Hospital

Gordon Memorial Hospital

Gordon Memorial Hospital in Gordon, NE publishes cash prices for 318 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 246 of 314 procedures and below it for 68. By typical cash price it ranks #39 of 45 Nebraska hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

300 East 8TH St, Gordon, NE 69343 Collected Sep 27, 2026 Source price file (308) 282-0401

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 281358 · CMS hospital register

The price file shows no self-pay discount

For 713 of the 713 prices listed here, the cash price in Gordon Memorial Hospital's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing.

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 Rt Comp	$435.00	$435.00	$67.00–$409.00	32% above	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Ankle Lt Comp	$435.00	$435.00	$67.00–$409.00	32% above	—
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Us Abi	$670.00	$670.00	$143.00–$637.00	44% above	—
Barium swallow (esophagus X-ray with contrast) CPT 74220 Xr Esophagus	$725.00	$725.00	$348.00–$689.00	20% above	—
Bone scan, whole body (nuclear medicine) CPT 78306 Nm Bone Imaging Whole Body	$2,050.00	$2,050.00	$617.00–$1,948.00	19% above	—
Breast ultrasound, complete, one breast one side CPT 76641 Us Breast Left Complete	$685.00	$685.00	$216.00–$651.00	41% above	—
Breast ultrasound, complete, one breast one side CPT 76641 Us Breast Right Complete	$685.00	$685.00	$216.00–$651.00	41% above	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us Breast Left Limited	$505.00	$505.00	$177.00–$480.00	31% above	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us Breast Right Limited	$505.00	$505.00	$177.00–$480.00	31% above	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Cta Chest W Aortic Dissection	$4,050.00	$4,050.00	$585.00–$3,848.00	26% above	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct Pe Angio Chest W	$4,050.00	$4,050.00	$585.00–$3,848.00	26% above	—
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Ct Angio Heart W 3d Image	$2,550.00	$2,550.00	$642.00–$2,423.00	95% above	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abd Pelvis Wo	$4,850.00	$4,850.00	$405.00–$4,559.00	41% above	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Kidney Stone Wo	$4,850.00	$4,850.00	$405.00–$4,559.00	41% above	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast	$5,500.00	$5,500.00	$641.00–$5,170.00	35% above	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Urogram	$6,250.00	$6,250.00	$724.00–$5,875.00	25% above	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd Pelvis Wo W	$6,250.00	$6,250.00	$724.00–$5,875.00	25% above	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd & Pelv 1/> Regns	$6,250.00	$6,250.00	$724.00–$5,875.00	25% above	—
CT scan of the abdomen with contrast CPT 74160 Ct Abd Liver W	$3,250.00	$3,250.00	$479.00–$3,088.00	25% above	—
CT scan of the abdomen with contrast CPT 74160 Ct Angio Liver Donor W	$3,250.00	$3,250.00	$479.00–$3,088.00	25% above	—
CT scan of the abdomen with contrast CPT 74160 Ct Pancreatic Mass W	$3,250.00	$3,250.00	$479.00–$3,088.00	25% above	—
CT scan of the abdomen with contrast CPT 74160 Ct Liver W	$3,250.00	$3,250.00	$479.00–$3,088.00	25% above	—
CT scan of the abdomen with contrast CPT 74160 Ct Liver Volume W	$3,250.00	$3,250.00	$479.00–$3,088.00	25% above	—
CT scan of the abdomen with contrast CPT 74160 Ct Biphasic Liver W	$3,250.00	$3,250.00	$479.00–$3,088.00	25% above	—
CT scan of the abdomen with contrast CPT 74160 Ct Abd W	$3,250.00	$3,250.00	$479.00–$3,088.00	25% above	—
CT scan of the abdomen with contrast CPT 74160 Ct Adrenals Protocol W Abd	$3,550.00	$3,550.00	$479.00–$3,373.00	37% above	—
CT scan of the abdomen without contrast CPT 74150 Ct Abd Wo	$2,950.00	$2,950.00	$302.00–$2,803.00	34% above	—
CT scan of the abdomen without contrast CPT 74150 Ct Adrenals Protocol Wo Abd	$3,550.00	$3,550.00	$302.00–$3,373.00	61% above	—
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Sinus Lmt Wo	$2,550.00	$2,550.00	$280.00–$2,423.00	41% above	—
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Paranasal Sinuses Wo	$2,550.00	$2,550.00	$280.00–$2,423.00	41% above	—
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Facial Bones Wo	$2,550.00	$2,550.00	$280.00–$2,423.00	41% above	—
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Sinus Comp Wo	$2,550.00	$2,550.00	$280.00–$2,423.00	41% above	—
CT scan of the head or brain, no contrast dye CPT 70450 CT scan	$2,550.00	$2,550.00	$233.00–$2,397.00	34% above	—
CT scan of the head with contrast CPT 70460 Ct Head W	$2,850.00	$2,850.00	$1,368.00–$2,708.00	38% above	—
CT scan of the head without and with contrast CPT 70470 Ct Angio Head Cow Wo/w	$3,200.00	$3,200.00	$385.00–$3,008.00	28% above	—
CT scan of the head without and with contrast CPT 70470 Ct Head Wo W	$3,200.00	$3,200.00	$385.00–$3,008.00	28% above	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct Spine Lumbar Wo	$2,850.00	$2,850.00	$325.00–$2,708.00	31% above	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct Spine Cervical Wo	$2,850.00	$2,850.00	$331.00–$2,708.00	27% above	—
CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast	$3,250.00	$3,250.00	$469.00–$3,088.00	35% above	—
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Us Carotid Doppler	$1,720.00	$1,720.00	$335.00–$1,634.00	9% above	—
Chest X-ray, 2 views CPT 71046 Xr Chest 2 V	$415.00	$415.00	$63.00–$390.00	47% above	—
Chest X-ray, single view CPT 71045 Xr Chest 1 V	$360.00	$360.00	$50.00–$342.00	56% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Us Renal Comp	$970.00	$970.00	$227.00–$922.00	23% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Us Renal W Doppler	$1,270.00	$1,270.00	$227.00–$1,207.00	61% above	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Dexa	$620.00	$620.00	$80.00–$589.00	58% above	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest Wo	$2,750.00	$2,750.00	$320.00–$2,613.00	28% above	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest Hi Resolution Wo	$2,750.00	$2,750.00	$320.00–$2,613.00	28% above	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Lung W	$3,050.00	$3,050.00	$395.00–$2,867.00	22% above	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest W	$3,050.00	$3,050.00	$395.00–$2,867.00	22% above	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Angio Aortic Dissection W	$3,050.00	$3,050.00	$395.00–$2,867.00	22% above	—
Diagnostic mammogram, both breasts CPT 77066 Mammography of both breasts	$480.00	$480.00	$230.00–$456.00	7% above	—
Diagnostic mammogram, one breast CPT 77065 Mammography of one breast	$400.00	$400.00	$192.00–$380.00	28% above	—
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Us Art Doppler Low Ext Bilat	$1,520.00	$1,520.00	$425.00–$1,444.00	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Us Venous Reflux Study Bilat	$1,810.00	$1,810.00	$324.00–$1,720.00	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Us Venous D Scan Bilat Ext	$1,820.00	$1,820.00	$324.00–$1,729.00	—	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Us Echo Doppler	$2,650.00	$2,650.00	$348.00–$2,518.00	24% above	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nm Hepatoductal System, Gb W/o Cck	$2,050.00	$2,050.00	$984.00–$1,948.00	41% above	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Sleep Study Thera Titrati	$5,076.00	$5,076.00	$1,071.00–$4,822.00	34% above	—
Knee X-ray, 3 views one side CPT 73562 Xr Knee Rt 3 V	$460.00	$460.00	$74.00–$432.00	23% above	—
Knee X-ray, 3 views one side CPT 73562 Xr Knee Lt 3 V	$460.00	$460.00	$74.00–$432.00	23% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Abd Lmt	$820.00	$820.00	$183.00–$779.00	47% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Abd Lmt W Doppler	$1,120.00	$1,120.00	$183.00–$1,064.00	100% above	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct Low Dose Lung Screening Wo	$2,050.00	$2,050.00	$984.00–$1,948.00	230% above	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct Low Dose Lung Ca Screen Wo	$2,050.00	$2,050.00	$984.00–$1,948.00	230% above	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct Low Dose Lung Screen	$2,050.00	$2,050.00	$984.00–$1,948.00	230% above	—
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI scan of leg joint	$3,650.00	$3,650.00	$468.00–$3,431.00	42% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 Mr Hips Bilat Wo W	$4,350.00	$4,350.00	$922.00–$4,133.00	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mr Joint Lt Lower Wo W	$4,350.00	$4,350.00	$922.00–$4,133.00	29% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mr Joint Rt Lower Wo W	$4,350.00	$4,350.00	$922.00–$4,133.00	29% above	—
MRI of the abdomen without contrast CPT 74181 Mr Abd Wo	$3,750.00	$3,750.00	$491.00–$3,563.00	27% above	—
MRI of the abdomen, without and then with contrast dye CPT 74183 Mr Abd Wo W	$5,030.00	$5,030.00	$802.00–$4,779.00	35% above	—
MRI of the brain, no contrast dye CPT 70551 Mr Pituitary Wo	$4,050.00	$4,050.00	$456.00–$3,848.00	28% above	—
MRI of the brain, no contrast dye CPT 70551 Mr Brain Wo	$4,050.00	$4,050.00	$456.00–$3,848.00	28% above	—
MRI of the brain, no contrast dye CPT 70551 Mr Inner Auditory Canal Wo	$4,050.00	$4,050.00	$456.00–$3,848.00	28% above	—
MRI of the brain, with and without contrast dye CPT 70553 MRI Scan	$4,650.00	$4,650.00	$746.00–$4,418.00	19% above	—
MRI of the lower back, no contrast dye CPT 72148 MRI scan of lower spinal canal	$4,050.00	$4,050.00	$445.00–$3,807.00	28% above	—
MRI of the lower back, without and then with contrast dye CPT 72158 Mr Spine Lumbar Wo W	$4,950.00	$4,950.00	$749.00–$4,703.00	26% above	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mr Spine Thoracic Wo	$4,050.00	$4,050.00	$445.00–$3,848.00	24% above	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 Mr Spine Cerv Wo W	$5,175.00	$5,175.00	$751.00–$4,916.00	33% above	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 Mr Spine Cerv Wo	$4,050.00	$4,050.00	$444.00–$3,848.00	27% above	—
MRI of the pelvis without and with contrast CPT 72197 Mr Pelvis Wo W	$4,650.00	$4,650.00	$801.00–$4,418.00	29% above	—
MRI of the pelvis without and with contrast CPT 72197 Mr Sacrum Wo W	$4,650.00	$4,650.00	$801.00–$4,418.00	29% above	—
MRI of the pelvis, no contrast dye CPT 72195 Mr Sacrum Wo	$3,650.00	$3,650.00	$543.00–$3,468.00	30% above	—
MRI of the pelvis, no contrast dye CPT 72195 Mr Pelvis Wo	$3,650.00	$3,650.00	$543.00–$3,468.00	30% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mr Joint Rt Upper Wo	$2,996.00	$2,996.00	$468.00–$2,846.00	23% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mr Joint Lt Upper Wo	$3,550.00	$3,550.00	$468.00–$3,373.00	46% above	—
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nm Myocardial Spect Multiple	$4,850.00	$4,850.00	$965.00–$4,559.00	17% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us Pelvic Bladder Limited	$630.00	$630.00	$99.00–$599.00	76% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us Pelvic Non Ob Lmt W Dopp	$930.00	$930.00	$99.00–$884.00	161% above	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us Pelvic Comp W Dopp	$1,230.00	$1,230.00	$220.00–$1,169.00	56% above	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Abdomial ultrasound of pregnant uterus	$970.00	$970.00	$283.00–$922.00	39% above	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Us Ob 1st Trimester	$820.00	$820.00	$248.00–$779.00	34% above	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Limited Emergent	$550.00	$550.00	$170.00–$523.00	40% above	—
Screening mammogram, both breasts both sides CPT 77067 Mammography, screening, bilateral	$550.00	$550.00	$236.00–$517.00	—	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder Rt Min 2 V	$460.00	$460.00	$60.00–$437.00	37% above	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder Lt Min 2 V	$460.00	$460.00	$60.00–$437.00	37% above	—
Sleep study in a lab (polysomnography) CPT 95810 Sleep study	$4,320.00	$4,320.00	$1,022.00–$4,104.00	21% above	—
Transvaginal pelvic ultrasound CPT 76830 Ultrasound pelvis through vagina	$1,120.00	$1,120.00	$245.00–$1,064.00	82% above	—
Transvaginal ultrasound during pregnancy CPT 76817 Us Ob Transvaginal	$695.00	$695.00	$195.00–$660.00	37% above	—
Ultrasound of the abdomen, complete CPT 76700 Ultrasound of abdomen	$1,045.00	$1,045.00	$245.00–$982.00	26% above	—
Ultrasound of the scrotum and testicles CPT 76870 Us Scrotum Lmt W Dopp	$1,120.00	$1,120.00	$212.00–$1,064.00	72% above	—
Ultrasound of the scrotum and testicles CPT 76870 Us Scrotum W Dopp	$1,120.00	$1,120.00	$212.00–$1,064.00	72% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Head Neck Superficial Lump	$770.00	$770.00	$231.00–$732.00	30% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Thyroid	$770.00	$770.00	$231.00–$732.00	30% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Neck	$770.00	$770.00	$231.00–$732.00	30% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Venous Us Lt	$1,270.00	$1,270.00	$201.00–$1,207.00	24% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Venous Us Rt	$1,270.00	$1,270.00	$201.00–$1,207.00	24% above	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Rt Comp	$460.00	$460.00	$73.00–$437.00	39% above	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Lt Comp	$460.00	$460.00	$73.00–$437.00	39% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip Lt 2-3 V	$410.00	$410.00	$86.00–$390.00	42% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip Rt 2-3 V	$410.00	$410.00	$86.00–$390.00	42% above	—
X-ray of the abdomen, 1 view CPT 74018 Xr Abd Kub 1v	$360.00	$360.00	$57.00–$342.00	36% above	—
X-ray of the ankle, 2 views one side CPT 73600 Xr Ankle Rt 1 Or 2 V	$335.00	$335.00	$161.00–$318.00	34% above	—
X-ray of the ankle, 2 views one side CPT 73600 Xr Ankle Lt 1 Or 2 V	$335.00	$335.00	$161.00–$318.00	34% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Fingers Rt 2 V	$275.00	$275.00	$67.00–$261.00	22% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Fingers Lt 2 V	$275.00	$275.00	$67.00–$261.00	22% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Hand Lt 3rd Digit	$285.00	$285.00	$67.00–$271.00	26% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Hand Lt 2nd Digit	$285.00	$285.00	$67.00–$271.00	26% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Hand Lt Thumb	$285.00	$285.00	$67.00–$271.00	26% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Hand Lt 5th Digit	$285.00	$285.00	$67.00–$271.00	26% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Hand Rt 4th Digit	$285.00	$285.00	$67.00–$271.00	26% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Hand Rt 5th Digit	$285.00	$285.00	$67.00–$271.00	26% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Hand Rt 3rd Digit	$285.00	$285.00	$67.00–$271.00	26% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Hand Rt 2nd Digit	$285.00	$285.00	$67.00–$271.00	26% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Hand Rt Thumb	$285.00	$285.00	$67.00–$271.00	26% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Hand Lt 4th Digit	$285.00	$285.00	$67.00–$271.00	26% above	—
X-ray of the foot, 2 views one side CPT 73620 Xr Foot Rt 1 Or 2 V	$360.00	$360.00	$173.00–$342.00	66% above	—
X-ray of the foot, 2 views one side CPT 73620 Xr Foot Lt 1 Or 2 V	$360.00	$360.00	$173.00–$342.00	66% above	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Lt Min 3 V	$460.00	$460.00	$62.00–$432.00	46% above	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Rt Min 3 V	$460.00	$460.00	$62.00–$432.00	46% above	—
X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Lt 3 V	$410.00	$410.00	$67.00–$390.00	20% above	—
X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Rt 3 V	$410.00	$410.00	$67.00–$390.00	20% above	—
X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee Lt 1 Or 2 V	$410.00	$410.00	$64.00–$390.00	29% above	—
X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee Rt 1 Or 2 V	$410.00	$410.00	$64.00–$390.00	29% above	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Xr Spine Lumbar 2-3 V	$535.00	$535.00	$73.00–$508.00	35% above	—
X-ray of the lower back, 4 or more views CPT 72110 X-Ray of lower back	$645.00	$645.00	$102.00–$613.00	36% above	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Xr Spine Thoracic Ap Lat	$425.00	$425.00	$68.00–$404.00	39% above	—
X-ray of the nasal bones, 3 or more views CPT 70160 Xr Nasal Bones	$385.00	$385.00	$185.00–$366.00	32% above	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xr Spine Cerv 2-3 V	$435.00	$435.00	$73.00–$413.00	37% above	—
X-ray of the pelvis, 1 or 2 views CPT 72170 Xr Pelvis 1-2 V	$395.00	$395.00	$66.00–$375.00	47% above	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Xr Sacrum Coccyx 2 V	$385.00	$385.00	$185.00–$366.00	43% above	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alt	$89.00	$89.00	$10.00–$85.00	46% above	—
AST (aspartate aminotransferase) enzyme test CPT 84450 Ast	$86.00	$86.00	$10.00–$82.00	51% above	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute Hepatitis Panel (Ref)	$384.00	$384.00	$89.00–$365.00	21% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cabbage (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Region 9 (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Red Sorrel Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Pigweed Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Russian Thistle Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Mugwort Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Short Ragweed Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cottonwood Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Olive Tree Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Mulberry Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Elm Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Oak Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Mountain Cedar Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Grey Alder Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Box Elder/maple S Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria Tenuis Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus Fumigatus Igg Abs (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda Grass Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Dander Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Epithelium Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Mites/df Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Mites/dp Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Gluten Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Insulin (Human) Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Lobster Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Tuna Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Crab Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Codfish Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Corn-food Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Soybean Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Wheat Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Milk Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cocoa Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Beef Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Egg Yolk Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Pork Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Barley Add On (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Tomato (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Wheat (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Rice (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Soybean (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Oat (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Carrot (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Milk (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Rye (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Potato (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Orange (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Navy Bean (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Lettuce (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Grape (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Chicken (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Bell Pepper (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Stachybotrys Chartarum Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Orchard Grass Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Sage Brush Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Bakers Yeast Ige Serum (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 June Kentucky Grass Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Greer Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Meadow Fescue Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Alergen Indoor Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Hormodendrum Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Perennial Rye Grass Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Pistachio Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Pecan Nut Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Dandelion Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Pine Nut Ige (Ref)	$48.00	$48.00	$23.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Profile (Rasp Panel) (Arup)	$553.00	$553.00	$265.00–$525.00	1077% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Food Allergen Profile W/ Reflux (Ref)	$678.00	$678.00	$325.00–$644.00	1343% above	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Ccp Antibodies (Ref)	$193.00	$193.00	$24.00–$183.00	85% above	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Screen Ifa W/refl Titer/pattern(ref)	$152.00	$152.00	$23.00–$144.00	90% above	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Screen Ifa W/refl (Do Not Order)	$152.00	$152.00	$23.00–$144.00	90% above	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibodies Non Reflex (Ref)	$152.00	$152.00	$23.00–$144.00	90% above	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Vasculitis Anca Igg Panel (Ref)	$253.00	$253.00	$23.00–$240.00	216% above	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Bnp	$428.00	$428.00	$66.00–$407.00	118% above	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Bnp Istat	$428.00	$428.00	$66.00–$407.00	118% above	—
Basic metabolic panel (blood test) CPT 80048 Basic metabolic panel	$173.00	$173.00	$16.00–$163.00	27% above	—
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Lvliv Sur Path Gr & Micr (Ref)	$258.00	$258.00	$111.00–$245.00	34% above	—
Blood culture for bacteria CPT 87040 Blood Culture Set 2 (Ref)	$295.00	$295.00	$142.00–$280.00	64% above	—
Blood culture for bacteria CPT 87040 Blood Culture Set 1 (Ref)	$295.00	$295.00	$142.00–$280.00	64% above	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Cl Venipuncture, Spec Coll	$14.00	$14.00	$4.00–$28.00	46% below	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Collection Venipuncture	$39.00	$39.00	$4.00–$37.00	52% above	—
Blood glucose (sugar) test CPT 82947 Glucose	$77.00	$77.00	$7.00–$73.00	61% above	—
Blood lead test CPT 83655 .Lead Heavy Metal Charge (Ref)	$107.00	$107.00	$23.00–$102.00	65% above	—
Blood lead test CPT 83655 Lead Blood Capillary (Ref)	$107.00	$107.00	$23.00–$102.00	65% above	—
Blood lead test CPT 83655 Lead Blood Venous (Ref)	$107.00	$107.00	$23.00–$102.00	65% above	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Gonadotropin Chorionic (Hcg) (Ref)	$148.00	$148.00	$14.00–$141.00	35% above	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bb Abo Group Type	$76.00	$76.00	$6.00–$72.00	41% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Do Not Order -Daily Crp (Ref)	$114.00	$114.00	$10.00–$108.00	25% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Daily Crp	$122.00	$122.00	$10.00–$116.00	34% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Crp	$133.00	$133.00	$10.00–$126.00	46% above	—
C. difficile toxin gene test (stool PCR) CPT 87493 C Diff Toxin By Pcr	$240.00	$240.00	$115.00–$228.00	56% above	—
CA 19-9 blood test (tumor marker) CPT 86301 Ca 19-9 (Ref)	$262.00	$262.00	$126.00–$249.00	68% above	—
CA-125 blood test (ovarian cancer marker) CPT 86304 Ca 125 (Ref)	$255.00	$255.00	$39.00–$242.00	96% above	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Covid Pcr	$194.00	$194.00	$65.00–$182.00	53% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Amplified (Ref)	$160.00	$160.00	$66.00–$152.00	45% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis Amplifie (Ref)	$168.00	$168.00	$66.00–$160.00	53% above	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids	$183.00	$183.00	$25.00–$172.00	58% above	—
Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (CBC), with differential white blood cells, automated	$138.00	$138.00	$15.00–$130.00	50% above	—
Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (CBC), automated	$108.00	$108.00	$12.00–$103.00	52% above	—
Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals	$208.00	$208.00	$20.00–$196.00	33% above	—
DHEA sulfate (DHEA-S) blood test CPT 82627 Dhea Sulfate (Ref)	$237.00	$237.00	$42.00–$225.00	67% above	—
Estradiol blood test CPT 82670 Estradiol (E2) Serum (Don't Order)(ref)	$212.00	$212.00	$52.00–$201.00	54% above	—
Estradiol blood test CPT 82670 Estradiol (Ref)	$212.00	$212.00	$52.00–$201.00	54% above	—
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone	$167.00	$167.00	$35.00–$159.00	48% above	—
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone (Ref)	$167.00	$167.00	$35.00–$159.00	48% above	—
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin Feces (Ref)	$535.00	$535.00	$257.00–$508.00	49% above	—
Ferritin blood test (iron stores) CPT 82728 Ferritin	$163.00	$163.00	$26.00–$155.00	56% above	—
Ferritin blood test (iron stores) CPT 82728 Ferritin (Ref)	$163.00	$163.00	$26.00–$155.00	56% above	—
Folate (folic acid) blood test CPT 82746 Folate (Ref)	$159.00	$159.00	$28.00–$151.00	51% above	—
Folate (folic acid) blood test CPT 82746 Folate	$159.00	$159.00	$28.00–$151.00	51% above	—
Free T3 thyroid hormone test CPT 84481 Free T3	$223.00	$223.00	$32.00–$212.00	43% above	—
Free T3 thyroid hormone test CPT 84481 T3 Free (Ref)	$223.00	$223.00	$32.00–$212.00	43% above	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Free	$148.00	$148.00	$17.00–$141.00	70% above	—
Free testosterone test CPT 84402 Testosterone Free (Ref)	$218.00	$218.00	$48.00–$207.00	97% above	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Tolerance 1 Hr (50mg Gdm Screen)	$76.00	$76.00	$9.00–$72.00	38% above	—
Glucose tolerance test, 3 samples CPT 82951 *Glucose Tolerance Charge	$194.00	$194.00	$24.00–$184.00	48% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Gc Amplified (Ref)	$151.00	$151.00	$66.00–$143.00	37% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae Amplifie (Ref)	$159.00	$159.00	$66.00–$151.00	44% above	—
H. pylori stool antigen test CPT 87338 Hpylori Antigen Stool (Ref)	$206.00	$206.00	$99.00–$196.00	28% above	—
HIV-1 and HIV-2 antibody test CPT 86703 Hiv 1/2 Antibody Eval (Obsolete) (Ref)	$120.00	$120.00	$26.00–$114.00	68% above	—
HIV-1 and HIV-2 antibody test CPT 86703 Hiv1/hiv2 Abs Combo	$120.00	$120.00	$26.00–$114.00	68% above	—
HIV-1 and HIV-2 antibody test CPT 86703 Hiv Combo (Ref)	$120.00	$120.00	$26.00–$114.00	68% above	—
HIV-1 and HIV-2 antibody test CPT 86703 Hiv 1 & 2 Abs-prenatal	$120.00	$120.00	$26.00–$114.00	68% above	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 Hpv High Risk (Ref)	$159.00	$159.00	$66.00–$151.00	44% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c	$113.00	$113.00	$18.00–$107.00	55% above	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody (Ref)	$186.00	$186.00	$20.00–$177.00	105% above	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen	$123.00	$123.00	$19.00–$117.00	32% above	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen (Ref)	$123.00	$123.00	$19.00–$117.00	32% above	—
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody Igg	$137.00	$137.00	$27.00–$130.00	50% above	—
Hepatitis C antibody blood test (screening) CPT 86803 Hep C Medicare Screening	$137.00	$137.00	$27.00–$130.00	50% above	—
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody (Ref)	$137.00	$137.00	$27.00–$130.00	50% above	—
Hepatitis C viral load (HCV RNA) test CPT 87522 Hcv Rna Quant Pcr W/rfx To Genotype (Ref	$625.00	$625.00	$300.00–$594.00	85% above	—
Hepatitis C viral load (HCV RNA) test CPT 87522 Hcv Rna Quant Pcr (Ref)	$625.00	$625.00	$300.00–$594.00	85% above	—
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex 1 Igg (Ref)	$127.00	$127.00	$61.00–$121.00	24% above	—
Herpes blood test, HSV-1 antibody CPT 86695 Antibody Herpes Simplex Type1 (Ref)	$127.00	$127.00	$61.00–$121.00	24% above	—
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex 2 Igg (Ref)	$127.00	$127.00	$61.00–$121.00	19% above	—
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Virus Type 2 (Ref)	$133.00	$133.00	$64.00–$126.00	25% above	—
High-sensitivity CRP (hs-CRP) test CPT 86141 C-reactive Protein High Sensi	$114.00	$114.00	$24.00–$108.00	37% above	—
Homocysteine blood test CPT 83090 Homocysteine Do Not Order	$268.00	$268.00	$129.00–$255.00	87% above	—
Homocysteine blood test CPT 83090 Homocysteine Plasma (Ref)	$268.00	$268.00	$129.00–$255.00	87% above	—
Homocysteine blood test CPT 83090 Homocysteine Serum (Ref)	$268.00	$268.00	$129.00–$255.00	87% above	—
Insulin blood test CPT 83525 Insulin 120 Minutes (Ref)	$146.00	$146.00	$70.00–$139.00	35% above	—
Insulin blood test CPT 83525 Cardio Iq Insulin Resist Panel (Ref)	$146.00	$146.00	$70.00–$139.00	35% above	—
Insulin blood test CPT 83525 Insulin Total(ref)	$146.00	$146.00	$70.00–$139.00	35% above	—
Iron blood test (serum iron) CPT 83540 Iron Level	$90.00	$90.00	$12.00–$86.00	43% above	—
Iron blood test (serum iron) CPT 83540 Adomps 13 Inhibitor (Ref)	$90.00	$90.00	$12.00–$86.00	43% above	—
Iron blood test (serum iron) CPT 83540 Iron (Ref)	$90.00	$90.00	$12.00–$86.00	43% above	—
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity (Ref)	$104.00	$104.00	$16.00–$99.00	46% above	—
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity	$104.00	$104.00	$16.00–$99.00	46% above	—
Kidney function blood test panel CPT 80069 Kidney function panel test	$177.00	$177.00	$16.00–$168.00	29% above	—
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone (Ref)	$182.00	$182.00	$35.00–$173.00	46% above	—
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone	$182.00	$182.00	$35.00–$173.00	46% above	—
Lipase blood test (pancreas enzyme) CPT 83690 Daily Lipase	$175.00	$175.00	$13.00–$166.00	83% above	—
Lipase blood test (pancreas enzyme) CPT 83690 Lipase	$178.00	$178.00	$13.00–$169.00	86% above	—
Liver function blood test panel CPT 80076 Liver function blood test	$190.00	$190.00	$15.00–$181.00	44% above	—
Lyme disease antibody test CPT 86618 (Don't Order)lyme Antibodies W/ref (Ref)	$244.00	$244.00	$117.00–$232.00	87% above	—
Lyme disease antibody test CPT 86618 Lyme Disease Serology (Que)	$244.00	$244.00	$117.00–$232.00	87% above	—
Magnesium blood test CPT 83735 Daily Magnesium	$108.00	$108.00	$13.00–$103.00	57% above	—
Magnesium blood test CPT 83735 Ss Magnesium 24 Hr (Ref)	$118.00	$118.00	$13.00–$112.00	72% above	—
Magnesium blood test CPT 83735 Magnesium 24 Hr Urine (Ref)	$118.00	$118.00	$13.00–$112.00	72% above	—
Magnesium blood test CPT 83735 Magnesium Rbc (Ref)	$118.00	$118.00	$13.00–$112.00	72% above	—
Magnesium blood test CPT 83735 Magnesium Random Ur (Ref)	$118.00	$118.00	$13.00–$112.00	72% above	—
Magnesium blood test CPT 83735 Magnesium	$128.00	$128.00	$13.00–$122.00	86% above	—
Magnesium blood test CPT 83735 Magnesium Feces (Ref)	$563.00	$563.00	$13.00–$535.00	718% above	—
Measles (rubeola) antibody test CPT 86765 Rubeola (Measles) Igg Abs (Ref)	$144.00	$144.00	$69.00–$137.00	71% above	—
Mono test (heterophile antibody, Monospot) CPT 86308 Monospot	$97.00	$97.00	$10.00–$92.00	50% above	—
PSA (prostate-specific antigen) blood test, free CPT 84154 Total prostate-specific antigen (PSA) test	$166.00	$166.00	$80.00–$158.00	30% above	—
PSA (prostate-specific antigen) blood test, total CPT 84153 Total prostate-specific antigen (PSA) test	$158.00	$158.00	$35.00–$150.00	50% above	—
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Cytopath Thin Layer Pap S (Ref)	$147.00	$147.00	$38.00–$140.00	158% above	—
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone (Don't Order) (Ref)	$320.00	$320.00	$78.00–$304.00	52% above	—
Parathyroid hormone (PTH) blood test CPT 83970 Pth, Intact W/ Minerals (Ref)	$320.00	$320.00	$78.00–$304.00	52% above	—
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone, Intact (Ref)	$320.00	$320.00	$78.00–$304.00	52% above	—
Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test	$123.00	$123.00	$11.00–$117.00	59% above	—
Progesterone blood test CPT 84144 Progesterone (Ref)	$180.00	$180.00	$39.00–$171.00	62% above	—
Prolactin blood test CPT 84146 Prolactin (Ref)	$222.00	$222.00	$36.00–$211.00	87% above	—
Prolactin blood test CPT 84146 Thyroid Releasing Hormone (Ref)	$222.00	$222.00	$36.00–$211.00	87% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time	$206.00	$206.00	$7.00–$194.00	307% above	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Urine Drug Screen	$238.00	$238.00	$21.00–$226.00	149% above	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Test Drug Screen-no Order	$238.00	$238.00	$21.00–$226.00	149% above	—
Rapid flu test (influenza antigen) CPT 87804 Cl Influenza A Test	$43.00	$43.00	$21.00–$41.00	39% below	—
Rapid flu test (influenza antigen) CPT 87804 Cl Influenza B Test	$43.00	$43.00	$21.00–$41.00	39% below	—
Rapid flu test (influenza antigen) CPT 87804 Influenza B	$153.00	$153.00	$28.00–$145.00	117% above	—
Rapid flu test (influenza antigen) CPT 87804 Influenza A	$153.00	$153.00	$28.00–$145.00	117% above	—
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor (Ref)	$91.00	$91.00	$11.00–$86.00	67% above	—
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Add On Charge (Ref)	$91.00	$91.00	$11.00–$86.00	67% above	—
Rubella antibody test (immunity check) CPT 86762 Rubella Antibodies Igg	$122.00	$122.00	$27.00–$116.00	62% above	—
Rubella antibody test (immunity check) CPT 86762 Rubella Antibodies (Ref)	$122.00	$122.00	$27.00–$116.00	62% above	—
Stool ova and parasites exam CPT 87177 Ova/parasites(que)	$122.00	$122.00	$59.00–$116.00	61% above	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 Cl Occult Blood	$43.00	$43.00	$7.00–$41.00	55% above	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood	$51.00	$51.00	$7.00–$48.00	84% above	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin Confirmation	$74.00	$74.00	$8.00–$70.00	75% above	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rpr Confirm (Ref)	$74.00	$74.00	$8.00–$70.00	75% above	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon-tb Gold (Ref)	$280.00	$280.00	$116.00–$266.00	39% above	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Female/child (Ref)	$196.00	$196.00	$48.00–$186.00	70% above	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Free/total (Que)	$196.00	$196.00	$48.00–$186.00	70% above	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total Male Only (Ref)	$196.00	$196.00	$48.00–$186.00	70% above	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Anti- Lc1 (Ref)	$142.00	$142.00	$27.00–$135.00	57% above	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibody (Ref)	$142.00	$142.00	$27.00–$135.00	57% above	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver/kidney Microsome Ab (Ref)	$142.00	$142.00	$27.00–$135.00	57% above	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Ribas P Ab Add On Charge (Ref)	$142.00	$142.00	$27.00–$135.00	57% above	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH)	$168.00	$168.00	$32.00–$158.00	56% above	—
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis Pcr	$119.00	$119.00	$57.00–$113.00	27% above	—
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis (Ref)	$119.00	$119.00	$57.00–$113.00	27% above	—
Uric acid blood test CPT 84550 Uric Acid	$80.00	$80.00	$8.00–$76.00	52% above	—
Urinalysis with microscope exam, automated CPT 81001 Urinalysis test using microscope	$73.00	$73.00	$6.00–$69.00	43% above	—
Urinalysis without microscope exam, automated CPT 81003 Urinalysis test	$63.00	$63.00	$4.00–$60.00	100% above	—
Urinalysis without microscope exam, manual CPT 81002 Urinalysis test	$20.00	$20.00	$6.00–$19.00	7% below	—
Urine culture for bacteria, with colony count CPT 87086 Urine Culture (Ref)	$113.00	$113.00	$15.00–$107.00	57% above	—
Urine pregnancy test, read by color change CPT 81025 Cl Pregnancy Test, Urine	$23.00	$23.00	$11.00–$22.00	64% below	—
Urine pregnancy test, read by color change CPT 81025 Hcg Urine	$105.00	$105.00	$15.00–$100.00	66% above	—
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 (Ref)	$178.00	$178.00	$28.00–$169.00	58% above	—
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12	$188.00	$188.00	$28.00–$179.00	66% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Don't Order Vitamin D (Ref)	$205.00	$205.00	$56.00–$195.00	39% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D Total	$228.00	$228.00	$56.00–$217.00	54% above	—
Zinc blood test CPT 84630 Zinc Serum (Ref)	$130.00	$130.00	$62.00–$124.00	90% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta Hcg, Quant Tumor Marker (Ref)	$155.00	$155.00	$28.00–$147.00	75% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Bhcg Tumor Marker (Ref)	$163.00	$163.00	$28.00–$155.00	84% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Quantitative	$163.00	$163.00	$28.00–$155.00	84% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Bhcg Triple/quad (Ref)	$163.00	$163.00	$28.00–$155.00	84% above	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Pfmc Knee Arthr/surg Aid Acl Rpr/aug/rec	$2,022.00	$2,022.00	$807.00–$1,921.00	40% below	—
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Knee Arthro/surg Aid Acl Rpr/augmn/recon	$24,500.00	$24,500.00	$1,961.00–$23,275.00	624% above	—
Arthroscopic rotator cuff repair of the shoulder CPT 29827 Pf Mc Arthroscopy Rotator Cuff	$2,227.00	$2,227.00	$885.00–$2,116.00	16% below	—
Arthroscopic rotator cuff repair of the shoulder CPT 29827 Arthroscopy Rotator Cuff Rpr	$27,000.00	$27,000.00	$2,123.00–$25,650.00	920% above	—
Botox injections for chronic migraine both sides CPT 64615 Pf Bont Facial Trigem, Bilateral	$346.00	$346.00	$94.00–$329.00	—	—
Botox injections for chronic migraine both sides CPT 64615 Bont Facial Trigem, Bilateral	$3,300.00	$3,300.00	$236.00–$3,135.00	—	—
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Pf Cl Tx Dist Fib Fx W/o	$699.00	$699.00	$269.00–$664.00	68% above	—
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Ed/closed Dist Fib Fract	$1,055.00	$1,055.00	$506.00–$1,002.00	153% above	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Closed Metatarsal Each	$672.00	$672.00	$192.00–$638.00	83% above	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Ed/closed Metatarsal Ea	$760.00	$760.00	$365.00–$722.00	107% above	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Ext Pf	$712.00	$712.00	$90.00–$676.00	50% below	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 Ed/elective Cardioversion	$1,735.00	$1,735.00	$189.00–$1,648.00	21% above	—
Carpal tunnel release, open surgery CPT 64721 Carpal Tunnel And Guyon Decompression	$1,337.00	$1,337.00	$385.00–$1,270.00	10% below	—
Carpal tunnel release, open surgery CPT 64721 Carpal Tunnel Surgery	$8,500.00	$8,500.00	$853.00–$8,075.00	470% above	—
Cataract surgery with lens implant CPT 66984 Removal of cataract with insertion of lens	$8,000.00	$8,000.00	$3,840.00–$7,600.00	128% above	—
Cervical biopsy CPT 57500 Pf Mc Bx Cervix Or Excision W/ Or W/o	$145.00	$145.00	$62.00–$138.00	60% below	—
Cervical biopsy CPT 57500 Cl Biopsy Cervix Or Excision	$275.00	$275.00	$132.00–$261.00	25% below	—
Cervical biopsy CPT 57500 Bx Cervix Or Excision W/ Or W/o	$700.00	$700.00	$336.00–$665.00	92% above	—
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Cl Circumcision Newborn	$520.00	$520.00	$201.00–$494.00	23% above	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Pf Cl Tx Distal Raid Fx W	$899.00	$899.00	$313.00–$854.00	87% above	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Ed/clsd Distal Raid Fx	$1,195.00	$1,195.00	$574.00–$1,135.00	149% above	—
Colonoscopy with polyp removal CPT 45385 Removal of polyps or growths of large bowel using an endoscope	$5,000.00	$5,000.00	$527.00–$4,750.00	330% above	—
Colonoscopy with tissue sample CPT 45380 Biopsy exam of large bowel using an endoscope	$4,000.00	$4,000.00	$415.00–$3,800.00	180% above	—
Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using an endoscope	$3,500.00	$3,500.00	$381.00–$3,325.00	177% above	—
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Cl Colposcopy W/biopsies	$370.00	$370.00	$178.00–$352.00	22% above	—
Complex cataract surgery with lens implant CPT 66982 Pf Mc Cataract Removal Complex	$1,851.00	$1,851.00	$593.00–$1,758.00	17% below	—
Complex cataract surgery with lens implant CPT 66982 Cataract Complex With Omni System	$7,000.00	$7,000.00	$3,360.00–$6,650.00	213% above	—
Complex cataract surgery with lens implant CPT 66982 Cataract Complex Extracapsular Intraocul	$11,000.00	$11,000.00	$5,280.00–$10,450.00	391% above	—
Complex cataract surgery with lens implant CPT 66982 Cataract Complex With Malyugin Ring	$11,500.00	$11,500.00	$5,520.00–$10,925.00	414% above	—
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cl-prevnar-20 Vaccine 0.5ml Syringe	$574.00	$574.00	$167.00–$545.00	5% above	—
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Prevnar-20 Vaccine 0.5ml Syringe	$667.00	$667.00	$167.00–$634.00	22% above	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Cl Destruction Lesions By An	$162.00	$162.00	$78.00–$154.00	27% above	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 Cl Remove Impacted Ear Wax	$36.00	$36.00	$17.00–$34.00	23% below	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 Irrigation Imp Cerumen	$55.00	$55.00	$26.00–$52.00	18% above	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 Mc Pf Irrigation Imp Cerumen	$62.00	$62.00	$16.00–$59.00	33% above	—
Earwax removal with instruments, one ear CPT 69210 Ear Impacted Cerumen	$110.00	$110.00	$25.00–$105.00	23% above	—
Earwax removal with instruments, one ear CPT 69210 Cl Cerumen Removal	$114.00	$114.00	$55.00–$108.00	28% above	—
Earwax removal with instruments, one ear CPT 69210 Ed/ear Impacted Cerumen	$115.00	$115.00	$55.00–$109.00	29% above	—
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Cl Endometrial Biopsy	$243.00	$243.00	$117.00–$231.00	9% above	—
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Spc Endometrial Biopsy	$415.00	$415.00	$50.00–$394.00	86% above	—
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Pfinj Interlamin Epidsubarac Cervthor Im	$341.00	$341.00	$90.00–$324.00	68% below	—
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Inj Interlamin Epid/subarac Cerv/thor Im	$3,500.00	$3,500.00	$222.00–$3,325.00	230% above	—
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 Pf Bilat Inj Parav Facet Lum/sac Sng Lvl	$432.00	$432.00	$76.00–$410.00	—	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj Paraverte Facet Lum/sac Sng Lvl	$2,800.00	$2,800.00	$186.00–$2,660.00	119% above	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Pm Bilt Inj Paravert Facet Lum/sac 1lvl	$6,300.00	$6,300.00	$186.00–$5,985.00	392% above	—
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Pfmc Rpr Antr Abd Hernia Any Reduc3-10cm	$709.00	$709.00	$463.00–$674.00	45% below	—
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Repair Antr Abd Hernia Any Reduce 3-10cm	$11,000.00	$11,000.00	$5,280.00–$10,450.00	756% above	—
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Pf Mc Rep Abdominal Hernia W/mesh	$476.00	$476.00	$279.00–$452.00	34% below	—
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Repair Antr Abd Hernia Any App Mesh < 3	$6,500.00	$6,500.00	$3,120.00–$6,175.00	798% above	—
Gallbladder removal, laparoscopic CPT 47562 Removal of gallbladder using an endoscope	$11,500.00	$11,500.00	$1,298.00–$10,925.00	529% above	—
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Pf Mc Cholecystectomy W/ Cholangiography	$1,456.00	$1,456.00	$607.00–$1,383.00	9% below	—
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Cholecystectomy With Cholangiography	$12,500.00	$12,500.00	$1,411.00–$11,875.00	682% above	—
Gallbladder removal, open surgery through a larger incision CPT 47600 Pf Mc Open Chole	$1,751.00	$1,751.00	$897.00–$1,663.00	27% below	—
Gallbladder removal, open surgery through a larger incision CPT 47600 Open Cholecystectomy	$19,000.00	$19,000.00	$9,120.00–$18,050.00	690% above	—
Hemorrhoid banding (rubber band ligation) CPT 46221 Pf Mc Op Rband Ligation Internal Hemorr	$614.00	$614.00	$181.00–$583.00	1% above	—
Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoidectomy Internal Rubr Bandlag	$3,000.00	$3,000.00	$386.00–$2,850.00	394% above	—
Hemorrhoid banding (rubber band ligation) CPT 46221 Ligation Of Hemorrhoids	$3,000.00	$3,000.00	$386.00–$2,850.00	394% above	—
Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorrhoidectomy Int/ext	$1,260.00	$1,260.00	$605.00–$1,197.00	1% above	—
Hemorrhoidectomy (internal and external), one area CPT 46255 Pf Hemorrhoidectomy Int/	$3,563.00	$3,563.00	$320.00–$3,385.00	185% above	—
Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorrhoidectomy Internal External Singl	$5,500.00	$5,500.00	$2,640.00–$5,225.00	340% above	—
Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy W/ Endometrial Ablation	$7,500.00	$7,500.00	$502.00–$7,125.00	191% above	—
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Pf Mc Vag Hyst Uter>250g Rpr Enterocele	$334.00	$334.00	$186.00–$317.00	79% below	—
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Vag Hyst Uterus>250g Repair Enterocele	$10,000.00	$10,000.00	$471.00–$9,500.00	538% above	—
IUD insertion (the device itself billed separately) CPT 58300 Cl Iud Insertion	$267.00	$267.00	$109.00–$254.00	22% above	—
IUD insertion (the device itself billed separately) CPT 58300 Insertion Of Iud	$500.00	$500.00	$109.00–$475.00	128% above	—
Incision and drainage of a simple or single skin abscess CPT 10060 Cl I & D Abscess	$303.00	$303.00	$145.00–$288.00	17% above	—
Incision and drainage of a simple or single skin abscess CPT 10060 I&d Abscess Simple	$313.00	$313.00	$93.00–$297.00	21% above	—
Incision and drainage of a simple or single skin abscess CPT 10060 Ed/i&d Abscess Simple	$385.00	$385.00	$185.00–$366.00	49% above	—
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair of groin hernia patient age 5 years or older	$4,500.00	$4,500.00	$1,027.00–$4,275.00	144% above	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Cl Inj Tendon/liga/trg Point	$203.00	$203.00	$80.00–$193.00	8% above	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inject Tendon Sheath/ligament	$1,500.00	$1,500.00	$80.00–$1,425.00	701% above	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Pm Inject Tendon Sheath/ligament	$1,700.00	$1,700.00	$80.00–$1,615.00	808% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 Pf Mc Bilat Major Joint-shou/hip/knee	$237.00	$237.00	$36.00–$225.00	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Cl Arthrocentesis Mj	$153.00	$153.00	$73.00–$145.00	20% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Ed/majr Joint/chou/hip/kn	$160.00	$160.00	$77.00–$152.00	16% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Aspirat/inj Maj Joint/bur	$1,500.00	$1,500.00	$93.00–$1,425.00	685% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Pm Aspirat/inj Maj Joint/bur W/ Us Imag	$1,700.00	$1,700.00	$93.00–$1,615.00	790% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Pm Bilt Asp/inj Maj Joint/bur W/ Us Img	$2,550.00	$2,550.00	$93.00–$2,423.00	1234% above	—
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Spc Etonogestrel Implant Insertion	$300.00	$300.00	$50.00–$285.00	28% above	—
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Cl Etonogestrel Implant Insertion	$300.00	$300.00	$144.00–$285.00	28% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 Mc Pf Bilat Aspiration/inj Intermed Joi	$203.00	$203.00	$30.00–$193.00	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 Pm Bilat Arthrocentesis Interm Joint	$2,250.00	$2,250.00	$76.00–$2,138.00	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Asspiration/inj Intermed Joint	$130.00	$130.00	$62.00–$124.00	27% below	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Cl Arthrocentesis Ij	$131.00	$131.00	$63.00–$124.00	26% below	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis Interm Joint	$1,500.00	$1,500.00	$76.00–$1,425.00	747% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Pm Arthrocentesis Interm Joi	$1,600.00	$1,600.00	$76.00–$1,520.00	803% above	—
Joint injection or drainage, small joint (fingers, toes) both sides CPT 20600 Mc Pf Bilat Arthrocentesis Inj/asp	$55.00	$55.00	$29.00–$52.00	—	—
Joint injection or drainage, small joint (fingers, toes) both sides CPT 20600 Pm Bilat Arthrocentesis Inj/asp	$2,250.00	$2,250.00	$73.00–$2,138.00	—	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Cl Arthrocent Aspira/inj Sm	$127.00	$127.00	$61.00–$121.00	11% below	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Aspiration/inj Small Joint Bur	$130.00	$130.00	$62.00–$124.00	9% below	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Pm Arthrocentesis Inj/asp	$1,500.00	$1,500.00	$73.00–$1,425.00	952% above	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis Inj/asp	$1,500.00	$1,500.00	$73.00–$1,425.00	952% above	—
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Pf Mc Pr Knee Scope,med Or Lat Menis Rpr	$1,546.00	$1,546.00	$583.00–$1,469.00	29% below	—
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Pr Knee Scope,med Or Lat Menis Repair	$16,500.00	$16,500.00	$1,389.00–$15,675.00	659% above	—
Knee arthroscopy with meniscus trim CPT 29881 Removal of one knee cartilage using an endoscope	$12,000.00	$12,000.00	$1,079.00–$11,400.00	365% above	—
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Pf Mc Arthroscopy Knee Medial And Menisc	$1,400.00	$1,400.00	$484.00–$1,330.00	39% below	—
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Arthroscopy Knee Medial And Menisci	$8,000.00	$8,000.00	$1,120.00–$7,600.00	250% above	—
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Pf Mc Appendectomy	$1,077.00	$1,077.00	$514.00–$1,023.00	28% below	—
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Appendectomy	$10,500.00	$10,500.00	$1,186.00–$9,975.00	605% above	—
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 Pf Mc Lap Inguinal Hernia	$866.00	$866.00	$378.00–$823.00	13% below	—
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 Laparoscopic Repair Intl Inguinal Hernia	$7,000.00	$7,000.00	$3,360.00–$6,650.00	603% above	—
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Pf Mc Lap Recurr Inguinal Hernia Repair	$1,111.00	$1,111.00	$490.00–$1,055.00	15% below	—
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Laparoscopic Surg Repair Rec Ing Hernia	$9,000.00	$9,000.00	$4,320.00–$8,550.00	592% above	—
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Pf Mc Lap Salpingectomy Or Oophorectomy	$1,045.00	$1,045.00	$531.00–$993.00	39% below	—
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Lap Salpingectomy Or Oophorectomy	$16,500.00	$16,500.00	$1,306.00–$15,675.00	869% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Ed/up To 2.5 Cm-repair	$550.00	$550.00	$264.00–$523.00	31% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Cl Suture Imtermediate Scalp	$634.00	$634.00	$304.00–$602.00	51% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Mc Up To 2.5 Cm-repair	$654.00	$654.00	$124.00–$621.00	56% above	—
Lower-back epidural injection, with imaging guidance CPT 62323 Injection(s) of therapeutic substance	$3,200.00	$3,200.00	$204.00–$3,040.00	180% above	—
Lower-back epidural injection, without imaging guidance CPT 62322 Injection(s) of therapeutic substance	$2,800.00	$2,800.00	$1,344.00–$2,660.00	345% above	—
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection(s) of anesthetic into lower spine using imaging guidance	$5,100.00	$5,100.00	$230.00–$4,845.00	247% above	—
Miscarriage treatment with D&C, first trimester CPT 59820 Cl Treatment Of Missed Abort	$865.00	$865.00	$415.00–$822.00	7% below	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Mc Pf Exc, Benign Lesion, Mrgn <0.5cm	$257.00	$257.00	$71.00–$244.00	14% below	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Cl Exc Benign Trunk To 0.5cm	$308.00	$308.00	$148.00–$293.00	3% above	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc, Benign Lesion, Mrgn 0.5cm Or Less	$1,000.00	$1,000.00	$164.00–$950.00	233% above	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Cl Exc Ben Face-ears To 0.5	$346.00	$346.00	$166.00–$329.00	2% above	—
Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate Sing	$170.00	$170.00	$82.00–$162.00	24% below	—
Nail removal (partial or complete), one nail CPT 11730 Ed/avulsion Simple	$195.00	$195.00	$94.00–$185.00	13% below	—
Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate	$275.00	$275.00	$114.00–$261.00	22% above	—
Nail removal (partial or complete), one nail CPT 11730 Cl Avulsion, Nail	$278.00	$278.00	$114.00–$264.00	24% above	—
Nail removal (partial or complete), one nail CPT 11730 Avulsion Simple	$287.00	$287.00	$46.00–$273.00	28% above	—
Occipital nerve block (injection for headaches) both sides CPT 64405 Inj Bilat Greater Occipital Ner	$993.00	$993.00	$41.00–$943.00	—	—
Occipital nerve block (injection for headaches) both sides CPT 64405 Pm Bilat Inj Greater Occipital Ner	$2,850.00	$2,850.00	$1,368.00–$2,708.00	—	—
Occipital nerve block (injection for headaches) CPT 64405 Inj Greater Occipital Ner	$175.00	$175.00	$84.00–$166.00	58% below	—
Occipital nerve block (injection for headaches) CPT 64405 Pm Inj Greater Occipital Ner	$1,900.00	$1,900.00	$912.00–$1,805.00	359% above	—
Paracentesis with imaging guidance CPT 49083 Pf Abd Paracentesis/wguid	$1,027.00	$1,027.00	$87.00–$976.00	23% above	—
Paracentesis with imaging guidance CPT 49083 Us Abd Paracentesis W Guide	$1,520.00	$1,520.00	$224.00–$1,444.00	81% above	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Cl Excision Of Nail Bed	$386.00	$386.00	$185.00–$367.00	16% above	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Ed Excision Nail Matrix	$460.00	$460.00	$210.00–$437.00	38% above	—
Radiofrequency ablation of facet joint nerves, lower back, one level both sides CPT 64635 Pf Bilat Dest Neuro,lum/sacr Sng Fct Jnt	$923.00	$923.00	$163.00–$877.00	—	—
Radiofrequency ablation of facet joint nerves, lower back, one level both sides CPT 64635 Pm Bilat Dest Neuro,lum/sacr Sng Fct Jnt	$8,250.00	$8,250.00	$457.00–$7,838.00	—	—
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Dest Neuro, Lum/sacr Sng Facet Jnt	$5,500.00	$5,500.00	$457.00–$5,225.00	168% above	—
Removal of a breast lump, open surgery CPT 19120 Removal of one or more breast growth, open procedure	$1,401.00	$1,401.00	$672.00–$1,331.00	17% above	—
Removal of a foreign object under the skin, simple CPT 10120 Cl I & D Removal Foreign Body	$362.00	$362.00	$174.00–$344.00	9% above	—
Removal of a foreign object under the skin, simple CPT 10120 Ed/subcutaneous-simple	$380.00	$380.00	$182.00–$361.00	15% above	—
Removal of a foreign object under the skin, simple CPT 10120 Subcutaneous-simple	$514.00	$514.00	$95.00–$488.00	55% above	—
Removal of a foreign object under the skin, simple CPT 10120 In & Rem Subq Simple	$1,500.00	$1,500.00	$210.00–$1,425.00	353% above	—
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Screening Colonoscopy	$1,249.00	$1,249.00	$153.00–$1,187.00	58% above	—
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colonoscopy Screening	$3,500.00	$3,500.00	$260.00–$3,325.00	344% above	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colonoscopy Screen High Risk	$1,249.00	$1,249.00	$153.00–$1,187.00	51% above	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colonoscopy Screening High Risk	$3,500.00	$3,500.00	$260.00–$3,325.00	324% above	—
Short arm cast (elbow to hand) CPT 29075 Cast: Elbowfinger	$220.00	$220.00	$106.00–$209.00	11% above	—
Short arm cast (elbow to hand) CPT 29075 Cl Apply Short Arm Cast	$306.00	$306.00	$147.00–$291.00	55% above	—
Short arm cast (elbow to hand) CPT 29075 Pf Elbow/finger Shrtarm C	$316.00	$316.00	$54.00–$300.00	60% above	—
Short arm splint (forearm and hand) CPT 29125 Ed/splint Short Arm	$145.00	$145.00	$70.00–$138.00	6% below	—
Short arm splint (forearm and hand) CPT 29125 Cl Apply Short Arm Splint	$233.00	$233.00	$112.00–$221.00	52% above	—
Short arm splint (forearm and hand) CPT 29125 Splint Short Arm	$240.00	$240.00	$38.00–$228.00	56% above	—
Short leg cast (below the knee) CPT 29405 Application Short Leg Cast	$185.00	$185.00	$89.00–$176.00	at median	—
Short leg cast (below the knee) CPT 29405 Ed Apply Short Leg Cast	$210.00	$210.00	$101.00–$200.00	13% above	—
Short leg cast (below the knee) CPT 29405 Cl Apply Short Leg Cast	$280.00	$280.00	$134.00–$266.00	51% above	—
Short leg cast (below the knee) CPT 29405 Pf Application Short Leg Cast	$289.00	$289.00	$51.00–$275.00	56% above	—
Short leg splint (calf to foot) CPT 29515 Ed/splint Short Leg	$175.00	$175.00	$84.00–$166.00	8% above	—
Short leg splint (calf to foot) CPT 29515 Splint Short Leg	$260.00	$260.00	$46.00–$247.00	61% above	—
Short leg splint (calf to foot) CPT 29515 Cl Apply Short Leg Splint	$310.00	$310.00	$149.00–$295.00	92% above	—
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Pf Mc Arthroscopy Shoulder W/ Clavicle	$1,612.00	$1,612.00	$580.00–$1,531.00	8% below	—
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Arthroscopy Shoulder W/ Clavicle	$15,500.00	$15,500.00	$7,440.00–$14,725.00	788% above	—
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shaving of shoulder bone using endoscope	$5,500.00	$5,500.00	$350.00–$5,225.00	360% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Ed/up To 2.5 Cm-w & L	$155.00	$155.00	$74.00–$147.00	25% below	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Cl Suture Trunk Etc To 2.5 C	$223.00	$223.00	$90.00–$212.00	7% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Up To 2.5 Cm-w&l	$230.00	$230.00	$40.00–$219.00	11% above	—
Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy Skin Single Lesion	$150.00	$150.00	$72.00–$143.00	41% below	—
Skin biopsy, punch, one lesion CPT 11104 Cl Biopsy Skin-subq	$303.00	$303.00	$101.00–$288.00	19% above	—
Skin biopsy, punch, one lesion CPT 11104 Pf Punch Bx Skin Single Lesion	$313.00	$313.00	$36.00–$297.00	23% above	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Cl Exc Malig Lesion <0.5cm	$474.00	$474.00	$228.00–$450.00	17% above	—
Skin tag removal, up to 15 tags CPT 11200 Cl Skin Tags/excise/up To 15	$220.00	$220.00	$106.00–$209.00	16% above	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar Puncture-dx	$190.00	$190.00	$91.00–$181.00	50% below	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 Ed/lumbar Puncture	$215.00	$215.00	$103.00–$204.00	44% below	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 Mc Lumbar Puncture	$415.00	$415.00	$52.00–$394.00	8% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Ed/w/l 2.6cm To 7.5cm	$200.00	$200.00	$96.00–$190.00	17% below	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Cl Suture Trunk Etc 2.6-7.5	$269.00	$269.00	$118.00–$256.00	12% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 W/l 2.6cm To 7.5cm	$278.00	$278.00	$52.00–$264.00	16% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Ed/repair-up To 2.5 Cm	$190.00	$190.00	$91.00–$181.00	16% below	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Cl Suture Face-ear To 2.5 Cm	$267.00	$267.00	$111.00–$254.00	18% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Pf Smple Rep Face =<2.5cm	$354.00	$354.00	$49.00–$336.00	56% above	—
Thoracentesis with imaging guidance CPT 32555 Mc Pf Aspirate Pleura Drainage W/ Imag	$383.00	$383.00	$88.00–$364.00	53% below	—
Thoracentesis with imaging guidance CPT 32555 Us Thoracentesis	$1,620.00	$1,620.00	$233.00–$1,539.00	100% above	—
Total hip replacement CPT 27130 Pf Mc Arthroplasty Total Hip	$2,456.00	$2,456.00	$1,048.00–$2,333.00	45% below	—
Total hip replacement CPT 27130 Arthroplasty Total Hip	$33,500.00	$33,500.00	$2,702.00–$31,825.00	656% above	—
Total knee replacement CPT 27447 Pf Mc Arthroplasty Total Knee	$2,450.00	$2,450.00	$1,046.00–$2,328.00	28% below	—
Total knee replacement CPT 27447 Arthroplasty Total Knee	$33,500.00	$33,500.00	$2,701.00–$31,825.00	887% above	—
Total shoulder replacement CPT 23472 Pf Mc Arthro Total Shoulder Glenohumeral	$2,771.00	$2,771.00	$1,176.00–$2,632.00	37% below	—
Total shoulder replacement CPT 23472 Arthroplasty Total Shoulder Glenohumeral	$38,000.00	$38,000.00	$2,902.00–$36,100.00	769% above	—
Trigger finger release surgery CPT 26055 Trigger Finger Decompression	$2,174.00	$2,174.00	$263.00–$2,065.00	64% above	—
Trigger finger release surgery CPT 26055 Incise Finger Tendon Sheath	$11,000.00	$11,000.00	$620.00–$10,450.00	731% above	—
Trigger point injections, 1 or 2 muscles CPT 20552 Cl Inj; Trigger Pts 1 Or 2 Musc	$127.00	$127.00	$61.00–$121.00	1% below	—
Trigger point injections, 1 or 2 muscles CPT 20552 Pf Inj Trigger Point 1/2 Muscl	$131.00	$131.00	$33.00–$124.00	2% above	—
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Point 1/2 Muscl	$135.00	$135.00	$65.00–$128.00	5% above	—
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trig Pnt 1-2 Muscl	$1,500.00	$1,500.00	$78.00–$1,425.00	1072% above	—
Trigger point injections, 1 or 2 muscles CPT 20552 Pm Inj Trig Pnt 1-2 Muscl	$1,500.00	$1,500.00	$78.00–$1,425.00	1072% above	—
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 Pf Mc Lap Tubal Ligation Transection	$709.00	$709.00	$304.00–$674.00	32% below	—
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 Laparoscopic Tubal Ligation Transection	$10,000.00	$10,000.00	$735.00–$9,500.00	853% above	—
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Pf Mc Egd With Balloon Dilation	$256.00	$256.00	$127.00–$243.00	85% below	—
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Egd With Balloon Dilation	$3,000.00	$3,000.00	$317.00–$2,850.00	72% above	—
Upper endoscopy (EGD) with biopsy CPT 43239 Biopsy exam of esophagus, stomach or small bowel using an endoscope	$3,000.00	$3,000.00	$286.00–$2,850.00	95% above	—
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Pf Mc Egd W/ Snare Technique	$318.00	$318.00	$161.00–$302.00	74% below	—
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Egd W/ Snare Technique	$4,000.00	$4,000.00	$406.00–$3,800.00	231% above	—
Upper endoscopy (EGD), diagnostic CPT 43235 Diagnostic exam of esophagus, stomach or small bowel using an endoscope	$3,500.00	$3,500.00	$253.00–$3,325.00	363% above	—
Vaginal delivery, including prenatal and postpartum care CPT 59400 Obstetric care, planned vaginal delivery	$3,492.00	$3,492.00	$1,676.00–$3,317.00	25% below	—
Wart removal, up to 14 warts CPT 17110 Cl Destruction Flat Warts 1-	$274.00	$274.00	$132.00–$260.00	51% above	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Pf Op Debridement Subq Tissue =/< 20 Cm	$193.00	$193.00	$52.00–$183.00	35% below	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Wc Debridement Of Subq 1st 20cm	$450.00	$450.00	$125.00–$428.00	52% above	—
Wrist fracture surgery (plate and screws), distal radius CPT 25607 Pf Mc Treat Fx Rad Extra-articul	$1,829.00	$1,829.00	$633.00–$1,738.00	1% below	—
Wrist fracture surgery (plate and screws), distal radius CPT 25607 Treat Fx Rad Extra-articul	$16,500.00	$16,500.00	$7,920.00–$15,675.00	792% above	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion Per Day	$140.00	$140.00	$67.00–$133.00	80% below	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration 1-4 Hours	$345.00	$345.00	$166.00–$328.00	51% below	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration 4-8 Hours	$695.00	$695.00	$334.00–$660.00	2% below	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration 8-16 Hours	$1,385.00	$1,385.00	$665.00–$1,316.00	96% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration 16-23 Hours	$2,070.00	$2,070.00	$994.00–$1,967.00	193% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Subsequent	$300.00	$300.00	$144.00–$285.00	173% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Sub 2nd Med Freq	$300.00	$300.00	$144.00–$285.00	173% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Mdi Subsequent	$300.00	$300.00	$144.00–$285.00	173% above	—
Chemotherapy IV infusion, first hour CPT 96413 Chemo Adm Iv Infus 1st Hr	$530.00	$530.00	$231.00–$504.00	5% below	—
Critical care, first 30 to 74 minutes CPT 99291 Critical Care 1st Hour	$531.00	$531.00	$187.00–$504.00	17% below	—
Critical care, first 30 to 74 minutes CPT 99291 Categ Vi (Critical)30-74m	$2,650.00	$2,650.00	$372.00–$2,518.00	312% above	—
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram, routine, with interpretation and report	$497.00	$497.00	$28.00–$472.00	457% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Cl Ekg Tracing	$20.00	$20.00	$10.00–$168.00	91% below	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg Nursing Tracing	$346.00	$346.00	$14.00–$325.00	48% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg	$346.00	$346.00	$14.00–$325.00	48% above	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Exam-minimal/brief	$43.00	$43.00	$10.00–$41.00	72% below	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Category I (Brief) 2	$375.00	$375.00	$180.00–$356.00	146% above	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Category I (Brief)	$375.00	$375.00	$180.00–$356.00	146% above	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Exam-limited	$92.00	$92.00	$38.00–$87.00	50% below	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Legal Blood Alcohol Visit	$122.00	$122.00	$59.00–$116.00	34% below	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Exam-limited 2	$221.00	$221.00	$177.00–$210.00	20% above	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Category Ii (Limited) 2	$600.00	$600.00	$69.00–$570.00	227% above	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Category Ii (Limited)	$600.00	$600.00	$69.00–$570.00	227% above	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Exam-routine	$157.00	$157.00	$65.00–$149.00	37% below	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Exam-routine 2	$331.00	$331.00	$265.00–$314.00	32% above	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Category Iii (Intermed)	$950.00	$950.00	$104.00–$903.00	280% above	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Category Iii (Intermed) 2	$950.00	$950.00	$104.00–$903.00	280% above	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Exam-intermediate	$265.00	$265.00	$110.00–$252.00	43% below	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Exam-intermediate 2	$552.00	$552.00	$442.00–$524.00	20% above	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Category Iv (Extended) 2	$1,350.00	$1,350.00	$197.00–$1,283.00	193% above	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Category Iv (Extended)	$1,350.00	$1,350.00	$197.00–$1,283.00	193% above	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Exam-comprehensive	$384.00	$384.00	$160.00–$365.00	41% below	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Exam-comprehensive 2	$854.00	$854.00	$683.00–$811.00	30% above	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Category V (Complex)	$1,800.00	$1,800.00	$289.00–$1,710.00	175% above	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Category V (Complex) 2	$1,800.00	$1,800.00	$289.00–$1,710.00	175% above	—
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 Holter Rec/analysis/inter	$432.00	$432.00	$148.00–$410.00	62% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Hydration Int 3160 Minu	$390.00	$390.00	$63.00–$371.00	2% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Hydration 31m To 1 Hr	$390.00	$390.00	$63.00–$371.00	2% above	—
IV infusion of a medicine, first hour CPT 96365 Ther/proph/diag Iv Inf Init =<	$420.00	$420.00	$118.00–$395.00	9% above	—
IV infusion of a medicine, first hour CPT 96365 Iv Inf-ther Dx 1st Hr	$420.00	$420.00	$118.00–$395.00	9% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Cl Therapeutic Inj Subc/im	$30.00	$30.00	$14.00–$29.00	67% below	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection (Im Or Sub Q)	$175.00	$175.00	$28.00–$166.00	94% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Antibiotic Injection Im	$185.00	$185.00	$28.00–$176.00	106% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injections Sc/im	$185.00	$185.00	$28.00–$176.00	106% above	—
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Re-ed 15 Min	$105.00	$105.00	$50.00–$100.00	13% above	—
Neuromuscular re-education, 15 minutes CPT 97112 Pt Neuromuscular Re-ed 15 Min	$125.00	$125.00	$51.00–$119.00	35% above	—
Neuromuscular re-education, 15 minutes CPT 97112 Ot Tele Neuromuscular Reeducation 15 Min	$125.00	$125.00	$51.00–$119.00	35% above	—
Neuromuscular re-education, 15 minutes CPT 97112 Ot Neuromuscular Re-education 15 Min	$125.00	$125.00	$51.00–$119.00	35% above	—
Neuromuscular re-education, 15 minutes CPT 97112 Pt Tele Neuromuscular Re-ed 15 Min	$125.00	$125.00	$51.00–$119.00	35% above	—
New patient office visit, about 30 minutes CPT 99203 New patient office or other outpatient visit, 30 min	$217.00	$217.00	$104.00–$204.00	5% above	—
New patient office visit, about 45 minutes CPT 99204 New patient office or other outpatient visit, 45 min	$319.00	$319.00	$149.00–$300.00	5% above	—
New patient office visit, about 60 minutes CPT 99205 New patient office or other outpatient visit, 60 min	$502.00	$502.00	$202.00–$472.00	36% above	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Specialty Clinic	$55.00	$55.00	$26.00–$84.00	55% below	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Ops Treatment Room Level1	$135.00	$135.00	$65.00–$127.00	11% above	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Cl Physician E/m, Ephyfee/ephyfee/sf	$145.00	$145.00	$70.00–$136.00	19% above	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Pf Spc Phys E/m Level 2 New Patient	$250.00	$250.00	$39.00–$238.00	105% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Mnt Initial 15-mins	$155.00	$155.00	$74.00–$147.00	220% above	—
Occupational therapy evaluation, low complexity CPT 97165 Ot Tele Health Eval Low Complexity	$205.00	$205.00	$98.00–$195.00	24% above	—
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Low Complexity	$205.00	$205.00	$98.00–$195.00	24% above	—
Occupational therapy evaluation, low complexity CPT 97165 Wc Ot Eval Low Complexity	$220.00	$220.00	$106.00–$209.00	33% above	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval Of High Complex 45 Min	$310.00	$310.00	$149.00–$295.00	46% above	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval High Complexity	$330.00	$330.00	$158.00–$314.00	55% above	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Tele Eval High Complexity	$330.00	$330.00	$158.00–$314.00	55% above	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Of Low Complex 20 Mins	$175.00	$175.00	$84.00–$166.00	10% above	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Low Complexity	$195.00	$195.00	$94.00–$185.00	22% above	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Tele Eval Low Complexity	$195.00	$195.00	$94.00–$185.00	22% above	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Of Mod Complex 30 Mins	$215.00	$215.00	$103.00–$204.00	20% above	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Tele Eval Moderate Complexity	$235.00	$235.00	$113.00–$223.00	31% above	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Moderate Complexity	$235.00	$235.00	$113.00–$223.00	31% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy 15min	$120.00	$120.00	$41.00–$113.00	24% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Ot Manual Therapy 15 Min	$140.00	$140.00	$41.00–$132.00	45% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Pt Manual Therapy 15 Min	$140.00	$140.00	$41.00–$132.00	45% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Pt Tele Manual Therapy 15 Min	$140.00	$140.00	$41.00–$132.00	45% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Ot Tele Manual Therapy 15 Min	$140.00	$140.00	$41.00–$132.00	45% above	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Physical therapy, therapeutic exercise	$135.00	$135.00	$45.00–$127.00	42% above	—
Preventive checkup, new patient aged 18–39 CPT 99385 Initial new patient preventative medicine evaluation (18-39 years)	$253.00	$253.00	$121.00–$240.00	2% above	—
Preventive checkup, new patient aged 40–64 CPT 99386 Initial new patient preventative medicine evaluation (40-64 years)	$291.00	$291.00	$140.00–$276.00	3% above	—
Preventive checkup, new patient aged 65 or older CPT 99387 Cl E/m Healthy (65+)-new	$314.00	$314.00	$151.00–$298.00	9% above	—
Preventive checkup, returning patient aged 18–39 CPT 99395 Cl E/m Healthy (18-39) Est P	$228.00	$228.00	$109.00–$217.00	4% above	—
Preventive checkup, returning patient aged 18–39 CPT 99395 Spc E/m Healthy (18-39) Est Patient	$235.00	$235.00	$188.00–$223.00	7% above	—
Preventive checkup, returning patient aged 40–64 CPT 99396 Cl E/m Healthy (40-64) Est P	$243.00	$243.00	$117.00–$231.00	4% above	—
Preventive checkup, returning patient aged 40–64 CPT 99396 Spc E/m Healthy (40-64) Est Patient	$279.00	$279.00	$223.00–$265.00	19% above	—
Preventive checkup, returning patient aged 65 or older CPT 99397 Cl E/m Healthy (65+) Est Pt	$261.00	$261.00	$125.00–$248.00	8% above	—
Preventive checkup, returning patient aged 65 or older CPT 99397 Spc E/m Healthy (65+) Est Patient	$365.00	$365.00	$292.00–$347.00	50% above	—
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking Cessation Counsel I	$50.00	$50.00	$24.00–$48.00	71% above	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Cl Physician E/m, C/c/hc	$346.00	$346.00	$166.00–$325.00	44% above	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Cltelehealth Level 5	$346.00	$346.00	$166.00–$325.00	44% above	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Spc Phys E/m Level 5 Est Pt Mcd/wellmark	$405.00	$405.00	$119.00–$385.00	69% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Treatment Room Level 3	$155.00	$155.00	$74.00–$146.00	29% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Cl Telehealth Level 3 Visit	$179.00	$179.00	$86.00–$168.00	49% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Cl Physician E/m, Ephyfee/ephyfee/lc	$179.00	$179.00	$86.00–$168.00	49% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Pf Spc Phys E/m Level 3 Est Patient	$250.00	$250.00	$55.00–$238.00	108% above	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Cl Physician E/m, D/d/mc	$249.00	$249.00	$120.00–$234.00	39% above	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Cl Tele Health Level 4 Visit	$249.00	$249.00	$120.00–$234.00	39% above	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Pf Spc Phys E/m Level 4 Est Patient	$300.00	$300.00	$80.00–$285.00	68% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Level 2 Problem Focus	$110.00	$110.00	$43.00–$103.00	30% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Treatment Room Level 2	$110.00	$110.00	$43.00–$103.00	30% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Cl Physician E/m, Phyfee/phyfee/sf	$115.00	$115.00	$43.00–$108.00	36% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Cl Telehealth Level 2 Visit	$115.00	$115.00	$43.00–$108.00	36% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Pf Spc Phys E/m Level 2 Est Patient	$200.00	$200.00	$29.00–$190.00	137% above	—
Speech and language evaluation CPT 92523 St Eval Speech And Language	$485.00	$485.00	$233.00–$461.00	56% above	—
Speech therapy session, individual CPT 92507 St Speech Therapy Treatment	$360.00	$360.00	$136.00–$342.00	47% above	—
Spirometry (breathing test) CPT 94010 Spirometry	$350.00	$350.00	$59.00–$333.00	28% above	—
Spirometry before and after a bronchodilator CPT 94060 Pre And Post Spirometry	$750.00	$750.00	$99.00–$713.00	33% above	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Thera Activity 1on1 15min	$115.00	$115.00	$55.00–$109.00	31% above	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Pt Therapeutic Activity 15 Min	$135.00	$135.00	$58.00–$128.00	54% above	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Ot Tele Therapeutic Activities 15 Min	$135.00	$135.00	$58.00–$128.00	54% above	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Ot Therapeutic Activities 15 Min	$135.00	$135.00	$58.00–$128.00	54% above	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Pt Tele Therapeutic Activity 15 Min	$135.00	$135.00	$58.00–$128.00	54% above	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Cl Phlebotomy	$83.00	$83.00	$40.00–$165.00	57% below	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy	$168.00	$168.00	$81.00–$165.00	12% below	—
Treadmill or drug stress test with ECG, supervision and report CPT 93015 Cardiovascular Stress Test	$1,100.00	$1,100.00	$120.00–$1,045.00	289% above	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 Cl Mc Influenza Vaccine (Fluad) 0.5ml	$100.00	$100.00	$48.00–$95.00	31% above	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Cl Vfc Influenza >3	$20.00	$20.00	$10.00–$19.00	23% below	—
Hepatitis A vaccine, adult dose CPT 90632 Cl Vfc Hep A Adult	$20.00	$20.00	$10.00–$76.00	77% below	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Cl Vfc Hep B Adult (Age 19)	$20.00	$20.00	$10.00–$84.00	77% below	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Cl Hep B Age 19	$128.00	$128.00	$61.00–$122.00	50% above	—
MMR vaccine (measles, mumps and rubella), live CPT 90707 Cl Vfc Mmr	$20.00	$20.00	$10.00–$66.00	82% below	—
Rabies vaccine, one dose CPT 90675 Rabavert (Rabies) Vaccine	$710.00	$710.00	$341.00–$675.00	40% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Cl Td=>7 Yrs Intramuscular Use	$62.00	$62.00	$30.00–$59.00	19% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Cl Vfc Tdap	$70.00	$70.00	$34.00–$67.00	at median	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Cl Sd Vfc Administration	$20.00	$20.00	$10.00–$28.00	42% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immun Admin 1 Vaccine	$20.00	$20.00	$10.00–$28.00	42% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Cl Immunization Admin Single	$20.00	$20.00	$10.00–$28.00	42% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Cl Influenza Administration	$20.00	$20.00	$10.00–$28.00	42% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Hep B Administration	$39.00	$39.00	$19.00–$37.00	14% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin 1 Vaccine	$40.00	$40.00	$19.00–$38.00	17% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pneumonia Administration	$47.00	$47.00	$23.00–$45.00	37% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Administrati	$95.00	$95.00	$28.00–$90.00	178% above	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Cogentin 1mg Tablet	$4.00	$4.00	$2.00–$21.00	88% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Ciprofloxacin 500 Mg Tablet	$4.00	$4.00	$2.00–$21.00	88% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Nifedipine 10mg Oral Capsule	$5.00	$5.00	$2.00–$21.00	85% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Decadron 4mg Tablet	$5.00	$5.00	$2.00–$21.00	85% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Nystatin 500,000 Units/5 Ml Ud Susp	$6.00	$6.00	$3.00–$21.00	82% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Cl Sd Vfc Admin Ea Addl	$20.00	$20.00	$10.00–$21.00	40% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin Each Additional	$20.00	$20.00	$10.00–$21.00	40% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Cl Immunization Admin Two Or	$27.00	$27.00	$13.00–$26.00	19% below	—

Source file: https://secure.claraprice.net/price-transparency/FSVG-1715881425274/machine-readable/470533032_gordon-memorial-hospital_standardcharges.json