Alegent Health Memorial Hospital, Schuyler
Alegent Health Memorial Hospital, Schuyler in Schuyler, NE publishes cash prices for 60 common procedures listed here, from its own machine-readable price file updated Feb 28, 2026. Click a procedure to compare it with other hospitals nearby.
104 West 17th Street, Schuyler, NE 68661 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN PELVIS W CONTRST | $5,948.30 | $6,998.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN PELVIS W CONTRST | $5,948.30 | $6,998.00 | 15% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD WO CONTRAST | $2,176.00 | $2,560.00 | 15% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD WO CONTRAST | $2,176.00 | $2,560.00 | 15% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST | $2,513.45 | $2,957.00 | 15% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST | $2,513.45 | $2,957.00 | 15% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC MAMMOGRAM DIGITAL BILATERAL | $261.80 | $308.00 | 15% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC MAMMOGRAM DIGITAL BILATERAL | $261.80 | $308.00 | 15% |
| Diagnostic mammogram, one breast CPT 77065 HC MAMMOGRAM DIGITAL UNILATERL | $191.25 | $225.00 | 15% |
| Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO INCL CAD UNI | $261.80 | $308.00 | 15% |
| Diagnostic mammogram, one breast inpatient CPT 77065 HC MAMMOGRAM DIGITAL UNILATERL | $191.25 | $225.00 | 15% |
| Diagnostic mammogram, one breast inpatient CPT 77065 HC DX MAMMO INCL CAD UNI | $261.80 | $308.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MR JOINT LOWER EXT WO CONT | $2,966.50 | $3,490.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MR JOINT LOWER EXT WO CONT | $2,966.50 | $3,490.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MR JNT LOWER EXT W WO CONT | $3,677.95 | $4,327.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MR JNT LOWER EXT W WO CONT | $3,677.95 | $4,327.00 | 15% |
| MRI of the brain, no contrast dye CPT 70551 HC MR BRAIN WO CONTRAST | $4,866.25 | $5,725.00 | 15% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MR BRAIN WO CONTRAST | $4,866.25 | $5,725.00 | 15% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MR BRAIN W WO CONTRAST | $4,505.85 | $5,301.00 | 15% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MR BRAIN W WO CONTRAST | $4,505.85 | $5,301.00 | 15% |
| MRI of the lower back, no contrast dye CPT 72148 HC MR LUMBAR WO CONTRAST | $3,965.25 | $4,665.00 | 15% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MR LUMBAR WO CONTRAST | $3,965.25 | $4,665.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US PREGNANCY >14 WKS | $852.55 | $1,003.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC ULTRASOUND COMPLETE | $863.60 | $1,016.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US PREGNANCY >14 WKS | $852.55 | $1,003.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC ULTRASOUND COMPLETE | $863.60 | $1,016.00 | 15% |
| Screening mammogram, both breasts both sides CPT 77067 HC SCR MAMMO BI INCL CAD | $334.90 | $394.00 | 15% |
| Screening mammogram, both breasts CPT 77067 HC MAMMOGRAM DIGITAL SCREEN | $284.75 | $335.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 HC MAMMOG DR UNILAT SCREEN M52 | $185.30 | $218.00 | 15% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCR MAMMO BI INCL CAD | $334.90 | $394.00 | 15% |
| Screening mammogram, both breasts inpatient CPT 77067 HC MAMMOGRAM DIGITAL SCREEN | $284.75 | $335.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC MAMMOG DR UNILAT SCREEN M52 | $185.30 | $218.00 | 15% |
| Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAPHY=> 6 YR | $4,548.35 | $5,351.00 | 15% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAPHY=> 6 YR | $4,548.35 | $5,351.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL | $729.30 | $858.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL | $729.30 | $858.00 | 15% |
| Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMEN | $976.65 | $1,149.00 | 15% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMEN | $976.65 | $1,149.00 | 15% |
| X-ray of the lower back, 4 or more views CPT 72110 HC RHC LUMB SAC SPINE 4 VWS | $85.00 | $100.00 | 15% |
| X-ray of the lower back, 4 or more views CPT 72110 HC LUMBR SPINE W OBLIQUES 4OR> | $617.95 | $727.00 | 15% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC RHC LUMB SAC SPINE 4 VWS | $85.00 | $100.00 | 15% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC LUMBR SPINE W OBLIQUES 4OR> | $617.95 | $727.00 | 15% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC RHC BASIC METABOLIC PANL | $22.10 | $26.00 | 15% |
| Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL | $233.75 | $275.00 | 15% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC RHC BASIC METABOLIC PANL | $22.10 | $26.00 | 15% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL | $233.75 | $275.00 | 15% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC HEART CHECK LIPID | $8.50 | $10.00 | 15% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC RHC LIPID PANEL | $34.85 | $41.00 | 15% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL | $256.70 | $302.00 | 15% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC HEART CHECK LIPID | $8.50 | $10.00 | 15% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC RHC LIPID PANEL | $34.85 | $41.00 | 15% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL | $256.70 | $302.00 | 15% |
| Complete blood count (CBC) with differential CPT 85025 HC RHC CBC AUTOMATED W DIFF | $12.75 | $15.00 | 15% |
| Complete blood count (CBC) with differential CPT 85025 HC CBC W AUTO DIFF | $164.90 | $194.00 | 15% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC RHC CBC AUTOMATED W DIFF | $12.75 | $15.00 | 15% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC W AUTO DIFF | $164.90 | $194.00 | 15% |
| Complete blood count (CBC), no differential CPT 85027 HC RHC HEMOGRAM CBC W O DIFF | $17.00 | $20.00 | 15% |
| Complete blood count (CBC), no differential CPT 85027 HC HEMOGRAM CBC WITHOUT DIFF | $119.85 | $141.00 | 15% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC RHC HEMOGRAM CBC W O DIFF | $17.00 | $20.00 | 15% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC HEMOGRAM CBC WITHOUT DIFF | $119.85 | $141.00 | 15% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC RHC COMP METABOLIC PANEL | $27.20 | $32.00 | 15% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE PANEL | $298.35 | $351.00 | 15% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC RHC COMP METABOLIC PANEL | $27.20 | $32.00 | 15% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHENSIVE PANEL | $298.35 | $351.00 | 15% |
| Kidney function blood test panel CPT 80069 HC RHC RENAL FUNC PANEL | $22.95 | $27.00 | 15% |
| Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL | $309.40 | $364.00 | 15% |
| Kidney function blood test panel inpatient CPT 80069 HC RHC RENAL FUNC PANEL | $22.95 | $27.00 | 15% |
| Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL | $309.40 | $364.00 | 15% |
| Liver function blood test panel CPT 80076 HC RHC HEPAT FUNCTN PANEL | $21.25 | $25.00 | 15% |
| Liver function blood test panel CPT 80076 HC HEPATIC PROFILE | $258.40 | $304.00 | 15% |
| Liver function blood test panel inpatient CPT 80076 HC RHC HEPAT FUNCTN PANEL | $21.25 | $25.00 | 15% |
| Liver function blood test panel inpatient CPT 80076 HC HEPATIC PROFILE | $258.40 | $304.00 | 15% |
| Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL | $111.35 | $131.00 | 15% |
| Obstetric blood test panel CPT 80055 HC RHC OBSTETRIC PANEL | $123.25 | $145.00 | 15% |
| Obstetric blood test panel inpatient CPT 80055 HC OBSTETRIC PANEL | $111.35 | $131.00 | 15% |
| Obstetric blood test panel inpatient CPT 80055 HC RHC OBSTETRIC PANEL | $123.25 | $145.00 | 15% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC RHC PSA FREE | $47.60 | $56.00 | 15% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA FREE | $338.30 | $398.00 | 15% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC RHC PSA FREE | $47.60 | $56.00 | 15% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PSA FREE | $338.30 | $398.00 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC RHC PROST SPEC ANTIGN | $47.60 | $56.00 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA | $187.85 | $221.00 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC RHC PROST SPEC ANTIGN | $47.60 | $56.00 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA | $187.85 | $221.00 | 15% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC RCH THROMBOPLSTN TIME | $21.25 | $25.00 | 15% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT | $110.50 | $130.00 | 15% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC RCH THROMBOPLSTN TIME | $21.25 | $25.00 | 15% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT | $110.50 | $130.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC RHC PROTIME | $10.20 | $12.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC POCT PT | $73.95 | $87.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PT | $77.35 | $91.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC RHC PROTIME | $10.20 | $12.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC POCT PT | $73.95 | $87.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PT | $77.35 | $91.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC RHC TSH | $43.35 | $51.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH | $149.60 | $176.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC RHC TSH | $43.35 | $51.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH | $149.60 | $176.00 | 15% |
| Urinalysis with microscope exam, automated CPT 81001 HC RHC COMPL UA W MICRO | $8.50 | $10.00 | 15% |
| Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTOMATD W MICRO | $62.90 | $74.00 | 15% |
| Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS | $86.70 | $102.00 | 15% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC RHC COMPL UA W MICRO | $8.50 | $10.00 | 15% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS AUTOMATD W MICRO | $62.90 | $74.00 | 15% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS | $86.70 | $102.00 | 15% |
| Urinalysis with microscope exam, manual CPT 81000 HC RHC URINALYSIS W MICRO | $8.50 | $10.00 | 15% |
| Urinalysis with microscope exam, manual CPT 81000 HC URINALYSIS DIPSTICK W MICRO | $61.20 | $72.00 | 15% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC RHC URINALYSIS W MICRO | $8.50 | $10.00 | 15% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC URINALYSIS DIPSTICK W MICRO | $61.20 | $72.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 HC RHC UA WO MICRO AUTO | $5.95 | $7.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO WO MICRO | $54.40 | $64.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC RHC UA WO MICRO AUTO | $5.95 | $7.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO WO MICRO | $54.40 | $64.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 HC RHC URINALY WO MICRO | $6.80 | $8.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 HC URINALY NON AUTO WO SCOPE | $35.70 | $42.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS MANUAL | $76.50 | $90.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC RHC URINALY WO MICRO | $6.80 | $8.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINALY NON AUTO WO SCOPE | $35.70 | $42.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINALYSIS MANUAL | $76.50 | $90.00 | 15% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy with endoscopic ultrasound CPT 45391 PC COLONOSCOPY W ENDO US | $611.15 | $719.00 | 15% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 PC COLONOSCOPY W ENDO US | $611.15 | $719.00 | 15% |
| Colonoscopy with polyp removal CPT 45385 PC LESION REM COLONOSCPY SNARE | $1,113.50 | $1,310.00 | 15% |
| Colonoscopy with polyp removal CPT 45385 HC COLONOSCOPY FLEX W BIOPSY | $1,938.85 | $2,281.00 | 15% |
| Colonoscopy with polyp removal inpatient CPT 45385 PC LESION REM COLONOSCPY SNARE | $1,113.50 | $1,310.00 | 15% |
| Colonoscopy with polyp removal inpatient CPT 45385 HC COLONOSCOPY FLEX W BIOPSY | $1,938.85 | $2,281.00 | 15% |
| Colonoscopy with tissue sample CPT 45380 PC COLONOSCOPY W BX | $1,070.15 | $1,259.00 | 15% |
| Colonoscopy with tissue sample CPT 45380 HC COLONOSCOPY W BIOPSY | $2,688.55 | $3,163.00 | 15% |
| Colonoscopy with tissue sample inpatient CPT 45380 PC COLONOSCOPY W BX | $1,070.15 | $1,259.00 | 15% |
| Colonoscopy with tissue sample inpatient CPT 45380 HC COLONOSCOPY W BIOPSY | $2,688.55 | $3,163.00 | 15% |
| Colonoscopy, diagnostic CPT 45378 PC COLONOSCOPY DX | $637.50 | $750.00 | 15% |
| Colonoscopy, diagnostic CPT 45378 HC COLONOSCOPY DX SCRN | $1,994.95 | $2,347.00 | 15% |
| Colonoscopy, diagnostic CPT 45378 HC COLONOSCOPY FLEX DIAGNOSTIC | $1,999.20 | $2,352.00 | 15% |
| Colonoscopy, diagnostic inpatient CPT 45378 PC COLONOSCOPY DX | $637.50 | $750.00 | 15% |
| Colonoscopy, diagnostic inpatient CPT 45378 HC COLONOSCOPY DX SCRN | $1,994.95 | $2,347.00 | 15% |
| Colonoscopy, diagnostic inpatient CPT 45378 HC COLONOSCOPY FLEX DIAGNOSTIC | $1,999.20 | $2,352.00 | 15% |
| Gallbladder removal, laparoscopic CPT 47562 PC LAPAROSCOPY CHOLECYSTECTOMY | $1,513.00 | $1,780.00 | 15% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 PC LAPAROSCOPY CHOLECYSTECTOMY | $1,513.00 | $1,780.00 | 15% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PC RPR INGUINL HERN AGE 5 OR> | $1,201.90 | $1,414.00 | 15% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PC RPR INGUINL HERN AGE 5 OR> | $1,201.90 | $1,414.00 | 15% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 HC AFTER CATARACT LASER SURGERY | $584.80 | $688.00 | 15% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 HC POST CATARACT LASER SURGERY | $877.20 | $1,032.00 | 15% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 HC AFTER CATARACT LASER SURGERY | $584.80 | $688.00 | 15% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 HC POST CATARACT LASER SURGERY | $877.20 | $1,032.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 PC CRNA INJ LMBR SAC W IMG GDN | $413.10 | $486.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 PC INJ LMBR SAC W IMG GDN | $629.00 | $740.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ ANE DRG LUM SAC W IMG GDN | $1,531.70 | $1,802.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PC CRNA INJ LMBR SAC W IMG GDN | $413.10 | $486.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PC INJ LMBR SAC W IMG GDN | $629.00 | $740.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ ANE DRG LUM SAC W IMG GDN | $1,531.70 | $1,802.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 PC CRNA INJ ANE DRG LUM SAC W O IMG GDN | $296.65 | $349.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX INTERLAMINAR LMBR SAC WO IMG GDN | $842.35 | $991.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC INJ ANE DRG LUM SAC W O IMG GDN | $1,057.40 | $1,244.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 PC CRNA INJ ANE DRG LUM SAC W O IMG GDN | $296.65 | $349.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC NJX INTERLAMINAR LMBR SAC WO IMG GDN | $842.35 | $991.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC INJ ANE DRG LUM SAC W O IMG GDN | $1,057.40 | $1,244.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PC CRNA INJ TRNSFRM LUM SNGL W IMG | $600.10 | $706.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ TRNSFRM LUM SNGL W IMAG | $1,404.20 | $1,652.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 PC CRNA INJ TRNSFRM LUM SNGL W IMG | $600.10 | $706.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ TRNSFRM LUM SNGL W IMAG | $1,404.20 | $1,652.00 | 15% |
| Prostate biopsy CPT 55700 HC BIOPSY PROSTATE | $787.10 | $926.00 | 15% |
| Prostate biopsy inpatient CPT 55700 HC BIOPSY PROSTATE | $787.10 | $926.00 | 15% |
| Removal of a breast lump, open surgery CPT 19120 PC OPEN EXCISION BREAST LESION | $1,208.70 | $1,422.00 | 15% |
| Removal of a breast lump, open surgery CPT 19120 HC EXCN CYST TUMOR FIBRO OPEN | $2,634.15 | $3,099.00 | 15% |
| Removal of a breast lump, open surgery inpatient CPT 19120 PC OPEN EXCISION BREAST LESION | $1,208.70 | $1,422.00 | 15% |
| Removal of a breast lump, open surgery inpatient CPT 19120 HC EXCN CYST TUMOR FIBRO OPEN | $2,634.15 | $3,099.00 | 15% |
| Total knee replacement CPT 27447 PC TOTAL KNEE ARTHROPLASTY | $2,964.80 | $3,488.00 | 15% |
| Total knee replacement inpatient CPT 27447 PC TOTAL KNEE ARTHROPLASTY | $2,964.80 | $3,488.00 | 15% |
| Upper endoscopy (EGD) with biopsy CPT 43239 PC EGD BIOPSY SINGLE MULTIPLE | $935.00 | $1,100.00 | 15% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC EGD BIOPSY SINGLE MULTIPLE | $2,108.00 | $2,480.00 | 15% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PC EGD BIOPSY SINGLE MULTIPLE | $935.00 | $1,100.00 | 15% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC EGD BIOPSY SINGLE MULTIPLE | $2,108.00 | $2,480.00 | 15% |
| Upper endoscopy (EGD), diagnostic CPT 43235 PC EGD DIAGNOSTIC BRUSH WASH | $730.15 | $859.00 | 15% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC EGD DIAGNOSTIC BRUSH WASH | $2,068.05 | $2,433.00 | 15% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PC EGD DIAGNOSTIC BRUSH WASH | $730.15 | $859.00 | 15% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC EGD DIAGNOSTIC BRUSH WASH | $2,068.05 | $2,433.00 | 15% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Family therapy with the patient, 50 minutes CPT 90847 HC SP PSY FAMILY THERAPY W PT 50 MIN | $294.95 | $347.00 | 15% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC SP PSY FAMILY THERAPY W PT 50 MIN | $294.95 | $347.00 | 15% |
| Family therapy without the patient, 50 minutes CPT 90846 HC SP PSY FAMILY THERAPY WO PT 50 MIN | $294.95 | $347.00 | 15% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC SP PSY FAMILY THERAPY WO PT 50 MIN | $294.95 | $347.00 | 15% |
| Group psychotherapy session CPT 90853 HC THERAPIST GRP PSYCHOTHERAPY | $294.95 | $347.00 | 15% |
| Group psychotherapy session inpatient CPT 90853 HC THERAPIST GRP PSYCHOTHERAPY | $294.95 | $347.00 | 15% |
| New patient office visit, about 30 minutes CPT 99203 PC OFFICE VISIT NEW PRO 30-44 MINS | $266.90 | $314.00 | 15% |
| New patient office visit, about 30 minutes CPT 99203 HC OFFICE OUTPATIENT NEW 30-44 MINS | $309.40 | $364.00 | 15% |
| New patient office visit, about 30 minutes inpatient CPT 99203 PC OFFICE VISIT NEW PRO 30-44 MINS | $266.90 | $314.00 | 15% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC OFFICE OUTPATIENT NEW 30-44 MINS | $309.40 | $364.00 | 15% |
| New patient office visit, about 45 minutes CPT 99204 PC OFFICE VISIT NEW PRO 45-59 MINS | $399.50 | $470.00 | 15% |
| New patient office visit, about 45 minutes CPT 99204 HC OFFICE OUTPATIENT NEW 45-59 MINS | $470.05 | $553.00 | 15% |
| New patient office visit, about 45 minutes inpatient CPT 99204 PC OFFICE VISIT NEW PRO 45-59 MINS | $399.50 | $470.00 | 15% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC OFFICE OUTPATIENT NEW 45-59 MINS | $470.05 | $553.00 | 15% |
| New patient office visit, about 60 minutes CPT 99205 PC OFFICE VISIT NEW PRO 60-74 MINS | $528.70 | $622.00 | 15% |
| New patient office visit, about 60 minutes CPT 99205 HC OFFICE OUTPATIENT NEW 60-74 MINS | $582.25 | $685.00 | 15% |
| New patient office visit, about 60 minutes inpatient CPT 99205 PC OFFICE VISIT NEW PRO 60-74 MINS | $528.70 | $622.00 | 15% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC OFFICE OUTPATIENT NEW 60-74 MINS | $582.25 | $685.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PT THERAPEUTIC EXERCISE 15M | $74.80 | $88.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT THER EXERCISE 15M M59 | $76.50 | $90.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PT THER EXERCISE 15M M59 | $79.05 | $93.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT THERAPEUTIC EXERCISE 15M | $85.85 | $101.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT LYMPHEDEMA THER EXERCISE | $134.30 | $158.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT THERAPEUTIC PROCEDURE | $1,493.45 | $1,757.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC PT THERAPEUTIC EXERCISE 15M | $74.80 | $88.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC OT THER EXERCISE 15M M59 | $76.50 | $90.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC PT THER EXERCISE 15M M59 | $79.05 | $93.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC OT THERAPEUTIC EXERCISE 15M | $85.85 | $101.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC OT LYMPHEDEMA THER EXERCISE | $134.30 | $158.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC OT THERAPEUTIC PROCEDURE | $1,493.45 | $1,757.00 | 15% |
| Psychotherapy session, 30 minutes CPT 90832 HC PSYCHOTHERAPY W PATIENT 30 MINUTES | $294.95 | $347.00 | 15% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCHOTHERAPY W PATIENT 30 MINUTES | $294.95 | $347.00 | 15% |
| Psychotherapy session, 45 minutes CPT 90834 HC PSYCHOTHERAPY W PATIENT 45 MINUTES | $294.95 | $347.00 | 15% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCHOTHERAPY W PATIENT 45 MINUTES | $294.95 | $347.00 | 15% |
| Psychotherapy session, 60 minutes CPT 90837 HC SP NEUPSY 60 MIN PSYCHOTHERAPY | $294.95 | $347.00 | 15% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC SP NEUPSY 60 MIN PSYCHOTHERAPY | $294.95 | $347.00 | 15% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PC OFFICE CONSULTATION LVL III | $223.55 | $263.00 | 15% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PC OFFICE CONSULTATION LVL III | $223.55 | $263.00 | 15% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PC OFFICE CONSULTATION LVL IV | $334.90 | $394.00 | 15% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 PC OFFICE CONSULTATION LVL IV | $334.90 | $394.00 | 15% |