Gothenburg Health
Gothenburg Health in Gothenburg, NE publishes cash prices for 215 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 above the Nebraska median for 171 of 214 procedures and below it for 38. By typical cash price it ranks #33 of 44 Nebraska hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
Po Box 469 910 20TH St, Gothenburg, NE 69138 Collected Sep 27, 2026 Source price file (308) 537-3661
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 281313 · CMS hospital register
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Ankle Comp Min 3 Views Lt | $342.00 | $380.00 | $233.00–$365.00 | 5% above | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 93922tc Ankle/arm Index | $423.00 | $470.00 | $288.00–$451.00 | 8% below | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 93922 Transcutaneous Oximetry (Tcpo2) Limited | $468.00 | $520.00 | $76.00–$499.00 | 2% above | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 93922 Abi | $473.00 | $525.00 | $322.00–$504.00 | 3% above | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Us Abi Limited | $540.00 | $600.00 | $368.00–$576.00 | 18% above | 10% |
| Bone scan, whole body (nuclear medicine) CPT 78306 Nm Whole Body Bone Scan | $1,823.00 | $2,025.00 | $1,243.00–$1,944.00 | 8% above | 10% |
| Bone scan, whole body (nuclear medicine) CPT 78306 Nm Bone Imaging Whole Body | $1,850.00 | $2,055.00 | $1,261.00–$1,973.00 | 10% above | 10% |
| Breast ultrasound, complete, one breast one side CPT 76641 Us Breast Comp Rt. | $585.00 | $650.00 | $399.00–$624.00 | 23% above | 10% |
| Breast ultrasound, complete, one breast one side CPT 76641 Us Breast Comp Lt. | $585.00 | $650.00 | $399.00–$624.00 | 23% above | 10% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 Us Breast Bil. | $405.00 | $450.00 | $276.00–$432.00 | 5% above | 10% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct Angio Chest W/ + W/o Cont | $3,330.00 | $3,700.00 | $2,271.00–$3,552.00 | 5% above | 10% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct Angio Chest W/ Cont | $3,330.00 | $3,700.00 | $2,271.00–$3,552.00 | 5% above | 10% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 Ct Cardiac Calcium Score | $135.00 | $150.00 | $92.00–$144.00 | 2% above | 10% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abdomen +Pelvis W/o Cont | $4,163.00 | $4,625.00 | $2,839.00–$4,440.00 | 21% above | 10% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast | $4,770.00 | $5,300.00 | $3,253.00–$5,088.00 | 18% above | 10% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abdomen +Pelvis W/ + W/o Cont | $5,535.00 | $6,150.00 | $3,775.00–$5,904.00 | 13% above | 10% |
| CT scan of the abdomen with contrast CPT 74160 Ct Abdomen W/ Cont | $2,700.00 | $3,000.00 | $1,841.00–$2,880.00 | 5% above | 10% |
| CT scan of the abdomen without contrast CPT 74150 Ct Abdomen W/o Cont | $2,430.00 | $2,700.00 | $1,657.00–$2,592.00 | 11% above | 10% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Sinus Or Facial W/o Cont | $1,980.00 | $2,200.00 | $1,350.00–$2,112.00 | 11% above | 10% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT scan | $2,070.00 | $2,300.00 | $1,412.00–$2,208.00 | 11% above | 10% |
| CT scan of the head with contrast CPT 70460 Ct Head Or Brain W/ Cont | $2,340.00 | $2,600.00 | $1,596.00–$2,496.00 | 14% above | 10% |
| CT scan of the head without and with contrast CPT 70470 Ct Head Or Brain W/ + W/o Cont | $3,150.00 | $3,500.00 | $2,148.00–$3,360.00 | 27% above | 10% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct Spine Lumbar W/o Cont | $2,430.00 | $2,700.00 | $1,657.00–$2,592.00 | 14% above | 10% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct Spine Cervical W/o Cont | $2,453.00 | $2,725.00 | $1,673.00–$2,616.00 | 10% above | 10% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast | $2,738.00 | $3,042.00 | $1,867.00–$2,920.00 | 15% above | 10% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Us Carotid Duplex Bil | $1,575.00 | $1,750.00 | $1,074.00–$1,680.00 | 1% above | 10% |
| Chest X-ray, 2 views CPT 71046 Xr Chest 2 Views | $356.00 | $395.00 | $242.00–$379.00 | 26% above | 10% |
| Chest X-ray, single view CPT 71045 Xr Chest 1 View | $288.00 | $320.00 | $196.00–$307.00 | 27% above | 10% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Us Retroperitoneal Comp | $810.00 | $900.00 | $552.00–$864.00 | 3% above | 10% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 Bd Dexa Axial Skeleton | $495.00 | $550.00 | $338.00–$528.00 | 26% above | 10% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Bd Dexa Appendicular Skeleton | $243.00 | $270.00 | $166.00–$259.00 | 5% above | 10% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Us, Pregnancy, Fetal/maternal Eval.+fetal Anatomic Exam; Single Or 1st Gestation Charge | $422.00 | $469.00 | $86.00–$450.00 | 14% below | 10% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Us Pregnant Detailed 1st Gest | $540.00 | $600.00 | $368.00–$576.00 | 10% above | 10% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest W/o Cont | $2,385.00 | $2,650.00 | $1,627.00–$2,544.00 | 12% above | 10% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest W/ Cont | $2,565.00 | $2,850.00 | $1,749.00–$2,736.00 | 4% above | 10% |
| Diagnostic mammogram, both breasts CPT 77066 Mammography of both breasts | $383.00 | $425.00 | $261.00–$408.00 | 12% below | 10% |
| Diagnostic mammogram, one breast CPT 77065 Mammography of one breast | $360.00 | $400.00 | $246.00–$384.00 | 16% above | 10% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 Us Le Art Doppler Mult Level Bil | $1,215.00 | $1,350.00 | $829.00–$1,296.00 | 14% above | 10% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 Us Le Veins Duplex Bil | $1,530.00 | $1,700.00 | $1,043.00–$1,632.00 | 7% above | 10% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Us Echo 2d Comp | $2,295.00 | $2,550.00 | $1,565.00–$2,448.00 | 9% above | 10% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nm Hepatobiliary Imag Wo Gbef | $1,440.00 | $1,600.00 | $982.00–$1,536.00 | 1% below | 10% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nm Hepatobiliary Study | $1,590.00 | $1,767.00 | $1,085.00–$1,696.00 | 9% above | 10% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep Study Home | $743.00 | $825.00 | $506.00–$792.00 | 62% above | 10% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 Sleep Study W Cpap | $4,680.00 | $5,200.00 | $3,192.00–$4,992.00 | 24% above | 10% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Sleep Study Split W/ C-pap Titration < 6 Hours Cp | $4,680.00 | $5,200.00 | $3,192.00–$4,992.00 | 24% above | 10% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Sleep Study Therapeutic C-pap Titration | $4,680.00 | $5,200.00 | $3,192.00–$4,992.00 | 24% above | 10% |
| Knee X-ray, 3 views one side CPT 73562 Xr Knee 3 Views Lt | $383.00 | $425.00 | $261.00–$408.00 | 4% above | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Abdomen Ltd | $711.00 | $790.00 | $485.00–$758.00 | 28% above | 10% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct Chest Low Dose Screen W/o Cont | $1,810.00 | $2,011.00 | $1,234.00–$1,931.00 | 192% above | 10% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI scan of leg joint | $2,610.00 | $2,900.00 | $1,780.00–$2,784.00 | 3% above | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri Le Joint W/ + W/o Cont Bil | $3,488.00 | $3,875.00 | $2,378.00–$3,720.00 | 3% above | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri Le Non Joint W/ + W/o Cont Bil | $3,488.00 | $3,875.00 | $2,378.00–$3,720.00 | 3% above | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Le Joint W/ + W/o Cont Rt | $3,488.00 | $3,875.00 | $2,378.00–$3,720.00 | 3% above | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Le Joint W/ + W/o Cont Lt | $3,488.00 | $3,875.00 | $2,378.00–$3,720.00 | 3% above | 10% |
| MRI of the abdomen without contrast CPT 74181 Mri Abdomen W/o Cont | $3,083.00 | $3,425.00 | $2,102.00–$3,288.00 | 4% above | 10% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Abdomen W/ + W/o Cont | $4,230.00 | $4,700.00 | $2,885.00–$4,512.00 | 15% above | 10% |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain W/o Cont | $3,600.00 | $4,000.00 | $2,455.00–$3,840.00 | 17% above | 10% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Scan | $4,050.00 | $4,500.00 | $2,762.00–$4,320.00 | 3% above | 10% |
| MRI of the lower back, no contrast dye CPT 72148 MRI scan of lower spinal canal | $3,465.00 | $3,850.00 | $2,363.00–$3,696.00 | 11% above | 10% |
| MRI of the lower back, without and then with contrast dye CPT 72158 Mri Spine Lumbar W/ + W/o Cont | $4,140.00 | $4,600.00 | $2,823.00–$4,416.00 | 6% above | 10% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri Spine Thoracic W/o Cont | $3,600.00 | $4,000.00 | $2,455.00–$3,840.00 | 12% above | 10% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri Spine Cervical W/ + W/o Cont | $4,963.00 | $5,514.00 | $3,384.00–$5,293.00 | 27% above | 10% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri Spine Cervical W/o Cont | $3,600.00 | $4,000.00 | $2,455.00–$3,840.00 | 17% above | 10% |
| MRI of the pelvis without and with contrast CPT 72197 Mri Pelvis W/ + W/o Cont | $4,050.00 | $4,500.00 | $2,762.00–$4,320.00 | 15% above | 10% |
| MRI of the pelvis, no contrast dye CPT 72195 Mri Pelvis W/o Cont | $3,150.00 | $3,500.00 | $2,148.00–$3,360.00 | 18% above | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri Ue Joint W/o Cont Bil | $2,588.00 | $2,875.00 | $1,765.00–$2,760.00 | 7% above | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Ue Joint W/o Cont Lt | $2,588.00 | $2,875.00 | $1,765.00–$2,760.00 | 7% above | 10% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nm Heart Image (3d) Multiple Study Tomographic Spect Multi Study At Rest Of Stress | $4,005.00 | $4,450.00 | $2,731.00–$4,272.00 | at median | 10% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us Pelvic Non-ob Comp | $788.00 | $875.00 | $31.00–$840.00 | 2% above | 10% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us Bladder | $788.00 | $875.00 | $537.00–$840.00 | 2% above | 10% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Abdomial ultrasound of pregnant uterus | $345.00 | $383.00 | $235.00–$368.00 | 50% below | 10% |
| Screening mammogram, both breasts both sides CPT 77067 Mammography, screening, bilateral | $396.00 | $440.00 | $270.00–$422.00 | — | 10% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder Comp Min 2 Views Rt | $520.00 | $578.00 | $355.00–$555.00 | 55% above | 10% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep study | $4,140.00 | $4,600.00 | $2,823.00–$4,416.00 | 16% above | 10% |
| Ultrasound of the abdomen, complete CPT 76700 Ultrasound of abdomen | $1,255.00 | $1,394.00 | $856.00–$1,338.00 | 52% above | 10% |
| Ultrasound of the scrotum and testicles CPT 76870 Us Scrotum +Contents | $698.00 | $775.00 | $476.00–$744.00 | 8% above | 10% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Soft Tissue Neck | $912.00 | $1,013.00 | $622.00–$972.00 | 55% above | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Ue Veins Duplex Rt | $1,256.00 | $1,396.00 | $857.00–$1,340.00 | 23% above | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Le Veins Duplex Lt | $1,256.00 | $1,396.00 | $857.00–$1,340.00 | 23% above | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Le Veins Duplex Rt | $1,256.00 | $1,396.00 | $857.00–$1,340.00 | 23% above | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Ue Veins Duplex Lt | $1,256.00 | $1,396.00 | $857.00–$1,340.00 | 23% above | 10% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Comp Min 3 Views Rt | $338.00 | $375.00 | $230.00–$360.00 | 2% above | 10% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 Xr Pelvis +Hip Infant Min 2 Views | $360.00 | $400.00 | $246.00–$384.00 | 26% above | 10% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip Comp Min 2 Views Lt +Pelvis | $360.00 | $400.00 | $246.00–$384.00 | 26% above | 10% |
| X-ray of the abdomen, 1 view CPT 74018 Xr Abdomen 1 View | $324.00 | $360.00 | $221.00–$346.00 | 24% above | 10% |
| X-ray of the ankle, 2 views CPT 73600 Xr Ankle 2 Views Bil | $261.00 | $290.00 | $178.00–$278.00 | 15% above | 10% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Fingers Min 2 Views Lt | $252.00 | $280.00 | $172.00–$269.00 | 12% above | 10% |
| X-ray of the foot, 2 views one side CPT 73620 Xr Foot 2 Views Lt | $270.00 | $300.00 | $184.00–$288.00 | 25% above | 10% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Comp Min 3 Views Lt | $360.00 | $400.00 | $246.00–$384.00 | 15% above | 10% |
| X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Min 3 Views Lt | $374.00 | $415.00 | $255.00–$398.00 | 9% above | 10% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee 1 Or 2 Views Lt | $333.00 | $370.00 | $227.00–$355.00 | 5% above | 10% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Xr Spine Lumbosacral 2 Or 3 Views | $473.00 | $525.00 | $322.00–$504.00 | 25% above | 10% |
| X-ray of the lower back, 4 or more views CPT 72110 X-Ray of lower back | $540.00 | $600.00 | $368.00–$576.00 | 16% above | 10% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 Xr Spine Thoracic 2 Views | $387.00 | $430.00 | $264.00–$413.00 | 26% above | 10% |
| X-ray of the nasal bones, 3 or more views CPT 70160 Xr Nasal Bones Comp Min 3 Views | $338.00 | $375.00 | $230.00–$360.00 | 17% above | 10% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xr Spine Cerv 2 Or 3 Views | $360.00 | $400.00 | $246.00–$384.00 | 18% above | 10% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 Xr Pelvis 1 Or 2 Views | $347.00 | $385.00 | $236.00–$370.00 | 30% above | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Xr Sacrum +Coccyx Min 2 Views | $338.00 | $375.00 | $230.00–$360.00 | 26% above | 10% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alt | $81.00 | $90.00 | $55.00–$86.00 | 33% above | 10% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Ast | $77.00 | $85.00 | $52.00–$82.00 | 36% above | 9% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-type Natriuretic Peptide | $306.00 | $340.00 | $209.00–$326.00 | 56% above | 10% |
| Basic metabolic panel (blood test) CPT 80048 Basic metabolic panel | $149.00 | $165.00 | $101.00–$158.00 | 11% above | 10% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bill Tissue Processing, Level Iv | $338.00 | $375.00 | $230.00–$360.00 | 77% above | 10% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Collection: Cord Blood | $32.00 | $36.00 | $22.00–$35.00 | 21% above | 11% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Venipuncture | $32.00 | $36.00 | $22.00–$35.00 | 21% above | 11% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Collection: Iv Start | $32.00 | $36.00 | $22.00–$35.00 | 21% above | 11% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Insurance Collection Of Urine And/or Blood | $54.00 | $60.00 | $37.00–$58.00 | 105% above | 10% |
| Blood glucose (sugar) test CPT 82947 Glucose Level | $72.00 | $80.00 | $49.00–$77.00 | 53% above | 10% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo/rh 8 | $116.00 | $129.00 | $79.00–$124.00 | 116% above | 10% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive Protein | $117.00 | $130.00 | $80.00–$125.00 | 29% above | 10% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Coronavirus Sars Ag (Sofia) | $144.00 | $160.00 | $98.00–$154.00 | 16% above | 10% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids | $131.00 | $146.00 | $90.00–$140.00 | 15% above | 10% |
| Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (CBC), with differential white blood cells, automated | $122.00 | $135.00 | $83.00–$130.00 | 35% above | 10% |
| Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals | $194.00 | $215.00 | $132.00–$206.00 | 26% above | 10% |
| D-dimer blood test (blood clot marker) CPT 85379 D-dimer | $180.00 | $200.00 | $123.00–$192.00 | 35% above | 10% |
| Folate (folic acid) blood test CPT 82746 Folate Level | $122.00 | $135.00 | $83.00–$130.00 | 16% above | 10% |
| Folate (folic acid) blood test CPT 82746 Folate | $162.00 | $180.00 | $110.00–$173.00 | 54% above | 10% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 | $122.00 | $135.00 | $83.00–$130.00 | 43% above | 10% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Panel | $455.00 | $505.00 | $310.00–$485.00 | 56% above | 10% |
| Glucose tolerance test, 3 samples CPT 82951 .Glucose Fasting | $72.00 | $80.00 | $49.00–$77.00 | 45% below | 10% |
| Glucose tolerance test, 3 samples CPT 82951 .Gtt-3 Hr | $189.00 | $210.00 | $129.00–$202.00 | 45% above | 10% |
| Glucose tolerance test, 3 samples CPT 82951 .Gtt 2hr Pp | $189.00 | $210.00 | $129.00–$202.00 | 45% above | 10% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c | $90.00 | $100.00 | $61.00–$96.00 | 26% above | 10% |
| Kidney function blood test panel CPT 80069 Kidney function panel test | $162.00 | $180.00 | $110.00–$173.00 | 20% above | 10% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level | $135.00 | $150.00 | $92.00–$144.00 | 41% above | 10% |
| Liver function blood test panel CPT 80076 Liver function blood test | $149.00 | $165.00 | $101.00–$158.00 | 15% above | 10% |
| Magnesium blood test CPT 83735 Magnesium Level | $95.00 | $105.00 | $64.00–$101.00 | 39% above | 10% |
| Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen | $90.00 | $100.00 | $61.00–$96.00 | 39% above | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Total prostate-specific antigen (PSA) test | $144.00 | $160.00 | $98.00–$154.00 | 38% above | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test | $108.00 | $120.00 | $74.00–$115.00 | 40% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time | $68.00 | $75.00 | $46.00–$72.00 | 35% above | 9% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Urine Drug Screen 13 | $198.00 | $220.00 | $135.00–$211.00 | 108% above | 10% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep Poc Brady | $86.00 | $95.00 | $58.00–$91.00 | 76% above | 9% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Screen 5 | $45.00 | $50.00 | $31.00–$48.00 | 63% above | 10% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 Hemocult Poc Brady | $50.00 | $55.00 | $34.00–$53.00 | 21% above | 9% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH) | $140.00 | $155.00 | $95.00–$149.00 | 33% above | 10% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis test using microscope | $63.00 | $70.00 | $43.00–$67.00 | 26% above | 10% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis test | $63.00 | $70.00 | $43.00–$67.00 | 100% above | 10% |
| Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test Poc Brady | $90.00 | $100.00 | $61.00–$96.00 | 42% above | 10% |
| Urine pregnancy test, read by color change CPT 81025 Pregnancy Test Urine | $95.00 | $105.00 | $64.00–$101.00 | 50% above | 10% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 | $162.00 | $180.00 | $110.00–$173.00 | 43% above | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D Total | $198.00 | $220.00 | $135.00–$211.00 | 42% above | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Quantitative | $153.00 | $170.00 | $104.00–$163.00 | 73% above | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Pregnancy Test Serum | $153.00 | $170.00 | $104.00–$163.00 | 73% above | 10% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 Ma Stereotactic Loc Rt. | $3,240.00 | $3,600.00 | $2,210.00–$3,456.00 | 36% above | 10% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Cltx Dstl Fibular Fx Lat Mall W/o Man | $296.00 | $329.00 | $202.00–$316.00 | 26% below | 10% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Closed Trtmt Of Distal Fibular Fx (Lateral Malleolus); W/o Manipulation Charge | $838.00 | $931.00 | $266.00–$894.00 | 110% above | 10% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 Cltx Metatarsal Fracture W/o Man | $255.00 | $283.00 | $174.00–$272.00 | 30% below | 10% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 Treat Metatarsal Fracture | $596.00 | $662.00 | $406.00–$636.00 | 64% above | 10% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion | $1,521.00 | $1,690.00 | $1,037.00–$1,622.00 | 6% above | 10% |
| Cataract surgery with lens implant CPT 66984 Removal of cataract with insertion of lens | $3,848.00 | $4,275.00 | $2,624.00–$4,104.00 | 9% above | 10% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 Obstetric care, planned cesarean delivery | $4,773.00 | $5,303.00 | $3,255.00–$5,091.00 | 6% below | 10% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Closed Tx Of Distal Radius Fracture Including Casting | $788.00 | $875.00 | $537.00–$840.00 | 72% above | 10% |
| Colonoscopy with polyp removal CPT 45385 Removal of polyps or growths of large bowel using an endoscope | $3,993.00 | $4,437.00 | $2,723.00–$4,260.00 | 259% above | 10% |
| Colonoscopy with tissue sample CPT 45380 Biopsy exam of large bowel using an endoscope | $4,712.00 | $5,236.00 | $3,214.00–$5,027.00 | 264% above | 10% |
| Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using an endoscope | $1,229.00 | $1,365.00 | $838.00–$1,310.00 | at median | 10% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 69209 Ear Irrigation W/o Instruments | $45.00 | $50.00 | $15.00–$48.00 | 3% below | 10% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 Remvl Impacted Cerumen Irrigation/lvg Unilat | $96.00 | $107.00 | $66.00–$103.00 | 106% above | 10% |
| Earwax removal with instruments, one ear CPT 69210 69210 Remvl Impacted Cerumen Instrumentation | $86.00 | $96.00 | $59.00–$92.00 | at median | 10% |
| Earwax removal with instruments, one ear CPT 69210 Ear Lavage Charge | $104.00 | $116.00 | $25.00–$111.00 | 21% above | 10% |
| Gallbladder removal, laparoscopic CPT 47562 Removal of gallbladder using an endoscope | $7,226.00 | $8,029.00 | $4,928.00–$7,708.00 | 316% above | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 10060 Ed I & D Abscess, Smpl Charge | $371.00 | $412.00 | $253.00–$396.00 | 43% above | 10% |
| Knee arthroscopy with meniscus trim CPT 29881 Removal of one knee cartilage using an endoscope | $3,357.00 | $3,730.00 | $2,289.00–$3,581.00 | 44% above | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Layer Closure Of Wounds Of Scalp, Axillae, Trunk, Extremities(exclude Hands And Feet) 2.5 Cm Or Less | $477.00 | $530.00 | $325.00–$509.00 | 15% above | 10% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Injection(s) of therapeutic substance | $1,935.00 | $2,150.00 | $1,320.00–$2,064.00 | 69% above | 10% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection(s) of anesthetic into lower spine using imaging guidance | $1,935.00 | $2,150.00 | $1,320.00–$2,064.00 | 34% above | 10% |
| Paracentesis with imaging guidance CPT 49083 49083 Abd Paracentesis W/imaging . | $1,148.00 | $1,275.00 | $86.00–$1,224.00 | 39% above | 10% |
| Paracentesis with imaging guidance CPT 49083 Us Guide Paracentesis | $1,350.00 | $1,500.00 | $921.00–$1,440.00 | 63% above | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 Remove Skin Foreign Body, Simple Charge | $307.00 | $341.00 | $94.00–$327.00 | 6% below | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 10121 Ed Foreign Body Removal, Comp Charge | $394.00 | $438.00 | $269.00–$420.00 | 21% above | 10% |
| Short arm splint (forearm and hand) CPT 29125 29125 Ed Application Short Arm Splint | $218.00 | $242.00 | $149.00–$232.00 | 41% above | 10% |
| Short leg cast (below the knee) CPT 29405 29405 Application Of Short Leg Cast (Below Knee To Toes) | $266.00 | $296.00 | $182.00–$284.00 | 43% above | 10% |
| Short leg splint (calf to foot) CPT 29515 29515 Ed Application Short Leg Splint | $230.00 | $255.00 | $157.00–$245.00 | 45% above | 10% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shaving of shoulder bone using endoscope | $4,631.00 | $5,145.00 | $3,158.00–$4,939.00 | 287% above | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk And/or Extrem; 2.5 Cm > Charge | $313.00 | $348.00 | $39.00–$334.00 | 50% above | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Simple Repair Scalp/neck/ax/genit/trunk 2.5cm/< Techfee | $323.00 | $359.00 | $220.00–$345.00 | 55% above | 10% |
| Skin biopsy, punch, one lesion CPT 11104 11104 Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion | $254.00 | $282.00 | $173.00–$271.00 | at median | 10% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Anesth Spinal Puncture, Lumbar, Diagnostic | $821.00 | $912.00 | $52.00–$876.00 | 114% above | 10% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Spinal Puncture Lumbar Diagnostic | $851.00 | $946.00 | $581.00–$908.00 | 122% above | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Repair Smpl Scalp/neck/ax/genit/trunk 2.6-7.5cm | $348.00 | $387.00 | $238.00–$372.00 | 43% above | 10% |
| 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 Scalp, Neck, Axillae, Ext. Genital, Trunk And/or Extrem; 2.6 Cm To 7.5 Cm Charge | $350.00 | $389.00 | $51.00–$373.00 | 44% above | 10% |
| 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 | $344.00 | $382.00 | $48.00–$367.00 | 51% above | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Repair Smpl F/e/e/n/l/m 2.5cm/< | $344.00 | $382.00 | $234.00–$367.00 | 51% above | 10% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion | $204.00 | $227.00 | $139.00–$218.00 | 7% above | 10% |
| Tonsil and adenoid removal, child under 12 CPT 42820 Removal of tonsils and adenoid glands, patient younger than age 12 | $4,532.00 | $5,035.00 | $3,090.00–$4,834.00 | 242% above | 10% |
| Trigger point injections, 1 or 2 muscles CPT 20552 20552 Inj(s); Single Or Mult Trigger Point(s), One Or Two Muscle(s) Charge | $120.00 | $133.00 | $82.00–$128.00 | 7% below | 10% |
| Trigger point injections, 1 or 2 muscles CPT 20552 20552 Injection(s); Single Or Multiple Trigger Point(s), 1 Or 2 Muscle(s) | $492.00 | $547.00 | $33.00–$525.00 | 281% above | 10% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 58670 Laparoscopy, Surgical; With Fulguration Of Oviducts (With Or Without Transection) | $2,070.00 | $2,300.00 | $1,412.00–$2,208.00 | 73% above | 10% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Us Breast Biopsy Bil. | $2,498.00 | $2,775.00 | $1,703.00–$2,664.00 | 21% above | 10% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 Us Breast Biopsy Lt | $2,498.00 | $2,775.00 | $1,703.00–$2,664.00 | 21% above | 10% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 Us Breast Biopsy Rt | $2,498.00 | $2,775.00 | $1,703.00–$2,664.00 | 21% above | 10% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Biopsy exam of esophagus, stomach or small bowel using an endoscope | $3,470.00 | $3,855.00 | $2,366.00–$3,701.00 | 128% above | 10% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Diagnostic exam of esophagus, stomach or small bowel using an endoscope | $4,087.00 | $4,541.00 | $2,787.00–$4,359.00 | 460% above | 10% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 Obstetric care, planned vaginal delivery | $6,840.00 | $7,600.00 | $4,665.00–$7,296.00 | 46% above | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debridement, Subq, First 20 Sq Cm Or Less | $277.00 | $308.00 | $51.00–$296.00 | 8% below | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debridement Subcutaneous Tissue 20 Sq Cm/< Techfee | $750.00 | $833.00 | $511.00–$800.00 | 150% above | 10% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 36430 Blood Adminstration | $1,109.00 | $1,232.00 | $756.00–$1,183.00 | 55% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Nebulizer Administration Charge | $33.00 | $37.00 | $23.00–$36.00 | 69% below | 11% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Pressurized Or Nonpressurized Inhalation Treatment For Acute | $270.00 | $300.00 | $8.00–$288.00 | 155% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment | $270.00 | $300.00 | $184.00–$288.00 | 155% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer | $284.00 | $315.00 | $193.00–$302.00 | 168% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94640 Rt Aerosol Initial Charge | $293.00 | $325.00 | $199.00–$312.00 | 177% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94640 Rt Aerosol Subsequent Charge | $293.00 | $325.00 | $199.00–$312.00 | 177% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94640 Rt Metered Dose Inhaler Initial Charge | $293.00 | $325.00 | $199.00–$312.00 | 177% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94640 Rt Metered Dose Inhaler Subsequent Charge | $293.00 | $325.00 | $199.00–$312.00 | 177% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94799 Rt Ezpap/accupap Subsequent Charge | $428.00 | $475.00 | $292.00–$456.00 | 304% above | 10% |
| Chemotherapy IV infusion, first hour CPT 96413 96413 Chemo Iv Up To 1 Hr Charge | $639.00 | $710.00 | $436.00–$682.00 | 12% above | 10% |
| Critical care, first 30 to 74 minutes CPT 99291 99291 Anesth Critcal Care, Evaluation And Management Of The Critically Ill Or Critically Injured Pat | $1,313.00 | $1,459.00 | $185.00–$1,401.00 | 102% above | 10% |
| Critical care, first 30 to 74 minutes CPT 99291 99291fac Ed Critical Care | $1,575.00 | $1,750.00 | $1,074.00–$1,680.00 | 142% above | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg (Lab) | $306.00 | $340.00 | $209.00–$326.00 | 29% above | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram | $329.00 | $365.00 | $224.00–$350.00 | 39% above | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 Ekg 12 Lead Cp | $329.00 | $365.00 | $224.00–$350.00 | 39% above | 10% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Physicians Fee I Ed Charge | $113.00 | $126.00 | $10.00–$121.00 | 26% below | 10% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 Fac Ed Level 1 -Room Charge | $211.00 | $234.00 | $144.00–$225.00 | 38% above | 10% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Physicians Fee Ii Ed Charge | $137.00 | $152.00 | $37.00–$146.00 | 29% below | 10% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282fac Ed Level 2 Room Charge | $381.00 | $423.00 | $260.00–$406.00 | 98% above | 10% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Physicians Fee Iii Ed Charge | $246.00 | $273.00 | $64.00–$262.00 | 10% below | 10% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283fac Ed Level 3room Charge | $585.00 | $650.00 | $399.00–$624.00 | 113% above | 10% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency Department Visit Level 499284 | $630.00 | $700.00 | $109.00–$672.00 | 34% above | 10% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284fac Ed Level 4 Room Charge | $878.00 | $975.00 | $598.00–$936.00 | 87% above | 10% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Physicians Fee V Ed Charge | $945.00 | $1,050.00 | $158.00–$1,008.00 | 44% above | 10% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285fac Ed Level 5room Charge | $1,413.00 | $1,570.00 | $964.00–$1,507.00 | 115% above | 10% |
| Family therapy with the patient, 50 minutes CPT 90847 Family psychotherapy, including patient, 50 min | $761.00 | $845.00 | $519.00–$811.00 | 228% above | 10% |
| Family therapy without the patient, 50 minutes CPT 90846 Family psychotherapy, not including patient, 50 min | $725.00 | $805.00 | $494.00–$773.00 | 255% above | 10% |
| Group psychotherapy session CPT 90853 Group psychotherapy | $662.00 | $735.00 | $451.00–$706.00 | 192% above | 10% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360ed Iv Infusion Hydration Initial Hour | $365.00 | $405.00 | $249.00–$389.00 | 4% below | 10% |
| IV infusion of a medicine, first hour CPT 96365 96365 Ed Iv Infusion Initial Up To 1 Hour | $383.00 | $425.00 | $261.00–$408.00 | at median | 10% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic, Prophylactic, Or Diagnostic Injection, Subcutaneous Or Intramuscular; Clinic | $90.00 | $100.00 | $61.00–$96.00 | 1% below | 10% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372ed Subq/im Injection | $162.00 | $180.00 | $110.00–$173.00 | 78% above | 10% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 Psychiatric Diagnostic Evaluation (Intake, Enrollement) | $270.00 | $300.00 | $184.00–$288.00 | 26% above | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 Ot Neuromuscular Reeducation Rehab Units | $104.00 | $115.00 | $71.00–$110.00 | 14% above | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 Pt Neuromuscular Reeducation Rehab Units | $140.00 | $155.00 | $95.00–$149.00 | 54% above | 10% |
| New patient office visit, about 30 minutes CPT 99203 New patient office or other outpatient visit, 30 min | $113.00 | $125.00 | $77.00–$120.00 | 45% below | 10% |
| New patient office visit, about 45 minutes CPT 99204 New patient office or other outpatient visit, 45 min | $158.00 | $175.00 | $107.00–$168.00 | 48% below | 10% |
| New patient office visit, about 60 minutes CPT 99205 New patient office or other outpatient visit, 60 min | $212.00 | $235.00 | $144.00–$226.00 | 43% below | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Level 2 New Pt Virtual Visit20 Min | $86.00 | $95.00 | $58.00–$91.00 | 31% below | 9% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Office Visit New Pt- Sfw Mdm | $162.00 | $180.00 | $110.00–$173.00 | 31% above | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Level 2 New Pt. Telemedicine20 Min | $216.00 | $240.00 | $39.00–$230.00 | 75% above | 10% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 97802-nutrition Counseling, Initial (Ppp Service) | $26.00 | $29.00 | $18.00–$28.00 | 46% below | 10% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Medical Nutrition Education | $90.00 | $100.00 | $61.00–$96.00 | 87% above | 10% |
| Occupational therapy evaluation, low complexity CPT 97165 Ot Evaluation Low Complexity Units | $188.00 | $209.00 | $128.00–$201.00 | 15% above | 10% |
| Occupational therapy evaluation, low complexity CPT 97165 97165 Telemedicine Ot Evaulationlow Complexity | $194.00 | $215.00 | $132.00–$206.00 | 18% above | 10% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Evaluation High Complexity Units | $234.00 | $260.00 | $160.00–$250.00 | 12% above | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Evaluation Low Complexity Units | $185.00 | $205.00 | $126.00–$197.00 | 17% above | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 97161 Telemedicine Pt Evaluation- Low Complexity | $194.00 | $215.00 | $132.00–$206.00 | 23% above | 10% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Evaluation Moderate Complexity Units | $212.00 | $235.00 | $144.00–$226.00 | 20% above | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Ot Manual Therapy Rehab Units | $105.00 | $117.00 | $72.00–$112.00 | 9% above | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Pt Manual Therapy Rehab Units | $113.00 | $125.00 | $77.00–$120.00 | 18% above | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Physical therapy, therapeutic exercise | $117.00 | $130.00 | $80.00–$125.00 | 23% above | 10% |
| Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 min | $549.00 | $610.00 | $374.00–$586.00 | 246% above | 10% |
| Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 min | $680.00 | $755.00 | $463.00–$725.00 | 229% above | 10% |
| Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 min | $693.00 | $770.00 | $473.00–$739.00 | 175% above | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Level 5 Virtual Visit40 Min | $171.00 | $190.00 | $117.00–$182.00 | 28% below | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Level 5 Telemedicine40 Min | $369.00 | $410.00 | $118.00–$394.00 | 56% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Level 3 Virtual Visit15 Min | $72.00 | $80.00 | $49.00–$77.00 | 39% below | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office Visit Est Pt Low Mdm | $144.00 | $160.00 | $98.00–$154.00 | 22% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Level 3 Telemedicine15 Min | $194.00 | $215.00 | $54.00–$206.00 | 64% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Allergy Serum + Office Visit Level 3 Established | $441.00 | $490.00 | $301.00–$470.00 | 273% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Level 4 Virtual Visit25 Min | $104.00 | $115.00 | $71.00–$110.00 | 41% below | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Level 4 Telemedicine25 Min | $257.00 | $285.00 | $80.00–$274.00 | 47% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Allergy Serum + Office Visit Level 4 Established | $495.00 | $550.00 | $338.00–$528.00 | 183% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Level 2 Virtual Visit10 Min | $59.00 | $65.00 | $40.00–$62.00 | 30% below | 9% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Level 2 Telemedicine10 Min | $167.00 | $185.00 | $29.00–$178.00 | 99% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Allergy Serum + Office Visit Level 2 Established | $414.00 | $460.00 | $282.00–$442.00 | 393% above | 10% |
| Speech and language evaluation CPT 92523 Slp Sound Prod W/ Lang Comp Eval Rehab Units | $333.00 | $370.00 | $227.00–$355.00 | 8% above | 10% |
| Speech therapy session, individual CPT 92507 92507 Telemedicine Tx Of Speech, Language, Voice, Communication, Auditory | $252.00 | $280.00 | $172.00–$269.00 | 4% above | 10% |
| Speech therapy session, individual CPT 92507 92507 Treatment/speech/language 15min | $277.00 | $308.00 | $189.00–$296.00 | 14% above | 10% |
| Speech therapy session, individual CPT 92507 Slp Auditory Processing Tx Rehab Units | $284.00 | $315.00 | $193.00–$302.00 | 17% above | 10% |
| Spirometry (breathing test) CPT 94010 94010 Spirometry Charge | $306.00 | $340.00 | $209.00–$326.00 | 13% above | 10% |
| Spirometry (breathing test) CPT 94010 Spirometry | $315.00 | $350.00 | $215.00–$336.00 | 17% above | 10% |
| Spirometry before and after a bronchodilator CPT 94060 Pft Pulmonary Function Pre/post Gbmh Cp | $608.00 | $675.00 | $414.00–$648.00 | 8% above | 10% |
| Spirometry before and after a bronchodilator CPT 94060 94060 Spirometry Pre And Post Bronchodilator Charge | $675.00 | $750.00 | $460.00–$720.00 | 20% above | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 97530 Job Sight Analysis 15 Min Charge | $27.00 | $30.00 | $18.00–$29.00 | 69% below | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Tens Use Charge | $90.00 | $100.00 | $61.00–$96.00 | 4% above | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Functional Training Charges | $99.00 | $110.00 | $68.00–$106.00 | 15% above | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 97530 Telemedicine Ot Therapeutic Activities, One To One Each 15 Minutes | $104.00 | $115.00 | $71.00–$110.00 | 21% above | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Transfer Charge | $108.00 | $120.00 | $74.00–$115.00 | 25% above | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Pt Therapeutic Activity Rehab Units | $117.00 | $130.00 | $80.00–$125.00 | 36% above | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Ot Therapeutic Activities Subsc Rehab Units | $117.00 | $130.00 | $80.00–$125.00 | 36% above | 10% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy 3 | $207.00 | $230.00 | $141.00–$221.00 | 8% above | 10% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 Cardiovas Stress Test Using Maximal/submaximal Treadmill Or Bike Exercise, Cont.electrocardiographic | $261.00 | $290.00 | $178.00–$278.00 | at median | 10% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella Virus Vaccine Poc | $309.00 | $343.00 | $211.00–$329.00 | 55% above | 10% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Vfc Influenza 6-35 Months Charge | $14.00 | $15.00 | $9.00–$14.00 | 48% below | 7% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Vfc Influenza 3 Years + Charge | $14.00 | $15.00 | $9.00–$14.00 | 48% below | 7% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza Split Virus Vaccine, Inactivated (Influenza Vaccine) | $41.00 | $46.00 | $28.00–$44.00 | 52% above | 11% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Q2037 Influenza Medicare | $42.00 | $47.00 | $29.00–$45.00 | 56% above | 11% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza Virus Vaccine, Splie Virus, Preservative Free, For Children 6-35 Months Of Age, Im Poc (In | $42.00 | $47.00 | $29.00–$45.00 | 56% above | 11% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Flu Vaccine Split 3 Yrs And Above Im Poc | $42.00 | $47.00 | $29.00–$45.00 | 56% above | 11% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Human Papilloma Virus (Hpv) Vaccine Poc | $496.00 | $551.00 | $338.00–$529.00 | 34% above | 10% |
| Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A Adult Vaccine Charge | $121.00 | $134.00 | $82.00–$129.00 | 29% above | 10% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B Vaccine Recombivax, Adult | $80.00 | $89.00 | $55.00–$85.00 | 12% below | 10% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Q2038 Influenza High Dose 65+commercial | $118.00 | $131.00 | $80.00–$126.00 | 44% above | 10% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal Conjugate Vaccine, Serogroups A, C, Y And W-135 (Tetravalent), For Im Use Poc | $188.00 | $209.00 | $128.00–$201.00 | 3% above | 10% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Bexsero Vaccine Charge | $262.00 | $291.00 | $179.00–$279.00 | 5% below | 10% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 90677 Pneumococcal 20-valent Vaccine | $433.00 | $481.00 | $295.00–$462.00 | at median | 10% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Nirsevimab-alip (Cvx 306) (Beyfortus) Vaccine 50 Mg Charge | $824.00 | $915.00 | $562.00–$878.00 | 16% above | 10% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 Rsv Vacc Pref A And Pref B/pfâ (Abrysvo)â Vaccine Charge | $449.00 | $499.00 | $306.00–$479.00 | 19% above | 10% |
| Rabies vaccine, one dose CPT 90675 Rabies Vaccine Im Charge | $486.00 | $540.00 | $331.00–$518.00 | at median | 10% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Shingrix Vaccine, 1 Dose Charge | $293.00 | $326.00 | $200.00–$313.00 | 2% above | 10% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus-diphtheria Toxoids 7 Yrs And Older Poc | $55.00 | $61.00 | $37.00–$59.00 | 6% above | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Vfc Boostrix Charge | $14.00 | $15.00 | $9.00–$14.00 | 80% below | 7% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus, Diphtheria Toxoids & Acellular Pertussis Vaccine (Tdap), | $68.00 | $75.00 | $46.00–$72.00 | 3% below | 9% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Flu (Influenza) Immunization Admin Charge | $27.00 | $30.00 | $18.00–$29.00 | 24% below | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Clinic Immunization Admin 1st Vaccine | $65.00 | $72.00 | $44.00–$69.00 | 84% above | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Administration 1st Vaccine | $77.00 | $85.00 | $52.00–$82.00 | 118% above | 9% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 Clinic Immun Admin: Each Additional Vaccine | $27.00 | $30.00 | $18.00–$29.00 | 19% below | 10% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 Each Additional Immunization Admin Charge. | $50.00 | $55.00 | $34.00–$53.00 | 49% above | 9% |