflux WHC	$321.44	$1,285.75	$90.66–$1,195.75	—	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY	$265.50	$1,062.00	$90.66–$987.66	59% below	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US Study Follow-Up WHC	$265.50	$1,062.00	$90.66–$987.66	59% below	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient both sides CPT 93971 US Venous Duplex Limited Bilat With Reflux WHC	$321.44	$1,285.75	$90.66–$1,195.75	—	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US Study Follow-Up WHC	$265.50	$1,062.00	$90.66–$987.66	—	75%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 EXTREMITY STUDY	$265.50	$1,062.00	$90.66–$987.66	—	75%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen AP View	$105.56	$422.25	$49.23–$392.69	50% below	75%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen AP View	$105.56	$422.25	$49.23–$392.69	—	75%
X-ray of the knee, 1 or 2 views CPT 73560 XR Knees (Both) Standing AP	$149.63	$598.50	$49.23–$556.61	21% below	75%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR Knees (Both) Standing AP	$149.63	$598.50	$49.23–$556.61	—	75%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS	$210.38	$841.50	$60.56–$782.60	23% below	75%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS	$210.38	$841.50	$60.56–$782.60	—	75%
X-ray of the lower back, 4 or more views CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS	$300.00	$1,200.00	$60.56–$1,116.00	25% below	75%
X-ray of the lower back, 4 or more views inpatient CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS	$300.00	$1,200.00	$60.56–$1,116.00	—	75%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-RAY EXAM THORAC SPINE 2VWS	$182.94	$731.75	$60.56–$680.53	18% below	75%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 X-RAY EXAM THORAC SPINE 2VWS	$182.94	$731.75	$60.56–$680.53	—	75%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bone 3 Views or More	$168.44	$673.75	$49.23–$626.59	27% below	75%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bone 3 Views or More	$168.44	$673.75	$49.23–$626.59	—	75%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW	$202.56	$810.25	$49.23–$753.53	19% below	75%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW	$202.56	$810.25	$49.23–$753.53	—	75%
X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY EXAM OF PELVIS	$92.00	$368.00	$60.56–$342.24	55% below	75%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-RAY EXAM OF PELVIS	$92.00	$368.00	$60.56–$342.24	—	75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/ Coccyx	$179.63	$718.50	$49.23–$668.21	20% below	75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum/ Coccyx	$179.63	$718.50	$49.23–$668.21	—	75%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (Alanine Transaminase)	$32.25	$129.00	$4.77–$119.97	14% below	75%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT (Alanine Transaminase)	$32.25	$129.00	$4.77–$119.97	—	75%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST (Aspartate Transaminase)	$32.25	$129.00	$4.66–$119.97	13% below	75%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST (Aspartate Transaminase)	$32.25	$129.00	$4.66–$119.97	—	75%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel, Acute with Reflex to confirmation	$91.88	$367.50	$40.89–$341.78	56% below	75%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Panel, Acute with Reflex to confirmation	$91.88	$367.50	$40.89–$341.78	—	75%
Allergy blood test, specific IgE, per allergen CPT 86003 Hypersensitivity Pneumo Extended Panel	$29.38	$117.50	$4.70–$109.28	5% below	75%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Food, Alpha-Gal	$47.63	$190.50	$4.70–$177.17	54% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA	$72.38	$289.50	$4.70–$269.24	134% above	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hypersensitivity Pneumo Extended Panel	$29.38	$117.50	$4.70–$109.28	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Food, Alpha-Gal	$47.63	$190.50	$4.70–$177.17	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLG SPEC IGE CRUDE XTRC EA	$72.38	$289.50	$4.70–$269.24	—	75%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrulinated Peptide Ab, IgG	$56.81	$227.25	$11.66–$211.34	47% below	75%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrulinated Peptide Ab, IgG	$56.81	$227.25	$11.66–$211.34	—	75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES	$33.94	$135.75	$10.88–$126.25	52% below	75%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES	$33.94	$135.75	$10.88–$126.25	—	75%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Pro BNP	$88.31	$353.25	$33.70–$328.52	31% below	75%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Pro BNP	$88.31	$353.25	$33.70–$328.52	—	75%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PNL TOTAL CA	$55.63	$222.50	$7.61–$206.93	32% below	75%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PNL TOTAL CA	$55.63	$222.50	$7.61–$206.93	—	75%
Blood culture for bacteria CPT 87040 Blood Culture	$59.06	$236.25	$9.29–$219.71	21% below	75%
Blood culture for bacteria inpatient CPT 87040 Blood Culture	$59.06	$236.25	$9.29–$219.71	—	75%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE	$13.56	$54.25	$9.34–$50.45	26% below	75%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLL VENOUS BLD VENIPUNCTURE	$13.56	$54.25	$9.34–$50.45	—	75%
Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE BLOOD QUANT	$30.06	$120.25	$3.54–$111.83	7% below	75%
Blood glucose (sugar) test inpatient CPT 82947 ASSAY GLUCOSE BLOOD QUANT	$30.06	$120.25	$3.54–$111.83	—	75%
Blood lead test CPT 83655 ASSAY OF LEAD	$15.94	$63.75	$10.90–$59.29	69% below	75%
Blood lead test CPT 83655 Lead Industrial Exposure	$20.63	$82.50	$10.90–$76.73	60% below	75%
Blood lead test inpatient CPT 83655 ASSAY OF LEAD	$15.94	$63.75	$10.90–$59.29	—	75%
Blood lead test inpatient CPT 83655 Lead Industrial Exposure	$20.63	$82.50	$10.90–$76.73	—	75%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHORIONIC GONADOTROPIN ASSAY	$52.00	$208.00	$6.77–$193.44	9% below	75%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 CHORIONIC GONADOTROPIN ASSAY	$52.00	$208.00	$6.77–$193.44	—	75%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO	$34.44	$137.75	$3.02–$137.75	61% below	75%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO	$34.44	$137.75	$3.02–$137.75	—	75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$51.63	$206.50	$4.66–$192.05	8% above	75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$51.63	$206.50	$4.66–$192.05	—	75%
C. difficile toxin gene test (stool PCR) CPT 87493 C difficle, Toxigenic and Epi Stain, by PCR	$72.06	$288.25	$33.54–$268.07	33% below	75%
C. difficile toxin gene test (stool PCR) CPT 87493 C. Difficile by PCR	$78.31	$313.25	$33.54–$291.32	28% below	75%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C difficle, Toxigenic and Epi Stain, by PCR	$72.06	$288.25	$33.54–$268.07	—	75%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C. Difficile by PCR	$78.31	$313.25	$33.54–$291.32	—	75%
CA 19-9 blood test (tumor marker) CPT 86301 Cancer Ag 19-9	$58.06	$232.25	$18.73–$215.99	32% below	75%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Cancer Ag 19-9	$58.06	$232.25	$18.73–$215.99	—	75%
CA-125 blood test (ovarian cancer marker) CPT 86304 Cancer Antigen 125	$79.94	$319.75	$18.73–$297.37	13% below	75%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Cancer Antigen 125	$79.94	$319.75	$18.73–$297.37	—	75%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$81.31	$325.25	$44.05–$302.48	40% below	75%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$81.31	$325.25	$44.05–$302.48	—	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Genital Ulcer Disease Panel, PCR	$13.13	$52.50	$29.98–$52.50	88% below	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/GC by TMA, EYE	$20.50	$82.00	$31.58–$76.26	82% below	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE	$56.00	$224.00	$31.58–$208.32	51% below	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Genital Ulcer Disease Panel, PCR	$13.13	$52.50	$29.98–$52.50	—	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/GC by TMA, EYE	$20.50	$82.00	$31.58–$76.26	—	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLMYD TRACH DNA AMP PROBE	$56.00	$224.00	$31.58–$208.32	—	75%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$89.06	$356.25	$12.05–$331.31	3% above	75%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$89.06	$356.25	$12.05–$331.31	—	75%
Complete blood count (CBC) with differential CPT 85025 Complete Blood Count - POC	$12.88	$51.50	$6.67–$51.50	68% below	75%
Complete blood count (CBC) with differential CPT 85025 Complete Blood Count, with Differential	$55.31	$221.25	$6.67–$205.76	36% above	75%
Complete blood count (CBC) with differential inpatient CPT 85025 Complete Blood Count - POC	$12.88	$51.50	$6.67–$51.50	—	75%
Complete blood count (CBC) with differential inpatient CPT 85025 Complete Blood Count, with Differential	$55.31	$221.25	$6.67–$205.76	—	75%
Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED	$43.00	$172.00	$5.82–$159.96	8% below	75%
Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE CBC AUTOMATED	$43.00	$172.00	$5.82–$159.96	—	75%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL	$99.00	$396.00	$9.50–$368.28	5% below	75%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL	$99.00	$396.00	$9.50–$368.28	—	75%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$127.00	$508.00	$9.16–$472.44	9% above	75%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer	$127.00	$508.00	$9.16–$472.44	—	75%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dheas Sulfate Serum Level	$102.38	$409.50	$20.01–$380.84	20% below	75%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dheas Sulfate Serum Level	$102.38	$409.50	$20.01–$380.84	—	75%
Estradiol blood test CPT 82670 Estradiol Level	$99.38	$397.50	$25.15–$369.68	41% below	75%
Estradiol blood test inpatient CPT 82670 Estradiol Level	$99.38	$397.50	$25.15–$369.68	—	75%
FSH (follicle-stimulating hormone) test CPT 83001 FSH (Follicle Stimulating Hormone)	$78.56	$314.25	$16.72–$292.25	31% below	75%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH (Follicle Stimulating Hormone)	$78.56	$314.25	$16.72–$292.25	—	75%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Fecal	$114.50	$458.00	$17.67–$425.94	48% below	75%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Fecal	$114.50	$458.00	$17.67–$425.94	—	75%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$78.50	$314.00	$12.27–$292.02	11% below	75%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$78.50	$314.00	$12.27–$292.02	—	75%
Folate (folic acid) blood test CPT 82746 Folate Level	$44.75	$179.00	$13.23–$166.47	54% below	75%
Folate (folic acid) blood test inpatient CPT 82746 Folate Level	$44.75	$179.00	$13.23–$166.47	—	75%
Free T3 thyroid hormone test CPT 84481 Free T3 (Triiodothyronine, Free)	$47.13	$188.50	$15.25–$175.31	63% below	75%
Free T3 thyroid hormone test inpatient CPT 84481 Free T3 (Triiodothyronine, Free)	$47.13	$188.50	$15.25–$175.31	—	75%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 (Free Thyroxine)	$66.88	$267.50	$8.12–$248.78	10% above	75%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4 (Free Thyroxine)	$66.88	$267.50	$8.12–$248.78	—	75%
Free testosterone test CPT 84402 Testosterone, Free (ADULT MALE)	$39.25	$157.00	$22.92–$146.01	72% below	75%
Free testosterone test CPT 84402 Testosterone, Free (FEMALE and CHILDREN ON	$73.38	$293.50	$22.92–$272.96	48% below	75%
Free testosterone test inpatient CPT 84402 Testosterone, Free (ADULT MALE)	$39.25	$157.00	$22.92–$146.01	—	75%
Free testosterone test inpatient CPT 84402 Testosterone, Free (FEMALE and CHILDREN ON	$73.38	$293.50	$22.92–$272.96	—	75%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose, 2 hr, GTF2	$30.06	$120.25	$4.28–$111.83	37% below	75%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TEST	$40.50	$162.00	$4.28–$150.66	16% below	75%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose, 2 hr, GTF2	$30.06	$120.25	$4.28–$111.83	—	75%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE TEST	$40.50	$162.00	$4.28–$150.66	—	75%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$100.63	$402.50	$11.58–$374.33	9% above	75%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$100.63	$402.50	$11.58–$374.33	—	75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N. gonorrhoeae by TMA	$21.75	$87.00	$31.58–$80.91	79% below	75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N. gonorrhoeae by TMA	$21.75	$87.00	$31.58–$80.91	—	75%
H. pylori stool antigen test CPT 87338 H. Pylori Ag, Fecal, by EIA	$93.56	$374.25	$12.94–$348.05	18% below	75%
H. pylori stool antigen test inpatient CPT 87338 H. Pylori Ag, Fecal, by EIA	$93.56	$374.25	$12.94–$348.05	—	75%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV Quant. RNA PCR Ultrasensitive	$80.13	$320.50	$46.00–$298.07	76% below	75%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 by Quantitative NAAT, Plasma	$129.75	$519.00	$46.00–$482.67	62% below	75%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV Quant. RNA PCR Ultrasensitive	$80.13	$320.50	$46.00–$298.07	—	75%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 by Quantitative NAAT, Plasma	$129.75	$519.00	$46.00–$482.67	—	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV Duo, 1/2 Ab/Ag , Reflex to Differentiation and PCR	$62.50	$250.00	$21.67–$232.50	32% below	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV Ag/Ab with reflex to Differentiation to ARUP	$75.13	$300.50	$21.67–$279.47	18% below	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV Duo, 1/2 Ab/Ag , Reflex to Differentiation and PCR	$62.50	$250.00	$21.67–$232.50	—	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV Ag/Ab with reflex to Differentiation to ARUP	$75.13	$300.50	$21.67–$279.47	—	75%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV High Risk from Liquid PAP	$98.69	$394.75	$31.58–$367.12	39% below	75%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV High Risk from Liquid PAP	$98.69	$394.75	$31.58–$367.12	—	75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C	$39.00	$156.00	$8.74–$145.08	44% below	75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C	$39.00	$156.00	$8.74–$145.08	—	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody	$30.56	$122.25	$9.67–$113.69	58% below	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Antibody	$30.56	$122.25	$9.67–$113.69	—	75%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen	$35.25	$141.00	$9.30–$131.13	40% below	75%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen	$35.25	$141.00	$9.30–$131.13	—	75%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB TEST	$74.81	$299.25	$12.84–$278.30	1% below	75%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB TEST	$74.81	$299.25	$12.84–$278.30	—	75%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Virus Quant Reflex to Genoty	$137.75	$551.00	$36.77–$512.43	55% below	75%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Viral Load reflexed from Hep	$163.19	$652.75	$36.77–$607.06	46% below	75%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Virus RNA Quant., PCR	$178.94	$715.75	$36.77–$665.65	41% below	75%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C RNA B DNA	$222.63	$890.50	$36.77–$828.17	27% below	75%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Virus Quant Reflex to Genoty	$137.75	$551.00	$36.77–$512.43	—	75%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Viral Load reflexed from Hep	$163.19	$652.75	$36.77–$607.06	—	75%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Virus RNA Quant., PCR	$178.94	$715.75	$36.77–$665.65	—	75%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C RNA B DNA	$222.63	$890.50	$36.77–$828.17	—	75%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Virus, Type 1 Glycoprotein G-specific Ab, IgG	$34.25	$137.00	$11.32–$127.41	64% below	75%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex Virus, Type 1 Glycoprotein G-specific Ab, IgG	$34.25	$137.00	$11.32–$127.41	—	75%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Virus, Type 2 Glycoprotein G-specific Ab, IgG	$37.56	$150.25	$17.42–$139.73	57% below	75%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex Virus, Type 2 Glycoprotein G-specific Ab, IgG	$37.56	$150.25	$17.42–$139.73	—	75%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein High Sensitivity, Cardiac	$51.63	$206.50	$11.12–$192.05	43% below	75%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein High Sensitivity, Cardiac	$51.63	$206.50	$11.12–$192.05	—	75%
Homocysteine blood test CPT 83090 Homocysteine Total	$60.19	$240.75	$16.13–$223.90	74% below	75%
Homocysteine blood test inpatient CPT 83090 Homocysteine Total	$60.19	$240.75	$16.13–$223.90	—	75%
Insulin blood test CPT 83525 Insulin, 90 minutes	$44.38	$177.50	$10.29–$165.08	45% below	75%
Insulin blood test CPT 83525 ASSAY OF INSULIN	$50.88	$203.50	$10.29–$189.26	37% below	75%
Insulin blood test inpatient CPT 83525 Insulin, 90 minutes	$44.38	$177.50	$10.29–$165.08	—	75%
Insulin blood test inpatient CPT 83525 ASSAY OF INSULIN	$50.88	$203.50	$10.29–$189.26	—	75%
Iron blood test (serum iron) CPT 83540 ASSAY OF IRON	$36.56	$146.25	$5.56–$136.01	15% below	75%
Iron blood test (serum iron) inpatient CPT 83540 ASSAY OF IRON	$36.56	$146.25	$5.56–$136.01	—	75%
Kidney function blood test panel CPT 80069 Renal Function Panel	$69.81	$279.25	$7.81–$259.70	2% below	75%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$69.81	$279.25	$7.81–$259.70	—	75%
LH (luteinizing hormone) test CPT 83002 Luteninzing Hormone Level	$68.06	$272.25	$16.67–$253.19	39% below	75%
LH (luteinizing hormone) test inpatient CPT 83002 Luteninzing Hormone Level	$68.06	$272.25	$16.67–$253.19	—	75%
Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE	$60.69	$242.75	$6.20–$225.76	3% below	75%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 ASSAY OF LIPASE	$60.69	$242.75	$6.20–$225.76	—	75%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$66.31	$265.25	$7.35–$246.68	28% below	75%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$66.31	$265.25	$7.35–$246.68	—	75%
Lyme disease antibody test CPT 86618 Lyme (B. burgdorferi) Antibodies IgM and IgG, 2nd Tier	$19.50	$78.00	$14.62–$73.49	84% below	75%
Lyme disease antibody test CPT 86618 Lyme (Borrelia burgdorferi) Antibody, Reflex to IgG IgM, Mod	$39.00	$156.00	$14.62–$145.08	68% below	75%
Lyme disease antibody test CPT 86618 Haptoglobin	$54.63	$218.50	$14.62–$203.21	55% below	75%
Lyme disease antibody test CPT 86618 Lyme (Borrelia Burgdorferi) CSF, by ELIS	$55.63	$222.50	$14.62–$206.93	54% below	75%
Lyme disease antibody test inpatient CPT 86618 Lyme (B. burgdorferi) Antibodies IgM and IgG, 2nd Tier	$19.50	$78.00	$14.62–$73.49	—	75%
Lyme disease antibody test inpatient CPT 86618 Lyme (Borrelia burgdorferi) Antibody, Reflex to IgG IgM, Mod	$39.00	$156.00	$14.62–$145.08	—	75%
Lyme disease antibody test inpatient CPT 86618 Haptoglobin	$54.63	$218.50	$14.62–$203.21	—	75%
Lyme disease antibody test inpatient CPT 86618 Lyme (Borrelia Burgdorferi) CSF, by ELIS	$55.63	$222.50	$14.62–$206.93	—	75%
Magnesium blood test CPT 83735 Magnesium Urine	$38.44	$153.75	$6.03–$142.99	29% below	75%
Magnesium blood test CPT 83735 Magnesium Level	$45.69	$182.75	$6.03–$169.96	15% below	75%
Magnesium blood test inpatient CPT 83735 Magnesium Urine	$38.44	$153.75	$6.03–$142.99	—	75%
Magnesium blood test inpatient CPT 83735 Magnesium Level	$45.69	$182.75	$6.03–$169.96	—	75%
Measles (rubeola) antibody test CPT 86765 Measles (Rubeola) Antibody, IgG	$18.19	$72.75	$11.06–$67.66	81% below	75%
Measles (rubeola) antibody test inpatient CPT 86765 Measles (Rubeola) Antibody, IgG	$18.19	$72.75	$11.06–$67.66	—	75%
Mono test (heterophile antibody, Monospot) CPT 86308 Monotest, POC	$9.25	$37.00	$4.66–$37.00	80% below	75%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN	$50.88	$203.50	$4.66–$189.26	10% above	75%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Monotest, POC	$9.25	$37.00	$4.66–$37.00	—	75%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODY SCREEN	$50.88	$203.50	$4.66–$189.26	—	75%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, Free	$48.00	$192.00	$16.55–$178.56	48% below	75%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, Free	$48.00	$192.00	$16.55–$178.56	—	75%
PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL	$62.44	$249.75	$16.55–$232.27	40% below	75%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL	$62.44	$249.75	$16.55–$232.27	—	75%
Pap test (liquid-based, automated screening with review) CPT 88175 CPT 88175 MAWD, Cytopath c/v auto fluid	$10.50	$42.00	$23.95–$42.00	89% below	75%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CPT 88175 MAWD, Cytopath c/v auto fluid	$10.50	$42.00	$23.95–$42.00	—	75%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CPT 88142 MAWD, Cytopath c/v thin layer	$7.88	$31.50	$17.99–$31.50	92% below	75%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH C/V THIN LAYER	$49.13	$196.50	$18.03–$182.75	51% below	75%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CPT 88142 MAWD, Cytopath c/v thin layer	$7.88	$31.50	$17.99–$31.50	—	75%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATH C/V THIN LAYER	$49.13	$196.50	$18.03–$182.75	—	75%
Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE	$56.69	$226.75	$35.44–$210.88	72% below	75%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 ASSAY OF PARATHORMONE	$56.69	$226.75	$35.44–$210.88	—	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 Bill Reflexed to PTT Ratio, Treated	$23.00	$92.00	$5.30–$85.56	48% below	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT-D Heparin Reflex Bill	$27.81	$111.25	$5.30–$103.46	37% below	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 Reflex PTT Inhibitor Screen, 1 hour, 1:1 Mix	$31.00	$124.00	$5.30–$115.32	30% below	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL	$37.19	$148.75	$5.30–$138.34	16% below	75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Bill Reflexed to PTT Ratio, Treated	$23.00	$92.00	$5.30–$85.56	—	75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT-D Heparin Reflex Bill	$27.81	$111.25	$5.30–$103.46	—	75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Reflex PTT Inhibitor Screen, 1 hour, 1:1 Mix	$31.00	$124.00	$5.30–$115.32	—	75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL	$37.19	$148.75	$5.30–$138.34	—	75%
Progesterone blood test CPT 84144 Progesterone Level	$68.06	$272.25	$18.77–$253.19	38% below	75%
Progesterone blood test inpatient CPT 84144 Progesterone Level	$68.06	$272.25	$18.77–$253.19	—	75%
Prolactin blood test CPT 84146 ASSAY OF PROLACTIN	$96.63	$386.50	$17.44–$359.45	25% below	75%
Prolactin blood test inpatient CPT 84146 ASSAY OF PROLACTIN	$96.63	$386.50	$17.44–$359.45	—	75%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$30.06	$120.25	$3.86–$111.83	3% below	75%
Prothrombin time (PT/INR) clotting test CPT 85610 PT, Protime with INR	$31.56	$126.25	$3.86–$117.41	2% above	75%
Prothrombin time (PT/INR) clotting test CPT 85610 Inhibitor Assay, PT, Reflex to 1:1 Mix	$37.19	$148.75	$3.86–$138.34	20% above	75%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$30.06	$120.25	$3.86–$111.83	—	75%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT, Protime with INR	$31.56	$126.25	$3.86–$117.41	—	75%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Inhibitor Assay, PT, Reflex to 1:1 Mix	$37.19	$148.75	$3.86–$138.34	—	75%
Rheumatoid factor (RF) test CPT 86431 RA Factor, Fluid	$26.56	$106.25	$5.10–$98.81	44% below	75%
Rheumatoid factor (RF) test inpatient CPT 86431 RA Factor, Fluid	$26.56	$106.25	$5.10–$98.81	—	75%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibody, IgG	$42.69	$170.75	$12.35–$158.80	26% below	75%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibody, IgG	$42.69	$170.75	$12.35–$158.80	—	75%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation Rate	$36.56	$146.25	$2.43–$136.01	13% above	75%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sedimentation Rate	$36.56	$146.25	$2.43–$136.01	—	75%
Stool ova and parasites exam CPT 87177 Ova and Parasite to ARUP	$43.19	$172.75	$8.01–$160.66	29% below	75%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasite to ARUP	$43.19	$172.75	$8.01–$160.66	—	75%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood, Feces SCREEN	$25.81	$103.25	$3.86–$96.02	4% below	75%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood, Feces SCREEN	$25.81	$103.25	$3.86–$96.02	—	75%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 IFOB, Immunoassay Fecal Occult Blood	$21.69	$86.75	$13.67–$80.68	58% below	75%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 IFOB, Immunoassay Fecal Occult Blood	$21.69	$86.75	$13.67–$80.68	—	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL	$26.69	$106.75	$3.84–$99.28	25% below	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, CSF (T Pallidum), Reflex to Titer	$28.13	$112.50	$3.84–$104.63	21% below	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREP QUAL	$26.69	$106.75	$3.84–$99.28	—	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL, CSF (T Pallidum), Reflex to Titer	$28.13	$112.50	$3.84–$104.63	—	75%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon TB Gold Plus, 1-Tube	$65.44	$261.75	$46.00–$243.43	65% below	75%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon TB Gold Plus, 1-Tube	$65.44	$261.75	$46.00–$243.43	—	75%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total (FEMALE and CHILDREN O	$68.25	$273.00	$23.23–$253.89	52% below	75%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Free and Total (FEMALE and C	$73.38	$293.50	$23.23–$272.96	49% below	75%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total (ADULT MALE)	$86.06	$344.25	$23.23–$320.15	40% below	75%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Free and Total (ADULT MALE	$96.38	$385.50	$23.23–$358.52	33% below	75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total (FEMALE and CHILDREN O	$68.25	$273.00	$23.23–$253.89	—	75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Free and Total (FEMALE and C	$73.38	$293.50	$23.23–$272.96	—	75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total (ADULT MALE)	$86.06	$344.25	$23.23–$320.15	—	75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Free and Total (ADULT MALE	$96.38	$385.50	$23.23–$358.52	—	75%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Antibodies	$19.19	$76.75	$13.10–$71.38	75% below	75%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Ab	$57.56	$230.25	$13.10–$214.13	26% below	75%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Antibodies	$19.19	$76.75	$13.10–$71.38	—	75%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Ab	$57.56	$230.25	$13.10–$214.13	—	75%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Pregnancy TSH (Thyroid Stimulating Hormone) with Reflex	$84.50	$338.00	$15.12–$314.34	6% below	75%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE	$88.75	$355.00	$15.12–$330.15	1% below	75%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Pregnancy TSH (Thyroid Stimulating Hormone) with Reflex	$84.50	$338.00	$15.12–$314.34	—	75%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE	$88.75	$355.00	$15.12–$330.15	—	75%
Trichomonas test (NAAT) CPT 87661 CPT 87661 MAWD, Trichomonas vaginalis amplif	$11.00	$44.00	$25.12–$44.00	92% below	75%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$30.94	$123.75	$31.58–$115.09	78% below	75%
Trichomonas test (NAAT) inpatient CPT 87661 CPT 87661 MAWD, Trichomonas vaginalis amplif	$11.00	$44.00	$25.12–$44.00	—	75%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$30.94	$123.75	$31.58–$115.09	—	75%
Uric acid blood test CPT 84550 Uric Acid	$34.69	$138.75	$4.07–$129.04	7% below	75%
Uric acid blood test inpatient CPT 84550 Uric Acid	$34.69	$138.75	$4.07–$129.04	—	75%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$52.56	$210.25	$2.85–$195.53	52% above	75%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE	$52.56	$210.25	$2.85–$195.53	—	75%
Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick, Point of Care	$6.69	$26.75	$1.93–$26.75	70% below	75%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis, Dipstick Only	$30.44	$121.75	$1.93–$113.23	35% above	75%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Dipstick, Point of Care	$6.69	$26.75	$1.93–$26.75	—	75%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis, Dipstick Only	$30.44	$121.75	$1.93–$113.23	—	75%
Urinalysis without microscope exam, manual CPT 81002 Total Protein, Urine Qualitative	$2.63	$10.50	$3.04–$10.50	85% below	75%
Urinalysis without microscope exam, manual CPT 81002 LUS Urine Dipstick, POC	$6.38	$25.50	$3.04–$25.50	64% below	75%
Urinalysis without microscope exam, manual inpatient CPT 81002 Total Protein, Urine Qualitative	$2.63	$10.50	$3.04–$10.50	—	75%
Urinalysis without microscope exam, manual inpatient CPT 81002 LUS Urine Dipstick, POC	$6.38	$25.50	$3.04–$25.50	—	75%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture with Colony Count	$48.44	$193.75	$7.26–$180.19	9% below	75%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture with Colony Count	$48.44	$193.75	$7.26–$180.19	—	75%
Urine pregnancy test, read by color change CPT 81025 Urine HCG, POC	$11.00	$44.00	$7.50–$44.00	76% below	75%
Urine pregnancy test, read by color change CPT 81025 HCG, Qualitative, Urine	$38.56	$154.25	$7.50–$143.45	17% below	75%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine HCG, POC	$11.00	$44.00	$7.50–$44.00	—	75%
Urine pregnancy test, read by color change inpatient CPT 81025 HCG, Qualitative, Urine	$38.56	$154.25	$7.50–$143.45	—	75%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12	$29.69	$118.75	$13.57–$110.44	66% below	75%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12	$29.69	$118.75	$13.57–$110.44	—	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25-Hydroxy Level	$68.56	$274.25	$25.41–$255.05	72% below	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25-Hydroxy Level	$68.56	$274.25	$25.41–$255.05	—	75%
Zinc blood test CPT 84630 Zinc Serum Level	$48.19	$192.75	$10.25–$179.26	17% below	75%
Zinc blood test inpatient CPT 84630 Zinc Serum Level	$48.19	$192.75	$10.25–$179.26	—	75%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta HCG tumor marker tumor marker	$28.13	$112.50	$12.92–$104.63	70% below	75%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta-HCG (Quantitative)	$92.19	$368.75	$12.92–$342.94	3% below	75%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta HCG tumor marker tumor marker	$28.13	$112.50	$12.92–$104.63	—	75%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta-HCG (Quantitative)	$92.19	$368.75	$12.92–$342.94	—	75%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Clsd Tx Dis Fibula W/O Manip	$690.75	$2,763.00	$204.50–$2,569.59	68% above	75%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Clsd Tx Dis Fibula W/O Manip	$690.75	$2,763.00	$204.50–$2,569.59	—	75%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Clsd Tx Metatarsal Fx W/P Manip,	$690.75	$2,763.00	$204.50–$2,569.59	109% above	75%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Clsd Tx Metatarsal Fx W/P Manip,	$690.75	$2,763.00	$204.50–$2,569.59	—	75%
Cardiac catheterization with coronary angiogram one side CPT 93458 CV Lt HT Cath w/wo LV and Cors	$3,897.69	$15,590.75	$1,903.20–$14,499.40	82% below	75%
Cardiac catheterization with coronary angiogram one side CPT 93458 Lt Ht Cath/Perc W/Or W/O Lt Vent/Cors	$3,897.69	$15,590.75	$1,903.20–$14,499.40	82% below	75%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 CV Lt HT Cath w/wo LV and Cors	$3,897.69	$15,590.75	$1,903.20–$14,499.40	—	75%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 Lt Ht Cath/Perc W/Or W/O Lt Vent/Cors	$3,897.69	$15,590.75	$1,903.20–$14,499.40	—	75%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT	$496.31	$1,985.25	$212.94–$1,985.25	12% below	75%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion ER	$496.31	$1,985.25	$212.94–$1,846.28	12% below	75%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Procedure/ICU Charge	$496.31	$1,985.25	$212.94–$1,846.28	12% below	75%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion ER	$496.31	$1,985.25	$212.94–$1,846.28	—	75%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTRIC EXT	$496.31	$1,985.25	$212.94–$1,985.25	—	75%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Procedure/ICU Charge	$496.31	$1,985.25	$212.94–$1,846.28	—	75%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONL BLOCK	$592.38	$2,369.50	$666.42–$2,369.50	50% above	75%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/REGIONL BLOCK	$592.38	$2,369.50	$666.42–$2,369.50	—	75%
Circumcision, surgical, older than a newborn CPT 54160 Circumcision No Device Nsy	$817.13	$3,268.50	$288.86–$3,039.71	at median	75%
Circumcision, surgical, older than a newborn inpatient CPT 54160 Circumcision No Device Nsy	$817.13	$3,268.50	$288.86–$3,039.71	—	75%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Clsd Tx Distal Radial Fx W/O Man	$690.75	$2,763.00	$204.50–$2,569.59	51% above	75%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Clsd Tx Distal Radial Fx W/O Man	$690.75	$2,763.00	$204.50–$2,569.59	—	75%
Coronary stent placement, one artery CPT 92928 CV BMS w/wo PTCA initial Vessel	$7,063.13	$28,252.50	$3,569.00–$26,274.83	41% below	75%
Coronary stent placement, one artery inpatient CPT 92928 CV BMS w/wo PTCA initial Vessel	$7,063.13	$28,252.50	$3,569.00–$26,274.83	—	75%
D&C (dilation and curettage), not related to pregnancy CPT 58120 D and C	$1,813.75	$7,255.00	$1,022.91–$6,747.15	26% above	75%
D&C (dilation and curettage), not related to pregnancy CPT 58120 D andC	$1,813.75	$7,255.00	$780.00–$6,747.15	26% above	75%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 D and C	$1,813.75	$7,255.00	$1,022.91–$6,747.15	—	75%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 D andC	$1,813.75	$7,255.00	$780.00–$6,747.15	—	75%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION	$157.81	$631.25	$65.51–$587.06	47% above	75%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALG LESION	$157.81	$631.25	$65.51–$587.06	—	75%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Rem Impacted Ear Wax Uni	$50.00	$200.00	$38.19–$200.00	39% below	75%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Ear Irrigation, Removal Cerumen Impaction	$99.56	$398.25	$38.19–$398.25	21% above	75%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Rem Impacted Ear Wax Uni	$50.00	$200.00	$38.19–$200.00	—	75%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Ear Irrigation, Removal Cerumen Impaction	$99.56	$398.25	$38.19–$398.25	—	75%
Earwax removal with instruments, one ear CPT 69210 Remove Impacted Cerumen 1Or2 Ears	$99.56	$398.25	$50.63–$398.25	20% above	75%
Earwax removal with instruments, one ear CPT 69210 Rem Impacted Cerumen	$99.56	$398.25	$50.63–$398.25	20% above	75%
Earwax removal with instruments, one ear inpatient CPT 69210 Remove Impacted Cerumen 1Or2 Ears	$99.56	$398.25	$50.63–$398.25	—	75%
Earwax removal with instruments, one ear inpatient CPT 69210 Rem Impacted Cerumen	$99.56	$398.25	$50.63–$398.25	—	75%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Biopsy Of Uterus Lining	$206.06	$824.25	$53.97–$780.00	12% below	75%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Biopsy Of Uterus Lining	$206.06	$824.25	$53.97–$780.00	—	75%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC	$713.19	$2,852.75	$380.92–$2,653.06	41% below	75%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 NJX INTERLAMINAR CRV/THRC	$713.19	$2,852.75	$380.92–$2,653.06	—	75%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 CT Inj Therapeutic Paravertebral Facet	$556.44	$2,225.75	$263.41–$2,069.95	43% below	75%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj Paravert F Jnt L/S 1 Lev OPS	$696.81	$2,787.25	$263.41–$2,592.14	29% below	75%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 CT Inj Therapeutic Paravertebral Facet	$556.44	$2,225.75	$263.41–$2,069.95	—	75%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Inj Paravert F Jnt L/S 1 Lev OPS	$696.81	$2,787.25	$263.41–$2,592.14	—	75%
Hemorrhoid banding (rubber band ligation) CPT 46221 Ligation Of Hemorrhoids	$632.06	$2,528.25	$299.04–$2,351.27	48% below	75%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 Ligation Of Hemorrhoids	$632.06	$2,528.25	$299.04–$2,351.27	—	75%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER FOR HYSTEROGRAPHY	$209.69	$838.75	$92.41–$780.04	69% below	75%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATHETER FOR HYSTEROGRAPHY	$209.69	$838.75	$92.41–$780.04	—	75%
Incision and drainage of a simple or single skin abscess CPT 10060 I andD Abscess Simple	$253.13	$1,012.50	$169.39–$941.63	22% above	75%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$253.13	$1,012.50	$169.39–$941.63	22% above	75%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$253.13	$1,012.50	$169.39–$941.63	—	75%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I andD Abscess Simple	$253.13	$1,012.50	$169.39–$941.63	—	75%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection Tendon/Ligament	$329.06	$1,316.25	$194.11–$1,224.11	127% above	75%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 NJX 1 TENDON SHEATH/LIGAMENT	$329.06	$1,316.25	$194.11–$1,224.11	127% above	75%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 NJX 1 TENDON SHEATH/LIGAMENT	$329.06	$1,316.25	$194.11–$1,224.11	—	75%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Injection Tendon/Ligament	$329.06	$1,316.25	$194.11–$1,224.11	—	75%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$404.38	$1,617.50	$251.65–$1,504.28	84% above	75%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis,Asp,Inj Maj Joint	$404.38	$1,617.50	$251.65–$1,504.28	84% above	75%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis,Asp,Inj Maj Joint	$404.38	$1,617.50	$251.65–$1,504.28	—	75%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$404.38	$1,617.50	$251.65–$1,504.28	—	75%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Joint Inject Intermed (PM)	$195.88	$783.50	$194.11–$728.66	14% below	75%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis,Intermed Joint,Bur	$195.88	$783.50	$194.11–$780.00	14% below	75%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Joint Inject Intermed (PM)	$195.88	$783.50	$194.11–$728.66	—	75%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis,Intermed Joint,Bur	$195.88	$783.50	$194.11–$780.00	—	75%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 XR Arthrocent/Aspir/Inj Sm Jt	$239.00	$956.00	$194.11–$889.08	12% above	75%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 XR Arthrocent/Aspir/Inj Sm Jt	$239.00	$956.00	$194.11–$889.08	—	75%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Repair, scalp, trunk, extremities 2.5cm or less	$267.38	$1,069.50	$288.86–$994.64	23% below	75%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Int Lac less2.6Cm Body,Scalp	$267.38	$1,069.50	$288.86–$994.64	23% below	75%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Repair, scalp, trunk, extremities 2.5cm or less	$267.38	$1,069.50	$288.86–$994.64	—	75%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Int Lac less2.6Cm Body,Scalp	$267.38	$1,069.50	$288.86–$994.64	—	75%
Left heart catheterization, diagnostic one side CPT 93452 CV Left Hrt Cath W/Ventrclgrphy	$3,199.69	$12,798.75	$2,302.76–$11,902.84	80% below	75%
Left heart catheterization, diagnostic inpatient one side CPT 93452 CV Left Hrt Cath W/Ventrclgrphy	$3,199.69	$12,798.75	$2,302.76–$11,902.84	—	75%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC	$756.25	$3,025.00	$380.92–$2,813.25	37% below	75%
Lower-back epidural injection, with imaging guidance CPT 62323 Nerve Block Epidural Lumbar/Sacral	$756.25	$3,025.00	$380.92–$2,813.25	37% below	75%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Nerve Block Epidural Lumbar/Sacral	$756.25	$3,025.00	$380.92–$2,813.25	—	75%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC	$756.25	$3,025.00	$380.92–$2,813.25	—	75%
Lower-back epidural injection, without imaging guidance CPT 62322 Nerve Blk Epi Lumbar/Sacral w/o Guidance PM	$633.50	$2,534.00	$380.92–$2,356.62	20% below	75%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Nerve Blk Epi Lumbar/Sacral w/o Guidance PM	$633.50	$2,534.00	$380.92–$2,356.62	—	75%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Nerve Blk Paravert Lumb/Sacr Sgl	$724.44	$2,897.75	$298.22–$2,694.91	30% below	75%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Nerve Blk Paravert Lumb/Sacr Sgl	$724.44	$2,897.75	$298.22–$2,694.91	—	75%
Mastectomy (total removal of the breast) CPT 19303 Mastectomy Simple Complete	$4,281.31	$17,125.25	$1,175.80–$15,926.48	8% above	75%
Mastectomy (total removal of the breast) inpatient CPT 19303 Mastectomy Simple Complete	$4,281.31	$17,125.25	$1,175.80–$15,926.48	—	75%
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<	$331.69	$1,326.75	$259.97–$1,264.27	78% above	75%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc Les TAL 0.5 cm or less	$331.69	$1,326.75	$259.97–$1,264.27	78% above	75%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<	$331.69	$1,326.75	$259.97–$1,264.27	—	75%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Exc Les TAL 0.5 cm or less	$331.69	$1,326.75	$259.97–$1,264.27	—	75%
Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate	$147.69	$590.75	$169.39–$590.75	6% above	75%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SIMPLE 1	$147.69	$590.75	$169.39–$549.40	6% above	75%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SIMPLE 1	$147.69	$590.75	$169.39–$549.40	—	75%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion Nail Plate	$147.69	$590.75	$169.39–$590.75	—	75%
Occipital nerve block (injection for headaches) CPT 64405 Nerve Blk-Greater Occipital	$329.06	$1,316.25	$194.11–$1,224.11	12% below	75%
Occipital nerve block (injection for headaches) CPT 64405 Nerve Block-Greater Occipital Nrv	$329.06	$1,316.25	$194.11–$1,224.11	12% below	75%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Nerve Blk-Greater Occipital	$329.06	$1,316.25	$194.11–$1,224.11	—	75%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Nerve Block-Greater Occipital Nrv	$329.06	$1,316.25	$194.11–$1,224.11	—	75%
Pacemaker implant (dual chamber) CPT 33208 Insertion/Replace Perm Pacer ELC ATR VEN	$8,634.31	$34,537.25	$4,983.00–$32,119.64	60% below	75%
Pacemaker implant (dual chamber) CPT 33208 CV Insert/Replace Perm Pacer A/V Leads w/fluoro	$8,634.31	$34,537.25	$4,983.00–$32,119.64	60% below	75%
Pacemaker implant (dual chamber) inpatient CPT 33208 CV Insert/Replace Perm Pacer A/V Leads w/fluoro	$8,634.31	$34,537.25	$4,983.00–$32,119.64	—	75%
Pacemaker implant (dual chamber) inpatient CPT 33208 Insertion/Replace Perm Pacer ELC ATR VEN	$8,634.31	$34,537.25	$4,983.00–$32,119.64	—	75%
Paracentesis with imaging guidance CPT 49083 CT Paracentesis With Guidance	$716.38	$2,865.50	$263.07–$2,664.92	9% above	75%
Paracentesis with imaging guidance CPT 49083 Abd Paracentesis W/Imaging	$752.19	$3,008.75	$263.07–$2,798.14	15% above	75%
Paracentesis with imaging guidance CPT 49083 US Paracentesis Abdominal	$752.19	$3,008.75	$263.07–$2,798.14	15% above	75%
Paracentesis with imaging guidance inpatient CPT 49083 CT Paracentesis With Guidance	$716.38	$2,865.50	$263.07–$2,664.92	—	75%
Paracentesis with imaging guidance inpatient CPT 49083 Abd Paracentesis W/Imaging	$752.19	$3,008.75	$263.07–$2,798.14	—	75%
Paracentesis with imaging guidance inpatient CPT 49083 US Paracentesis Abdominal	$752.19	$3,008.75	$263.07–$2,798.14	—	75%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision Of Nail And Nail Matrix	$412.94	$1,651.75	$288.86–$1,536.13	8% above	75%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Removal Of Nail Bed - Permanent	$412.94	$1,651.75	$288.86–$1,536.13	8% above	75%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excision Of Nail And Nail Matrix	$412.94	$1,651.75	$288.86–$1,536.13	—	75%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Removal Of Nail Bed - Permanent	$412.94	$1,651.75	$288.86–$1,536.13	—	75%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE	$1,330.81	$5,323.25	$666.42–$4,950.62	5% below	75%
Prostate biopsy CPT 55700 US Transrectal Biopsy	$1,397.38	$5,589.50	$666.42–$5,198.24	at median	75%
Prostate biopsy inpatient CPT 55700 BIOPSY OF PROSTATE	$1,330.81	$5,323.25	$666.42–$4,950.62	—	75%
Prostate biopsy inpatient CPT 55700 US Transrectal Biopsy	$1,397.38	$5,589.50	$666.42–$5,198.24	—	75%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Destrct Lumb/Sacral Facet Jnt	$1,063.50	$4,254.00	$616.07–$3,956.22	43% below	75%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Destrct Lumb/Sacral Facet Jnt	$1,063.50	$4,254.00	$616.07–$3,956.22	—	75%
Removal of a breast lump, open surgery CPT 19120 Exc Breast Cyst, Tumor, Lesion	$2,403.69	$9,614.75	$512.68–$8,941.72	1% above	75%
Removal of a breast lump, open surgery inpatient CPT 19120 Exc Breast Cyst, Tumor, Lesion	$2,403.69	$9,614.75	$512.68–$8,941.72	—	75%
Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL	$290.56	$1,162.25	$225.31–$1,162.25	23% above	75%
Removal of a foreign object under the skin, simple CPT 10120 I and Rem Fb Simple	$290.56	$1,162.25	$225.31–$1,162.25	23% above	75%
Removal of a foreign object under the skin, simple CPT 10120 CV Incision/Removal Fb Simple	$290.56	$1,162.25	$225.31–$1,162.25	23% above	75%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INC&RMVL FB SUBQ TISS SMPL	$290.56	$1,162.25	$225.31–$1,162.25	—	75%
Removal of a foreign object under the skin, simple inpatient CPT 10120 I and Rem Fb Simple	$290.56	$1,162.25	$225.31–$1,162.25	—	75%
Removal of a foreign object under the skin, simple inpatient CPT 10120 CV Incision/Removal Fb Simple	$290.56	$1,162.25	$225.31–$1,162.25	—	75%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 Lithotripsy Eswl	$6,622.31	$26,489.25	$1,573.37–$24,635.00	3% below	75%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 Lithotripsy Eswl	$6,622.31	$26,489.25	$1,573.37–$24,635.00	—	75%
Short arm cast (elbow to hand) CPT 29075 Apply Short Arm Cast	$199.06	$796.25	$226.40–$780.00	8% below	75%
Short arm cast (elbow to hand) inpatient CPT 29075 Apply Short Arm Cast	$199.06	$796.25	$226.40–$780.00	—	75%
Short arm splint (forearm and hand) CPT 29125 Apply Short Arm Splint	$127.31	$509.25	$109.89–$509.25	27% below	75%
Short arm splint (forearm and hand) inpatient CPT 29125 Apply Short Arm Splint	$127.31	$509.25	$109.89–$509.25	—	75%
Short leg cast (below the knee) CPT 29405 Apply Short Leg Cast (Knee To Toe	$149.31	$597.25	$226.40–$597.25	20% below	75%
Short leg cast (below the knee) inpatient CPT 29405 Apply Short Leg Cast (Knee To Toe	$149.31	$597.25	$226.40–$597.25	—	75%
Short leg splint (calf to foot) CPT 29515 Apply Short Leg Splint (Calf To F	$190.44	$761.75	$134.52–$761.75	20% above	75%
Short leg splint (calf to foot) inpatient CPT 29515 Apply Short Leg Splint (Calf To F	$190.44	$761.75	$134.52–$761.75	—	75%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Sim Lac Less2.6Cm Body,Scalp,Hand	$222.94	$891.75	$169.39–$829.33	9% below	75%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Sim Lac Less2.6Cm Body,Scalp,Hand	$222.94	$891.75	$169.39–$829.33	—	75%
Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy Skin Single LES	$291.31	$1,165.25	$130.46–$1,083.68	42% below	75%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Biopsy Skin Single LES	$291.31	$1,165.25	$130.46–$1,083.68	—	75%
Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR	$550.75	$2,203.00	$226.27–$2,048.79	5% above	75%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar ER	$550.75	$2,203.00	$226.27–$2,048.79	5% above	75%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Lumbar ER	$550.75	$2,203.00	$226.27–$2,048.79	—	75%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 DX LMBR SPI PNXR	$550.75	$2,203.00	$226.27–$2,048.79	—	75%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Sim Lac 2.6-7.5Cm	$231.81	$927.25	$169.39–$862.34	17% below	75%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Sim Lac 2.6-7.5Cm	$231.81	$927.25	$169.39–$862.34	—	75%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Sim Lac Less Than 2.6Cm Fc,Ch,Ers	$252.38	$1,009.50	$69.33–$938.84	6% below	75%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Sim Lac Less Than 2.6Cm Fc,Ch,Ers	$252.38	$1,009.50	$69.33–$938.84	—	75%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Skin Biopsy	$155.31	$621.25	$127.42–$621.25	40% below	75%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Skin Biopsy	$155.31	$621.25	$127.42–$621.25	—	75%
Thoracentesis with imaging guidance CPT 32555 CT Thoracentesis	$738.19	$2,952.75	$281.56–$2,746.06	16% below	75%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis w/Imaging Guidance	$775.13	$3,100.50	$281.56–$2,883.47	12% below	75%
Thoracentesis with imaging guidance CPT 32555 US Thoracentesis with Guid	$775.13	$3,100.50	$281.56–$2,883.47	12% below	75%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis ER, With Guid	$775.13	$3,100.50	$281.56–$2,883.47	12% below	75%
Thoracentesis with imaging guidance inpatient CPT 32555 CT Thoracentesis	$738.19	$2,952.75	$281.56–$2,746.06	—	75%
Thoracentesis with imaging guidance inpatient CPT 32555 US Thoracentesis with Guid	$775.13	$3,100.50	$281.56–$2,883.47	—	75%
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis w/Imaging Guidance	$775.13	$3,100.50	$281.56–$2,883.47	—	75%
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis ER, With Guid	$775.13	$3,100.50	$281.56–$2,883.47	—	75%
Trigger point injections, 1 or 2 muscles CPT 20552 Inject Trigger Point, 1 Or 2	$410.38	$1,641.50	$194.11–$1,526.60	174% above	75%
Trigger point injections, 1 or 2 muscles CPT 20552 NJX 1/MLT TRIGGER POINT 1/2	$410.38	$1,641.50	$194.11–$1,526.60	174% above	75%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inject Trigger Point, 1 Or 2	$410.38	$1,641.50	$194.11–$1,526.60	—	75%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 NJX 1/MLT TRIGGER POINT 1/2	$410.38	$1,641.50	$194.11–$1,526.60	—	75%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG	$1,153.06	$4,612.25	$479.35–$4,289.39	41% below	75%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST 1ST LESION US IMAG	$1,153.06	$4,612.25	$479.35–$4,289.39	—	75%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 Cysto Uretero w Lithotripsy	$8,373.31	$33,493.25	$1,692.99–$31,148.72	108% above	75%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 Cysto Uretero w Lithotripsy	$8,373.31	$33,493.25	$1,692.99–$31,148.72	—	75%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 Cysto Uretero Stent w Lithotripsy	$8,373.31	$33,493.25	$2,256.04–$31,148.72	51% above	75%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 Cysto Uretero Stent w Lithotripsy	$8,373.31	$33,493.25	$2,256.04–$31,148.72	—	75%
Vein ablation, radiofrequency, first vein CPT 36475 Endovenous RF First Vein	$2,032.19	$8,128.75	$1,878.68–$7,559.74	56% below	75%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 Endovenous RF First Vein	$2,032.19	$8,128.75	$1,878.68–$7,559.74	—	75%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<	$369.75	$1,479.00	$288.86–$1,375.47	15% above	75%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debridement, Skin Subq and Tissue	$369.75	$1,479.00	$288.86–$1,375.47	15% above	75%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debridement, Skin Subq and Tissue	$369.75	$1,479.00	$288.86–$1,375.47	—	75%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<	$369.75	$1,479.00	$288.86–$1,375.47	—	75%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion Service ER	$564.38	$2,257.50	$259.97–$2,099.48	2% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion	$598.19	$2,392.75	$259.97–$2,225.26	4% above	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion Service ER	$564.38	$2,257.50	$259.97–$2,099.48	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion	$598.19	$2,392.75	$259.97–$2,225.26	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$65.56	$262.25	$69.78–$262.25	43% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$65.56	$262.25	$69.78–$262.25	—	75%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR	$324.06	$1,296.25	$114.91–$1,205.51	18% below	75%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1 HR	$324.06	$1,296.25	$114.91–$1,205.51	—	75%
Critical care, first 30 to 74 minutes CPT 99291 Critical Care,1St Hr,Facility Fee	$1,113.81	$4,455.25	$123.49–$4,143.38	68% above	75%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care,1St Hr,Facility Fee	$1,113.81	$4,455.25	$123.49–$4,143.38	—	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING	$149.56	$598.25	$21.07–$556.37	18% below	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM TRACING	$149.56	$598.25	$21.07–$556.37	—	75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Level 1, ER Facility Fee	$100.00	$400.00	$75.06–$400.00	29% below	75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Level 1, ER Facility Fee	$100.00	$400.00	$75.06–$400.00	—	75%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Level 2, ER Facility Fee	$236.25	$945.00	$106.05–$945.00	23% above	75%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Level 2, ER Facility Fee	$236.25	$945.00	$106.05–$945.00	—	75%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Level 3, ER Facility Fee	$393.75	$1,575.00	$106.05–$1,575.00	44% above	75%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Level 3, ER Facility Fee	$393.75	$1,575.00	$106.05–$1,575.00	—	75%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM	$600.00	$2,400.00	$106.05–$2,232.00	53% above	75%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPT VISIT MOD MDM	$600.00	$2,400.00	$106.05–$2,232.00	—	75%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Level 5, ER Facility Fee	$661.50	$2,646.00	$106.05–$2,485.00	3% above	75%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Level 5, ER Facility Fee	$661.50	$2,646.00	$106.05–$2,485.00	—	75%
Exercise stress test, tracing only, the hospital charge CPT 93017 CV STRESS TEST TRACING ONLY	$305.75	$1,223.00	$102.70–$1,137.39	47% below	75%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CV STRESS TEST TRACING ONLY	$305.75	$1,223.00	$102.70–$1,137.39	—	75%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Infus, Hydration 31M-1Hr	$198.88	$795.50	$50.31–$780.00	18% below	75%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT	$198.88	$795.50	$50.31–$739.82	18% below	75%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Infus, Hydration 31M-1Hr	$198.88	$795.50	$50.31–$780.00	—	75%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT	$198.88	$795.50	$50.31–$739.82	—	75%
IV infusion of a medicine, first hour CPT 96365 CT IV Infusion, Therapeu/Dx; Up to 1 Hr RAD Chg	$202.38	$809.50	$87.81–$752.84	23% below	75%
IV infusion of a medicine, first hour CPT 96365 IV Infus, Therapeu/Dx, Up To 1 Hr	$212.50	$850.00	$87.81–$790.50	20% below	75%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT	$212.50	$850.00	$87.81–$790.50	20% below	75%
IV infusion of a medicine, first hour inpatient CPT 96365 CT IV Infusion, Therapeu/Dx; Up to 1 Hr RAD Chg	$202.38	$809.50	$87.81–$752.84	—	75%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT	$212.50	$850.00	$87.81–$790.50	—	75%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Infus, Therapeu/Dx, Up To 1 Hr	$212.50	$850.00	$87.81–$790.50	—	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 RHO D Full Dose Muscle Inj	$53.06	$212.25	$17.00–$197.39	21% below	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeu/Dx Inj Sub-Q Or Im, ER	$66.69	$266.75	$17.00–$266.75	at median	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM	$66.69	$266.75	$17.00–$248.08	at median	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 RHO D Vein Infusion	$81.31	$325.25	$17.00–$302.48	22% above	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 RHO D Mini Dose Muscle Inj	$123.06	$492.25	$17.00–$457.79	84% above	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 RHO D Full Dose Muscle Inj	$53.06	$212.25	$17.00–$197.39	—	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapeu/Dx Inj Sub-Q Or Im, ER	$66.69	$266.75	$17.00–$266.75	—	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM	$66.69	$266.75	$17.00–$248.08	—	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 RHO D Vein Infusion	$81.31	$325.25	$17.00–$302.48	—	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 RHO D Mini Dose Muscle Inj	$123.06	$492.25	$17.00–$457.79	—	75%
New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30 MIN	$115.44	$461.75	$52.41–$429.43	24% below	75%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE O/P NEW LOW 30 MIN	$115.44	$461.75	$52.41–$429.43	—	75%
New patient office visit, about 45 minutes CPT 99204 Level 4 OP Services New	$161.63	$646.50	$109.97–$601.25	19% below	75%
New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45 MIN	$161.63	$646.50	$52.41–$601.25	19% below	75%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE O/P NEW MOD 45 MIN	$161.63	$646.50	$52.41–$601.25	—	75%
New patient office visit, about 45 minutes inpatient CPT 99204 Level 4 OP Services New	$161.63	$646.50	$109.97–$601.25	—	75%
New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60 MIN	$212.06	$848.25	$52.41–$788.87	23% below	75%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE O/P NEW HI 60 MIN	$212.06	$848.25	$52.41–$788.87	—	75%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE O/P NEW SF 15 MIN	$92.44	$369.75	$52.41–$343.87	20% below	75%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE O/P NEW SF 15 MIN	$92.44	$369.75	$52.41–$343.87	—	75%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION INDIV IN	$21.88	$87.50	$20.07–$81.38	26% below	75%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MEDICAL NUTRITION INDIV IN	$21.88	$87.50	$20.07–$81.38	—	75%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$24.75	$99.00	$20.77–$92.07	11% below	75%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$24.75	$99.00	$20.77–$92.07	—	75%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40 MIN	$212.06	$848.25	$52.41–$788.87	2% above	75%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE O/P EST HI 40 MIN	$212.06	$848.25	$52.41–$788.87	—	75%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 LEVEL 3 ANTI-COAGUL VISIT - EST PT	$109.94	$439.75	$52.41–$408.97	19% below	75%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20 MIN	$115.44	$461.75	$52.41–$429.43	15% below	75%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 LEVEL 3 ANTI-COAGUL VISIT - EST PT	$109.94	$439.75	$52.41–$408.97	—	75%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE O/P EST LOW 20 MIN	$115.44	$461.75	$52.41–$429.43	—	75%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 LEVEL 4 ANTI-COAGUL VISIT - EST PT	$146.63	$586.50	$52.41–$545.45	15% below	75%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30 MIN	$161.63	$646.50	$52.41–$601.25	7% below	75%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OBA Level 4 -greater IV	$336.31	$1,345.25	$52.41–$1,251.08	94% above	75%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 LEVEL 4 ANTI-COAGUL VISIT - EST PT	$146.63	$586.50	$52.41–$545.45	—	75%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE O/P EST MOD 30 MIN	$161.63	$646.50	$52.41–$601.25	—	75%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OBA Level 4 -greater IV	$336.31	$1,345.25	$52.41–$1,251.08	—	75%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 LEVEL 2 ANTI-COAGUL VISIT-EST PT	$88.06	$352.25	$52.41–$327.59	16% below	75%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10 MIN	$92.44	$369.75	$52.41–$343.87	11% below	75%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 LEVEL 2 ANTI-COAGUL VISIT-EST PT	$88.06	$352.25	$52.41–$327.59	—	75%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE O/P EST SF 10 MIN	$92.44	$369.75	$52.41–$343.87	—	75%
Spirometry (breathing test) CPT 94010 Spirometry	$151.63	$606.50	$51.11–$564.05	48% below	75%
Spirometry (breathing test) inpatient CPT 94010 Spirometry	$151.63	$606.50	$51.11–$564.05	—	75%
Spirometry before and after a bronchodilator CPT 94060 Bronchodialator Responsiveness	$306.94	$1,227.75	$102.70–$1,141.81	31% below	75%
Spirometry before and after a bronchodilator inpatient CPT 94060 Bronchodialator Responsiveness	$306.94	$1,227.75	$102.70–$1,141.81	—	75%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY	$79.69	$318.75	$94.24–$296.44	33% below	75%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY	$79.69	$318.75	$94.24–$296.44	—	75%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Kansas	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 (Moderna 12+ yr) vaccine 50 mcg/0.5 mL inj	$255.25	$1,021.00	$8.07–$949.53	98% above	75%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID-19 (Moderna 12+ yr) vaccine 50 mcg/0.5 mL inj	$255.25	$1,021.00	$8.07–$949.53	—	75%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 varicella virus vaccine - inj	$345.59	$1,382.35	$8.07–$1,285.59	56% above	75%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 varicella virus vaccine - inj	$345.59	$1,382.35	$8.07–$1,285.59	—	75%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza vaccine (FluLaval) trivalent (6mos to 64yrs) PF 0.5 mL inj	$45.25	$181.00	$8.07–$168.33	41% above	75%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza vaccine (FluLaval) trivalent (6mos to 64yrs) PF 0.5 mL inj	$45.25	$181.00	$8.07–$168.33	—	75%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 human papillomavirus vaccine, 9-valent inj	$592.14	$2,368.55	$8.07–$2,202.75	48% above	75%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 human papillomavirus vaccine, 9-valent inj	$592.14	$2,368.55	$8.07–$2,202.75	—	75%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 hepatitis A-hepatitis B vaccine 720 units-20 mcg/mL preservative free Sus UD	$252.18	$1,008.70	$102.01–$938.09	6% below	75%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 hepatitis A-hepatitis B vaccine 720 units-20 mcg/mL preservative free Sus UD	$252.18	$1,008.70	$102.01–$938.09	—	75%
Hepatitis A vaccine, adult dose CPT 90632 hepatitis A vac 1440 units/mL syringe (ADULT Havrix)	$159.88	$639.50	$74.28–$594.74	30% above	75%
Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A vac 1440 units/mL syringe (ADULT Havrix)	$159.88	$639.50	$74.28–$594.74	—	75%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B ADULT vacc 20 mcg/mL Sus	$133.84	$535.35	$75.90–$497.88	15% above	75%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B ADULT vacc 20 mcg/mL Sus	$133.84	$535.35	$75.90–$497.88	—	75%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 influenza vaccine (Fluzone HD) high-dose trival (65+ yrs) PF 0.5 mL inj	$155.00	$620.00	$99.36–$576.60	81% above	75%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 influenza vaccine (Fluzone HD) high-dose trival (65+ yrs) PF 0.5 mL inj	$155.00	$620.00	$99.36–$576.60	—	75%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles/mumps/rubella vaccine Priorix	$172.34	$689.35	$24.20–$641.10	45% above	75%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles/mumps/rubella vaccine Priorix	$172.34	$689.35	$24.20–$641.10	—	75%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACWYD/MENACWYCRM VACC IM	$316.73	$1,266.90	$8.07–$1,178.22	24% above	75%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENACWYD/MENACWYCRM VACC IM	$316.73	$1,266.90	$8.07–$1,178.22	—	75%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 meningococcal group B vaccine, OMV (Bexsero)	$451.01	$1,804.05	$8.07–$1,677.77	44% above	75%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 meningococcal group B vaccine, OMV (Bexsero)	$451.01	$1,804.05	$8.07–$1,677.77	—	75%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conj vaccine inj	$538.43	$2,153.70	$8.07–$2,002.94	43% above	75%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conj vaccine inj	$538.43	$2,153.70	$8.07–$2,002.94	—	75%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 pneumococcal 23-valent vaccine 0.5 mL inj	$210.75	$843.00	$8.07–$783.99	26% above	75%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 pneumococcal 23-valent vaccine 0.5 mL inj	$210.75	$843.00	$8.07–$783.99	—	75%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 nirsevimab-alip (Beyfortus) PF 50 mg/0.5 mL inj	$1,071.11	$4,284.45	$8.07–$3,984.54	7% below	75%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 nirsevimab-alip (Beyfortus) PF 50 mg/0.5 mL inj	$1,071.11	$4,284.45	$8.07–$3,984.54	—	75%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV vaccine, preF A and B, recomb (Abrysvo) 120 mcg/0.5 mL	$574.34	$2,297.35	$297.95–$2,136.54	58% above	75%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV vaccine, preF A and B, recomb (Abrysvo) 120 mcg/0.5 mL	$574.34	$2,297.35	$297.95–$2,136.54	—	75%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSV vaccine preF3, recombinant preservative-free 120 mcg REC	$551.44	$2,205.75	$282.80–$2,051.35	49% above	75%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 RSV vaccine preF3, recombinant preservative-free 120 mcg REC	$551.44	$2,205.75	$282.80–$2,051.35	—	75%
Rabies vaccine, one dose CPT 90675 rabies vaccine, HUMAN 2.5 units inj	$673.50	$2,694.00	$319.75–$2,505.42	17% above	75%
Rabies vaccine, one dose CPT 90675 rabies vaccine, EMBRYO 2.5 unit/1 mL inj	$782.30	$3,129.20	$319.75–$2,910.16	36% above	75%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, HUMAN 2.5 units inj	$673.50	$2,694.00	$319.75–$2,505.42	—	75%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, EMBRYO 2.5 unit/1 mL inj	$782.30	$3,129.20	$319.75–$2,910.16	—	75%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 zoster vaccine, inact adjuv inj	$422.45	$1,689.80	$292.36–$1,571.51	50% above	75%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 zoster vaccine, inact adjuv inj	$422.45	$1,689.80	$292.36–$1,571.51	—	75%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 diphtheria-tetanus toxoid 0.5 mL inj Tenivac	$82.20	$328.80	$16.13–$305.78	33% above	75%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 diphtheria-tetanus toxoid 0.5 mL inj Tenivac	$82.20	$328.80	$16.13–$305.78	—	75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertuss (Tdap) adult/adol (Adacel)	$82.28	$329.10	$24.20–$306.06	16% above	75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus/Diphth/AcePertus (Tdap) (Boostrix)	$86.21	$344.85	$24.20–$320.71	21% above	75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphth/pertuss (Tdap) adult/adol (Adacel)	$82.28	$329.10	$24.20–$306.06	—	75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tetanus/Diphth/AcePertus (Tdap) (Boostrix)	$86.21	$344.85	$24.20–$320.71	—	75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN	$19.69	$78.75	$11.03–$78.75	48% below	75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN	$19.69	$78.75	$11.03–$78.75	—	75%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD	$10.50	$42.00	$11.03–$39.06	56% below	75%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EACH ADD	$10.50	$42.00	$11.03–$39.06	—	75%

Source file: https://www.lmh.org/wp-content/uploads/2026/03/48-6033703_The-Lawrence-Memorial-Hospital_standardcharges.csv