Hospital

St Francis Memorial Hospital

Listed in its price file as “Franciscan Care Services”.

St Francis Memorial Hospital in West Point, NE publishes cash prices for 246 common procedures listed here, from its own machine-readable price file updated Mar 18, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Nebraska median for 233 of 246 procedures and below it for 12. By typical cash price it ranks #33 of 34 Nebraska hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

430 N Monitor, West Point, NE 68788 Collected Sep 27, 2026 Source price file (402) 372-2404

Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 2 of 5 CCN 281322 · CMS hospital register

The price file shows no self-pay discount

For 962 of the 962 prices listed here, the cash price in St Francis 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 Comp Min 3 Views Lt	$548.00	$548.00	$208.24–$526.08	92% above	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Comp Min 3 Views Rt	$548.00	$548.00	$208.24–$526.08	92% above	—
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Comp Min 3 Views Rt	$548.00	$548.00	$274.00–$526.08	—	—
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Comp Min 3 Views Lt	$548.00	$548.00	$274.00–$526.08	—	—
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US Ankle Brachial Index	$978.00	$978.00	$371.64–$938.88	164% above	—
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US Ankle Brachial Index	$978.00	$978.00	$489.00–$938.88	—	—
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus (Fluoro)	$940.00	$940.00	$357.20–$902.40	86% above	—
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus	$940.00	$940.00	$357.20–$902.40	86% above	—
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus	$940.00	$940.00	$470.00–$902.40	—	—
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus (Fluoro)	$940.00	$940.00	$470.00–$902.40	—	—
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Whole Body	$3,415.00	$3,415.00	$1,297.70–$3,278.40	106% above	—
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Whole Body	$3,415.00	$3,415.00	$1,707.50–$3,278.40	—	—
Breast ultrasound, complete, one breast CPT 76641 US Breast Comp Uni	$839.00	$839.00	$318.82–$805.44	86% above	—
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Comp Lt.	$839.00	$839.00	$318.82–$805.44	86% above	—
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Comp Rt.	$839.00	$839.00	$318.82–$805.44	86% above	—
Breast ultrasound, complete, one breast inpatient CPT 76641 US Breast Comp Uni	$839.00	$839.00	$419.50–$805.44	—	—
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Comp Lt.	$839.00	$839.00	$419.50–$805.44	—	—
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Comp Rt.	$839.00	$839.00	$419.50–$805.44	—	—
Breast ultrasound, limited (one breast or one area) CPT 76642 US Breast Ltd Bil.	$689.00	$689.00	$261.82–$661.44	103% above	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Ltd Lt.	$591.00	$591.00	$224.58–$567.36	74% above	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Ltd Rt.	$591.00	$591.00	$224.58–$567.36	74% above	—
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US Breast Ltd Bil.	$689.00	$689.00	$344.50–$661.44	—	—
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Ltd Rt.	$591.00	$591.00	$295.50–$567.36	—	—
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Ltd Lt.	$591.00	$591.00	$295.50–$567.36	—	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest	$4,673.00	$4,673.00	$1,775.74–$4,486.08	53% above	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest	$4,673.00	$4,673.00	$2,336.50–$4,486.08	—	—
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Cardiac Calcium Score	$165.00	$165.00	$62.70–$158.40	32% above	—
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Cardiac Calcium Score	$165.00	$165.00	$82.50–$158.40	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen +Pelvis w/o Cont	$6,612.00	$6,612.00	$2,217.82–$6,347.52	132% above	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen +Pelvis w/o Cont	$6,612.00	$6,612.00	$3,306.00–$6,347.52	—	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen +Pelvis w/ Cont	$7,290.00	$7,290.00	$2,721.05–$6,998.40	87% above	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen +Pelvis w/ Cont	$7,290.00	$7,290.00	$3,645.00–$6,998.40	—	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen +Pelvis w/ + w/o Cont	$8,208.00	$8,208.00	$3,044.64–$7,879.68	87% above	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen +Pelvis w/ + w/o Cont	$8,208.00	$8,208.00	$4,104.00–$7,879.68	—	—
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Cont	$4,532.00	$4,532.00	$1,722.16–$4,350.72	93% above	—
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Cont	$4,532.00	$4,532.00	$2,266.00–$4,350.72	—	—
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Cont	$4,067.00	$4,067.00	$1,545.46–$3,904.32	108% above	—
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Cont	$4,067.00	$4,067.00	$2,033.50–$3,904.32	—	—
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus Facial w/o Contrast	$3,131.00	$3,131.00	$1,189.78–$3,005.76	94% above	—
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Cont	$3,131.00	$3,131.00	$1,189.78–$3,005.76	94% above	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus Facial w/o Contrast	$3,131.00	$3,131.00	$1,565.50–$3,005.76	—	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Cont	$3,131.00	$3,131.00	$1,565.50–$3,005.76	—	—
CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Cont	$3,465.00	$3,465.00	$1,316.70–$3,326.40	104% above	—
CT scan of the head or brain, no contrast dye CPT 70450 CT Stroke Study	$3,465.00	$3,465.00	$1,316.70–$3,326.40	104% above	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Stroke Study	$3,465.00	$3,465.00	$1,732.50–$3,326.40	—	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Cont	$3,465.00	$3,465.00	$1,732.50–$3,326.40	—	—
CT scan of the head with contrast CPT 70460 CT Head or Brain w/ Cont	$3,731.00	$3,731.00	$1,417.78–$3,581.76	89% above	—
CT scan of the head with contrast inpatient CPT 70460 CT Head or Brain w/ Cont	$3,731.00	$3,731.00	$1,865.50–$3,581.76	—	—
CT scan of the head without and with contrast CPT 70470 CT Head or Brain w/ + w/o Cont	$4,548.00	$4,548.00	$1,728.24–$4,366.08	94% above	—
CT scan of the head without and with contrast inpatient CPT 70470 CT Head or Brain w/ + w/o Cont	$4,548.00	$4,548.00	$2,274.00–$4,366.08	—	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Cont	$3,792.00	$3,792.00	$1,440.96–$3,640.32	86% above	—
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Cont	$3,792.00	$3,792.00	$1,896.00–$3,640.32	—	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Cont	$3,600.00	$3,600.00	$1,368.00–$3,456.00	73% above	—
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Cont	$3,600.00	$3,600.00	$1,800.00–$3,456.00	—	—
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Cont	$4,316.00	$4,316.00	$1,640.08–$4,143.36	85% above	—
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Cont	$4,316.00	$4,316.00	$2,158.00–$4,143.36	—	—
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US Carotid Doppler Bil	$2,481.00	$2,481.00	$942.78–$2,381.76	61% above	—
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US Carotid Doppler Bil	$2,481.00	$2,481.00	$1,240.50–$2,381.76	—	—
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$533.00	$533.00	$130.15–$511.68	98% above	—
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$533.00	$533.00	$266.50–$511.68	—	—
Chest X-ray, single view CPT 71045 XR Chest 1 View	$390.00	$390.00	$148.20–$374.40	103% above	—
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View	$390.00	$390.00	$195.00–$374.40	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Comp	$1,121.00	$1,121.00	$425.98–$1,076.16	45% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Comp	$1,121.00	$1,121.00	$560.50–$1,076.16	—	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD DEXA Axial Skeleton	$865.00	$865.00	$328.70–$830.40	125% above	—
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD DEXA Axial Skeleton	$865.00	$865.00	$432.50–$830.40	—	—
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD DEXA Appendicular Skeleton	$339.00	$339.00	$128.82–$325.44	90% above	—
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD DEXA Appendicular Skeleton	$339.00	$339.00	$169.50–$325.44	—	—
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US Pregnant Detailed 1st Gest	$1,224.00	$1,224.00	$465.12–$1,175.04	149% above	—
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US Pregnant Detailed 1st Gest	$1,224.00	$1,224.00	$612.00–$1,175.04	—	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Cont	$4,028.00	$4,028.00	$1,530.64–$3,866.88	96% above	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Cont	$4,028.00	$4,028.00	$2,014.00–$3,866.88	—	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Cont	$4,168.00	$4,168.00	$1,476.09–$4,001.28	76% above	—
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Cont	$4,168.00	$4,168.00	$2,084.00–$4,001.28	—	—
Diagnostic mammogram, both breasts CPT 77066 MA Diag Digital Bil	$715.00	$715.00	$271.70–$686.40	60% above	—
Diagnostic mammogram, both breasts CPT 77066 MA Diag Digital Bil.	$715.00	$715.00	$271.70–$686.40	60% above	—
Diagnostic mammogram, both breasts inpatient CPT 77066 MA Diag Digital Bil	$715.00	$715.00	$357.50–$686.40	—	—
Diagnostic mammogram, both breasts inpatient CPT 77066 MA Diag Digital Bil.	$715.00	$715.00	$357.50–$686.40	—	—
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Digital Lt	$535.00	$535.00	$203.30–$513.60	161% above	—
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Digital Rt	$535.00	$535.00	$203.30–$513.60	161% above	—
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Digital Lt.	$535.00	$535.00	$203.30–$513.60	161% above	—
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Digital Rt.	$535.00	$535.00	$203.30–$513.60	161% above	—
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Digital Rt.	$535.00	$535.00	$267.50–$513.60	—	—
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Digital Lt.	$535.00	$535.00	$267.50–$513.60	—	—
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Digital Lt	$535.00	$535.00	$267.50–$513.60	—	—
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Digital Rt	$535.00	$535.00	$267.50–$513.60	—	—
Duplex ultrasound of the leg arteries, both legs CPT 93925 US LE Art Duplex Bil	$1,946.00	$1,946.00	$739.48–$1,868.16	88% above	—
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US LE Art Duplex Bil	$1,946.00	$1,946.00	$973.00–$1,868.16	—	—
Duplex ultrasound of the leg veins, both legs CPT 93970 US UE Veins Duplex Bil	$2,300.00	$2,300.00	$874.00–$2,208.00	66% above	—
Duplex ultrasound of the leg veins, both legs CPT 93970 US LE Veins Duplex Bil	$2,300.00	$2,300.00	$874.00–$2,208.00	66% above	—
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US UE Veins Duplex Bil	$2,300.00	$2,300.00	$1,150.00–$2,208.00	—	—
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US LE Veins Duplex Bil	$2,300.00	$2,300.00	$1,150.00–$2,208.00	—	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo Comp w/ Contrast	$3,132.00	$3,132.00	$1,190.16–$3,006.72	56% above	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 .ECHO W/DOPPLER/COLOR FLOW/BUBBLE	$3,132.00	$3,132.00	$1,190.16–$3,006.72	56% above	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo 2D Comp w/ Bubble	$3,132.00	$3,132.00	$1,190.16–$3,006.72	56% above	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 .ECHO W/DOPPLER/COLOR FLOW	$3,132.00	$3,132.00	$1,190.16–$3,006.72	56% above	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo Doppler Comp	$3,132.00	$3,132.00	$1,190.16–$3,006.72	56% above	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo Doppler Comp	$3,132.00	$3,132.00	$1,566.00–$3,006.72	—	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo 2D Comp w/ Bubble	$3,132.00	$3,132.00	$1,566.00–$3,006.72	—	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo Comp w/ Contrast	$3,132.00	$3,132.00	$1,566.00–$3,006.72	—	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 .ECHO W/DOPPLER/COLOR FLOW/BUBBLE	$3,132.00	$3,132.00	$1,566.00–$3,006.72	—	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 .ECHO W/DOPPLER/COLOR FLOW	$3,132.00	$3,132.00	$1,566.00–$3,006.72	—	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepa Duct System w/o Pharm	$2,721.00	$2,721.00	$1,033.98–$2,612.16	78% above	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepa Duct System w/o Pharm	$2,721.00	$2,721.00	$1,360.50–$2,612.16	—	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 .OVERNIGHT SLEEP STUDY W/ CPAP	$6,615.00	$6,615.00	$2,513.70–$6,350.40	87% above	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 .OVERNIGHT SLEEP STUDY W/ CPAP	$6,615.00	$6,615.00	$3,307.50–$6,350.40	—	—
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Lt	$634.00	$634.00	$240.92–$608.64	86% above	—
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Rt	$634.00	$634.00	$240.92–$608.64	86% above	—
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Lt	$634.00	$634.00	$317.00–$608.64	—	—
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Rt	$634.00	$634.00	$317.00–$608.64	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Ltd	$966.00	$966.00	$367.08–$927.36	86% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Ltd	$966.00	$966.00	$483.00–$927.36	—	—
MRI of both breasts, without and then with contrast dye CPT 77049 MRI Breast w/ + w/o Cont Bil.	$6,122.00	$6,122.00	$2,326.36–$5,877.12	117% above	—
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 MRI Breast w/ + w/o Cont Bil.	$6,122.00	$6,122.00	$3,061.00–$5,877.12	—	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Cont Lt	$3,931.00	$3,931.00	$1,484.50–$3,773.76	60% above	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Cont Rt	$3,931.00	$3,931.00	$1,484.50–$3,773.76	60% above	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Cont Rt	$3,931.00	$3,931.00	$1,484.50–$3,773.76	60% above	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Cont Lt	$3,931.00	$3,931.00	$1,484.50–$3,773.76	60% above	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Cont Rt	$3,931.00	$3,931.00	$1,484.50–$3,773.76	60% above	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Cont Lt	$3,931.00	$3,931.00	$1,484.50–$3,773.76	60% above	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE Joint w/o Cont Lt	$4,128.00	$4,128.00	$1,484.50–$3,962.88	68% above	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE Joint w/o Cont Rt	$4,128.00	$4,128.00	$1,484.50–$3,962.88	68% above	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Cont Rt	$3,931.00	$3,931.00	$1,965.50–$3,773.76	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Cont Rt	$3,931.00	$3,931.00	$1,965.50–$3,773.76	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Cont Lt	$3,931.00	$3,931.00	$1,965.50–$3,773.76	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Cont Lt	$3,931.00	$3,931.00	$1,965.50–$3,773.76	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Cont Lt	$3,931.00	$3,931.00	$1,965.50–$3,773.76	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Cont Rt	$3,931.00	$3,931.00	$1,965.50–$3,773.76	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE Joint w/o Cont Lt	$4,128.00	$4,128.00	$2,064.00–$3,962.88	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE Joint w/o Cont Rt	$4,128.00	$4,128.00	$2,064.00–$3,962.88	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Cont Rt	$4,690.00	$4,690.00	$1,782.20–$4,502.40	39% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Cont Rt	$4,690.00	$4,690.00	$1,782.20–$4,502.40	39% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Cont Lt	$4,690.00	$4,690.00	$1,782.20–$4,502.40	39% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Cont Lt	$4,690.00	$4,690.00	$1,782.20–$4,502.40	39% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Cont Rt	$4,690.00	$4,690.00	$1,782.20–$4,502.40	39% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Cont Lt	$4,690.00	$4,690.00	$1,782.20–$4,502.40	39% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE Joint w/ + w/o Cont Lt	$4,925.00	$4,925.00	$1,871.50–$4,728.00	46% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE Joint w/ + w/o Cont Rt	$4,925.00	$4,925.00	$1,871.50–$4,728.00	46% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Cont Lt	$4,690.00	$4,690.00	$2,345.00–$4,502.40	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Cont Lt	$4,690.00	$4,690.00	$2,345.00–$4,502.40	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Cont Rt	$4,690.00	$4,690.00	$2,345.00–$4,502.40	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Cont Rt	$4,690.00	$4,690.00	$2,345.00–$4,502.40	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Cont Lt	$4,690.00	$4,690.00	$2,345.00–$4,502.40	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Cont Rt	$4,690.00	$4,690.00	$2,345.00–$4,502.40	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE Joint w/ + w/o Cont Lt	$4,925.00	$4,925.00	$2,462.50–$4,728.00	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE Joint w/ + w/o Cont Rt	$4,925.00	$4,925.00	$2,462.50–$4,728.00	—	—
MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Cont	$4,079.00	$4,079.00	$1,550.02–$3,915.84	48% above	—
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Cont	$4,079.00	$4,079.00	$2,039.50–$3,915.84	—	—
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Cont	$6,161.00	$6,161.00	$2,341.18–$5,914.56	68% above	—
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Cont	$6,161.00	$6,161.00	$3,080.50–$5,914.56	—	—
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Cont	$5,639.00	$5,639.00	$2,142.82–$5,413.44	124% above	—
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Cont	$5,639.00	$5,639.00	$2,819.50–$5,413.44	—	—
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Cont	$6,993.00	$6,993.00	$2,657.34–$6,713.28	83% above	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Cont	$6,993.00	$6,993.00	$3,496.50–$6,713.28	—	—
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Cont	$5,871.00	$5,871.00	$1,954.12–$5,636.16	91% above	—
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Cont	$5,871.00	$5,871.00	$2,935.50–$5,636.16	—	—
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Cont	$7,027.00	$7,027.00	$2,670.26–$6,745.92	82% above	—
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Cont	$7,027.00	$7,027.00	$3,513.50–$6,745.92	—	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Cont	$6,417.00	$6,417.00	$2,438.46–$6,160.32	104% above	—
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Cont	$6,417.00	$6,417.00	$3,208.50–$6,160.32	—	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Cont	$7,162.00	$7,162.00	$2,721.56–$6,875.52	87% above	—
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Cont	$7,162.00	$7,162.00	$3,581.00–$6,875.52	—	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Cont	$6,300.00	$6,300.00	$2,394.00–$6,048.00	109% above	—
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Cont	$6,300.00	$6,300.00	$3,150.00–$6,048.00	—	—
MRI of the pelvis without and with contrast CPT 72197 MRI Prostate w/ + w/o Cont	$5,605.00	$5,605.00	$2,129.90–$5,380.80	67% above	—
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Cont	$5,605.00	$5,605.00	$2,129.90–$5,380.80	67% above	—
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Prostate w/ + w/o Cont	$5,605.00	$5,605.00	$2,802.50–$5,380.80	—	—
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Cont	$5,605.00	$5,605.00	$2,802.50–$5,380.80	—	—
MRI of the pelvis, no contrast dye CPT 72195 MRI Prostate w/o Cont	$4,760.00	$4,760.00	$1,808.80–$4,569.60	99% above	—
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Cont	$4,760.00	$4,760.00	$1,808.80–$4,569.60	99% above	—
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Prostate w/o Cont	$4,760.00	$4,760.00	$2,380.00–$4,569.60	—	—
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Cont	$4,760.00	$4,760.00	$2,380.00–$4,569.60	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Cont Lt	$4,053.00	$4,053.00	$1,540.14–$3,890.88	68% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Cont Rt	$4,053.00	$4,053.00	$1,540.14–$3,890.88	68% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Cont Lt	$4,053.00	$4,053.00	$1,540.14–$3,890.88	68% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Cont Lt	$4,053.00	$4,053.00	$1,540.14–$3,890.88	68% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Cont Rt	$4,053.00	$4,053.00	$1,540.14–$3,890.88	68% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Cont Rt	$4,053.00	$4,053.00	$1,540.14–$3,890.88	68% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE Joint w/o Cont Lt	$4,053.00	$4,053.00	$1,540.14–$3,890.88	68% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE Joint w/o Cont Rt	$4,053.00	$4,053.00	$1,540.14–$3,890.88	68% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Cont Rt	$4,053.00	$4,053.00	$2,026.50–$3,890.88	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Cont Lt	$4,053.00	$4,053.00	$2,026.50–$3,890.88	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE Joint w/o Cont Lt	$4,053.00	$4,053.00	$2,026.50–$3,890.88	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Cont Lt	$4,053.00	$4,053.00	$2,026.50–$3,890.88	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Cont Rt	$4,053.00	$4,053.00	$2,026.50–$3,890.88	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Cont Rt	$4,053.00	$4,053.00	$2,026.50–$3,890.88	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Cont Lt	$4,053.00	$4,053.00	$2,026.50–$3,890.88	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE Joint w/o Cont Rt	$4,053.00	$4,053.00	$2,026.50–$3,890.88	—	—
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocard Perf Spect Mult Rest+Stress FAMC	$7,755.00	$7,755.00	$2,359.65–$7,444.80	109% above	—
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocard Perf Spect Mult Rest+Stress FAMC	$7,755.00	$7,755.00	$3,877.50–$7,444.80	—	—
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET Skull Base to Midthigh w/ CT Scan	$9,935.00	$9,935.00	$3,775.30–$9,537.60	84% above	—
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET Skull Base to Midthigh w/ CT Scan	$9,935.00	$9,935.00	$4,967.50–$9,537.60	—	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvis Non-OB Limited	$507.00	$507.00	$192.66–$486.72	58% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvis Non-OB Limited	$507.00	$507.00	$253.50–$486.72	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Non-OB Comp	$1,397.00	$1,397.00	$530.86–$1,341.12	80% above	—
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis Non-OB Comp	$1,397.00	$1,397.00	$698.50–$1,341.12	—	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Gender	$132.00	$132.00	$50.16–$126.72	81% below	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pregnant > 14 Weeks 1st Gest	$1,027.00	$1,027.00	$390.26–$985.92	49% above	—
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Gender	$132.00	$132.00	$66.00–$126.72	—	—
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pregnant > 14 Weeks 1st Gest	$1,027.00	$1,027.00	$513.50–$985.92	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Pregnant < 14 Weeks 1st Gest	$1,027.00	$1,027.00	$390.26–$985.92	73% above	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Pregnant < 14 Weeks 1st Gest	$1,027.00	$1,027.00	$513.50–$985.92	—	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pregnant Ltd	$772.00	$772.00	$293.36–$741.12	119% above	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Pregnant Ltd	$772.00	$772.00	$386.00–$741.12	—	—
Screening mammogram, both breasts CPT 77067 MA Routine Screen Digital Bil.	$550.00	$550.00	$209.00–$528.00	173% above	—
Screening mammogram, both breasts one side CPT 77067 MA Screening Digital Lt.	$550.00	$550.00	$209.00–$528.00	173% above	—
Screening mammogram, both breasts one side CPT 77067 MA Screening Digital Rt.	$550.00	$550.00	$209.00–$528.00	173% above	—
Screening mammogram, both breasts one side CPT 77067 MA Routine Screen Lt.	$550.00	$550.00	$209.00–$528.00	173% above	—
Screening mammogram, both breasts one side CPT 77067 MA Routine Screen Rt.	$550.00	$550.00	$209.00–$528.00	173% above	—
Screening mammogram, both breasts inpatient CPT 77067 MA Routine Screen Digital Bil.	$550.00	$550.00	$275.00–$528.00	—	—
Screening mammogram, both breasts inpatient one side CPT 77067 MA Screening Digital Rt.	$550.00	$550.00	$275.00–$528.00	—	—
Screening mammogram, both breasts inpatient one side CPT 77067 MA Routine Screen Lt.	$550.00	$550.00	$275.00–$528.00	—	—
Screening mammogram, both breasts inpatient one side CPT 77067 MA Screening Digital Lt.	$550.00	$550.00	$275.00–$528.00	—	—
Screening mammogram, both breasts inpatient one side CPT 77067 MA Routine Screen Rt.	$550.00	$550.00	$275.00–$528.00	—	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Comp Min 2 Views Rt	$500.00	$500.00	$190.00–$480.00	56% above	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Comp Min 2 Views Lt	$500.00	$500.00	$190.00–$480.00	56% above	—
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Comp Min 2 Views Rt	$500.00	$500.00	$250.00–$480.00	—	—
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Comp Min 2 Views Lt	$500.00	$500.00	$250.00–$480.00	—	—
Sleep study in a lab (polysomnography) CPT 95810 .OVERNIGHT SLEEP STUDY	$6,156.00	$6,156.00	$2,339.28–$5,909.76	97% above	—
Sleep study in a lab (polysomnography) inpatient CPT 95810 .OVERNIGHT SLEEP STUDY	$6,156.00	$6,156.00	$3,078.00–$5,909.76	—	—
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Stress/Dobutamine Echo	$2,322.00	$2,322.00	$882.36–$2,229.12	37% above	—
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Stress/Dobutamine Echo	$2,322.00	$2,322.00	$1,161.00–$2,229.12	—	—
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Swallowing Funct w/ Video (Fluoro)	$879.00	$879.00	$334.02–$843.84	60% above	—
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Swallowing Funct w/ Video (Fluoro)	$879.00	$879.00	$439.50–$843.84	—	—
Transvaginal pelvic ultrasound CPT 76830 US Pelvis Transvaginal	$1,024.00	$1,024.00	$389.12–$983.04	77% above	—
Transvaginal pelvic ultrasound inpatient CPT 76830 US Pelvis Transvaginal	$1,024.00	$1,024.00	$512.00–$983.04	—	—
Transvaginal ultrasound during pregnancy CPT 76817 US Pregnant Transvaginal	$801.00	$801.00	$304.38–$768.96	64% above	—
Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal	$801.00	$801.00	$304.38–$768.96	64% above	—
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal	$801.00	$801.00	$400.50–$768.96	—	—
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Pregnant Transvaginal	$801.00	$801.00	$400.50–$768.96	—	—
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Comp	$1,491.00	$1,491.00	$566.58–$1,431.36	84% above	—
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Comp	$1,491.00	$1,491.00	$745.50–$1,431.36	—	—
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum +Contents	$1,067.00	$1,067.00	$405.46–$1,024.32	70% above	—
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum +Contents	$1,067.00	$1,067.00	$533.50–$1,024.32	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid	$1,000.00	$1,000.00	$380.00–$960.00	71% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Soft Tissue Neck	$1,000.00	$1,000.00	$380.00–$960.00	71% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid	$1,000.00	$1,000.00	$500.00–$960.00	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Soft Tissue Neck	$1,000.00	$1,000.00	$500.00–$960.00	—	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UGI w/o KUB	$859.00	$859.00	$326.42–$824.64	77% above	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI	$859.00	$859.00	$326.42–$824.64	77% above	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UGI w/o KUB	$859.00	$859.00	$429.50–$824.64	—	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI	$859.00	$859.00	$429.50–$824.64	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Veins Duplex Lt	$1,515.00	$1,515.00	$575.70–$1,454.40	53% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Veins Duplex Rt	$1,515.00	$1,515.00	$575.70–$1,454.40	53% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Veins Duplex Rt	$1,515.00	$1,515.00	$575.70–$1,454.40	53% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Veins Duplex Lt	$1,515.00	$1,515.00	$575.70–$1,454.40	53% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Veins Duplex Rt	$1,515.00	$1,515.00	$757.50–$1,454.40	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Veins Duplex Rt	$1,515.00	$1,515.00	$757.50–$1,454.40	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Veins Duplex Lt	$1,515.00	$1,515.00	$757.50–$1,454.40	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Veins Duplex Lt	$1,515.00	$1,515.00	$757.50–$1,454.40	—	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Comp Min 3 Views Rt	$554.00	$554.00	$210.52–$531.84	69% above	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Comp Min 3 Views Lt	$554.00	$554.00	$210.52–$531.84	69% above	—
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Comp Min 3 Views Rt	$554.00	$554.00	$277.00–$531.84	—	—
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Comp Min 3 Views Lt	$554.00	$554.00	$277.00–$531.84	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Lt w/ Pelvis	$545.00	$545.00	$207.10–$523.20	189% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Rt w/ Pelvis	$545.00	$545.00	$207.10–$523.20	189% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Lt w/ Pelvis	$545.00	$545.00	$272.50–$523.20	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Rt w/ Pelvis	$545.00	$545.00	$272.50–$523.20	—	—
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View	$491.00	$491.00	$186.58–$471.36	96% above	—
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View	$491.00	$491.00	$245.50–$471.36	—	—
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Lt	$408.00	$408.00	$155.04–$391.68	107% above	—
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Rt	$408.00	$408.00	$155.04–$391.68	107% above	—
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Lt	$408.00	$408.00	$204.00–$391.68	—	—
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Rt	$408.00	$408.00	$204.00–$391.68	—	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 5th Digit Rt	$378.00	$378.00	$143.64–$362.88	70% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 4th Digit Lt	$378.00	$378.00	$143.64–$362.88	70% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views Thumb Lt	$378.00	$378.00	$143.64–$362.88	70% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views Thumb Rt	$378.00	$378.00	$143.64–$362.88	70% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 3rd Digit Rt	$378.00	$378.00	$143.64–$362.88	70% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 4th Digit Rt	$378.00	$378.00	$143.64–$362.88	70% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 3rd Digit Lt	$378.00	$378.00	$143.64–$362.88	70% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 2nd Digit Lt	$378.00	$378.00	$143.64–$362.88	70% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 2nd Digit Rt	$378.00	$378.00	$143.64–$362.88	70% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 5th Digit Lt	$378.00	$378.00	$143.64–$362.88	70% above	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 5th Digit Rt	$378.00	$378.00	$189.00–$362.88	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views Thumb Rt	$378.00	$378.00	$189.00–$362.88	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 5th Digit Lt	$378.00	$378.00	$189.00–$362.88	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 3rd Digit Lt	$378.00	$378.00	$189.00–$362.88	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views Thumb Lt	$378.00	$378.00	$189.00–$362.88	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 4th Digit Lt	$378.00	$378.00	$189.00–$362.88	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 4th Digit Rt	$378.00	$378.00	$189.00–$362.88	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 2nd Digit Lt	$378.00	$378.00	$189.00–$362.88	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 2nd Digit Rt	$378.00	$378.00	$189.00–$362.88	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 3rd Digit Rt	$378.00	$378.00	$189.00–$362.88	—	—
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Lt	$395.00	$395.00	$150.10–$379.20	94% above	—
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Rt	$395.00	$395.00	$150.10–$379.20	94% above	—
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Lt	$395.00	$395.00	$197.50–$379.20	—	—
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Rt	$395.00	$395.00	$197.50–$379.20	—	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Comp Min 3 Views Rt	$586.00	$586.00	$222.68–$562.56	93% above	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Comp Min 3 Views Lt	$586.00	$586.00	$222.68–$562.56	93% above	—
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Comp Min 3 Views Lt	$586.00	$586.00	$293.00–$562.56	—	—
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Comp Min 3 Views Rt	$586.00	$586.00	$293.00–$562.56	—	—
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Min 3 Views Lt	$563.00	$563.00	$213.94–$540.48	65% above	—
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Min 3 Views Rt	$563.00	$563.00	$213.94–$540.48	65% above	—
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Min 3 Views Lt	$563.00	$563.00	$281.50–$540.48	—	—
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Min 3 Views Rt	$563.00	$563.00	$281.50–$540.48	—	—
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Rt	$565.00	$565.00	$214.70–$542.40	86% above	—
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Lt	$565.00	$565.00	$214.70–$542.40	86% above	—
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Rt	$565.00	$565.00	$282.50–$542.40	—	—
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Lt	$565.00	$565.00	$282.50–$542.40	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$809.00	$809.00	$307.42–$776.64	136% above	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$809.00	$809.00	$404.50–$776.64	—	—
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Min 4 Views	$929.00	$929.00	$353.02–$891.84	119% above	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Min 4 Views	$929.00	$929.00	$464.50–$891.84	—	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views	$721.00	$721.00	$273.98–$692.16	160% above	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views	$721.00	$721.00	$360.50–$692.16	—	—
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Comp Min 3 Views	$569.00	$569.00	$216.22–$546.24	101% above	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones Comp Min 3 Views	$569.00	$569.00	$284.50–$546.24	—	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cerv 2 or 3 Views	$615.00	$615.00	$233.70–$590.40	127% above	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cerv 2 or 3 Views	$615.00	$615.00	$307.50–$590.40	—	—
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views	$500.00	$500.00	$190.00–$480.00	103% above	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views	$500.00	$500.00	$250.00–$480.00	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum +Coccyx Min 2 Views	$509.00	$509.00	$193.42–$488.64	96% above	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum +Coccyx Min 2 Views	$509.00	$509.00	$254.50–$488.64	—	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT	$119.00	$119.00	$45.22–$114.24	100% above	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT	$119.00	$119.00	$59.50–$114.24	—	—
AST (aspartate aminotransferase) enzyme test CPT 84450 AST	$119.00	$119.00	$45.22–$114.24	152% above	—
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST	$119.00	$119.00	$59.50–$114.24	—	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Profile Acute PLAB	$456.00	$456.00	$173.28–$437.76	46% above	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel 3 PLAB	$456.00	$456.00	$173.28–$437.76	46% above	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel 2 PLAB	$456.00	$456.00	$173.28–$437.76	46% above	—
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Panel 2 PLAB	$456.00	$456.00	$228.00–$437.76	—	—
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Profile Acute PLAB	$456.00	$456.00	$228.00–$437.76	—	—
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Panel 3 PLAB	$456.00	$456.00	$228.00–$437.76	—	—
Allergy blood test, specific IgE, per allergen CPT 86003 Respiratory Allergy Profile PLAB AO	$27.00	$27.00	$10.26–$25.92	36% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 Food: Peanut PLAB	$75.00	$75.00	$28.50–$72.00	78% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Food: Milk (Cow) PLAB	$75.00	$75.00	$28.50–$72.00	78% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Immunocap X 1 PLAB	$75.00	$75.00	$28.50–$72.00	78% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Food: Egg (Whole) PLAB	$75.00	$75.00	$28.50–$72.00	78% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Food: Egg White PLAB	$75.00	$75.00	$28.50–$72.00	78% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Latex IgE PLAB	$189.00	$189.00	$71.82–$181.44	347% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Food: Soybean PLAB	$189.00	$189.00	$71.82–$181.44	347% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Food: Wheat PLAB	$192.00	$192.00	$72.96–$184.32	355% above	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Respiratory Allergy Profile PLAB AO	$27.00	$27.00	$13.50–$25.92	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Immunocap X 1 PLAB	$75.00	$75.00	$37.50–$72.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food: Egg White PLAB	$75.00	$75.00	$37.50–$72.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food: Milk (Cow) PLAB	$75.00	$75.00	$37.50–$72.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food: Peanut PLAB	$75.00	$75.00	$37.50–$72.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food: Egg (Whole) PLAB	$75.00	$75.00	$37.50–$72.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Latex IgE PLAB	$189.00	$189.00	$94.50–$181.44	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food: Soybean PLAB	$189.00	$189.00	$94.50–$181.44	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food: Wheat PLAB	$192.00	$192.00	$96.00–$184.32	—	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP IgG PLAB	$211.00	$211.00	$80.18–$202.56	158% above	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP IgG PLAB	$211.00	$211.00	$105.50–$202.56	—	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab (ANA) PLAB	$275.00	$275.00	$104.50–$264.00	520% above	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA, IgG Screen w/ Reflex to CTD PLAB	$275.00	$275.00	$104.50–$264.00	520% above	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA, IgG Screen w/ Reflex to CTD PLAB	$275.00	$275.00	$137.50–$264.00	—	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Ab (ANA) PLAB	$275.00	$275.00	$137.50–$264.00	—	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Brain Natriuretic Peptide (BNP)	$356.00	$356.00	$135.28–$341.76	88% above	—
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Brain Natriuretic Peptide (BNP)	$356.00	$356.00	$178.00–$341.76	—	—
Basic metabolic panel (blood test) CPT 80048 BMP	$269.00	$269.00	$102.22–$258.24	103% above	—
Basic metabolic panel (blood test) CPT 80048 BMP 8	$269.00	$269.00	$102.22–$258.24	103% above	—
Basic metabolic panel (blood test) CPT 80048 BMP 2	$269.00	$269.00	$102.22–$258.24	103% above	—
Basic metabolic panel (blood test) inpatient CPT 80048 BMP	$269.00	$269.00	$134.50–$258.24	—	—
Basic metabolic panel (blood test) inpatient CPT 80048 BMP 2	$269.00	$269.00	$134.50–$258.24	—	—
Basic metabolic panel (blood test) inpatient CPT 80048 BMP 8	$269.00	$269.00	$134.50–$258.24	—	—
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bill Surg Level IV 88305	$274.00	$274.00	$104.12–$263.04	43% above	—
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Bill Surg Level IV 88305	$274.00	$274.00	$137.00–$263.04	—	—
Blood culture for bacteria CPT 87040 Blood Culture	$327.00	$327.00	$124.26–$313.92	81% above	—
Blood culture for bacteria inpatient CPT 87040 Blood Culture	$327.00	$327.00	$163.50–$313.92	—	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$50.00	$50.00	$19.00–$48.00	113% above	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture Only Charge	$50.00	$50.00	$19.00–$48.00	113% above	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$50.00	$50.00	$25.00–$48.00	—	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture Only Charge	$50.00	$50.00	$25.00–$48.00	—	—
Blood glucose (sugar) test CPT 82947 Glucose Level	$96.00	$96.00	$36.48–$92.16	131% above	—
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level	$96.00	$96.00	$48.00–$92.16	—	—
Blood lead test CPT 83655 Lead, Blood (Venous) PLAB	$110.00	$110.00	$41.80–$105.60	84% above	—
Blood lead test CPT 83655 83655 LEAD, BLOOD	$110.00	$110.00	$41.80–$105.60	84% above	—
Blood lead test CPT 83655 Lead, Blood (Capillary) PLAB	$110.00	$110.00	$41.80–$105.60	84% above	—
Blood lead test CPT 83655 Heavy Metals Panel 3, Whole Blood PLAB AO 1	$208.00	$208.00	$79.04–$199.68	247% above	—
Blood lead test inpatient CPT 83655 83655 LEAD, BLOOD	$110.00	$110.00	$55.00–$105.60	—	—
Blood lead test inpatient CPT 83655 Lead, Blood (Capillary) PLAB	$110.00	$110.00	$55.00–$105.60	—	—
Blood lead test inpatient CPT 83655 Lead, Blood (Venous) PLAB	$110.00	$110.00	$55.00–$105.60	—	—
Blood lead test inpatient CPT 83655 Heavy Metals Panel 3, Whole Blood PLAB AO 1	$208.00	$208.00	$104.00–$199.68	—	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Pregnancy Test Serum 1	$110.00	$110.00	$41.80–$105.60	3% above	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Pregnancy Test Serum	$110.00	$110.00	$41.80–$105.60	3% above	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Pregnancy Test Serum 1	$110.00	$110.00	$55.00–$105.60	—	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Pregnancy Test Serum	$110.00	$110.00	$55.00–$105.60	—	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bill ABO	$41.00	$41.00	$15.58–$39.36	21% below	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bill Ref ABO type	$41.00	$41.00	$15.58–$39.36	21% below	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Newborn ABO/Rh	$84.00	$84.00	$31.92–$80.64	61% above	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh	$84.00	$84.00	$31.92–$80.64	61% above	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Newborn ABORh	$84.00	$84.00	$31.92–$80.64	61% above	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 REF Antibody ID	$84.00	$84.00	$31.92–$80.64	61% above	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Bill ABO	$41.00	$41.00	$20.50–$39.36	—	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Bill Ref ABO type	$41.00	$41.00	$20.50–$39.36	—	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Newborn ABO/Rh	$84.00	$84.00	$42.00–$80.64	—	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 REF Antibody ID	$84.00	$84.00	$42.00–$80.64	—	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Newborn ABORh	$84.00	$84.00	$42.00–$80.64	—	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh	$84.00	$84.00	$42.00–$80.64	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$169.00	$169.00	$64.22–$162.24	81% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$169.00	$169.00	$84.50–$162.24	—	—
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium Difficile PCR	$359.00	$359.00	$136.42–$344.64	117% above	—
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Clostridium Difficile PCR	$359.00	$359.00	$179.50–$344.64	—	—
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$334.00	$334.00	$126.92–$320.64	190% above	—
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 PLAB	$334.00	$334.00	$126.92–$320.64	190% above	—
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 PLAB	$334.00	$334.00	$167.00–$320.64	—	—
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$334.00	$334.00	$167.00–$320.64	—	—
CA-125 blood test (ovarian cancer marker) CPT 86304 CA-125 PLAB	$382.00	$382.00	$145.16–$366.72	247% above	—
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$382.00	$382.00	$145.16–$366.72	247% above	—
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA-125 PLAB	$382.00	$382.00	$191.00–$366.72	—	—
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$382.00	$382.00	$191.00–$366.72	—	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) RNA (ID Now)	$191.00	$191.00	$65.35–$183.36	63% above	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert)	$200.00	$200.00	$65.35–$192.00	71% above	—
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) RNA (ID Now)	$191.00	$191.00	$95.50–$183.36	—	—
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert)	$200.00	$200.00	$100.00–$192.00	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/GC PCR Urine	$202.00	$202.00	$76.76–$193.92	85% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/GC PCR, Liquid Base Vial PLAB	$202.00	$202.00	$76.76–$193.92	85% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/GC PCR Swab	$202.00	$202.00	$76.76–$193.92	85% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/GC PCR, Liquid Base Vial PLAB	$202.00	$202.00	$101.00–$193.92	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/GC PCR Swab	$202.00	$202.00	$101.00–$193.92	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/GC PCR Urine	$202.00	$202.00	$101.00–$193.92	—	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$257.00	$257.00	$97.66–$246.72	127% above	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$257.00	$257.00	$128.50–$246.72	—	—
Complete blood count (CBC) with differential CPT 85025 CBC w/ Auto Diff 42	$157.00	$157.00	$59.66–$150.72	84% above	—
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Auto Diff 42	$157.00	$157.00	$78.50–$150.72	—	—
Complete blood count (CBC), no differential CPT 85027 CBC w/ Man Diff 42	$110.00	$110.00	$41.80–$105.60	56% above	—
Complete blood count (CBC), no differential CPT 85027 CBC w/ No Diff 42	$110.00	$110.00	$41.80–$105.60	56% above	—
Complete blood count (CBC), no differential inpatient CPT 85027 CBC w/ Man Diff 42	$110.00	$110.00	$55.00–$105.60	—	—
Complete blood count (CBC), no differential inpatient CPT 85027 CBC w/ No Diff 42	$110.00	$110.00	$55.00–$105.60	—	—
Comprehensive metabolic panel (blood test) CPT 80053 CMP 8	$273.00	$273.00	$103.74–$262.08	82% above	—
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$273.00	$273.00	$103.74–$262.08	82% above	—
Comprehensive metabolic panel (blood test) CPT 80053 CMP 13	$273.00	$273.00	$103.74–$262.08	82% above	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$273.00	$273.00	$136.50–$262.08	—	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP 8	$273.00	$273.00	$136.50–$262.08	—	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP 13	$273.00	$273.00	$136.50–$262.08	—	—
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S PLAB	$413.00	$413.00	$156.94–$396.48	191% above	—
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S PLAB	$413.00	$413.00	$206.50–$396.48	—	—
Estradiol blood test CPT 82670 Estradiol	$260.00	$260.00	$98.80–$249.60	131% above	—
Estradiol blood test CPT 82670 Estradiol, M, Child, Postmeno F PLAB	$260.00	$260.00	$98.80–$249.60	131% above	—
Estradiol blood test CPT 82670 Estradiol, Adult PLAB	$260.00	$260.00	$98.80–$249.60	131% above	—
Estradiol blood test inpatient CPT 82670 Estradiol, M, Child, Postmeno F PLAB	$260.00	$260.00	$130.00–$249.60	—	—
Estradiol blood test inpatient CPT 82670 Estradiol, Adult PLAB	$260.00	$260.00	$130.00–$249.60	—	—
Estradiol blood test inpatient CPT 82670 Estradiol	$260.00	$260.00	$130.00–$249.60	—	—
FSH (follicle-stimulating hormone) test CPT 83001 FSH PLAB	$235.00	$235.00	$89.30–$225.60	109% above	—
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$258.00	$258.00	$98.04–$247.68	129% above	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH PLAB	$235.00	$235.00	$117.50–$225.60	—	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$258.00	$258.00	$129.00–$247.68	—	—
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, F PLAB	$393.00	$393.00	$149.34–$377.28	13% above	—
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, F PLAB	$393.00	$393.00	$196.50–$377.28	—	—
Ferritin blood test (iron stores) CPT 82728 Ferritin Level	$228.00	$228.00	$86.64–$218.88	122% above	—
Ferritin blood test (iron stores) CPT 82728 Ferritin PLAB	$228.00	$228.00	$86.64–$218.88	122% above	—
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin PLAB	$228.00	$228.00	$114.00–$218.88	—	—
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin Level	$228.00	$228.00	$114.00–$218.88	—	—
Folate (folic acid) blood test CPT 82746 Folate	$258.00	$258.00	$98.04–$247.68	145% above	—
Folate (folic acid) blood test CPT 82746 Folate PLAB	$258.00	$258.00	$98.04–$247.68	145% above	—
Folate (folic acid) blood test inpatient CPT 82746 Folate PLAB	$258.00	$258.00	$129.00–$247.68	—	—
Folate (folic acid) blood test inpatient CPT 82746 Folate	$258.00	$258.00	$129.00–$247.68	—	—
Free T3 thyroid hormone test CPT 84481 T3, Free PLAB	$423.00	$423.00	$160.74–$406.08	226% above	—
Free T3 thyroid hormone test inpatient CPT 84481 T3, Free PLAB	$423.00	$423.00	$211.50–$406.08	—	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 (FT4) by Equilibrium Dialysis PLAB	$169.00	$169.00	$64.22–$162.24	130% above	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4	$169.00	$169.00	$64.22–$162.24	130% above	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4	$169.00	$169.00	$84.50–$162.24	—	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4 (FT4) by Equilibrium Dialysis PLAB	$169.00	$169.00	$84.50–$162.24	—	—
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel 3	$646.00	$646.00	$245.48–$620.16	140% above	—
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General Health Panel 3	$646.00	$646.00	$323.00–$620.16	—	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 1 HR PP	$109.00	$109.00	$41.42–$104.64	123% above	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 2 Hour PP	$109.00	$109.00	$41.42–$104.64	123% above	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 2 Hour PP	$109.00	$109.00	$54.50–$104.64	—	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 1 HR PP	$109.00	$109.00	$54.50–$104.64	—	—
Glucose tolerance test, 3 samples CPT 82951 .Glucose Fasting	$257.00	$257.00	$97.66–$246.72	121% above	—
Glucose tolerance test, 3 samples CPT 82951 GTT 3 Hour	$257.00	$257.00	$97.66–$246.72	121% above	—
Glucose tolerance test, 3 samples CPT 82951 82951 Glucose 3 Hour Total	$257.00	$257.00	$97.66–$246.72	121% above	—
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 3 Hour	$257.00	$257.00	$128.50–$246.72	—	—
Glucose tolerance test, 3 samples inpatient CPT 82951 82951 Glucose 3 Hour Total	$257.00	$257.00	$128.50–$246.72	—	—
Glucose tolerance test, 3 samples inpatient CPT 82951 .Glucose Fasting	$257.00	$257.00	$128.50–$246.72	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Chlamydia/GC PCR Add-On	$211.00	$211.00	$80.18–$202.56	125% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Chlamydia/GC PCR Add-On	$211.00	$211.00	$105.50–$202.56	—	—
H. pylori stool antigen test CPT 87338 Helicobacter Pylori Antigen, F PLAB	$210.00	$210.00	$79.80–$201.60	80% above	—
H. pylori stool antigen test inpatient CPT 87338 Helicobacter Pylori Antigen, F PLAB	$210.00	$210.00	$105.00–$201.60	—	—
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/2 Ab	$176.00	$176.00	$66.88–$168.96	295% above	—
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/2 Ab 1	$176.00	$176.00	$66.88–$168.96	295% above	—
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1/2 Ab 1	$176.00	$176.00	$88.00–$168.96	—	—
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1/2 Ab	$176.00	$176.00	$88.00–$168.96	—	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 Pap Smear, ThinPrep w/Rflx HPV PLAB AO 2	$183.00	$183.00	$69.54–$175.68	101% above	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV High Risk w/Rflx to 16/18 PLAB	$183.00	$183.00	$69.54–$175.68	101% above	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV High Risk Screen PLAB	$201.00	$201.00	$76.38–$192.96	121% above	—
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Pap Smear, ThinPrep w/Rflx HPV PLAB AO 2	$183.00	$183.00	$91.50–$175.68	—	—
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV High Risk w/Rflx to 16/18 PLAB	$183.00	$183.00	$91.50–$175.68	—	—
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV High Risk Screen PLAB	$201.00	$201.00	$100.50–$192.96	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c w/ Avg. Glucose	$147.00	$147.00	$55.86–$141.12	124% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c	$147.00	$147.00	$55.86–$141.12	124% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hgb A1c w/ eAG	$147.00	$147.00	$55.86–$141.12	124% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c	$147.00	$147.00	$73.50–$141.12	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c w/ Avg. Glucose	$147.00	$147.00	$73.50–$141.12	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hgb A1c w/ eAG	$147.00	$147.00	$73.50–$141.12	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis Panel 3 PLAB AO 1	$217.00	$217.00	$82.46–$208.32	147% above	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab PLAB	$217.00	$217.00	$82.46–$208.32	147% above	—
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis Panel 3 PLAB AO 1	$217.00	$217.00	$108.50–$208.32	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Ab PLAB	$217.00	$217.00	$108.50–$208.32	—	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen PLAB	$161.00	$161.00	$61.18–$154.56	85% above	—
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen PLAB	$161.00	$161.00	$80.50–$154.56	—	—
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab IgG PLAB AO	$221.00	$221.00	$83.98–$212.16	156% above	—
Hepatitis C antibody blood test (screening) CPT 86803 Screen	$221.00	$221.00	$83.98–$212.16	156% above	—
Hepatitis C antibody blood test (screening) CPT 86803 Diagnostic	$221.00	$221.00	$83.98–$212.16	156% above	—
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody PLAB	$221.00	$221.00	$83.98–$212.16	156% above	—
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Diagnostic	$221.00	$221.00	$110.50–$212.16	—	—
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Antibody PLAB	$221.00	$221.00	$110.50–$212.16	—	—
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Ab IgG PLAB AO	$221.00	$221.00	$110.50–$212.16	—	—
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Screen	$221.00	$221.00	$110.50–$212.16	—	—
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Viral Load by PCR PLAB	$310.00	$310.00	$117.80–$297.60	6% below	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Viral Load by PCR PLAB	$310.00	$310.00	$155.00–$297.60	—	—
Herpes blood test, HSV-1 antibody CPT 86695 HSV-1/HSV-2 w/Rflx to Type 1/2 PLAB AO 1	$118.00	$118.00	$44.84–$113.28	20% above	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV-1/HSV-2 w/Rflx to Type 1/2 PLAB AO 1	$118.00	$118.00	$59.00–$113.28	—	—
Herpes blood test, HSV-2 antibody CPT 86696 HSV-1/HSV-2 w/Rflx to Type 1/2 PLAB AO 2	$118.00	$118.00	$44.84–$113.28	11% above	—
Herpes blood test, HSV-2 antibody CPT 86696 .HSV 2 GlycG Ab, IgG PLAB	$118.00	$118.00	$44.84–$113.28	11% above	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 .HSV 2 GlycG Ab, IgG PLAB	$118.00	$118.00	$59.00–$113.28	—	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV-1/HSV-2 w/Rflx to Type 1/2 PLAB AO 2	$118.00	$118.00	$59.00–$113.28	—	—
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP, Highly Sensitive PLAB	$258.00	$258.00	$98.04–$247.68	223% above	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP, Highly Sensitive PLAB	$258.00	$258.00	$129.00–$247.68	—	—
Homocysteine blood test CPT 83090 Homocysteine Total PLAB	$419.00	$419.00	$159.22–$402.24	200% above	—
Homocysteine blood test inpatient CPT 83090 Homocysteine Total PLAB	$419.00	$419.00	$209.50–$402.24	—	—
Insulin blood test CPT 83525 Insulin 30 Minutes PLAB	$282.00	$282.00	$107.16–$270.72	170% above	—
Insulin blood test CPT 83525 Insulin 120 Minutes PLAB	$282.00	$282.00	$107.16–$270.72	170% above	—
Insulin blood test CPT 83525 Insulin 60 Minutes PLAB	$282.00	$282.00	$107.16–$270.72	170% above	—
Insulin blood test CPT 83525 Insulin, Fasting PLAB	$282.00	$282.00	$107.16–$270.72	170% above	—
Insulin blood test inpatient CPT 83525 Insulin 30 Minutes PLAB	$282.00	$282.00	$141.00–$270.72	—	—
Insulin blood test inpatient CPT 83525 Insulin 120 Minutes PLAB	$282.00	$282.00	$141.00–$270.72	—	—
Insulin blood test inpatient CPT 83525 Insulin 60 Minutes PLAB	$282.00	$282.00	$141.00–$270.72	—	—
Insulin blood test inpatient CPT 83525 Insulin, Fasting PLAB	$282.00	$282.00	$141.00–$270.72	—	—
Iron blood test (serum iron) CPT 83540 Iron & TIBC	$129.00	$129.00	$49.02–$123.84	105% above	—
Iron blood test (serum iron) CPT 83540 Iron Level	$129.00	$129.00	$49.02–$123.84	105% above	—
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$129.00	$129.00	$64.50–$123.84	—	—
Iron blood test (serum iron) inpatient CPT 83540 Iron & TIBC	$129.00	$129.00	$64.50–$123.84	—	—
Kidney function blood test panel CPT 80069 Renal Function Panel	$300.00	$300.00	$114.00–$288.00	130% above	—
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$300.00	$300.00	$150.00–$288.00	—	—
LH (luteinizing hormone) test CPT 83002 LH	$235.00	$235.00	$89.30–$225.60	89% above	—
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone PLAB	$235.00	$235.00	$89.30–$225.60	89% above	—
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone PLAB	$235.00	$235.00	$117.50–$225.60	—	—
LH (luteinizing hormone) test inpatient CPT 83002 LH	$235.00	$235.00	$117.50–$225.60	—	—
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$202.00	$202.00	$76.76–$193.92	116% above	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$202.00	$202.00	$101.00–$193.92	—	—
Liver function blood test panel CPT 80076 Hepatic Function Panel	$226.00	$226.00	$85.88–$216.96	87% above	—
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$226.00	$226.00	$113.00–$216.96	—	—
Lyme disease antibody test CPT 86618 Lyme Disease IgG/IgM Antibodies PLAB	$314.00	$314.00	$119.32–$301.44	147% above	—
Lyme disease antibody test inpatient CPT 86618 Lyme Disease IgG/IgM Antibodies PLAB	$314.00	$314.00	$157.00–$301.44	—	—
Magnesium blood test CPT 83735 Magnesium, Urine 24 Hour PLAB	$134.00	$134.00	$50.92–$128.64	113% above	—
Magnesium blood test CPT 83735 Magnesium Level	$141.00	$141.00	$53.58–$135.36	124% above	—
Magnesium blood test inpatient CPT 83735 Magnesium, Urine 24 Hour PLAB	$134.00	$134.00	$67.00–$128.64	—	—
Magnesium blood test inpatient CPT 83735 Magnesium Level	$141.00	$141.00	$70.50–$135.36	—	—
Measles (rubeola) antibody test CPT 86765 Rubeola IgG Ab PLAB	$225.00	$225.00	$85.50–$216.00	193% above	—
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola IgG Ab PLAB	$225.00	$225.00	$112.50–$216.00	—	—
Mono test (heterophile antibody, Monospot) CPT 86308 Mono Screen	$110.00	$110.00	$41.80–$105.60	95% above	—
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$110.00	$110.00	$41.80–$105.60	95% above	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen	$110.00	$110.00	$55.00–$105.60	—	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mono Screen	$110.00	$110.00	$55.00–$105.60	—	—
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free and Total PLAB	$334.00	$334.00	$126.92–$320.64	162% above	—
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free and Total PLAB	$334.00	$334.00	$167.00–$320.64	—	—
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Free and Total PLAB AO	$55.00	$55.00	$20.90–$52.80	41% below	—
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Health Index PLAB	$150.00	$150.00	$57.00–$144.00	61% above	—
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic	$204.00	$204.00	$77.52–$195.84	119% above	—
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total	$204.00	$204.00	$77.52–$195.84	119% above	—
PSA (prostate-specific antigen) blood test, total CPT 84153 Psa Total	$204.00	$204.00	$77.52–$195.84	119% above	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Free and Total PLAB AO	$55.00	$55.00	$27.50–$52.80	—	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Health Index PLAB	$150.00	$150.00	$75.00–$144.00	—	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Psa Total	$204.00	$204.00	$102.00–$195.84	—	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic	$204.00	$204.00	$102.00–$195.84	—	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total	$204.00	$204.00	$102.00–$195.84	—	—
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP: ThinPrep PLAB AO	$53.00	$53.00	$20.14–$50.88	10% above	—
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Pap Smear, ThinPrep w/Rflx HPV PLAB AO 1	$76.00	$76.00	$28.88–$72.96	58% above	—
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP THIN LAYER - SCREENING	$161.00	$161.00	$61.18–$154.56	234% above	—
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP: ThinPrep PLAB	$161.00	$161.00	$61.18–$154.56	234% above	—
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP: ThinPrep PLAB AO	$53.00	$53.00	$26.50–$50.88	—	—
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Pap Smear, ThinPrep w/Rflx HPV PLAB AO 1	$76.00	$76.00	$38.00–$72.96	—	—
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP THIN LAYER - SCREENING	$161.00	$161.00	$80.50–$154.56	—	—
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP: ThinPrep PLAB	$161.00	$161.00	$80.50–$154.56	—	—
Parathyroid hormone (PTH) blood test CPT 83970 PTH Intact	$404.00	$404.00	$153.52–$387.84	92% above	—
Parathyroid hormone (PTH) blood test CPT 83970 PTH, without Calcium PLAB	$404.00	$404.00	$153.52–$387.84	92% above	—
Parathyroid hormone (PTH) blood test CPT 83970 PTH, INTACT WITH CALCIUM PLAB AO	$404.00	$404.00	$153.52–$387.84	92% above	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH Intact	$404.00	$404.00	$202.00–$387.84	—	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, INTACT WITH CALCIUM PLAB AO	$404.00	$404.00	$202.00–$387.84	—	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, without Calcium PLAB	$404.00	$404.00	$202.00–$387.84	—	—
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$146.00	$146.00	$55.48–$140.16	117% above	—
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$146.00	$146.00	$55.48–$140.16	117% above	—
Partial thromboplastin time (PTT) clotting test CPT 85730 85730 PTT	$149.00	$149.00	$56.62–$143.04	122% above	—
Partial thromboplastin time (PTT) clotting test CPT 85730 Lupus Anticoagulant Screen w/reflex PLAB AO 2	$160.00	$160.00	$60.80–$153.60	138% above	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time	$146.00	$146.00	$73.00–$140.16	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$146.00	$146.00	$73.00–$140.16	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 85730 PTT	$149.00	$149.00	$74.50–$143.04	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Lupus Anticoagulant Screen w/reflex PLAB AO 2	$160.00	$160.00	$80.00–$153.60	—	—
Progesterone blood test CPT 84144 Progesterone PLAB	$248.00	$248.00	$94.24–$238.08	132% above	—
Progesterone blood test CPT 84144 Progesterone	$248.00	$248.00	$94.24–$238.08	132% above	—
Progesterone blood test inpatient CPT 84144 Progesterone PLAB	$248.00	$248.00	$124.00–$238.08	—	—
Progesterone blood test inpatient CPT 84144 Progesterone	$248.00	$248.00	$124.00–$238.08	—	—
Prolactin blood test CPT 84146 Prolactin PLAB	$326.00	$326.00	$123.88–$312.96	279% above	—
Prolactin blood test CPT 84146 Prolactin	$326.00	$326.00	$123.88–$312.96	279% above	—
Prolactin blood test inpatient CPT 84146 Prolactin PLAB	$326.00	$326.00	$163.00–$312.96	—	—
Prolactin blood test inpatient CPT 84146 Prolactin	$326.00	$326.00	$163.00–$312.96	—	—
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time	$82.00	$82.00	$30.47–$78.72	70% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 85610 Protime	$82.00	$82.00	$30.47–$78.72	70% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 Protime/PTT	$82.00	$82.00	$30.47–$78.72	70% above	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610 Protime	$82.00	$82.00	$41.00–$78.72	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Protime/PTT	$82.00	$82.00	$41.00–$78.72	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time	$82.00	$82.00	$41.00–$78.72	—	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep A PCR (ID NOW)	$100.00	$100.00	$38.00–$96.00	104% above	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Rapid Strep A Screen 1	$100.00	$100.00	$38.00–$96.00	104% above	—
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Strep A PCR (ID NOW)	$100.00	$100.00	$50.00–$96.00	—	—
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Rapid Strep A Screen 1	$100.00	$100.00	$50.00–$96.00	—	—
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor PLAB	$138.00	$138.00	$52.44–$132.48	207% above	—
Rheumatoid factor (RF) test CPT 86431 RA Factor, Fluid PLAB	$138.00	$138.00	$52.44–$132.48	207% above	—
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor 3	$138.00	$138.00	$52.44–$132.48	207% above	—
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor PLAB	$138.00	$138.00	$69.00–$132.48	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor 3	$138.00	$138.00	$69.00–$132.48	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 RA Factor, Fluid PLAB	$138.00	$138.00	$69.00–$132.48	—	—
Rubella antibody test (immunity check) CPT 86762 Rubella IgG	$138.00	$138.00	$52.44–$132.48	84% above	—
Rubella antibody test (immunity check) CPT 86762 Rubella IgG Ab PLAB	$174.00	$174.00	$66.12–$167.04	132% above	—
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella IgG	$138.00	$138.00	$69.00–$132.48	—	—
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella IgG Ab PLAB	$174.00	$174.00	$87.00–$167.04	—	—
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation Rate	$86.00	$86.00	$32.68–$82.56	92% above	—
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sedimentation Rate	$86.00	$86.00	$43.00–$82.56	—	—
Stool ova and parasites exam CPT 87177 87177 Ova and Parasite, Concentration & ID	$136.00	$136.00	$51.68–$130.56	110% above	—
Stool ova and parasites exam inpatient CPT 87177 87177 Ova and Parasite, Concentration & ID	$136.00	$136.00	$68.00–$130.56	—	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Screen 1-3	$63.00	$63.00	$23.94–$60.48	181% above	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Screen 1-3	$63.00	$63.00	$31.50–$60.48	—	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON TB-GOLD Plus, 1-Tube PLAB	$126.00	$126.00	$47.88–$120.96	38% below	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB Interferon Antigen PLAB	$363.00	$363.00	$137.94–$348.48	80% above	—
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QuantiFERON TB-GOLD Plus, 1-Tube PLAB	$126.00	$126.00	$63.00–$120.96	—	—
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB Interferon Antigen PLAB	$363.00	$363.00	$181.50–$348.48	—	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total PLAB	$160.00	$160.00	$60.80–$153.60	83% above	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total	$160.00	$160.00	$60.80–$153.60	83% above	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Free & Total w/ SHBG, Adult PLAB	$162.00	$162.00	$61.56–$155.52	86% above	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Free & Total w/ SHBG, Children (Age 17 & Under) PLAB	$162.00	$162.00	$61.56–$155.52	86% above	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Bioavail, Female/Child PLAB	$162.00	$162.00	$61.56–$155.52	86% above	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total	$160.00	$160.00	$80.00–$153.60	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total PLAB	$160.00	$160.00	$80.00–$153.60	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Free & Total w/ SHBG, Adult PLAB	$162.00	$162.00	$81.00–$155.52	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Free & Total w/ SHBG, Children (Age 17 & Under) PLAB	$162.00	$162.00	$81.00–$155.52	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Bioavail, Female/Child PLAB	$162.00	$162.00	$81.00–$155.52	—	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Ab PLAB	$264.00	$264.00	$100.32–$253.44	329% above	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Ab PLAB	$264.00	$264.00	$132.00–$253.44	—	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 zzTSH Ultra Sensitive PLAB	$113.00	$113.00	$42.94–$108.48	15% above	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH Ultra Sensitive PLAB	$113.00	$113.00	$42.94–$108.48	15% above	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$216.00	$216.00	$82.08–$207.36	120% above	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 zzTSH Ultra Sensitive PLAB	$113.00	$113.00	$56.50–$108.48	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH Ultra Sensitive PLAB	$113.00	$113.00	$56.50–$108.48	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$216.00	$216.00	$108.00–$207.36	—	—
Trichomonas test (NAAT) CPT 87661 Trichomonas by PCR PLAB	$114.00	$114.00	$43.32–$109.44	16% above	—
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas by PCR PLAB	$114.00	$114.00	$57.00–$109.44	—	—
Uric acid blood test CPT 84550 Uric Acid	$111.00	$111.00	$42.18–$106.56	119% above	—
Uric acid blood test inpatient CPT 84550 Uric Acid	$111.00	$111.00	$55.50–$106.56	—	—
Urinalysis with microscope exam, automated CPT 81001 UA w/ Microscopic Standard	$100.00	$100.00	$29.42–$96.00	119% above	—
Urinalysis with microscope exam, automated inpatient CPT 81001 UA w/ Microscopic Standard	$100.00	$100.00	$50.00–$96.00	—	—
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick	$63.00	$63.00	$23.94–$60.48	132% above	—
Urinalysis without microscope exam, automated CPT 81003 UA w/ Cult if Ind 42	$63.00	$63.00	$23.94–$60.48	132% above	—
Urinalysis without microscope exam, automated CPT 81003 Urinalysis	$63.00	$63.00	$23.94–$60.48	132% above	—
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis	$63.00	$63.00	$31.50–$60.48	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 UA w/ Cult if Ind 42	$63.00	$63.00	$31.50–$60.48	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick	$63.00	$63.00	$31.50–$60.48	—	—
Urinalysis without microscope exam, manual CPT 81002 ER URINE CLINITEK	$63.00	$63.00	$23.94–$60.48	194% above	—
Urinalysis without microscope exam, manual inpatient CPT 81002 ER URINE CLINITEK	$63.00	$63.00	$31.50–$60.48	—	—
Urine pregnancy test, read by color change CPT 81025 81025 URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS TechFee	$110.00	$110.00	$41.80–$105.60	80% above	—
Urine pregnancy test, read by color change CPT 81025 Pregnancy Test Urine 3	$110.00	$110.00	$41.80–$105.60	80% above	—
Urine pregnancy test, read by color change CPT 81025 Pregnancy Test Urine	$110.00	$110.00	$41.80–$105.60	80% above	—
Urine pregnancy test, read by color change inpatient CPT 81025 81025 URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS TechFee	$110.00	$110.00	$55.00–$105.60	—	—
Urine pregnancy test, read by color change inpatient CPT 81025 Pregnancy Test Urine	$110.00	$110.00	$55.00–$105.60	—	—
Urine pregnancy test, read by color change inpatient CPT 81025 Pregnancy Test Urine 3	$110.00	$110.00	$55.00–$105.60	—	—
Vitamin B12 (cobalamin) blood test CPT 82607 VitaminB12 PLAB	$252.00	$252.00	$95.76–$241.92	123% above	—
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12	$252.00	$252.00	$95.76–$241.92	123% above	—
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VitaminB12 PLAB	$252.00	$252.00	$126.00–$241.92	—	—
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12	$252.00	$252.00	$126.00–$241.92	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D Total	$251.00	$251.00	$95.38–$240.96	92% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25-hydroxy PLAB	$251.00	$251.00	$95.38–$240.96	92% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D Total	$251.00	$251.00	$125.50–$240.96	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25-hydroxy PLAB	$251.00	$251.00	$125.50–$240.96	—	—
Zinc blood test CPT 84630 Zinc, Serum PLAB	$137.00	$137.00	$52.06–$131.52	286% above	—
Zinc blood test inpatient CPT 84630 Zinc, Serum PLAB	$137.00	$137.00	$68.50–$131.52	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 hCG Quantitative	$214.00	$214.00	$81.32–$205.44	141% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 hCG Quantitative	$214.00	$214.00	$107.00–$205.44	—	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA Stereotactic Biopsy Rt.	$4,365.00	$4,365.00	$1,658.70–$4,190.40	93% above	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA Stereotactic Biopsy Lt.	$4,365.00	$4,365.00	$1,658.70–$4,190.40	93% above	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA Stereotactic Biopsy Lt	$4,365.00	$4,365.00	$1,658.70–$4,190.40	93% above	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA Stereotactic Biopsy Rt	$4,365.00	$4,365.00	$1,658.70–$4,190.40	93% above	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MA Stereotactic Biopsy Rt.	$4,365.00	$4,365.00	$2,182.50–$4,190.40	—	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MA Stereotactic Biopsy Rt	$4,365.00	$4,365.00	$2,182.50–$4,190.40	—	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MA Stereotactic Biopsy Lt	$4,365.00	$4,365.00	$2,182.50–$4,190.40	—	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MA Stereotactic Biopsy Lt.	$4,365.00	$4,365.00	$2,182.50–$4,190.40	—	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$2,159.00	$2,159.00	$820.42–$2,072.64	51% above	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion	$2,159.00	$2,159.00	$820.42–$2,072.64	51% above	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion	$2,159.00	$2,159.00	$1,079.50–$2,072.64	—	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$2,159.00	$2,159.00	$1,079.50–$2,072.64	—	—
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 LEEP PROCEDURE	$703.00	$703.00	$267.14–$674.88	10% above	—
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 LEEP PROCEDURE	$703.00	$703.00	$351.50–$674.88	—	—
Ear tube placement (tympanostomy) with local anesthesia, one ear both sides CPT 69433 MYRINGOTOMY, WITH TUBE, BILATERAL	$407.00	$407.00	$154.66–$390.72	—	—
Ear tube placement (tympanostomy) with local anesthesia, one ear one side CPT 69433 MYRINGOTOMY, WITH TUBE, UNILATERAL	$335.00	$335.00	$127.30–$321.60	18% below	—
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient both sides CPT 69433 MYRINGOTOMY, WITH TUBE, BILATERAL	$407.00	$407.00	$203.50–$390.72	—	—
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient one side CPT 69433 MYRINGOTOMY, WITH TUBE, UNILATERAL	$335.00	$335.00	$167.50–$321.60	—	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 Remove impacted ear wax ER	$208.00	$208.00	$79.04–$199.68	311% above	—
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Remove impacted ear wax ER	$208.00	$208.00	$104.00–$199.68	—	—
Earwax removal with instruments, one ear CPT 69210 69210 REMVL IMPACTED CERUMEN INSTRUMENTATION	$358.00	$358.00	$136.04–$343.68	326% above	—
Earwax removal with instruments, one ear inpatient CPT 69210 69210 REMVL IMPACTED CERUMEN INSTRUMENTATION	$358.00	$358.00	$179.00–$343.68	—	—
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BIOPSY	$553.00	$553.00	$210.14–$530.88	161% above	—
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BIOPSY	$553.00	$553.00	$276.50–$530.88	—	—
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ EPIDURAL, CERV OR THOR, W/IMAGING	$1,787.00	$1,787.00	$679.06–$1,715.52	69% above	—
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJ EPIDURAL, CERV OR THOR, W/IMAGING	$1,787.00	$1,787.00	$893.50–$1,715.52	—	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ FACET JT/MEDIAL BRANCH, LUMB/SACR, SINGLE LEVEL	$1,673.00	$1,673.00	$635.74–$1,606.08	31% above	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ FACET JT/MEDIAL BRANCH, LUMB/SACR, SINGLE LEV, BIL	$1,764.00	$1,764.00	$670.32–$1,693.44	38% above	—
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ FACET JT/MEDIAL BRANCH, LUMB/SACR, SINGLE LEVEL	$1,673.00	$1,673.00	$836.50–$1,606.08	—	—
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ FACET JT/MEDIAL BRANCH, LUMB/SACR, SINGLE LEV, BIL	$1,764.00	$1,764.00	$882.00–$1,693.44	—	—
Incision and drainage of a simple or single skin abscess CPT 10060 Drainage of Skin Abcess	$849.00	$849.00	$322.62–$815.04	215% above	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Drainage of Skin Abcess	$849.00	$849.00	$424.50–$815.04	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 INJ ARTHROCENTESIS MAJOR JOINT/BURS CHARGE	$409.00	$409.00	$155.42–$392.64	114% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 MS INJECTION MAJOR JOINT/BURSA	$409.00	$409.00	$155.42–$392.64	114% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Major Joint Injection (Hip, Knee, Shoulder)	$409.00	$409.00	$155.42–$392.64	114% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain/inj joint/bursa w/o us ER	$463.00	$463.00	$175.94–$444.48	142% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Cortisone Injection	$623.00	$623.00	$236.74–$598.08	226% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 FRAN RM1 CORTISONE INJECTION	$623.00	$623.00	$236.74–$598.08	226% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 FRAN 20610RT Shoulder/Knee/Hip Inject Rt	$623.00	$623.00	$236.74–$598.08	226% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 FRAN 20610LT Shoulder/Knee/Hip Inject Lt	$623.00	$623.00	$236.74–$598.08	226% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 INJ ARTHROCENTESIS MAJOR JOINT/BURS CHARGE	$409.00	$409.00	$204.50–$392.64	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 MS INJECTION MAJOR JOINT/BURSA	$409.00	$409.00	$204.50–$392.64	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Major Joint Injection (Hip, Knee, Shoulder)	$409.00	$409.00	$204.50–$392.64	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Drain/inj joint/bursa w/o us ER	$463.00	$463.00	$231.50–$444.48	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 FRAN RM1 CORTISONE INJECTION	$623.00	$623.00	$311.50–$598.08	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Cortisone Injection	$623.00	$623.00	$311.50–$598.08	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 FRAN 20610RT Shoulder/Knee/Hip Inject Rt	$623.00	$623.00	$311.50–$598.08	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 FRAN 20610LT Shoulder/Knee/Hip Inject Lt	$623.00	$623.00	$311.50–$598.08	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Intermediate Joint Injection (Wrist, Elbow or Ankle)	$284.00	$284.00	$107.92–$272.64	12% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 MS Inject Intermediate Joint/Bursa	$284.00	$284.00	$107.92–$272.64	12% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 FRAN 20605RT Foot/Ankle/Wrist Inject Rt	$545.00	$545.00	$207.10–$523.20	115% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 FRAN 20605LT Foot/Ankle/Wrist Inject Lt	$545.00	$545.00	$207.10–$523.20	115% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Intermediate Joint Injection (Wrist, Elbow or Ankle)	$284.00	$284.00	$142.00–$272.64	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 MS Inject Intermediate Joint/Bursa	$284.00	$284.00	$142.00–$272.64	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 FRAN 20605RT Foot/Ankle/Wrist Inject Rt	$545.00	$545.00	$272.50–$523.20	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 FRAN 20605LT Foot/Ankle/Wrist Inject Lt	$545.00	$545.00	$272.50–$523.20	—	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 MS Inject Small Joint/Bursa	$259.00	$259.00	$98.42–$248.64	77% above	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Small Joint Injection (Fingers, Toes)	$259.00	$259.00	$98.42–$248.64	77% above	—
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 FRAN 20600RT Toe Injection Rt	$397.00	$397.00	$150.86–$381.12	171% above	—
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 FRAN 20600LT Toe Injection Lt	$397.00	$397.00	$150.86–$381.12	171% above	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Small Joint Injection (Fingers, Toes)	$259.00	$259.00	$129.50–$248.64	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 MS Inject Small Joint/Bursa	$259.00	$259.00	$129.50–$248.64	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 FRAN 20600LT Toe Injection Lt	$397.00	$397.00	$198.50–$381.12	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 FRAN 20600RT Toe Injection Rt	$397.00	$397.00	$198.50–$381.12	—	—
Laser treatment of clouding after cataract surgery (YAG) both sides CPT 66821 YAG LASER, BILATERAL	$1,078.00	$1,078.00	$409.64–$1,034.88	—	—
Laser treatment of clouding after cataract surgery (YAG) one side CPT 66821 YAG LASER, UNILATERAL	$864.00	$864.00	$328.32–$829.44	19% above	—
Laser treatment of clouding after cataract surgery (YAG) inpatient both sides CPT 66821 YAG LASER, BILATERAL	$1,078.00	$1,078.00	$539.00–$1,034.88	—	—
Laser treatment of clouding after cataract surgery (YAG) inpatient one side CPT 66821 YAG LASER, UNILATERAL	$864.00	$864.00	$432.00–$829.44	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM	$788.00	$788.00	$299.44–$756.48	87% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM	$788.00	$788.00	$394.00–$756.48	—	—
Lower-back epidural injection, with imaging guidance CPT 62323 .INJ EPIDURAL, LUMBAR OR CAUDAL, W/IMAGING	$1,876.00	$1,876.00	$712.88–$1,800.96	76% above	—
Lower-back epidural injection, with imaging guidance CPT 62323 XR Fluoro Pain Management	$1,876.00	$1,876.00	$712.88–$1,800.96	76% above	—
Lower-back epidural injection, with imaging guidance CPT 62323 INJ EPIDURAL, LUMBAR OR CAUDAL, W/IMAGING CHARGE	$1,876.00	$1,876.00	$712.88–$1,800.96	76% above	—
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 XR Fluoro Pain Management	$1,876.00	$1,876.00	$938.00–$1,800.96	—	—
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 .INJ EPIDURAL, LUMBAR OR CAUDAL, W/IMAGING	$1,876.00	$1,876.00	$938.00–$1,800.96	—	—
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ EPIDURAL, LUMBAR OR CAUDAL, W/IMAGING CHARGE	$1,876.00	$1,876.00	$938.00–$1,800.96	—	—
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 .INJ TRANSF, LUMB/SACR, SINGLE LEVEL	$1,597.00	$1,597.00	$606.86–$1,533.12	40% above	—
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ TRANSF, LUMB/SACR, SINGLE LEVEL CHARGE	$1,597.00	$1,597.00	$606.86–$1,533.12	40% above	—
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ TRANSF, LUMB/SACR, SINGLE LEVEL, BIL	$1,852.00	$1,852.00	$703.76–$1,777.92	62% above	—
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ TRANSF, LUMB/SACR, SINGLE LEVEL CHARGE	$1,597.00	$1,597.00	$798.50–$1,533.12	—	—
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 .INJ TRANSF, LUMB/SACR, SINGLE LEVEL	$1,597.00	$1,597.00	$798.50–$1,533.12	—	—
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ TRANSF, LUMB/SACR, SINGLE LEVEL, BIL	$1,852.00	$1,852.00	$926.00–$1,777.92	—	—
Occipital nerve block (injection for headaches) CPT 64405 INJ GREATER OCCIPITAL NERVE	$424.00	$424.00	$161.12–$407.04	2% above	—
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJ GREATER OCCIPITAL NERVE	$424.00	$424.00	$212.00–$407.04	—	—
Paracentesis with imaging guidance CPT 49083 FRAN ABD Paracentesis with Imaging	$3,337.00	$3,337.00	$1,268.06–$3,203.52	357% above	—
Paracentesis with imaging guidance inpatient CPT 49083 FRAN ABD Paracentesis with Imaging	$3,337.00	$3,337.00	$1,668.50–$3,203.52	—	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL	$634.00	$634.00	$240.92–$608.64	89% above	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL	$634.00	$634.00	$317.00–$608.64	—	—
Removal of a foreign object under the skin, simple CPT 10120 Remove Foreign Body	$1,505.00	$1,505.00	$571.90–$1,444.80	335% above	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 Remove Foreign Body	$1,505.00	$1,505.00	$752.50–$1,444.80	—	—
Short arm cast (elbow to hand) CPT 29075 29075 APPLICATION CAST ELBOW FINGER SHORT ARM TechFee	$280.00	$280.00	$106.40–$268.80	42% above	—
Short arm cast (elbow to hand) CPT 29075 29075 OT ELBOW/FINGER SPLINT CHARGE	$419.00	$419.00	$159.22–$402.24	112% above	—
Short arm cast (elbow to hand) inpatient CPT 29075 29075 APPLICATION CAST ELBOW FINGER SHORT ARM TechFee	$280.00	$280.00	$140.00–$268.80	—	—
Short arm cast (elbow to hand) inpatient CPT 29075 29075 OT ELBOW/FINGER SPLINT CHARGE	$419.00	$419.00	$209.50–$402.24	—	—
Short arm splint (forearm and hand) CPT 29125 Apply forearm splint with supplies	$265.00	$265.00	$100.70–$254.40	73% above	—
Short arm splint (forearm and hand) CPT 29125 OT Short Arm Splint Units	$292.00	$292.00	$110.96–$280.32	90% above	—
Short arm splint (forearm and hand) CPT 29125 29125 OT SHORT ARM FOREARM HAND SPLINT CHARGE	$292.00	$292.00	$110.96–$280.32	90% above	—
Short arm splint (forearm and hand) inpatient CPT 29125 Apply forearm splint with supplies	$265.00	$265.00	$132.50–$254.40	—	—
Short arm splint (forearm and hand) inpatient CPT 29125 29125 OT SHORT ARM FOREARM HAND SPLINT CHARGE	$292.00	$292.00	$146.00–$280.32	—	—
Short arm splint (forearm and hand) inpatient CPT 29125 OT Short Arm Splint Units	$292.00	$292.00	$146.00–$280.32	—	—
Short leg cast (below the knee) CPT 29405 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE TechFee	$368.00	$368.00	$139.84–$353.28	99% above	—
Short leg cast (below the knee) inpatient CPT 29405 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE TechFee	$368.00	$368.00	$184.00–$353.28	—	—
Short leg splint (calf to foot) CPT 29515 Application lower leg splint with supplies	$312.00	$312.00	$118.56–$299.52	93% above	—
Short leg splint (calf to foot) inpatient CPT 29515 Application lower leg splint with supplies	$312.00	$312.00	$156.00–$299.52	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Repair Simple s/n/ax/gen/trnk 2.5cm/<	$434.00	$434.00	$164.92–$416.64	109% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Repair Simple s/n/ax/gen/trnk 2.5cm/<	$434.00	$434.00	$217.00–$416.64	—	—
Skin biopsy, punch, one lesion CPT 11104 11104 Punch Biopsy of Skin (including simple closure, when performed) Tech Fee	$331.00	$331.00	$125.78–$317.76	30% above	—
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch Biopsy of Skin (including simple closure, when performed) Tech Fee	$331.00	$331.00	$165.50–$317.76	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SMPL Reair, Scalp/Neck/AX/Genit/Trunk 2.6-7.5 CM	$465.00	$465.00	$176.70–$446.40	94% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SMPL Reair, Scalp/Neck/AX/Genit/Trunk 2.6-7.5 CM	$465.00	$465.00	$232.50–$446.40	—	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SMPL Repair, Face/Ears/Eyelids/Nose/Lips > 2.5 cm	$431.00	$431.00	$163.78–$413.76	84% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SMPL Repair, Face/Ears/Eyelids/Nose/Lips > 2.5 cm	$431.00	$431.00	$215.50–$413.76	—	—
Thoracentesis with imaging guidance CPT 32555 US Thoracentesis	$1,838.00	$1,838.00	$698.44–$1,764.48	149% above	—
Thoracentesis with imaging guidance CPT 32555 US Guide Thoracentesis	$1,838.00	$1,838.00	$698.44–$1,764.48	149% above	—
Thoracentesis with imaging guidance inpatient CPT 32555 US Guide Thoracentesis	$1,838.00	$1,838.00	$919.00–$1,764.48	—	—
Thoracentesis with imaging guidance inpatient CPT 32555 US Thoracentesis	$1,838.00	$1,838.00	$919.00–$1,764.48	—	—
Trigger finger release surgery CPT 26055 FRAN Finger Tendon Sheath Incision	$4,077.00	$4,077.00	$1,549.26–$3,913.92	240% above	—
Trigger finger release surgery inpatient CPT 26055 FRAN Finger Tendon Sheath Incision	$4,077.00	$4,077.00	$2,038.50–$3,913.92	—	—
Trigger point injections, 1 or 2 muscles CPT 20552 20552 INJ TRIGGER POINT 1 OR 2 MUSCLE CHARGE	$482.00	$482.00	$183.16–$462.72	220% above	—
Trigger point injections, 1 or 2 muscles CPT 20552 Trigger Point Injection, 1 or 2 muscles	$482.00	$482.00	$183.16–$462.72	220% above	—
Trigger point injections, 1 or 2 muscles CPT 20552 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$662.00	$662.00	$251.56–$635.52	340% above	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 INJ TRIGGER POINT 1 OR 2 MUSCLE CHARGE	$482.00	$482.00	$241.00–$462.72	—	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Trigger Point Injection, 1 or 2 muscles	$482.00	$482.00	$241.00–$462.72	—	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$662.00	$662.00	$331.00–$635.52	—	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Rt	$3,628.00	$3,628.00	$1,378.64–$3,482.88	76% above	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Lt	$3,628.00	$3,628.00	$1,378.64–$3,482.88	76% above	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Lt.	$3,628.00	$3,628.00	$1,378.64–$3,482.88	76% above	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Rt.	$3,628.00	$3,628.00	$1,378.64–$3,482.88	76% above	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Lt	$3,628.00	$3,628.00	$1,814.00–$3,482.88	—	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Rt.	$3,628.00	$3,628.00	$1,814.00–$3,482.88	—	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Rt	$3,628.00	$3,628.00	$1,814.00–$3,482.88	—	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Lt.	$3,628.00	$3,628.00	$1,814.00–$3,482.88	—	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debridement, SUBQ Tissue	$1,401.00	$1,401.00	$532.38–$1,344.96	335% above	—
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 Debridement, SUBQ Tissue	$1,401.00	$1,401.00	$700.50–$1,344.96	—	—

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 Administration	$1,276.00	$1,276.00	$484.88–$1,224.96	84% above	—
Blood transfusion (giving blood or blood components) CPT 36430 36430 BLOOD ADMINISTRATION CHARGE	$1,329.00	$1,329.00	$505.02–$1,275.84	91% above	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Administration	$1,276.00	$1,276.00	$638.00–$1,224.96	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 BLOOD ADMINISTRATION CHARGE	$1,329.00	$1,329.00	$664.50–$1,275.84	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler (MDI) Initial	$260.00	$260.00	$98.80–$249.60	146% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler (MDI) Subsequent	$260.00	$260.00	$98.80–$249.60	146% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZPAP Treatment	$260.00	$260.00	$98.80–$249.60	146% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Initial	$260.00	$260.00	$98.80–$249.60	146% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Meter Dose Inhaler Subsequent	$260.00	$260.00	$98.80–$249.60	146% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Subsequent	$260.00	$260.00	$98.80–$249.60	146% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZPAP SUBSEQUENT	$260.00	$260.00	$98.80–$249.60	146% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Aerosol Therapy	$260.00	$260.00	$98.80–$249.60	146% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZPAP INITIAL	$260.00	$260.00	$98.80–$249.60	146% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Aerosol Treatment.	$260.00	$260.00	$98.80–$249.60	146% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Meter Dose Inhaler Initial	$260.00	$260.00	$98.80–$249.60	146% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Aerosol Therapy	$260.00	$260.00	$130.00–$249.60	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 EZPAP INITIAL	$260.00	$260.00	$130.00–$249.60	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 Aerosol Treatment.	$260.00	$260.00	$130.00–$249.60	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Subsequent	$260.00	$260.00	$130.00–$249.60	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Initial	$260.00	$260.00	$130.00–$249.60	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 EZPAP SUBSEQUENT	$260.00	$260.00	$130.00–$249.60	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 EZPAP Treatment	$260.00	$260.00	$130.00–$249.60	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 Meter Dose Inhaler Initial	$260.00	$260.00	$130.00–$249.60	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 Meter Dose Inhaler Subsequent	$260.00	$260.00	$130.00–$249.60	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Meter Dose Inhaler (MDI) Subsequent	$260.00	$260.00	$130.00–$249.60	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Meter Dose Inhaler (MDI) Initial	$260.00	$260.00	$130.00–$249.60	—	—
Chemotherapy IV infusion, first hour CPT 96413 HIGH COMPLEX DRUG INFUSION, INITIAL, 1ST HR	$950.00	$950.00	$361.00–$912.00	94% above	—
Chemotherapy IV infusion, first hour CPT 96413 HIGH COMPLEX DRUG INFUSION, INITIAL 1ST HR	$986.00	$986.00	$374.68–$946.56	102% above	—
Chemotherapy IV infusion, first hour inpatient CPT 96413 HIGH COMPLEX DRUG INFUSION, INITIAL, 1ST HR	$950.00	$950.00	$475.00–$912.00	—	—
Chemotherapy IV infusion, first hour inpatient CPT 96413 HIGH COMPLEX DRUG INFUSION, INITIAL 1ST HR	$986.00	$986.00	$493.00–$946.56	—	—
Critical care, first 30 to 74 minutes CPT 99291 99291 - FAC ED Critical Care	$3,250.00	$3,250.00	$1,235.00–$3,120.00	406% above	—
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 - FAC ED Critical Care	$3,250.00	$3,250.00	$1,625.00–$3,120.00	—	—
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 .EKG NON-MEDICARE	$585.00	$585.00	$222.30–$561.60	932% above	—
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG - Cardiology/Nursing	$585.00	$585.00	$222.30–$561.60	932% above	—
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG MEDICARE TECH COMP	$585.00	$585.00	$222.30–$561.60	932% above	—
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG MEDICARE TECH COMP	$585.00	$585.00	$292.50–$561.60	—	—
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG - Cardiology/Nursing	$585.00	$585.00	$292.50–$561.60	—	—
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 .EKG NON-MEDICARE	$585.00	$585.00	$292.50–$561.60	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG - TECH COMPONENT	$66.00	$66.00	$25.08–$168.10	67% below	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG MEDICARE TECH COMP	$427.00	$427.00	$162.26–$409.92	113% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG - TECH COMPONENT	$66.00	$66.00	$33.00–$63.36	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG MEDICARE TECH COMP	$427.00	$427.00	$213.50–$409.92	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 FAC ED Level 1 -Room Charge	$312.00	$312.00	$118.56–$299.52	105% above	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 FAC ED Level 1 -Room Charge	$312.00	$312.00	$156.00–$299.52	—	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 - FAC ED Level 2 Room Charge	$568.00	$568.00	$215.84–$545.28	153% above	—
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 - FAC ED Level 2 Room Charge	$568.00	$568.00	$284.00–$545.28	—	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 - FAC ED Level 3 - Room Charge	$940.00	$940.00	$357.20–$902.40	200% above	—
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 - FAC ED Level 3 - Room Charge	$940.00	$940.00	$470.00–$902.40	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 - FAC ED Level 4 Room Charge	$1,390.00	$1,390.00	$528.20–$1,334.40	179% above	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 - FAC ED Level 4 Room Charge	$1,390.00	$1,390.00	$695.00–$1,334.40	—	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 - FAC ED Level 5 - Room Charge	$1,990.00	$1,990.00	$756.20–$1,910.40	182% above	—
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 - FAC ED Level 5 - Room Charge	$1,990.00	$1,990.00	$995.00–$1,910.40	—	—
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS TESTING.	$1,895.00	$1,895.00	$720.10–$1,819.20	80% above	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIAC STRESS TESTING.	$1,895.00	$1,895.00	$947.50–$1,819.20	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 INFUSION OF FLUIDS, INIT, 31 MIN - 1 HR CHARGE	$563.00	$563.00	$213.94–$540.48	43% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 - ED IV INFUSION HYDRATION INITIAL HOUR	$563.00	$563.00	$213.94–$540.48	43% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 - ED IV INFUSION HYDRATION INITIAL HOUR	$563.00	$563.00	$281.50–$540.48	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 INFUSION OF FLUIDS, INIT, 31 MIN - 1 HR CHARGE	$563.00	$563.00	$281.50–$540.48	—	—
IV infusion of a medicine, first hour CPT 96365 96365 INFUSION OF DRUG,INITIAL, UP TO 1 HR CHARGE	$620.00	$620.00	$235.60–$595.20	98% above	—
IV infusion of a medicine, first hour CPT 96365 96365 IV INFUSION 1ST HOUR CHARGE	$620.00	$620.00	$235.60–$595.20	98% above	—
IV infusion of a medicine, first hour CPT 96365 96365 ED IV Infusion Initial up to 1 hour	$620.00	$620.00	$235.60–$595.20	98% above	—
IV infusion of a medicine, first hour CPT 96365 .INFUSION OF DRUG, INITIAL, UP TO 1 HR	$630.00	$630.00	$239.40–$604.80	101% above	—
IV infusion of a medicine, first hour inpatient CPT 96365 96365 IV INFUSION 1ST HOUR CHARGE	$620.00	$620.00	$310.00–$595.20	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 96365 ED IV Infusion Initial up to 1 hour	$620.00	$620.00	$310.00–$595.20	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 96365 INFUSION OF DRUG,INITIAL, UP TO 1 HR CHARGE	$620.00	$620.00	$310.00–$595.20	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 .INFUSION OF DRUG, INITIAL, UP TO 1 HR	$630.00	$630.00	$315.00–$604.80	—	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION SUBQ OR IM	$192.00	$192.00	$72.96–$184.32	92% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 - ED Subq/IM Injection	$192.00	$192.00	$72.96–$184.32	92% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 IM/SQ INJ CHARGE	$192.00	$192.00	$72.96–$184.32	92% above	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION SUBQ OR IM	$192.00	$192.00	$96.00–$184.32	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 IM/SQ INJ CHARGE	$192.00	$192.00	$96.00–$184.32	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 - ED Subq/IM Injection	$192.00	$192.00	$96.00–$184.32	—	—
Neuromuscular re-education, 15 minutes CPT 97112 97112 OT NEUROMUSCULAR RE-EDUCATION	$181.00	$181.00	$68.78–$173.76	137% above	—
Neuromuscular re-education, 15 minutes CPT 97112 97112 PT NEUROMUSCULAR REEDUCATION 15 MINS Charge	$181.00	$181.00	$68.78–$173.76	137% above	—
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation Charges	$181.00	$181.00	$68.78–$173.76	137% above	—
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Reeducation Charges	$181.00	$181.00	$90.50–$173.76	—	—
Neuromuscular re-education, 15 minutes inpatient CPT 97112 97112 OT NEUROMUSCULAR RE-EDUCATION	$181.00	$181.00	$90.50–$173.76	—	—
Neuromuscular re-education, 15 minutes inpatient CPT 97112 97112 PT NEUROMUSCULAR REEDUCATION 15 MINS Charge	$181.00	$181.00	$90.50–$173.76	—	—
Occupational therapy evaluation, low complexity CPT 97165 OT EVALUATION, LOW COMPLEXITY	$278.00	$278.00	$105.64–$266.88	71% above	—
Occupational therapy evaluation, low complexity CPT 97165 OT Low Complex Units	$278.00	$278.00	$105.64–$266.88	71% above	—
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVALUATION, LOW COMPLEXITY	$278.00	$278.00	$139.00–$266.88	—	—
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT Low Complex Units	$278.00	$278.00	$139.00–$266.88	—	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT High Complex Units	$435.00	$435.00	$165.30–$417.60	157% above	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 97163 PT EVALUATION, HIGH COMPLEXITY	$435.00	$435.00	$165.30–$417.60	157% above	—
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 97163 PT EVALUATION, HIGH COMPLEXITY	$435.00	$435.00	$217.50–$417.60	—	—
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT High Complex Units	$435.00	$435.00	$217.50–$417.60	—	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 97161 PT EVALUATION, LOW COMPLEXITY	$278.00	$278.00	$105.64–$266.88	98% above	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Low Complex Units	$278.00	$278.00	$105.64–$266.88	98% above	—
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 97161 PT EVALUATION, LOW COMPLEXITY	$278.00	$278.00	$139.00–$266.88	—	—
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT Low Complex Units	$278.00	$278.00	$139.00–$266.88	—	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 97162 PT EVALUATION, MODERATE COMPLEXITY	$309.00	$309.00	$117.42–$296.64	83% above	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Moderate Complex Units	$309.00	$309.00	$117.42–$296.64	83% above	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 97162 PT EVALUATION, MODERATE COMPLEXITY	$309.00	$309.00	$154.50–$296.64	—	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT Moderate Complex Units	$309.00	$309.00	$154.50–$296.64	—	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 PT MANUAL THERAPY CHARGE Massage	$185.00	$185.00	$68.34–$177.60	116% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 OT MANUAL THERAPY 15 MIN CHARGE	$185.00	$185.00	$68.34–$177.60	116% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy Charge Units	$185.00	$185.00	$68.34–$177.60	116% above	—
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy Charge Units	$185.00	$185.00	$92.50–$177.60	—	—
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 97140 PT MANUAL THERAPY CHARGE Massage	$185.00	$185.00	$92.50–$177.60	—	—
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 97140 OT MANUAL THERAPY 15 MIN CHARGE	$185.00	$185.00	$92.50–$177.60	—	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges	$181.00	$181.00	$68.78–$173.76	125% above	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 PT THERAPEUTIC EXERCISE 15 MINS Charge	$181.00	$181.00	$68.78–$173.76	125% above	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXERCISE CHARGE	$181.00	$181.00	$68.78–$173.76	125% above	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPEUTIC EXERCISE CHARGE	$181.00	$181.00	$90.50–$173.76	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 PT THERAPEUTIC EXERCISE 15 MINS Charge	$181.00	$181.00	$90.50–$173.76	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Charges	$181.00	$181.00	$90.50–$173.76	—	—
Preventive checkup, returning patient aged 18–39 CPT 99395 MRI Chest w/o Cont	$5,272.00	$5,272.00	$2,003.36–$5,061.12	2341% above	—
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 MRI Chest w/o Cont	$5,272.00	$5,272.00	$2,636.00–$5,061.12	—	—
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking/Tobacco Cessation, 3-10 minutes	$52.00	$52.00	$19.76–$49.92	83% above	—
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Smoking/Tobacco Cessation, 3-10 minutes	$52.00	$52.00	$26.00–$49.92	—	—
Speech and language evaluation CPT 92523 92523 EVAL OF SPEECH SOUND PRODUCTION; WITH EVAL OF LANGUAGE COMP	$525.00	$525.00	$199.50–$504.00	88% above	—
Speech and language evaluation CPT 92523 Speech Sound Prod w/ Language Charge	$525.00	$525.00	$199.50–$504.00	88% above	—
Speech and language evaluation inpatient CPT 92523 92523 EVAL OF SPEECH SOUND PRODUCTION; WITH EVAL OF LANGUAGE COMP	$525.00	$525.00	$262.50–$504.00	—	—
Speech and language evaluation inpatient CPT 92523 Speech Sound Prod w/ Language Charge	$525.00	$525.00	$262.50–$504.00	—	—
Speech therapy session, individual CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Charge	$435.00	$435.00	$165.30–$417.60	104% above	—
Speech therapy session, individual CPT 92507 ST TREATMENT OF SPEECH	$435.00	$435.00	$165.30–$417.60	104% above	—
Speech therapy session, individual CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg	$435.00	$435.00	$165.30–$417.60	104% above	—
Speech therapy session, individual inpatient CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg	$435.00	$435.00	$217.50–$417.60	—	—
Speech therapy session, individual inpatient CPT 92507 ST TREATMENT OF SPEECH	$435.00	$435.00	$217.50–$417.60	—	—
Speech therapy session, individual inpatient CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Charge	$435.00	$435.00	$217.50–$417.60	—	—
Spirometry (breathing test) CPT 94010 SPIROMETRY INDUSTRIAL	$115.00	$115.00	$43.70–$110.40	53% below	—
Spirometry (breathing test) CPT 94010 94010 PFS PRE CHARGE	$509.00	$509.00	$193.42–$488.64	106% above	—
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY INDUSTRIAL	$115.00	$115.00	$57.50–$110.40	—	—
Spirometry (breathing test) inpatient CPT 94010 94010 PFS PRE CHARGE	$509.00	$509.00	$254.50–$488.64	—	—
Spirometry before and after a bronchodilator CPT 94060 94060 PFS PRE & POST BRONCHODIALATOR CHARGE	$1,066.00	$1,066.00	$405.08–$1,023.36	136% above	—
Spirometry before and after a bronchodilator inpatient CPT 94060 94060 PFS PRE & POST BRONCHODIALATOR CHARGE	$1,066.00	$1,066.00	$533.00–$1,023.36	—	—
Therapeutic activities (functional training), 15 minutes CPT 97530 97530 OTH THERAPEUTIC ACTIVITIES CHARGE	$181.00	$181.00	$68.78–$173.76	123% above	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Charge	$181.00	$181.00	$68.78–$173.76	123% above	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Charges	$181.00	$181.00	$68.78–$173.76	123% above	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Exercise Charges	$181.00	$181.00	$68.78–$173.76	123% above	—
Therapeutic activities (functional training), 15 minutes CPT 97530 97530 PTH THERAPEUTIC ACTIVITIES CHARGE	$181.00	$181.00	$68.78–$173.76	123% above	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Charge	$181.00	$181.00	$90.50–$173.76	—	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 97530 PTH THERAPEUTIC ACTIVITIES CHARGE	$181.00	$181.00	$90.50–$173.76	—	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Charges	$181.00	$181.00	$90.50–$173.76	—	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 97530 OTH THERAPEUTIC ACTIVITIES CHARGE	$181.00	$181.00	$90.50–$173.76	—	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Exercise Charges	$181.00	$181.00	$90.50–$173.76	—	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy Standard	$280.00	$280.00	$106.40–$268.80	46% above	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Therapeutic Phlebotomy Standard	$280.00	$280.00	$140.00–$268.80	—	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate vaccine - Sus	$374.52	$374.52	$142.32–$359.54	24% below	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conjugate vaccine - Sus	$374.52	$374.52	$187.26–$359.54	—	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 pneumococcal 23-valent vaccine Inj Sol 0 mL [FRAN]	$186.40	$186.40	$70.83–$178.94	3% below	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 pneumococcal 23-valent vaccine Inj Sol 0 mL [FRAN]	$186.40	$186.40	$93.20–$178.94	—	—
Rabies vaccine, one dose CPT 90675 rabies vaccine 2.5 IU Powder-Inj [FRAN]	$575.28	$575.28	$218.61–$552.27	4% above	—
Rabies vaccine, one dose CPT 90675 rabies vaccine, purified chick embryo cell 2.5 intl units Pow	$963.75	$963.75	$366.23–$925.20	75% above	—
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine 2.5 IU Powder-Inj [FRAN]	$575.28	$575.28	$287.64–$552.27	—	—
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, purified chick embryo cell 2.5 intl units Pow	$963.75	$963.75	$481.88–$925.20	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diphth toxoids (Td) adult/adol 5 units-2 units/0.5 mL preservative-free Sus UD [FRAN]	$146.69	$146.69	$55.74–$140.82	200% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus-diphth toxoids (Td) adult/adol 5 units-2 units/0.5 mL preservative-free Sus UD [FRAN]	$146.69	$146.69	$73.35–$140.82	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphtheria/pertussis, acel (Tdap) 5 units-2.5 units-18.5 mcg/0.5 mL IM Susp [FRAN]	$58.50	$58.50	$22.23–$56.16	18% below	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphtheria/pertussis, acel (Tdap) 5 units-2.5 units-18.5 mcg/0.5 mL IM Susp[FRAN]	$58.50	$58.50	$22.23–$56.16	18% below	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 zoster vaccine, inactivated adjuvanted Pow [FRAN]	$304.51	$304.51	$115.71–$292.33	325% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphtheria/pertussis, acel (Tdap) 5 units-2.5 units-18.5 mcg/0.5 mL IM Susp[FRAN]	$58.50	$58.50	$29.25–$56.16	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphtheria/pertussis, acel (Tdap) 5 units-2.5 units-18.5 mcg/0.5 mL IM Susp [FRAN]	$58.50	$58.50	$29.25–$56.16	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 zoster vaccine, inactivated adjuvanted Pow [FRAN]	$304.51	$304.51	$152.26–$292.33	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED 1st VACCINE ADMINISTRATION	$106.00	$106.00	$40.28–$101.76	200% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 VACCINE ADMINISTRATION CHARGE	$106.00	$106.00	$40.28–$101.76	200% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED 1st VACCINE ADMINISTRATION	$106.00	$106.00	$53.00–$101.76	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 VACCINE ADMINISTRATION CHARGE	$106.00	$106.00	$53.00–$101.76	—	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE TechFee	$45.00	$45.00	$17.10–$43.20	at median	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE TechFee	$45.00	$45.00	$22.50–$43.20	—	—

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/7971/470486026_franciscan-care-services_standardcharges.csv