Fleming County Hospital
Fleming County Hospital in Flemingsburg, KY publishes cash prices for 233 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the Kentucky median for 129 of 227 procedures and above it for 93. By typical cash price it ranks #34 of 74 Kentucky hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
55 Foundation Drive Flemingsburg KY 41041 Collected Sep 29, 2026 Source price file (606) 849-2351
Rural emergency hospital Emergency department CCN 180780 · CMS hospital register NPI 1881726347
CMS price transparency record
The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 1 action for a hospital named Fleming County Hospital in Flemingsburg, KY:
- Jun 17, 2025 Met requirements
Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken.
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 Kentucky | Off list |
|---|---|---|---|---|---|
| Ankle X-ray, complete, 3 or more views CPT 73610 Radiologic examination, ankle; complete, minimum of 3 views | $205.67 | $514.18 | $99.65–$514.18 | 32% below | 60% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial | $429.80 | $1,074.50 | $208.24–$1,074.50 | — | 60% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study | $168.10 | $420.26 | $81.45–$420.26 | 57% below | 60% |
| Bone scan, whole body (nuclear medicine) CPT 78306 Bone and/or joint imaging; whole body | $1,042.85 | $2,607.13 | $505.26–$2,607.13 | 22% below | 60% |
| Breast ultrasound, complete, one breast one side CPT 76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete | $542.20 | $1,355.50 | $262.70–$1,355.50 | 43% above | 60% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited | $299.94 | $749.85 | $145.32–$749.85 | 1% below | 60% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing | $1,727.03 | $4,317.58 | $600.00 | 29% above | 60% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Computed tomography, abdomen and pelvis; without contrast material | $2,986.62 | $7,466.56 | $484.00 | 74% above | 60% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Computed tomography, abdomen and pelvis; with contrast material(s) | $3,155.09 | $7,887.72 | $484.00 | 55% above | 60% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions | $3,546.56 | $8,866.41 | $484.00 | 40% above | 60% |
| CT scan of the abdomen with contrast CPT 74160 Computed tomography, abdomen; with contrast material(s) | $1,577.54 | $3,943.86 | $484.00 | 28% above | 60% |
| CT scan of the abdomen without contrast CPT 74150 Computed tomography, abdomen; without contrast material | $1,198.31 | $2,995.78 | $484.00 | 6% above | 60% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Computed tomography, maxillofacial area; without contrast material | $1,454.41 | $3,636.02 | $426.00 | 40% above | 60% |
| CT scan of the head or brain, no contrast dye CPT 70450 Computed tomography, head or brain; without contrast material | $1,198.31 | $2,995.78 | $484.00 | 14% above | 60% |
| CT scan of the head with contrast CPT 70460 Computed tomography, head or brain; with contrast material(s) | $1,577.54 | $3,943.86 | $484.00 | 39% above | 60% |
| CT scan of the head without and with contrast CPT 70470 Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections | $1,727.03 | $4,317.58 | $426.00 | 22% above | 60% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 Computed tomography, lumbar spine; without contrast material | $1,198.31 | $2,995.78 | $484.00 | 6% below | 60% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 Computed tomography, cervical spine; without contrast material | $1,454.41 | $3,636.02 | $484.00 | 15% above | 60% |
| CT scan of the pelvis, with contrast dye CPT 72193 Computed tomography, pelvis; with contrast material(s) | $1,577.54 | $3,943.86 | $484.00 | 30% above | 60% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Duplex scan of extracranial arteries; complete bilateral study | $717.86 | $1,794.66 | $347.81–$1,794.66 | — | 60% |
| Chest X-ray, 2 views CPT 71046 Radiologic examination, chest; 2 views | $181.94 | $454.84 | $88.15–$454.84 | 19% below | 60% |
| Chest X-ray, single view CPT 71045 Radiologic examination, chest; single view | $163.48 | $408.69 | $79.20–$408.69 | 12% below | 60% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete | $377.06 | $942.65 | $182.69–$942.65 | 38% below | 60% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) | $420.57 | $1,051.42 | $203.77–$1,051.42 | 40% above | 60% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 Computed tomography, thorax, diagnostic; without contrast material | $903.56 | $2,258.89 | $546.00 | 13% below | 60% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Computed tomography, thorax, diagnostic; with contrast material(s) | $1,333.10 | $3,332.74 | $484.00 | 9% above | 60% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral | $440.35 | $1,100.87 | $226.00 | — | 60% |
| Diagnostic mammogram, one breast one side CPT 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral | $297.89 | $744.72 | $226.00 | 37% above | 60% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study | $835.86 | $2,089.65 | $404.97–$2,089.65 | — | 60% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography | $684.90 | $1,712.25 | $331.83–$1,712.25 | 53% below | 60% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary system imaging, including gallbladder when present | $756.10 | $1,890.25 | $366.33–$1,890.25 | 28% below | 60% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist | $3,330.28 | $8,325.69 | $1,613.52–$8,325.69 | 10% above | 60% |
| Knee X-ray, 3 views CPT 73562 Radiologic examination, knee; 3 views | $179.96 | $449.91 | $87.19–$449.91 | 43% below | 60% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up) | $556.37 | $1,390.93 | $269.56–$1,390.93 | 3% above | 60% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) | $747.44 | $1,868.60 | $484.00 | 41% above | 60% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material | $1,500.96 | $3,752.41 | $808.00 | at median | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences | $2,102.58 | $5,256.45 | $808.00 | at median | 60% |
| MRI of the abdomen without contrast CPT 74181 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) | $1,500.96 | $3,752.41 | $711.00 | 3% below | 60% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences | $1,729.48 | $4,323.70 | $808.00 | 13% below | 60% |
| MRI of the brain, no contrast dye CPT 70551 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material | $1,140.74 | $2,851.85 | $800.00 | 20% below | 60% |
| MRI of the brain, with and without contrast dye CPT 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences | $1,597.76 | $3,994.40 | $808.00 | 18% below | 60% |
| MRI of the lower back, no contrast dye CPT 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material | $1,329.43 | $3,323.57 | $808.00 | 11% below | 60% |
| MRI of the lower back, without and then with contrast dye CPT 72158 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar | $1,860.58 | $4,651.44 | $808.00 | 16% below | 60% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material | $1,500.96 | $3,752.41 | $808.00 | 7% below | 60% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical | $1,860.58 | $4,651.44 | $808.00 | 14% below | 60% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material | $1,500.96 | $3,752.41 | $808.00 | 1% above | 60% |
| MRI of the pelvis without and with contrast CPT 72197 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences | $1,729.48 | $4,323.70 | $808.00 | 16% below | 60% |
| MRI of the pelvis, no contrast dye CPT 72195 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) | $1,235.08 | $3,087.70 | $808.00 | 18% below | 60% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) | $1,500.96 | $3,752.41 | $711.00 | at median | 60% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or red | $2,597.24 | $6,493.10 | $1,258.36–$6,493.10 | 15% below | 60% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles) | $258.41 | $646.02 | $125.20–$646.02 | 27% below | 60% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete | $686.89 | $1,717.23 | $332.80–$1,717.23 | 18% above | 60% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation | $609.10 | $1,522.74 | $295.11–$1,522.74 | 42% above | 60% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation | $738.97 | $1,847.43 | $358.03–$1,847.43 | 73% above | 60% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses | $377.06 | $942.65 | $182.69–$942.65 | 5% above | 60% |
| Screening mammogram, both breasts both sides CPT 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed | $334.66 | $836.64 | $226.00 | — | 60% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 Radiologic examination, shoulder; complete, minimum of 2 views | $189.18 | $472.96 | $91.66–$472.96 | 38% below | 60% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 Radiologic examination, swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study | $211.60 | $529.00 | $102.52–$529.00 | 51% below | 60% |
| Transvaginal pelvic ultrasound CPT 76830 Ultrasound, transvaginal | $600.53 | $1,501.32 | $290.96–$1,501.32 | 16% above | 60% |
| Transvaginal ultrasound during pregnancy CPT 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal | $556.37 | $1,390.93 | $269.56–$1,390.93 | 32% above | 60% |
| Ultrasound of the abdomen, complete CPT 76700 Ultrasound, abdominal, real time with image documentation; complete | $835.20 | $2,088.01 | $404.66–$2,088.01 | 21% above | 60% |
| Ultrasound of the scrotum and testicles CPT 76870 Ultrasound, scrotum and contents | $556.37 | $1,390.93 | $269.56–$1,390.93 | 5% above | 60% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation | $556.37 | $1,390.93 | $269.56–$1,390.93 | 6% above | 60% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study | $726.87 | $1,817.18 | $352.17–$1,817.18 | 70% above | 60% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study | $954.52 | $2,386.30 | $462.46–$2,386.30 | 85% above | 60% |
| Wrist X-ray, complete, 3 or more views CPT 73110 Radiologic examination, wrist; complete, minimum of 3 views | $205.67 | $514.18 | $99.65–$514.18 | 28% below | 60% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views | $105.46 | $263.66 | $51.10–$263.66 | 49% below | 60% |
| X-ray of the abdomen, 1 view CPT 74018 Radiologic examination, abdomen; 1 view | $156.23 | $390.58 | $75.69–$390.58 | 29% below | 60% |
| X-ray of the ankle, 2 views CPT 73600 Radiologic examination, ankle; 2 views | $139.08 | $347.71 | $67.39–$347.71 | 41% below | 60% |
| X-ray of the finger(s), 2 or more views CPT 73140 Radiologic examination, finger(s), minimum of 2 views | $205.67 | $514.18 | $99.65–$514.18 | 1% above | 60% |
| X-ray of the foot, 2 views CPT 73620 Radiologic examination, foot; 2 views | $205.67 | $514.18 | $99.65–$514.18 | 18% below | 60% |
| X-ray of the foot, complete, 3 or more views CPT 73630 Radiologic examination, foot; complete, minimum of 3 views | $205.67 | $514.18 | $99.65–$514.18 | 33% below | 60% |
| X-ray of the hand, 3 or more views CPT 73130 Radiologic examination, hand; minimum of 3 views | $168.75 | $421.88 | $81.76–$421.88 | 45% below | 60% |
| X-ray of the knee, 1 or 2 views CPT 73560 Radiologic examination, knee; 1 or 2 views | $179.96 | $449.91 | $87.19–$449.91 | 25% below | 60% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Radiologic examination, spine, lumbosacral; 2 or 3 views | $337.51 | $843.78 | $163.52–$843.78 | 3% above | 60% |
| X-ray of the lower back, 4 or more views CPT 72110 Radiologic examination, spine, lumbosacral; minimum of 4 views | $646.02 | $1,615.05 | $313.00–$1,615.05 | 49% above | 60% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 Radiologic examination, spine; thoracic, 2 views | $218.20 | $545.49 | $105.72–$545.49 | 24% below | 60% |
| X-ray of the nasal bones, 3 or more views CPT 70160 Radiologic examination, nasal bones, complete, minimum of 3 views | $205.67 | $514.18 | $99.65–$514.18 | 26% below | 60% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Radiologic examination, spine, cervical; 2 or 3 views | $218.20 | $545.49 | $105.72–$545.49 | 31% below | 60% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 Radiologic examination, pelvis; 1 or 2 views | $218.20 | $545.49 | $105.72–$545.49 | 2% above | 60% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Radiologic examination, sacrum and coccyx, minimum of 2 views | $337.51 | $843.78 | $163.52–$843.78 | 40% above | 60% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Kentucky | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Transferase; alanine amino (ALT) (SGPT) | $25.70 | $64.26 | $4.50 | 59% below | 60% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Transferase; aspartate amino (AST) (SGOT) | $30.98 | $77.45 | $4.40 | 51% below | 60% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803) | $88.34 | $220.85 | $40.48 | 65% below | 60% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each | $14.74 | $36.86 | $4.43 | 21% above | 60% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic citrullinated peptide (CCP), antibody | $181.94 | $454.84 | $11.00 | 127% above | 60% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear antibodies (ANA) | $81.09 | $202.72 | $10.27 | 5% above | 60% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Natriuretic peptide | $187.87 | $469.68 | $28.85 | 3% above | 60% |
| Basic metabolic panel (blood test) CPT 80048 Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) | $73.83 | $184.57 | $5.69 | 22% below | 60% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Level IV - Surgical pathology, gross and microscopic examination Abortion - spontaneous/missed Artery, biopsy Bone marrow, biopsy Bone exostosis Brain/meninges, other than for tumor resection Breast, biopsy, not requiring microscopic evaluation of surgical margins Breast, reduction mammoplasty Bronc | $82.40 | $206.01 | $36.44 | 48% below | 60% |
| Blood culture for bacteria CPT 87040 Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) | $77.13 | $192.82 | $8.77 | 39% below | 60% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Collection of venous blood by venipuncture | $5.93 | $14.82 | $5.00 | 64% below | 60% |
| Blood glucose (sugar) test CPT 82947 Glucose; quantitative, blood (except reagent strip) | $25.04 | $62.61 | $3.34 | 40% below | 60% |
| Blood lead test CPT 83655 Lead | $23.47 | $58.67 | $10.29 | 65% below | 60% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Gonadotropin, chorionic (hCG); qualitative | $66.59 | $166.47 | $6.38 | 25% below | 60% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood typing, serologic; ABO | $23.08 | $57.70 | $2.54 | 58% below | 60% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive protein | $56.04 | $140.09 | $3.25 | 2% above | 60% |
| C. difficile toxin gene test (stool PCR) CPT 87493 Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique | $94.26 | $235.65 | $29.83 | 6% below | 60% |
| CA 19-9 blood test (tumor marker) CPT 86301 Immunoassay for tumor antigen, quantitative; CA 19-9 | $98.87 | $247.18 | $17.69 | 23% below | 60% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Immunoassay for tumor antigen, quantitative; CA 125 | $85.04 | $212.60 | $17.69 | 35% below | 60% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique | $85.04 | $212.60 | $29.83 | 23% below | 60% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478) | $118.00 | $294.99 | $9.68 | at median | 60% |
| Complete blood count (CBC) with differential CPT 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count | $44.17 | $110.42 | $6.61 | 26% below | 60% |
| Complete blood count (CBC), no differential CPT 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) | $18.46 | $46.15 | $5.50 | 68% below | 60% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155) Sodium | $96.24 | $240.61 | $7.15 | 27% below | 60% |
| D-dimer blood test (blood clot marker) CPT 85379 Fibrin degradation products, D-dimer; quantitative | $45.49 | $113.72 | $8.65 | 50% below | 60% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone-sulfate (DHEA-S) | $69.21 | $173.03 | $18.89 | 47% below | 60% |
| Estradiol blood test CPT 82670 Estradiol; total | $83.06 | $207.65 | $23.75 | 42% below | 60% |
| FSH (follicle-stimulating hormone) test CPT 83001 Gonadotropin; follicle stimulating hormone (FSH) | $46.14 | $115.36 | $15.79 | 71% below | 60% |
| Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, fecal | $192.49 | $481.23 | $16.68 | 5% below | 60% |
| Ferritin blood test (iron stores) CPT 82728 Ferritin | $41.53 | $103.82 | $11.58 | 62% below | 60% |
| Folate (folic acid) blood test CPT 82746 Folic acid; serum | $38.90 | $97.24 | $12.49 | 64% below | 60% |
| Free T3 thyroid hormone test CPT 84481 Triiodothyronine T3; free | $50.10 | $125.24 | $14.40 | 66% below | 60% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine; free | $40.87 | $102.18 | $7.66 | 48% below | 60% |
| Free testosterone test CPT 84402 Testosterone; free | $46.14 | $115.36 | $21.64 | 42% below | 60% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose; post glucose dose (includes glucose) | $53.40 | $133.49 | $4.04 | at median | 60% |
| Glucose tolerance test, 3 samples CPT 82951 Glucose; tolerance test (GTT), 3 specimens (includes glucose) | $38.23 | $95.57 | $10.94 | 75% below | 60% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique | $85.70 | $214.24 | $29.83 | 20% below | 60% |
| H. pylori antibody blood test CPT 86677 Antibody; Helicobacter pylori | $46.82 | $117.04 | $12.34 | 51% below | 60% |
| H. pylori stool antigen test CPT 87338 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; Helicobacter pylori, stool | $102.18 | $255.44 | $12.22 | 35% below | 60% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification, includes reverse transcription when performed | $173.37 | $433.43 | $72.31 | 32% below | 60% |
| HIV-1 and HIV-2 antibody test CPT 86703 Antibody; HIV-1 and HIV-2, single result | $145.68 | $364.21 | $11.66 | 126% above | 60% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single resu | $145.68 | $364.21 | $20.47 | 81% above | 60% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin; glycosylated (A1C) | $30.98 | $77.45 | $8.25 | 56% below | 60% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B surface antibody (HBsAb) | $69.21 | $173.03 | $9.13 | 27% below | 60% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; hepatitis B surface antigen (HBsAg) | $69.21 | $173.03 | $8.78 | 9% below | 60% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C antibody | $93.60 | $234.01 | $12.13 | 11% below | 60% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed | $293.36 | $733.39 | $36.40 | 1% above | 60% |
| Herpes blood test, HSV-1 antibody CPT 86695 Antibody; herpes simplex, type 1 | $77.13 | $192.82 | $11.21 | 21% above | 60% |
| Herpes blood test, HSV-2 antibody CPT 86696 Antibody; herpes simplex, type 2 | $77.13 | $192.82 | $16.45 | 11% above | 60% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-reactive protein; high sensitivity (hsCRP) | $143.71 | $359.27 | $11.00 | 71% above | 60% |
| Homocysteine blood test CPT 83090 Homocysteine | $77.79 | $194.48 | $14.33 | 46% below | 60% |
| Insulin blood test CPT 83525 Insulin; total | $52.74 | $131.86 | $9.71 | 38% below | 60% |
| Iron blood test (serum iron) CPT 83540 Iron | $31.64 | $79.10 | $5.51 | 56% below | 60% |
| Iron-binding capacity (TIBC) test CPT 83550 Iron binding capacity | $13.84 | $34.61 | $7.43 | 84% below | 60% |
| Kidney function blood test panel CPT 80069 Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) | $122.62 | $306.54 | $5.69 | 33% above | 60% |
| LH (luteinizing hormone) test CPT 83002 Gonadotropin; luteinizing hormone (LH) | $46.14 | $115.36 | $15.74 | 68% below | 60% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase | $28.34 | $70.86 | $5.86 | 62% below | 60% |
| Liver function blood test panel CPT 80076 Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) | $102.18 | $255.44 | $5.69 | 1% above | 60% |
| Lyme disease antibody test CPT 86618 Antibody; Borrelia burgdorferi (Lyme disease) | $58.01 | $145.02 | $14.47 | 1% above | 60% |
| Magnesium blood test CPT 83735 Magnesium | $25.04 | $62.61 | $5.69 | 54% below | 60% |
| Measles (rubeola) antibody test CPT 86765 Antibody; rubeola | $58.01 | $145.02 | $10.95 | 2% above | 60% |
| Mono test (heterophile antibody, Monospot) CPT 86308 Heterophile antibodies; screening | $60.64 | $151.60 | $4.40 | 10% above | 60% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate specific antigen (PSA); free | $68.56 | $171.39 | $15.64 | 18% below | 60% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate specific antigen (PSA); total | $57.35 | $143.37 | $15.64 | 55% below | 60% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision | $87.02 | $217.55 | $17.22 | 55% above | 60% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathormone (parathyroid hormone) | $92.94 | $232.36 | $35.08 | 56% below | 60% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplastin time, partial (PTT); plasma or whole blood | $184.58 | $461.44 | $5.10 | 108% above | 60% |
| Progesterone blood test CPT 84144 Progesterone | $69.21 | $173.03 | $17.73 | 48% below | 60% |
| Prolactin blood test CPT 84146 Prolactin | $59.33 | $148.32 | $16.47 | 58% below | 60% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin time | $34.94 | $87.35 | $3.34 | 22% below | 60% |
| Rapid flu test (influenza antigen) CPT 87804 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Influenza | $63.94 | $159.85 | $9.73 | 40% above | 60% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group A | $58.01 | $145.02 | $9.73 | 2% below | 60% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid factor; quantitative | $44.17 | $110.42 | $4.82 | 8% below | 60% |
| Rubella antibody test (immunity check) CPT 86762 Antibody; rubella | $47.47 | $118.68 | $12.23 | 53% below | 60% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation rate, erythrocyte; automated | $56.02 | $140.04 | $2.30 | 44% above | 60% |
| Stool ova and parasites exam CPT 87177 Ova and parasites, direct smears, concentration and identification | $66.59 | $166.47 | $7.42 | 19% below | 60% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations | $46.14 | $115.36 | $13.52 | 16% above | 60% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) | $27.03 | $67.58 | $3.63 | 34% below | 60% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon | $205.67 | $514.18 | $52.67 | 44% above | 60% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone; total | $73.83 | $184.57 | $21.94 | 36% below | 60% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibodies (eg, thyroid or liver-kidney), each | $90.97 | $227.43 | $12.37 | 2% below | 60% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid stimulating hormone (TSH) | $38.23 | $95.57 | $14.28 | 61% below | 60% |
| Uric acid blood test CPT 84550 Uric acid; blood | $21.76 | $54.41 | $3.84 | 61% below | 60% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy | $20.44 | $51.10 | $2.69 | 60% below | 60% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy | $30.98 | $77.45 | $1.91 | 16% above | 60% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy | $13.84 | $34.61 | $2.05 | 22% below | 60% |
| Urine culture for bacteria, with colony count CPT 87086 Culture, bacterial; quantitative colony count, urine | $101.52 | $253.80 | $6.86 | 12% above | 60% |
| Urine pregnancy test, read by color change CPT 81025 Urine pregnancy test, by visual color comparison methods | $66.59 | $166.47 | $1.02 | 29% above | 60% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Cyanocobalamin (Vitamin B-12) | $31.64 | $79.10 | $12.81 | 64% below | 60% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed | $94.26 | $235.65 | $23.22 | 20% below | 60% |
| Zinc blood test CPT 84630 Zinc | $62.64 | $156.59 | $9.67 | 46% below | 60% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin, chorionic (hCG); quantitative | $69.21 | $173.03 | $12.80 | 55% below | 60% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Kentucky | Off list |
|---|---|---|---|---|---|
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion, elective, electrical conversion of arrhythmia; external | $876.07 | $2,190.18 | $424.46–$2,190.18 | 6% below | 60% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Removal impacted cerumen using irrigation/lavage, unilateral | $180.62 | $451.56 | $87.51–$451.56 | 87% above | 60% |
| Earwax removal with instruments, one ear one side CPT 69210 Removal impacted cerumen requiring instrumentation, unilateral | $118.19 | $295.49 | $57.26–$295.48 | 13% above | 60% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single | $246.92 | $617.31 | $119.63–$617.31 | 17% below | 60% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance | $416.86 | $1,042.14 | $201.97–$1,042.14 | 1% above | 60% |
| Nail removal (partial or complete), one nail CPT 11730 Avulsion of nail plate, partial or complete, simple; single | $244.96 | $612.40 | $118.68–$612.40 | at median | 60% |
| Paracentesis with imaging guidance CPT 49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance | $918.88 | $2,297.20 | $445.20–$2,297.20 | 18% below | 60% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal | $447.23 | $1,118.08 | $216.68–$1,118.08 | 2% below | 60% |
| Removal of a foreign object under the skin, simple CPT 10120 Incision and removal of foreign body, subcutaneous tissues; simple | $444.11 | $1,110.27 | $215.17–$1,110.26 | 50% above | 60% |
| Short arm splint (forearm and hand) CPT 29125 Application of short arm splint (forearm to hand); static | $172.05 | $430.13 | $83.36–$430.13 | 1% below | 60% |
| Short leg splint (calf to foot) CPT 29515 Application of short leg splint (calf to foot) | $223.47 | $558.68 | $108.27–$558.68 | 19% above | 60% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less | $273.32 | $683.31 | $132.43–$683.31 | 2% above | 60% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm | $288.62 | $721.56 | $139.84–$721.56 | 1% above | 60% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less | $266.39 | $665.97 | $129.06–$665.97 | 2% below | 60% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance | $2,037.59 | $5,093.97 | $987.21–$5,093.97 | 1% above | 60% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less | $418.70 | $1,046.76 | $202.86–$1,046.76 | 12% below | 60% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Kentucky | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Transfusion, blood or blood components | $651.29 | $1,628.23 | $315.55–$1,628.23 | 10% above | 60% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device | $280.81 | $153.27 | $136.05–$702.03 | 96% above | -83% |
| Chemotherapy IV infusion, first hour CPT 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug | $609.76 | $1,524.41 | $295.43–$1,524.41 | 25% above | 60% |
| Critical care, first 30 to 74 minutes CPT 99291 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | $1,583.20 | $3,957.99 | $767.06–$3,957.99 | 8% below | 60% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 Electroencephalogram (EEG); including recording awake and drowsy | $539.88 | $1,349.71 | $261.57–$1,349.71 | 12% below | 60% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | $121.30 | $303.25 | $58.77–$303.25 | 29% below | 60% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional | $143.57 | $358.92 | $236.00 | 2% below | 60% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making | $266.42 | $666.05 | $470.00 | 5% below | 60% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making | $475.86 | $1,189.65 | $1,601.00 | 20% above | 60% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making | $793.35 | $1,983.37 | $1,601.00 | 13% below | 60% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making | $1,180.40 | $2,950.99 | $1,601.00 | 2% above | 60% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report | $756.10 | $1,890.25 | $366.33–$1,890.25 | 2% below | 60% |
| Family therapy with the patient, 50 minutes CPT 90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes | $409.91 | $1,024.77 | $198.60–$1,024.77 | 3% above | 60% |
| Family therapy without the patient, 50 minutes CPT 90846 Family psychotherapy (without the patient present), 50 minutes | $390.50 | $976.26 | $189.20–$976.26 | 1% above | 60% |
| Group psychotherapy session CPT 90853 Group psychotherapy (other than of a multiple-family group) | $366.25 | $915.63 | $177.45–$915.63 | 84% above | 60% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour | $197.43 | $493.58 | $95.66–$493.58 | 30% below | 60% |
| IV infusion of a medicine, first hour CPT 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour | $342.98 | $857.44 | $166.17–$857.44 | 6% above | 60% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | $79.76 | $199.40 | $38.64–$199.40 | 10% below | 60% |
| Neuromuscular re-education, 15 minutes CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities | $65.92 | $164.79 | $31.94–$164.79 | 22% below | 60% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes | $23.73 | $59.32 | $11.50–$59.32 | 17% below | 60% |
| Occupational therapy evaluation, low complexity CPT 97165 Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance | $147.00 | $367.51 | $71.22–$367.51 | 16% below | 60% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from | $181.94 | $454.84 | $88.15–$454.84 | 11% below | 60% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and | $181.94 | $454.84 | $88.15–$454.84 | 4% above | 60% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements fro | $181.94 | $454.84 | $88.15–$454.84 | 6% below | 60% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes | $50.26 | $220.85 | $24.35–$125.65 | 35% below | 77% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility | $92.29 | $230.73 | $44.72–$230.73 | 3% above | 60% |
| Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 minutes with patient | $295.91 | $739.78 | $143.37–$739.78 | 85% above | 60% |
| Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 minutes with patient | $366.25 | $915.63 | $177.45–$915.63 | 88% above | 60% |
| Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 minutes with patient | $373.53 | $933.82 | $180.97–$933.82 | 48% above | 60% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes | $43.50 | $108.76 | $21.08–$108.76 | 35% above | 60% |
| Speech and language evaluation CPT 92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) | $339.50 | $848.74 | $164.49–$848.74 | 7% above | 60% |
| Speech therapy session, individual CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual | $256.42 | $641.06 | $124.24–$641.06 | 49% above | 60% |
| Spirometry (breathing test) CPT 94010 Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation | $315.10 | $787.74 | $152.66–$787.74 | 27% above | 60% |
| Spirometry before and after a bronchodilator CPT 94060 Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration | $537.26 | $1,343.16 | $260.30–$1,343.16 | 23% above | 60% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy, therapeutic (separate procedure) | $56.70 | $141.74 | $27.47–$141.74 | 64% below | 60% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report | $756.10 | $1,890.25 | $366.33–$1,890.25 | — | 60% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Kentucky | Off list |
|---|---|---|---|---|---|
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use | $66.44 | $166.10 | $23.31 | 99% above | 60% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use | $57.35 | $143.37 | $80.39 | 67% below | 60% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use | $232.08 | $580.20 | $150.15 | 20% below | 60% |
| Rabies vaccine, one dose CPT 90675 Rabies vaccine, for intramuscular use | $714.64 | $1,786.60 | $497.86 | 1% below | 60% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use | $95.72 | $239.30 | $35.69 | 44% above | 60% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use | $116.72 | $291.80 | $57.00 | 20% above | 60% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) | $99.45 | $248.62 | $48.18–$248.62 | 40% above | 60% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) | $87.02 | $217.55 | $42.16–$217.55 | 117% above | 60% |