Hospital

Chase County Hospital

Chase County Hospital in Imperial, NE publishes cash prices for 308 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Nebraska median for 197 of 304 procedures and below it for 106. By typical cash price it ranks #41 of 45 Nebraska hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

P O Box 819, 600 W 12TH St, Imperial, NE 69033 Collected Sep 27, 2026 Source price file (308) 882-7111

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 281351 · CMS hospital register

The price file shows no self-pay discount

For 590 of the 590 prices listed here, the cash price in Chase County 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 both sides CPT 73610 Xr Ankle Complete Bilateral	$785.00	$785.00	$275.00–$746.00	—	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Ankle Complete Left	$452.00	$452.00	$158.00–$429.00	37% above	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Ankle Complete Right	$452.00	$452.00	$158.00–$429.00	37% above	—
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Us Abi's	$632.00	$632.00	$221.00–$600.00	36% above	—
Bone scan, whole body (nuclear medicine) CPT 78306 Nm Bone Imaging Whole Body	$2,782.00	$2,782.00	$974.00–$2,643.00	62% above	—
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 Us Breast Bilateral Limited	$978.00	$978.00	$342.00–$929.00	—	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us Breast Right Limited	$515.00	$515.00	$180.00–$489.00	33% above	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us Breast Left Limited	$515.00	$515.00	$180.00–$489.00	33% above	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct Angiography Chest W/ Contrast	$5,126.00	$5,126.00	$1,794.00–$4,870.00	60% above	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abdomen/pelvis W/o Contrastcap Panel	$5,517.00	$5,517.00	$1,931.00–$5,241.00	60% above	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast	$6,471.00	$6,471.00	$2,265.00–$6,147.00	59% above	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abdomen/pelvis W/wo Contrastcap Panel	$7,502.00	$7,502.00	$2,626.00–$7,127.00	51% above	—
CT scan of the abdomen with contrast CPT 74160 Ct Abdomen W/ Contrast	$4,614.00	$4,614.00	$1,615.00–$4,383.00	78% above	—
CT scan of the abdomen without contrast CPT 74150 Ct Abdomen W/o Contrast	$4,194.00	$4,194.00	$1,468.00–$3,984.00	90% above	—
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Maxillofacial W/o Contrast	$2,620.00	$2,620.00	$917.00–$2,489.00	45% above	—
CT scan of the head or brain, no contrast dye CPT 70450 CT scan	$3,371.00	$3,371.00	$1,180.00–$3,202.00	77% above	—
CT scan of the head with contrast CPT 70460 Ct Head Or Brain W/ Contrast	$3,708.00	$3,708.00	$1,298.00–$3,523.00	79% above	—
CT scan of the head without and with contrast CPT 70470 Ct Head Or Brain W/ + W/o Contrast	$4,262.00	$4,262.00	$1,492.00–$4,049.00	71% above	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct Spine Lumbar W/o Contrast	$3,902.00	$3,902.00	$1,366.00–$3,707.00	80% above	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct Spine Cervical W/o Contrast	$3,746.00	$3,746.00	$1,311.00–$3,559.00	67% above	—
CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast	$3,882.00	$3,882.00	$1,359.00–$3,688.00	62% above	—
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Us Carotid Duplex Bilateral	$2,066.00	$2,066.00	$723.00–$1,963.00	—	—
Chest X-ray, 2 views CPT 71046 Xr Chest 2 Views	$477.00	$477.00	$167.00–$453.00	69% above	—
Chest X-ray, single view CPT 71045 X-ray Exam Chest 1 View	$376.00	$376.00	$132.00–$357.00	63% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Us Retroperitoneal Complete	$1,044.00	$1,044.00	$365.00–$992.00	33% above	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Bd Bone Density Dexa Study	$582.00	$582.00	$204.00–$553.00	48% above	—
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Bd Dexa Appendicular	$314.00	$314.00	$110.00–$298.00	35% above	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest W/o Contrastcap Panel	$3,886.00	$3,886.00	$1,360.00–$3,692.00	80% above	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest W/contrast	$4,112.00	$4,112.00	$1,439.00–$3,906.00	65% above	—
Diagnostic mammogram, both breasts CPT 77066 Mammography of both breasts	$537.00	$537.00	$188.00–$510.00	19% above	—
Diagnostic mammogram, one breast CPT 77065 Mammography of one breast	$409.00	$409.00	$143.00–$389.00	30% above	—
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Us Le Arterial Duplex Bilateral	$1,075.00	$1,075.00	$376.00–$1,021.00	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Dup-scan Xtr Veins Complete Bilateral Study	$1,935.00	$1,935.00	$677.00–$1,838.00	—	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Us Echocardiogram Complete	$3,048.00	$3,048.00	$1,067.00–$2,896.00	43% above	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nm Hida Scan W/o Cck	$1,740.00	$1,740.00	$609.00–$1,653.00	20% above	—
Knee X-ray, 3 views both sides CPT 73562 Xr Knee 3 Views Bilateral	$931.00	$931.00	$326.00–$884.00	—	—
Knee X-ray, 3 views one side CPT 73562 Xr Knee 3 Views Right	$468.00	$468.00	$164.00–$445.00	25% above	—
Knee X-ray, 3 views one side CPT 73562 Xr Knee 3 Views Left	$468.00	$468.00	$164.00–$445.00	25% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Abdomen Limitedreport Bce	$251.00	$251.00	$88.00–$238.00	55% below	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Abdomen Limited	$913.00	$913.00	$320.00–$867.00	63% above	—
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI scan of leg joint	$3,869.00	$3,869.00	$1,354.00–$3,676.00	50% 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 Contrast Right	$4,895.00	$4,895.00	$1,713.00–$4,650.00	45% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Lower Extremity Joint W/wo Contrast Left	$4,895.00	$4,895.00	$1,713.00–$4,650.00	45% above	—
MRI of the abdomen without contrast CPT 74181 Mri Abdomen W/o Contrast	$3,994.00	$3,994.00	$1,398.00–$3,794.00	35% above	—
MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Abdomen W/ + W/o Contrast	$5,054.00	$5,054.00	$1,769.00–$4,801.00	36% above	—
MRI of the brain, no contrast dye CPT 70551 Mri Brain W/o Contrast	$4,598.00	$4,598.00	$1,609.00–$4,368.00	45% above	—
MRI of the brain, with and without contrast dye CPT 70553 MRI Scan	$5,817.00	$5,817.00	$2,036.00–$5,526.00	48% above	—
MRI of the lower back, no contrast dye CPT 72148 MRI scan of lower spinal canal	$5,421.00	$5,421.00	$1,897.00–$5,150.00	71% above	—
MRI of the lower back, without and then with contrast dye CPT 72158 Mri Spine Lumbar W/ + W/o Contrast	$6,855.00	$6,855.00	$2,399.00–$6,512.00	75% above	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri Spine Thoracic W/o Contrast	$5,421.00	$5,421.00	$1,897.00–$5,150.00	66% above	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri Spine Cervical W/ + W/o Contrast	$6,855.00	$6,855.00	$2,399.00–$6,512.00	76% above	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri Spine Cervical W/o Contrast	$5,421.00	$5,421.00	$1,897.00–$5,150.00	70% above	—
MRI of the pelvis without and with contrast CPT 72197 Mri Pelvis W/ + W/o Contrast	$5,807.00	$5,807.00	$2,032.00–$5,517.00	61% above	—
MRI of the pelvis, no contrast dye CPT 72195 Mri Pelvis W/o Contrast	$4,592.00	$4,592.00	$1,607.00–$4,362.00	64% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Ue Joint W/o Contrast Left	$3,869.00	$3,869.00	$1,354.00–$3,676.00	59% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Ue Joint W/o Contrast Right	$3,869.00	$3,869.00	$1,354.00–$3,676.00	59% above	—
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nm Myocardial Spect Multi Rest/stress	$6,252.00	$6,252.00	$2,188.00–$5,939.00	51% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us Pelvic Limited	$528.00	$528.00	$185.00–$502.00	48% above	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us Pelvic Complete	$1,036.00	$1,036.00	$363.00–$984.00	32% above	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Abdomial ultrasound of pregnant uterus	$1,061.00	$1,061.00	$371.00–$1,008.00	52% above	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Us Ob < 14 Weeks Single	$872.00	$872.00	$305.00–$828.00	42% above	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Limited (Afi)	$562.00	$562.00	$197.00–$534.00	43% above	—
Screening mammogram, both breasts both sides CPT 77067 Mammography, screening, bilateral	$447.00	$447.00	$156.00–$425.00	—	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder Complete Left	$489.00	$489.00	$171.00–$465.00	46% above	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder Complete Right	$489.00	$489.00	$171.00–$465.00	46% above	—
Transvaginal pelvic ultrasound CPT 76830 Ultrasound pelvis through vagina	$944.00	$944.00	$330.00–$897.00	54% above	—
Transvaginal ultrasound during pregnancy CPT 76817 Us Pregnancy Transvaginal	$727.00	$727.00	$254.00–$691.00	44% above	—
Ultrasound of the abdomen, complete CPT 76700 Ultrasound of abdomen	$1,143.00	$1,143.00	$400.00–$1,086.00	38% above	—
Ultrasound of the scrotum and testicles CPT 76870 Us Scrotum (Contents)	$884.00	$884.00	$309.00–$840.00	36% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Head/neck Soft Tissue	$963.00	$963.00	$337.00–$915.00	63% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Le Venous Duplex Left	$1,488.00	$1,488.00	$521.00–$1,414.00	45% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Le Venous Duplex Right	$1,488.00	$1,488.00	$521.00–$1,414.00	45% above	—
Wrist X-ray, complete, 3 or more views both sides CPT 73110 Xr Wrist Complete Bilateral	$744.00	$744.00	$260.00–$707.00	—	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Complete Right	$376.00	$376.00	$132.00–$357.00	14% above	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Complete Left	$376.00	$376.00	$132.00–$357.00	14% 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	$415.00	$415.00	$145.00–$394.00	44% above	—
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	$415.00	$415.00	$145.00–$394.00	44% above	—
X-ray of the abdomen, 1 view CPT 74018 Xr Abdomen 1 View	$426.00	$426.00	$149.00–$405.00	61% above	—
X-ray of the ankle, 2 views both sides CPT 73600 Xr Ankle 2 Views Bilateral	$596.00	$596.00	$209.00–$566.00	—	—
X-ray of the ankle, 2 views one side CPT 73600 Xr Ankle 2 Views Right	$328.00	$328.00	$115.00–$312.00	31% above	—
X-ray of the ankle, 2 views one side CPT 73600 Xr Ankle 2 Views Left	$328.00	$328.00	$115.00–$312.00	31% above	—
X-ray of the finger(s), 2 or more views both sides CPT 73140 Xr Finger Bilateral	$554.00	$554.00	$194.00–$526.00	—	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger Left	$330.00	$330.00	$115.00–$314.00	46% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger Right	$330.00	$330.00	$115.00–$314.00	46% above	—
X-ray of the foot, 2 views both sides CPT 73620 Xr Foot 2 Views Bilateral	$612.00	$612.00	$214.00–$581.00	—	—
X-ray of the foot, 2 views one side CPT 73620 Xr Foot 2 Views Left	$443.00	$443.00	$155.00–$421.00	104% above	—
X-ray of the foot, 2 views one side CPT 73620 Xr Foot 2 Views Right	$443.00	$443.00	$155.00–$421.00	104% above	—
X-ray of the foot, complete, 3 or more views both sides CPT 73630 Xr Foot Complete Bilateral	$903.00	$903.00	$316.00–$858.00	—	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Complete Right	$452.00	$452.00	$158.00–$429.00	44% above	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Complete Left	$452.00	$452.00	$158.00–$429.00	44% above	—
X-ray of the hand, 3 or more views both sides CPT 73130 Xr Hand Complete Bilateral	$907.00	$907.00	$317.00–$862.00	—	—
X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Min 3 Views Left	$456.00	$456.00	$160.00–$433.00	33% above	—
X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Min 3 Views Right	$456.00	$456.00	$160.00–$433.00	33% above	—
X-ray of the knee, 1 or 2 views both sides CPT 73560 Xr Knee One Or Two Views Bilateral	$850.00	$850.00	$298.00–$808.00	—	—
X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee One Or Two Views Right	$442.00	$442.00	$155.00–$420.00	39% above	—
X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee One Or Two Views Left	$442.00	$442.00	$155.00–$420.00	39% above	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Xr Spine Lumbosacral 2 Or 3 Views	$583.00	$583.00	$204.00–$554.00	48% above	—
X-ray of the lower back, 4 or more views CPT 72110 X-Ray of lower back	$626.00	$626.00	$219.00–$595.00	32% above	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Xr Spine Thoracic 2 Views	$492.00	$492.00	$172.00–$467.00	60% above	—
X-ray of the nasal bones, 3 or more views CPT 70160 Xr Nasal Bones Minimum 3 Views	$477.00	$477.00	$167.00–$453.00	64% above	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xr Spine Cervical 2 Or 3 Views	$474.00	$474.00	$166.00–$450.00	49% above	—
X-ray of the pelvis, 1 or 2 views CPT 72170 Xr Pelvis 1 Or 2 Views	$517.00	$517.00	$181.00–$491.00	92% above	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Xr Sacrum And Coccyx	$419.00	$419.00	$147.00–$398.00	55% above	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase	$68.00	$68.00	$24.00–$65.00	12% above	—
AST (aspartate aminotransferase) enzyme test CPT 84450 Ast Pspc (Kse Addon)	$11.00	$11.00	$4.00–$10.00	81% below	—
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate Aminotransferase	$92.00	$92.00	$32.00–$87.00	61% above	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel, Acute (Rps) Pspc	$200.00	$200.00	$70.00–$190.00	37% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific Ige (Arup) Pspc	$12.00	$12.00	$4.00–$11.00	74% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific Ige, Quantitative	$13.00	$13.00	$5.00–$12.00	72% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Quant Pspc	$16.00	$16.00	$6.00–$15.00	66% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 Egg Whole, Ige (Ibt) Pspc	$33.00	$33.00	$12.00–$31.00	30% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 86003-allergen Specific Ige, Quant Pspc	$33.00	$33.00	$12.00–$31.00	30% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 Venison Ige Pspc	$48.00	$48.00	$17.00–$46.00	2% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Sole Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Eggwhite Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Grape Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Hake Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Hazelnut Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Herring Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Lemon Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Lime Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Lobster Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Macadamia Nut Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Mango Fruit Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Melona Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Orange Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Peach Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Pear Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Pecan Nut Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Perch, Ocean Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Pineapple Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Pistachio Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Potato Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Raspberry Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Red Snapper Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Salmon Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Scallop Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Soybean Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Tomato Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Trout Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Tuna Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Watermelon Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Almond Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Apple Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Avocado Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Banana Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Bass, Black (Sea Bass) Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Beef Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Brazil Nut Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Casein Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cashew Nut Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Catfish Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cherry Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Chicken Meat Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Clam Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Codfish Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cow's Milk Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Crab Ige Pspc	$54.00	$54.00	$19.00–$51.00	15% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Blueberry Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Sardine/pilchard Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Squid Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Sunflower Seed Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Tilapia Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Whey Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Papaya Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Poppy Seed Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cranberry Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Flaxseed Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Gulf Flounder Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Kiwi Fruit Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Anchovy Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Blackberry Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Mackerel Ige Pspc	$67.00	$67.00	$23.00–$64.00	43% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Strawberry Ige(ibt), Pspc	$76.00	$76.00	$27.00–$72.00	62% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Latex Allergen Ige (Ibt) Pspc	$78.00	$78.00	$27.00–$74.00	66% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cinnamon Ige Allergen Pspc	$81.00	$81.00	$28.00–$77.00	72% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Annatto Seed, Ige Pspc	$83.00	$83.00	$29.00–$79.00	77% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Pepper Chili, Ige Pspc	$111.00	$111.00	$39.00–$105.00	136% above	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Ccp Igg Ab Pspc	$71.00	$71.00	$25.00–$67.00	32% below	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Igg By Elisa W/reflex To Hep2 Substrate Pspc	$43.00	$43.00	$15.00–$41.00	46% below	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana (W/o Pattern) Pspc	$157.00	$157.00	$55.00–$149.00	96% above	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Bnpb Natriuretic Peptide (Pspc)	$80.00	$80.00	$28.00–$76.00	59% below	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Nt Pro-bnp	$394.00	$394.00	$138.00–$374.00	101% above	—
Basic metabolic panel (blood test) CPT 80048 Basic metabolic panel	$235.00	$235.00	$82.00–$223.00	73% above	—
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Cytology Cell Block, Tc Pspc	$127.00	$127.00	$44.00–$121.00	34% below	—
Blood culture for bacteria CPT 87040 Blood Culture Pspc	$64.00	$64.00	$22.00–$61.00	64% below	—
Blood culture for bacteria CPT 87040 Blood Culture	$317.00	$317.00	$111.00–$301.00	76% above	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Insurance/lab One Draw	$40.00	$40.00	$14.00–$38.00	56% above	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Non-insurance Draw	$58.00	$58.00	$20.00–$55.00	126% above	—
Blood glucose (sugar) test CPT 82947 Glucose Random	$80.00	$80.00	$28.00–$76.00	67% above	—
Blood lead test CPT 83655 Lead, Adult Pspc	$122.00	$122.00	$43.00–$116.00	89% above	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hcg Qualitative, Serum 1	$219.00	$219.00	$77.00–$208.00	100% above	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Hf Blood Type Abo	$13.00	$13.00	$5.00–$12.00	76% below	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo Type Arc	$89.00	$89.00	$31.00–$85.00	66% above	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Typing Abo	$91.00	$91.00	$32.00–$86.00	69% above	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo/rh(d) Pspc	$271.00	$271.00	$95.00–$257.00	404% above	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord Blood Eval Abo, Pspc	$271.00	$271.00	$95.00–$257.00	404% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Crp Pspc	$26.00	$26.00	$9.00–$25.00	71% below	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive Protein	$167.00	$167.00	$58.00–$159.00	84% above	—
C. difficile toxin gene test (stool PCR) CPT 87493 C Diff Toxin And Antigen (87449) Confirmatory Testing (Rsp) Pspc	$114.00	$114.00	$40.00–$108.00	26% below	—
C. difficile toxin gene test (stool PCR) CPT 87493 C Diff Pcr (Rps) Pspc	$121.00	$121.00	$42.00–$115.00	21% below	—
CA 19-9 blood test (tumor marker) CPT 86301 Ca 19-9, Pspc	$98.00	$98.00	$34.00–$93.00	37% below	—
CA-125 blood test (ovarian cancer marker) CPT 86304 Ca 125 Pspc	$211.00	$211.00	$74.00–$200.00	62% above	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Sars-cov-2 (Covid-19) Rna (Id Now)	$142.00	$142.00	$50.00–$135.00	12% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 87491	$34.00	$34.00	$12.00–$32.00	69% below	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Dna Add On Charge	$169.00	$169.00	$59.00–$161.00	54% above	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids	$202.00	$202.00	$71.00–$192.00	75% above	—
Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (CBC), with differential white blood cells, automated	$162.00	$162.00	$57.00–$154.00	76% above	—
Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (CBC), automated	$102.00	$102.00	$36.00–$97.00	44% above	—
Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals	$277.00	$277.00	$97.00–$263.00	77% above	—
D-dimer blood test (blood clot marker) CPT 85379 Hp D-dimer Pspc	$49.00	$49.00	$17.00–$47.00	63% below	—
D-dimer blood test (blood clot marker) CPT 85379 D-dimer Pspc	$50.00	$50.00	$18.00–$48.00	63% below	—
D-dimer blood test (blood clot marker) CPT 85379 D-dimer	$263.00	$263.00	$92.00–$250.00	97% above	—
DHEA sulfate (DHEA-S) blood test CPT 82627 Dhea Sulfate Pspc	$119.00	$119.00	$42.00–$113.00	16% below	—
Estradiol blood test CPT 82670 Estradiol Pspc	$198.00	$198.00	$69.00–$188.00	44% above	—
FSH (follicle-stimulating hormone) test CPT 83001 Fsh Pspc	$163.00	$163.00	$57.00–$155.00	45% above	—
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Stool Pspc	$686.00	$686.00	$240.00–$652.00	91% above	—
Ferritin blood test (iron stores) CPT 82728 Test Name Pspc	$234.00	$234.00	$82.00–$222.00	123% above	—
Folate (folic acid) blood test CPT 82746 Folate Pspc	$37.00	$37.00	$13.00–$35.00	65% below	—
Folate (folic acid) blood test CPT 82746 Folate Level	$184.00	$184.00	$64.00–$175.00	75% above	—
Free T3 thyroid hormone test CPT 84481 Ft3 Free T3 Pspc	$106.00	$106.00	$37.00–$101.00	32% below	—
Free T3 thyroid hormone test CPT 84481 Free T3	$257.00	$257.00	$90.00–$244.00	65% above	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 Ed Pspc	$122.00	$122.00	$43.00–$116.00	40% above	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4	$132.00	$132.00	$46.00–$125.00	52% above	—
Free testosterone test CPT 84402 Testo, Free Dir Pspc	$212.00	$212.00	$74.00–$201.00	92% above	—
Free testosterone test CPT 84402 Testo, T & Fed Pspc	$287.00	$287.00	$100.00–$273.00	159% above	—
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel Chas	$640.00	$640.00	$224.00–$608.00	119% above	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Gtt 1-hour	$113.00	$113.00	$40.00–$107.00	105% above	—
Glucose tolerance test, 3 samples CPT 82951 .Gluc Fasting	$210.00	$210.00	$74.00–$200.00	60% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Chlamydia/gc Pcr Pspc	$167.00	$167.00	$58.00–$159.00	51% above	—
H. pylori antibody blood test CPT 86677 H Pylori Iga Add On	$243.00	$243.00	$85.00–$231.00	218% above	—
H. pylori antibody blood test CPT 86677 H Pylori Igm Add On	$243.00	$243.00	$85.00–$231.00	218% above	—
H. pylori antibody blood test CPT 86677 Helicobacter Pylori Antibody, Igg (Rps) Pspc	$243.00	$243.00	$85.00–$231.00	218% above	—
H. pylori stool antigen test CPT 87338 H Pylori Ag, Stool Pspc	$263.00	$263.00	$92.00–$250.00	63% above	—
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv Rna Viral Load, Us Pspc	$364.00	$364.00	$127.00–$346.00	30% below	—
HIV-1 and HIV-2 antibody test CPT 86703 Rapid Hiv 1	$137.00	$137.00	$48.00–$130.00	91% above	—
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hiv 1/2 Abs Pspc	$60.00	$60.00	$21.00–$57.00	19% below	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 Hpv High Risk, W/rflx To Genotype Pspc	$113.00	$113.00	$40.00–$107.00	2% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hgb A1c, Pspc	$30.00	$30.00	$11.00–$29.00	59% below	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c	$128.00	$128.00	$45.00–$122.00	76% above	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody, Pspc	$39.00	$39.00	$14.00–$37.00	57% below	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hbsag, Pspc	$37.00	$37.00	$13.00–$35.00	60% below	—
Hepatitis C antibody blood test (screening) CPT 86803 Hep C Virus, Ab Pspc	$149.00	$149.00	$52.00–$142.00	63% above	—
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Virus Rna Detect/qnt (Rps) Pspc	$346.00	$346.00	$121.00–$329.00	3% above	—
Herpes blood test, HSV-1 antibody CPT 86695 Hsv 1, Igm Type Spec Pspc	$111.00	$111.00	$39.00–$105.00	9% above	—
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Type 1, Pspc	$124.00	$124.00	$43.00–$118.00	21% above	—
Herpes blood test, HSV-2 antibody CPT 86696 Hsv 2, Igm Type Spec Pspc	$111.00	$111.00	$39.00–$105.00	4% above	—
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Type 2, Pspc	$128.00	$128.00	$45.00–$122.00	20% above	—
High-sensitivity CRP (hs-CRP) test CPT 86141 Crp, Cardiac Pspc	$60.00	$60.00	$21.00–$57.00	28% below	—
Homocysteine blood test CPT 83090 Hp Homocysteine, Blood Pspc	$77.00	$77.00	$27.00–$73.00	46% below	—
Homocysteine blood test CPT 83090 Homocysteine. Ser Pspc	$342.00	$342.00	$120.00–$325.00	139% above	—
Insulin blood test CPT 83525 83527 Insulin, Total (Arup) Pspc	$39.00	$39.00	$14.00–$37.00	64% below	—
Insulin blood test CPT 83525 Insulin, Total Pspc	$66.00	$66.00	$23.00–$63.00	39% below	—
Iron blood test (serum iron) CPT 83540 Iron Pspciron & Ibc Pspc	$78.00	$78.00	$27.00–$74.00	24% above	—
Iron-binding capacity (TIBC) test CPT 83550 Tibc Add-oniron & Ibc Pspc	$98.00	$98.00	$34.00–$93.00	38% above	—
Kidney function blood test panel CPT 80069 Kidney function panel test	$216.00	$216.00	$76.00–$205.00	58% above	—
LH (luteinizing hormone) test CPT 83002 Lh Lut Hormone Pspc	$146.00	$146.00	$51.00–$139.00	17% above	—
Lipase blood test (pancreas enzyme) CPT 83690 Body Fluid Lipase Pspc	$41.00	$41.00	$14.00–$39.00	57% below	—
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$189.00	$189.00	$66.00–$180.00	97% above	—
Liver function blood test panel CPT 80076 Liver function blood test	$197.00	$197.00	$69.00–$187.00	50% above	—
Lyme disease antibody test CPT 86618 Lyme Disease Ab Pspc	$288.00	$288.00	$101.00–$274.00	121% above	—
Magnesium blood test CPT 83735 Magnesium, Urine Random Pspc	$40.00	$40.00	$14.00–$38.00	42% below	—
Magnesium blood test CPT 83735 Magnesium, Rbc Pspc	$86.00	$86.00	$30.00–$82.00	25% above	—
Magnesium blood test CPT 83735 Magnesium Level	$121.00	$121.00	$42.00–$115.00	76% above	—
Measles (rubeola) antibody test CPT 86765 Rubeola Ab Pspc	$41.00	$41.00	$14.00–$39.00	51% below	—
Measles (rubeola) antibody test CPT 86765 Rubeola Ab Igg Pspc	$81.00	$81.00	$28.00–$77.00	4% below	—
Mono test (heterophile antibody, Monospot) CPT 86308 Mono Screen 3	$132.00	$132.00	$46.00–$125.00	104% above	—
Obstetric blood test panel CPT 80055 Obstetric blood test panel	$339.00	$339.00	$119.00–$322.00	71% above	—
PSA (prostate-specific antigen) blood test, free CPT 84154 Total prostate-specific antigen (PSA) test	$194.00	$194.00	$68.00–$184.00	52% above	—
PSA (prostate-specific antigen) blood test, total CPT 84153 Total prostate-specific antigen (PSA) test	$166.00	$166.00	$58.00–$158.00	57% above	—
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Pap Liquid Based-surepath Pspc	$61.00	$61.00	$21.00–$58.00	7% above	—
Parathyroid hormone (PTH) blood test CPT 83970 Pth, Intact Pspc	$302.00	$302.00	$106.00–$287.00	43% above	—
Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test	$136.00	$136.00	$48.00–$129.00	76% above	—
Progesterone blood test CPT 84144 Progesterone Pspc	$78.00	$78.00	$27.00–$74.00	30% below	—
Prolactin blood test CPT 84146 Prolactin Pspc	$202.00	$202.00	$71.00–$192.00	70% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time	$117.00	$117.00	$41.00–$111.00	131% above	—
Rapid flu test (influenza antigen) CPT 87804 Rapid Flu Poc	$115.00	$115.00	$40.00–$109.00	63% above	—
Rapid flu test (influenza antigen) CPT 87804 Influenza A&b Pspc	$166.00	$166.00	$58.00–$158.00	135% above	—
Rapid flu test (influenza antigen) CPT 87804 Influenza A&b 1	$186.00	$186.00	$65.00–$177.00	164% above	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Rapid Strep Poc	$26.00	$26.00	$9.00–$25.00	47% below	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep A Screen 1	$139.00	$139.00	$49.00–$132.00	185% above	—
Rheumatoid factor (RF) test CPT 86431 Sle Profile (A) Pspc	$114.00	$114.00	$40.00–$108.00	109% above	—
Rubella antibody test (immunity check) CPT 86762 Rubella Screen Pspc	$50.00	$50.00	$18.00–$48.00	34% below	—
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation Rate	$90.00	$90.00	$31.00–$86.00	91% above	—
Stool ova and parasites exam CPT 87177 O/p, Fregn Trav Pspc	$163.00	$163.00	$57.00–$155.00	115% above	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Stool Screen 1	$64.00	$64.00	$22.00–$61.00	131% above	—
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Occult Blood Stool 1	$79.00	$79.00	$28.00–$75.00	91% above	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl, Csf Pspc	$96.00	$96.00	$34.00–$91.00	127% above	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tb Interferon Antigen Response (Quantiferon-tb Gold) Pspc	$266.00	$266.00	$93.00–$253.00	32% above	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total Add On Charge 1	$98.00	$98.00	$34.00–$93.00	15% below	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total Add On Charge 2	$168.00	$168.00	$59.00–$160.00	46% above	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Microsomal Ab Pspc	$64.00	$64.00	$22.00–$61.00	29% below	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Peroxidase (Tp0) Ab Pspc	$170.00	$170.00	$59.00–$162.00	88% above	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH)	$202.00	$202.00	$71.00–$192.00	87% above	—
Uric acid blood test CPT 84550 Uric Acid Pspc (Kse Addon)	$11.00	$11.00	$4.00–$10.00	79% below	—
Uric acid blood test CPT 84550 Uric Acid	$91.00	$91.00	$32.00–$86.00	73% above	—
Urinalysis with microscope exam, automated CPT 81001 Urinalysis test using microscope	$96.00	$96.00	$34.00–$91.00	88% above	—
Urinalysis without microscope exam, automated CPT 81003 Urinalysis test	$75.00	$75.00	$26.00–$71.00	138% above	—
Urine culture for bacteria, with colony count CPT 87086 Urine Culture	$146.00	$146.00	$51.00–$139.00	103% above	—
Urine culture for bacteria, with colony count CPT 87086 Urine Culture(rps) Pspc	$146.00	$146.00	$51.00–$139.00	103% above	—
Urine pregnancy test, read by color change CPT 81025 Hcg Qualitative, Urineclinic	$121.00	$121.00	$42.00–$115.00	91% above	—
Urine pregnancy test, read by color change CPT 81025 Hcg Qualitative, Urine 2	$121.00	$121.00	$42.00–$115.00	91% above	—
Vitamin B12 (cobalamin) blood test CPT 82607 Vit B12 & Folate Pspc	$37.00	$37.00	$13.00–$35.00	67% below	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25-hydroxyvitamin D2 And D3 Pspc	$107.00	$107.00	$37.00–$102.00	28% below	—
Zinc blood test CPT 84630 Zinc, Serum Or Plasma (Rps) Pspc	$71.00	$71.00	$25.00–$67.00	4% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta Hcg, Tmr Mrkr Pspc	$72.00	$72.00	$25.00–$68.00	19% below	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Quantitative	$229.00	$229.00	$80.00–$218.00	158% above	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Botox injections for chronic migraine CPT 64615 64615-chemodenerv Musc Migraine-surg Tech	$647.00	$647.00	$226.00–$615.00	60% above	—
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Cltx Dstl Fibular Fx Lat Malls W/o Manj Techfee	$458.00	$458.00	$160.00–$435.00	10% above	—
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Fracture Distal Fibula Clinic Charge	$618.00	$618.00	$216.00–$587.00	48% above	—
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); W/o Manipulation-clinic	$702.00	$702.00	$246.00–$667.00	68% above	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 Treat Metatarsal Fractureed Pf	$429.00	$429.00	$150.00–$408.00	17% above	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Fx Metatarsal Charge	$454.00	$454.00	$159.00–$431.00	23% above	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Treat Metatarsal Fractureclinic Charge	$534.00	$534.00	$187.00–$507.00	45% above	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28475 Closed Tx Of Metatarsal Fx, With Manipulation Each	$942.00	$942.00	$330.00–$895.00	156% above	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960-cardioversion Electric Ext-sc Tech	$134.00	$134.00	$47.00–$127.00	91% below	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960-cardioversion Electric External-ccc Ed Pf	$220.00	$220.00	$77.00–$209.00	85% below	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960-cardioversion Electric External-ccc Ed Tech	$2,033.00	$2,033.00	$712.00–$1,931.00	42% above	—
Cervical biopsy CPT 57500 57500 Biopsy Of Cervix	$114.00	$114.00	$40.00–$108.00	69% below	—
Cesarean delivery, including prenatal and postpartum care CPT 59510 Obstetric care, planned cesarean delivery	$5,098.00	$5,098.00	$1,784.00–$4,843.00	at median	—
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 54161 Circumcision	$401.00	$401.00	$140.00–$381.00	59% below	—
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 54161-circumcision Age >28 Days-ccc	$655.00	$655.00	$229.00–$622.00	33% below	—
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 Circumcision Charge	$193.00	$193.00	$68.00–$183.00	54% below	—
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision Charge	$3,648.00	$3,648.00	$1,277.00–$3,466.00	761% above	—
Circumcision, surgical, older than a newborn CPT 54160 Circumcision Neonate Charge	$2,417.00	$2,417.00	$846.00–$2,296.00	183% above	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Tx Distal Radial Frac Ed Charge	$607.00	$607.00	$212.00–$577.00	26% above	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Treat Fx Radius/ulna-ed	$683.00	$683.00	$239.00–$649.00	42% above	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Closed Trt Of Distal Radial Fracture (Eg Colles Or Smith Type) Or Epiphyseal Separation-clinic	$725.00	$725.00	$254.00–$689.00	51% above	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600-treat Fracture Radius/ulna-sc Tech	$875.00	$875.00	$306.00–$831.00	82% above	—
Colonoscopy with polyp removal CPT 45385 Removal of polyps or growths of large bowel using an endoscope	$2,705.00	$2,705.00	$947.00–$2,570.00	132% above	—
Colonoscopy with tissue sample CPT 45380 Biopsy exam of large bowel using an endoscope	$2,918.00	$2,918.00	$1,021.00–$2,772.00	104% above	—
Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using an endoscope	$2,918.00	$2,918.00	$1,021.00–$2,772.00	131% above	—
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Colposcopy Of The Cervix W/biopsy And Endocervical Curettage Technical Charge	$334.00	$334.00	$117.00–$317.00	10% above	—
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 52000 Cysto	$161.00	$161.00	$56.00–$153.00	70% below	—
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystourethroscopy Charge	$2,479.00	$2,479.00	$868.00–$2,355.00	355% above	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Electronic Analysis Of Implanted Neurostimulator Pulse Gener	$121.00	$121.00	$42.00–$115.00	5% below	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Destruction Benign/premalig Lesion Charge	$183.00	$183.00	$64.00–$174.00	43% above	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209-remove Impacted Ear Wax Uni-er Tech	$238.00	$238.00	$83.00–$226.00	411% above	—
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 Removal Impacted Cerumen Using Irrigation/lavage, Unilateral	$17.00	$17.00	$6.00–$16.00	64% below	—
Earwax removal with instruments, one ear CPT 69210 69210-remove Impacted Ear Wax Uni-sc Tech	$37.00	$37.00	$13.00–$35.00	59% below	—
Earwax removal with instruments, one ear CPT 69210 Remove Impacted Ear Wax Uni- 69210	$65.00	$65.00	$23.00–$62.00	27% below	—
Earwax removal with instruments, one ear CPT 69210 69210 Remove Impacted Ear Wax Unied Tech	$325.00	$325.00	$114.00–$309.00	264% above	—
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 58100 Endometrial Biopsy	$114.00	$114.00	$40.00–$108.00	49% below	—
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Biopsy Endometrial Charge	$239.00	$239.00	$84.00–$227.00	7% above	—
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 62321 Crna Epidural, Cervical Or Thoracic W/ Imaging Guidance (Fluoroscopy Or Ct)	$218.00	$218.00	$76.00–$207.00	79% below	—
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Epidural Cervical Or Thoracic W/imaging Guidance	$2,415.00	$2,415.00	$845.00–$2,294.00	128% above	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 64493- Inj Paravert F Jnt L/s 1 Level-scpf	$185.00	$185.00	$65.00–$176.00	86% below	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Facet Joint Inj	$1,810.00	$1,810.00	$634.00–$1,720.00	41% above	—
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330 Sigmoidoscopy Dx Pttech	$2,083.00	$2,083.00	$729.00–$1,979.00	370% above	—
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy Dx Charge	$2,083.00	$2,083.00	$729.00–$1,979.00	370% above	—
Gallbladder removal, laparoscopic CPT 47562 Removal of gallbladder using an endoscope	$9,649.00	$9,649.00	$3,377.00–$9,167.00	428% above	—
IUD insertion (the device itself billed separately) CPT 58300 58300 Iud, Insert Charge	$177.00	$177.00	$62.00–$168.00	19% below	—
Incision and drainage of a simple or single skin abscess CPT 10060 10060 -Drainage Of Skin Abscess -Sc Tech	$85.00	$85.00	$30.00–$81.00	67% below	—
Incision and drainage of a simple or single skin abscess CPT 10060 10060drainage Of Skin Abscessedpf	$218.00	$218.00	$76.00–$207.00	16% below	—
Incision and drainage of a simple or single skin abscess CPT 10060 10060 Drain Skin Abscess, Simple/single Charge	$286.00	$286.00	$100.00–$272.00	10% above	—
Incision and drainage of a simple or single skin abscess CPT 10060 10060 I&d Abscess Simple/single	$515.00	$515.00	$180.00–$489.00	99% above	—
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair of groin hernia patient age 5 years or older	$1,024.00	$1,024.00	$358.00–$973.00	44% below	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550-inj Tendon Sheath/ligament- Sc Tech	$41.00	$41.00	$14.00–$39.00	78% below	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Sc Pf/tech Inj Single Tendon Sheath/ligament [Chas]	$79.00	$79.00	$28.00–$75.00	58% below	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Injection(s); Single Tendon Sheath, Or Ligament, Apo Neurosis (Eg, Plantar Fascia)	$128.00	$128.00	$45.00–$122.00	32% below	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550-inj Tendon Sheath/ligament-surg Tech	$179.00	$179.00	$63.00–$170.00	4% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Drain/inj Joint/bursa W/o Us	$90.00	$90.00	$31.00–$86.00	53% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610-drain/inject Joint/bursasc Tech	$100.00	$100.00	$35.00–$95.00	48% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610-drain/inj Joint/bursa W/o Us	$226.00	$226.00	$79.00–$215.00	18% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Arthrocentesis Major Joint, Shoulder, Hip, Knee Charge	$239.00	$239.00	$84.00–$227.00	25% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Er/aspiration/inject Major Joint	$528.00	$528.00	$185.00–$502.00	176% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain/inj Joint/bursa W/o Us-tech	$528.00	$528.00	$185.00–$502.00	176% above	—
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981-insert Drug Implant Device-sc Pf	$124.00	$124.00	$43.00–$118.00	47% below	—
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 Insertion Drug Delivery Implantcontracept Syst	$339.00	$339.00	$119.00–$322.00	44% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605-drain/inject Joint/bursa -Sc Tech	$43.00	$43.00	$15.00–$41.00	76% below	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Arthrocentesis Intermed Joint, Wrist, Elbow, Ankle Charge	$111.00	$111.00	$30.00–$105.00	37% below	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605-drain/inj Joint/bursa W/o Us	$211.00	$211.00	$74.00–$200.00	19% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Drain/inj Joint/bursa W/o Us-tech	$528.00	$528.00	$185.00–$502.00	198% above	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600-drain/inject Joint/bursa -Sc Tech	$41.00	$41.00	$14.00–$39.00	71% below	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Drain/inject Joint/bursa	$72.00	$72.00	$25.00–$68.00	49% below	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600drain/inj Joint/bursa W/o Us -Surg Tech	$80.00	$80.00	$28.00–$76.00	44% below	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Arthrocentesis, Aspirtn And/or Inj; Small Joint Or Bursa (Eg, Fingers, Toes) Charge	$107.00	$107.00	$37.00–$102.00	25% below	—
Knee arthroscopy with meniscus trim CPT 29881 Removal of one knee cartilage using an endoscope	$1,091.00	$1,091.00	$382.00–$1,036.00	58% below	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Intmd Rpr S/a/t/ext 2.5 Cm/<-ed Pf	$307.00	$307.00	$107.00–$292.00	27% below	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Intmd Rpr S/a/t/ext 2.5 Cm/<-ccc	$553.00	$553.00	$194.00–$525.00	32% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Intmd Rpr S/a/t/ext 2.5 Cm/<-ed Tech	$662.00	$662.00	$232.00–$629.00	58% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Intmd Rpr S/a/t/ext 2.5 Cm/<ed Tech	$876.00	$876.00	$307.00–$832.00	109% above	—
Lower-back epidural injection, with imaging guidance CPT 62323 Injection(s) of therapeutic substance	$2,266.00	$2,266.00	$793.00–$2,153.00	98% above	—
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection(s) of anesthetic into lower spine using imaging guidance	$1,486.00	$1,486.00	$520.00–$1,412.00	1% above	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400-exctr-ext B9+marg 0.5 Cm<	$172.00	$172.00	$60.00–$163.00	43% below	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Remove Lesion, Trunk/arm/leg <.5 Cm Charge	$299.00	$299.00	$105.00–$284.00	at median	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Ex Ben Les Fce/er/ns/lip	$300.00	$300.00	$105.00–$285.00	12% below	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Remove Lesion, Face/lid/ear/nose/lip <.5 Cm Charge	$318.00	$318.00	$111.00–$302.00	6% below	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Or-complex First 30 Charge	$5,326.00	$5,326.00	$1,864.00–$5,060.00	1471% above	—
Nail removal (partial or complete), one nail CPT 11730 11730-removal Of Nail Plate-sc Tech	$64.00	$64.00	$22.00–$61.00	71% below	—
Nail removal (partial or complete), one nail CPT 11730 11730-removal Of Nail Plate-er Pf	$111.00	$111.00	$39.00–$105.00	51% below	—
Nail removal (partial or complete), one nail CPT 11730 11730- Removal Of Nail Plate -Tech	$318.00	$318.00	$111.00–$302.00	42% above	—
Nail removal (partial or complete), one nail CPT 11730 11730 Avulsion Of Nail Plate, Partial Or Complete, Simple; Single Charge	$342.00	$342.00	$120.00–$325.00	52% above	—
Nail removal (partial or complete), one nail CPT 11730 11730 Nail Avulsion Ed Tech	$549.00	$549.00	$192.00–$522.00	145% above	—
Occipital nerve block (injection for headaches) CPT 64405 64405 Nerve Block Inj Occipital-clinic	$220.00	$220.00	$77.00–$209.00	47% below	—
Occipital nerve block (injection for headaches) CPT 64405 N Block Inj Occipital	$528.00	$528.00	$185.00–$502.00	27% above	—
Paracentesis with imaging guidance CPT 49083 49083- Abd Paracentesis W/ Imaging -Tech	$2,892.00	$2,892.00	$1,012.00–$2,747.00	245% above	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750-removal Of Nail Bed-sc Tech	$172.00	$172.00	$60.00–$163.00	48% below	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750removal Of Nail Bedscpf	$209.00	$209.00	$73.00–$199.00	37% below	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Excise Of Nail & Matrix, Part. Or Complete, For Permanent Removal Charge	$560.00	$560.00	$196.00–$532.00	68% above	—
Prostate biopsy CPT 55700 Biopsy of prostate gland	$758.00	$758.00	$265.00–$720.00	33% below	—
Removal of a breast lump, open surgery CPT 19120 Removal of one or more breast growth, open procedure	$823.00	$823.00	$288.00–$782.00	31% below	—
Removal of a foreign object under the skin, simple CPT 10120 Incision And Removal Of Foreign Body, Subcutaneous	$212.00	$212.00	$74.00–$201.00	36% below	—
Removal of a foreign object under the skin, simple CPT 10120 10120 Incision & Removal Fb, Sub-q, Simple	$215.00	$215.00	$75.00–$204.00	35% below	—
Removal of a foreign object under the skin, simple CPT 10120 10120 Incision & Removal Of Foreign Body, Subcutaneous Tissues; Simple Charge	$366.00	$366.00	$128.00–$348.00	11% above	—
Removal of a foreign object under the skin, simple CPT 10120 10120 Fb Removal; Subq, Simpleed Tech	$620.00	$620.00	$217.00–$589.00	87% above	—
Removal of a foreign object under the skin, simple CPT 10120 10120 Fb Removal; Subq, Simple Ed Tech	$655.00	$655.00	$229.00–$622.00	98% above	—
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Cscope Screening Charge Medicare	$367.00	$367.00	$128.00–$349.00	53% below	—
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Cscope Screening Charge	$2,400.00	$2,400.00	$840.00–$2,280.00	204% above	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal Screen; Hi Risk Ind	$2,552.00	$2,552.00	$893.00–$2,424.00	209% above	—
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 50590 Lithotripsy Kidney	$1,530.00	$1,530.00	$483.00–$1,454.00	43% below	—
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 50590 Lithotripsy Esl	$11,624.00	$11,624.00	$4,068.00–$11,043.00	334% above	—
Short arm cast (elbow to hand) CPT 29075 29075 Cast Arm Short Apply	$127.00	$127.00	$44.00–$121.00	36% below	—
Short arm cast (elbow to hand) CPT 29075 29075 Cast Arm Short Apply -Sc Tech	$129.00	$129.00	$45.00–$123.00	35% below	—
Short arm cast (elbow to hand) CPT 29075 29075 Applic, Cast; Elbow To Finger (Short Arm) Charge	$234.00	$234.00	$82.00–$222.00	18% above	—
Short arm splint (forearm and hand) CPT 29125 29125 Apply Forearm Splinted Pf	$82.00	$82.00	$29.00–$78.00	47% below	—
Short arm splint (forearm and hand) CPT 29125 Applic Of Short Arm Splint (Forearm To Hand); Static Charge	$82.00	$82.00	$29.00–$78.00	47% below	—
Short arm splint (forearm and hand) CPT 29125 29125 Application Of Short Arm Splint; Static	$224.00	$224.00	$78.00–$213.00	46% above	—
Short arm splint (forearm and hand) CPT 29125 29125 Appl Splnt Shrt Arm St	$438.00	$438.00	$153.00–$416.00	185% above	—
Short leg cast (below the knee) CPT 29405 29405 Short Leg Cast/below Knee To Toes Clinic Charge	$118.00	$118.00	$41.00–$112.00	36% below	—
Short leg cast (below the knee) CPT 29405 29405 Apply Short Leg Casted Pf	$119.00	$119.00	$42.00–$113.00	36% below	—
Short leg cast (below the knee) CPT 29405 29405 Application Of Short Leg Cast-clinic	$179.00	$179.00	$63.00–$170.00	4% below	—
Short leg cast (below the knee) CPT 29405 29405 Apply Short Leg Casted Tech	$502.00	$502.00	$176.00–$477.00	171% above	—
Short leg splint (calf to foot) CPT 29515 29515-application Lower Leg Splint-sc Tech	$87.00	$87.00	$30.00–$83.00	46% below	—
Short leg splint (calf to foot) CPT 29515 29515 Apply Lower Leg Splint Calf-footprof Chg	$101.00	$101.00	$35.00–$96.00	38% below	—
Short leg splint (calf to foot) CPT 29515 29515 Applic Of Short Leg Splint (Calf To Foot) Charge	$162.00	$162.00	$57.00–$154.00	at median	—
Short leg splint (calf to foot) CPT 29515 29515 Apply Lower Leg Splint Calf-footed Tech	$263.00	$263.00	$92.00–$250.00	62% above	—
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shaving of shoulder bone using endoscope	$336.00	$336.00	$118.00–$319.00	72% below	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Rpr Smpl Sclp/nck/trnk/ex	$88.00	$88.00	$31.00–$84.00	58% below	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk And/or Extrem; 2.5 Cm > Charge	$215.00	$215.00	$75.00–$204.00	3% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001-rpr Smpl Sclp/nck/trnk/ex-ed Tech	$505.00	$505.00	$177.00–$480.00	143% above	—
Skin biopsy, punch, one lesion CPT 11104 11104- Punch Bx Skin Single Lesion -Scpf	$94.00	$94.00	$33.00–$89.00	63% below	—
Skin biopsy, punch, one lesion CPT 11104 11104 Punch Bx Of Skin; Single Lesion-clinic	$276.00	$276.00	$97.00–$262.00	9% above	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Exc Tr-ext Mal+marg 0.5 Cm/[	$247.00	$247.00	$86.00–$235.00	39% below	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Closed Treatment Of Posterior Malleolus Fracture; Without Ma	$425.00	$425.00	$149.00–$404.00	5% above	—
Skin tag removal, up to 15 tags CPT 11200 Sclerotherapy Of Fluid Collection	$89.00	$89.00	$31.00–$85.00	53% below	—
Skin tag removal, up to 15 tags CPT 11200 11200 Removal Of Skin Tags	$157.00	$157.00	$55.00–$149.00	17% below	—
Skin tag removal, up to 15 tags CPT 11200 11200 Removal Of Skin Tags, Mult Fibrocutaneous Tags, Any Area; Up To & W/15 Lesions Charge	$234.00	$234.00	$82.00–$222.00	23% above	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Spinal Tap Dx -Ed Pf	$124.00	$124.00	$43.00–$118.00	68% below	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Spinal Tap Dxed Tech	$903.00	$903.00	$316.00–$858.00	135% above	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar Puncture Tech Chg	$1,168.00	$1,168.00	$409.00–$1,110.00	205% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Rpr Smpl Scp Nck Trnk Ext	$115.00	$115.00	$40.00–$109.00	52% below	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk And/or Extrem; 2.6 Cm To 7.5 Cm Charge	$262.00	$262.00	$92.00–$249.00	9% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Smpl Repair Of Sprfcl Wounds Of Scalp, Neck, Axillae, Ext Genitalia, Trunk, Extrem 2.6-7.5 Cm Techn	$351.00	$351.00	$123.00–$333.00	46% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Rpr F/e/e/n/l/m 2.5 Cm/<ccc Pf	$109.00	$109.00	$38.00–$104.00	52% below	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Smpl Repair Of Sprfcl Wounds Of Face, Ears, Eyelids, Nose, Lips And Or Mms Less Than2.5 Cmtechnical	$272.00	$272.00	$95.00–$258.00	20% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Rpr/f/e/e/n/l/m 2.5cm/< Ed Tech	$357.00	$357.00	$125.00–$339.00	58% above	—
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangetial Biopsy, Single Lesion	$56.00	$56.00	$20.00–$53.00	71% below	—
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangential Bx Of Skin (Eg, Shave, Scoop, Saucerize, Curette)-clinic Pro	$218.00	$218.00	$76.00–$207.00	15% above	—
Thoracentesis with imaging guidance CPT 32555 32555-aspirate Pleura W/imaging-ed Pf	$219.00	$219.00	$77.00–$208.00	73% below	—
Thoracentesis with imaging guidance CPT 32555 32555aspirate Pleura W/ Imaging -Tech	$292.00	$292.00	$102.00–$277.00	64% below	—
Thoracentesis with imaging guidance CPT 32555 32555-aspirate Pleura W/imaginged Tech	$1,190.00	$1,190.00	$417.00–$1,131.00	47% above	—
Tonsil and adenoid removal, age 12 or older CPT 42821 42821 Tonsillectomy Adenoidectomy >12 Clinic Charge	$617.00	$617.00	$216.00–$586.00	1% below	—
Tonsil and adenoid removal, age 12 or older CPT 42821 Tonsillectomy & Adenoidectomy]12 Y/o	$4,727.00	$4,727.00	$1,654.00–$4,491.00	659% above	—
Tonsil and adenoid removal, child under 12 CPT 42820 Removal of tonsils and adenoid glands, patient younger than age 12	$592.00	$592.00	$207.00–$562.00	55% below	—
Trigger finger release surgery CPT 26055 26055 Tendon Sheath Incision Finger	$600.00	$600.00	$210.00–$570.00	55% below	—
Trigger finger release surgery CPT 26055 26055 Incise Finger Tendon Sheath	$600.00	$600.00	$210.00–$570.00	55% below	—
Trigger point injections, 1 or 2 muscles CPT 20552 20552-inj Trigger Point 1/2 Muscle-sc Tech	$52.00	$52.00	$18.00–$49.00	59% below	—
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Inj Trigger Point 1/2 Muscl-ed Pf	$74.00	$74.00	$26.00–$70.00	42% below	—
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Inj(s); Single Or Mult Trigger Point(s), One Or Two Muscle(s) Charge	$128.00	$128.00	$45.00–$122.00	at median	—
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Inj Trigger Point 1/2 Muscl- Ed Tech	$586.00	$586.00	$205.00–$557.00	358% above	—
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 43249 Esoph Endo, Dilat	$305.00	$305.00	$107.00–$290.00	83% below	—
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Esoph Egd Dilation <30 Mm- Facility	$3,069.00	$3,069.00	$1,074.00–$2,916.00	76% above	—
Upper endoscopy (EGD) with biopsy CPT 43239 Biopsy exam of esophagus, stomach or small bowel using an endoscope	$2,968.00	$2,968.00	$1,039.00–$2,820.00	93% above	—
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Remove Lesion Snare Tech	$3,069.00	$3,069.00	$1,074.00–$2,916.00	154% above	—
Upper endoscopy (EGD), diagnostic CPT 43235 Diagnostic exam of esophagus, stomach or small bowel using an endoscope	$2,968.00	$2,968.00	$1,039.00–$2,820.00	293% above	—
Vaginal delivery, including prenatal and postpartum care CPT 59400 Obstetric care, planned vaginal delivery	$4,635.00	$4,635.00	$1,622.00–$4,403.00	1% below	—
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 Vasectomy, Unilateral Or Bilateral (Separate Procedure), W/postoperative Semen Exam(s) Charge	$1,283.00	$1,283.00	$449.00–$1,219.00	—	—
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Removal Of Sperm Duct(s)	$470.00	$470.00	$165.00–$447.00	52% below	—
Wart removal, up to 14 warts CPT 17110 17110 Destruct B9 Lesion 1-14	$142.00	$142.00	$50.00–$135.00	22% below	—
Wart removal, up to 14 warts CPT 17110 17110-destruct B9 Lesion 1-14-tech	$177.00	$177.00	$62.00–$168.00	3% below	—
Wart removal, up to 14 warts CPT 17110 Destruction (Eg, Laser/electro/cryo/chemosurgery/curettement), Of Warts; Up To 14 Lesions Charge	$269.00	$269.00	$94.00–$256.00	48% above	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Deb Subq Tissue 20 Sq Cm/<ed Pf	$122.00	$122.00	$43.00–$116.00	59% below	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042dbrdmt Subq Tis 1st 20 Sqcm/<ed Tech	$173.00	$173.00	$61.00–$164.00	42% below	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debride Skin/soft Tissue Charge	$259.00	$259.00	$91.00–$246.00	13% below	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Deb Subq Tissue 20 Sq Cm/<ed Tech	$607.00	$607.00	$212.00–$577.00	104% above	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion <2 Hrs	$839.00	$839.00	$294.00–$797.00	19% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion <2 Hrs Non-ed	$856.00	$856.00	$300.00–$813.00	21% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 2 Hrs- Obs	$856.00	$856.00	$300.00–$813.00	21% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 2-4 Hrs	$1,043.00	$1,043.00	$365.00–$991.00	48% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 2-4 Hrs Non-ed	$1,065.00	$1,065.00	$373.00–$1,012.00	51% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 2-4 Hrsobs	$1,065.00	$1,065.00	$373.00–$1,012.00	51% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 4-6 Hrs	$1,248.00	$1,248.00	$437.00–$1,186.00	77% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 4-6 Hrsobs	$1,271.00	$1,271.00	$445.00–$1,207.00	80% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 4-6 Hrs Non-ed	$1,271.00	$1,271.00	$445.00–$1,207.00	80% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 6-8 Hrs	$1,509.00	$1,509.00	$528.00–$1,434.00	114% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 6-8 Hrsobs	$1,539.00	$1,539.00	$539.00–$1,462.00	118% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 6-8 Hrs Non-ed	$1,539.00	$1,539.00	$539.00–$1,462.00	118% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >8 Hrs	$1,713.00	$1,713.00	$600.00–$1,627.00	143% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion >8 Hrs Non-ed	$1,745.00	$1,745.00	$611.00–$1,658.00	147% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 8 Hrsobs	$1,745.00	$1,745.00	$611.00–$1,658.00	147% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Aerosol/vapor Inhal Trmt Charge	$271.00	$271.00	$95.00–$257.00	146% above	—
Chemotherapy IV infusion, first hour CPT 96413 Chemo Iv Infusion 1 Hr	$770.00	$770.00	$270.00–$732.00	37% above	—
Critical care, first 30 to 74 minutes CPT 99291 99291 Emergency Department Visit Level Critical Care Charge -Cccpf	$433.00	$433.00	$152.00–$411.00	33% below	—
Critical care, first 30 to 74 minutes CPT 99291 99291critical Care First Hour -Tech	$1,178.00	$1,178.00	$412.00–$1,119.00	83% above	—
Critical care, first 30 to 74 minutes CPT 99291 99291 Emergent Care Level Crit Care Manual -Tech	$2,350.00	$2,350.00	$823.00–$2,233.00	266% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Cv Electrocardiogram (Ekg)	$378.00	$378.00	$132.00–$359.00	62% above	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 Ed Medical Screening Examtech	$288.00	$288.00	$101.00–$274.00	89% above	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 Emergency Department Visit Level 2 Charge -Cccpf	$85.00	$85.00	$30.00–$81.00	54% below	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282- Ed Visit Lvl 2- Sf Dec Making	$424.00	$424.00	$148.00–$403.00	131% above	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 Emergency Department Visit Level 3 Charge -Cccpf	$144.00	$144.00	$50.00–$137.00	42% below	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 Emergent Care Level 3 Manual -Tech	$664.00	$664.00	$232.00–$631.00	166% above	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 Emergency Department Visit Level 4 Charge -Cccpf	$244.00	$244.00	$85.00–$232.00	47% below	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 Emergent Care Level 4 Manual -Tech	$1,010.00	$1,010.00	$354.00–$960.00	119% above	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 Emergent Care Level 5 -Cccpf	$354.00	$354.00	$124.00–$336.00	46% below	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 Emergent Care Level 5 Manual-tech	$1,417.00	$1,417.00	$496.00–$1,346.00	116% above	—
Exercise stress test, tracing only, the hospital charge CPT 93017 93017 Exercise Stress Test Chargetracing [Chas]	$1,841.00	$1,841.00	$644.00–$1,749.00	72% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 Iv Hydration First Hred Tech	$489.00	$489.00	$171.00–$465.00	28% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Hydration 1st Hour Tech Chg	$498.00	$498.00	$174.00–$473.00	30% above	—
IV infusion of a medicine, first hour CPT 96365 96365 Iv Meds First Hred Tech [Chas]	$522.00	$522.00	$183.00–$496.00	36% above	—
IV infusion of a medicine, first hour CPT 96365 Iv Meds First Hrchas Op	$532.00	$532.00	$186.00–$505.00	38% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic; Prophylactic, Or Diagnostic Injection, Subcutaneous Or Intramuscular	$52.00	$52.00	$18.00–$49.00	42% below	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Injection Sc/im Er Ed Tech	$170.00	$170.00	$59.00–$162.00	89% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection Sc/im	$173.00	$173.00	$61.00–$164.00	92% above	—
Neuromuscular re-education, 15 minutes CPT 97112 Pt Neuromuscular Reeducation Assistant Units	$142.00	$142.00	$50.00–$135.00	53% above	—
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation Charges	$338.00	$338.00	$118.00–$321.00	265% above	—
New patient office visit, about 30 minutes CPT 99203 New patient office or other outpatient visit, 30 min	$325.00	$325.00	$114.00–$309.00	58% above	—
New patient office visit, about 45 minutes CPT 99204 New patient office or other outpatient visit, 45 min	$381.00	$381.00	$133.00–$362.00	25% above	—
New patient office visit, about 60 minutes CPT 99205 New patient office or other outpatient visit, 60 min	$456.00	$456.00	$160.00–$433.00	23% above	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 New Pat Level 2	$96.00	$96.00	$34.00–$91.00	21% below	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office/op New Visit Level 2 99202	$269.00	$269.00	$94.00–$256.00	121% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 97802 Med Nutrition Therapyint Charge	$58.00	$58.00	$20.00–$55.00	20% above	—
Occupational therapy evaluation, low complexity CPT 97165 97165 Ot Eval Low Complex 30 Min (Untimed)	$152.00	$152.00	$53.00–$144.00	8% below	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt High Complex Units	$279.00	$279.00	$98.00–$265.00	31% above	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Low Complex Units	$208.00	$208.00	$73.00–$198.00	30% above	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Moderate Complex Units	$229.00	$229.00	$80.00–$218.00	28% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Pt Manual Therapy Assistant Units	$147.00	$147.00	$51.00–$140.00	52% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy Charge Units	$156.00	$156.00	$55.00–$148.00	62% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy Charge Unitsot Bce	$156.00	$156.00	$55.00–$148.00	62% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 Manual Therapy Charge Units	$156.00	$156.00	$55.00–$148.00	62% above	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Physical therapy, therapeutic exercise	$170.00	$170.00	$59.00–$162.00	79% above	—
Preventive checkup, new patient aged 18–39 CPT 99385 Initial new patient preventative medicine evaluation (18-39 years)	$513.00	$513.00	$180.00–$487.00	108% above	—
Preventive checkup, new patient aged 40–64 CPT 99386 Initial new patient preventative medicine evaluation (40-64 years)	$565.00	$565.00	$198.00–$537.00	101% above	—
Preventive checkup, new patient aged 65 or older CPT 99387 99387 Preventive Medicine 65+ Years New	$620.00	$620.00	$217.00–$589.00	115% above	—
Preventive checkup, returning patient aged 18–39 CPT 99395 99395 Preventive Medicine 18-39 Years Established	$464.00	$464.00	$162.00–$441.00	111% above	—
Preventive checkup, returning patient aged 40–64 CPT 99396 99396 Preventive Medicine 40-64 Years Established	$516.00	$516.00	$181.00–$490.00	121% above	—
Preventive checkup, returning patient aged 65 or older CPT 99397 99397 Preventive Medicine 65+ Years Established	$571.00	$571.00	$200.00–$542.00	135% above	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office/op Established Visit Level 5 99215	$522.00	$522.00	$183.00–$496.00	118% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Cdl Examination	$52.00	$52.00	$18.00–$49.00	57% below	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Estab Pat Level 3	$135.00	$135.00	$47.00–$128.00	12% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office/outpatient Visit Level 3 Established99213	$194.00	$194.00	$68.00–$184.00	62% above	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office/op Established Visit Level 4	$328.00	$328.00	$115.00–$312.00	84% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Estab Pat Level 2	$73.00	$73.00	$26.00–$69.00	13% below	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212spec Clinic Visit Chg-25	$94.00	$94.00	$33.00–$89.00	12% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212- Spec Clinic Visit Chg	$100.00	$100.00	$35.00–$95.00	19% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office/op Established Visit Level 2	$142.00	$142.00	$50.00–$135.00	68% above	—
Specialist consultation, low complexity or 30+ minutes CPT 99243 Patient office consultation, 40 min	$175.00	$175.00	$61.00–$166.00	20% below	—
Speech and language evaluation CPT 92523 St Speech Sound Lang Comprehchas	$438.00	$438.00	$153.00–$416.00	41% above	—
Speech therapy session, individual CPT 92507 St Speech/hearing Therapychas	$442.00	$442.00	$155.00–$420.00	81% above	—
Spirometry (breathing test) CPT 94010 94010 Spirometry Charge	$354.00	$354.00	$124.00–$336.00	29% above	—
Spirometry before and after a bronchodilator CPT 94060 94060 Bronchospasm Evaluation Charge	$760.00	$760.00	$266.00–$722.00	35% above	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Ot Therapeutic Activ 15 Min	$150.00	$150.00	$53.00–$143.00	71% above	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Charge	$150.00	$150.00	$53.00–$143.00	71% above	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Pt Therapeutic Activity Assistant Units	$150.00	$150.00	$53.00–$143.00	71% above	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy 3	$258.00	$258.00	$90.00–$245.00	35% above	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 99195 Phelbotomy Charge	$258.00	$258.00	$90.00–$245.00	35% above	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 91322 Spikevax (Covid-19) Vaccine Charge [Chas]	$295.00	$295.00	$103.00–$280.00	55% above	—
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 90716 Varivaxvaricella Virus Vacc [Chas]	$376.00	$376.00	$132.00–$357.00	89% above	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90656influenza Virus Vacc, Trivalent (Iiv3), Split Virus, Pf, Im	$20.00	$20.00	$7.00–$19.00	23% below	—
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 90651 (Hpv 9) Human Papilloma Vaccine [Chas]	$560.00	$560.00	$196.00–$532.00	51% above	—
Hepatitis A vaccine, adult dose CPT 90632 90632 Hepatitis A Adult Vaccine [Chas]	$191.00	$191.00	$67.00–$181.00	122% above	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 90746 Hepatitis B Adult Vaccine [Chas]	$161.00	$161.00	$56.00–$153.00	88% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 90662 Influenza Virus Vaccine, Split-dose, Pf Hi Dose [Chas]	$77.00	$77.00	$27.00–$73.00	6% below	—
MMR vaccine (measles, mumps and rubella), live CPT 90707 90707 Mmr Measles/mumps/rubella Vacc [Chas]	$199.00	$199.00	$70.00–$189.00	82% above	—
MMR vaccine (measles, mumps and rubella), live CPT 90707 Mmr Measles/mumps/rubella Virus Vaccine Poc	$210.00	$210.00	$74.00–$200.00	92% above	—
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal Conjugate Vaccine, Serogroups A, C, Y And W-135 (Tetravalent), For Im Use Poc	$315.00	$315.00	$110.00–$299.00	72% above	—
Meningococcal ACWY (MenACWY) vaccine CPT 90734 90734 Menveo -Meningococcal Conj-serogroup A/c/y/w13 [Chas]	$320.00	$320.00	$112.00–$304.00	75% above	—
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 90620 Bexsero Meningococcal Recomb 2 Dose Im [Chas]	$456.00	$456.00	$160.00–$433.00	65% above	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 90677 Pneumococcal 20 Valent Conj [Chas]	$461.00	$461.00	$161.00–$438.00	6% above	—
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 90678 Rsv Vaccine- Abrysvo [Chas]	$328.00	$328.00	$115.00–$312.00	13% below	—
Rabies vaccine, one dose CPT 90675 90675 Rabies Vaccine (Rabavert) Im [Chas]	$755.00	$755.00	$264.00–$717.00	49% above	—
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 90750 Shingrix Zoster Vccine (Hzv) Recomb/adjuv [Chas]	$396.00	$396.00	$139.00–$376.00	38% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus And Diphtheria Toxoids (Td) Adsorbed, Preservative Free, For Use In Individuals 7 Yrs Poc	$93.00	$93.00	$33.00–$88.00	79% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 90714 Tetanus And Diptheria Toxoids Adsorbed, Preservative Free, For Use In In Indv 7yrs Poc Charge	$113.00	$113.00	$40.00–$107.00	117% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Measles, Mumps, Rubella & Varicella Vaccine	$148.00	$148.00	$52.00–$141.00	111% above	—
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Typhoid Vaccine, Vi Capsular Polysaccharide (Vicps) Im Use	$253.00	$253.00	$89.00–$240.00	38% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Influenza Admin [Chas]	$40.00	$40.00	$14.00–$38.00	17% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Influenza Vaccine (G0008)	$40.00	$40.00	$14.00–$38.00	17% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Hepatitis B Admin [Chas]	$40.00	$40.00	$14.00–$38.00	17% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pneumococcal 20 Admin [Chas]	$40.00	$40.00	$14.00–$38.00	17% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Immunization Administration; 1 Vaccine	$46.00	$46.00	$16.00–$44.00	35% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Immunization Admin 1 Vacced Tech	$89.00	$89.00	$31.00–$85.00	160% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin-obs	$90.00	$90.00	$31.00–$86.00	163% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Immunization Admin- Op Tech	$126.00	$126.00	$44.00–$120.00	268% above	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 Each Additional Vaccine	$40.00	$40.00	$14.00–$38.00	20% above	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472-immunization Admin Each Add-ip	$67.00	$67.00	$23.00–$64.00	102% above	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin Ea Add Ed Charge	$67.00	$67.00	$23.00–$64.00	102% above	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472-immunization Admis Each Add-tech	$70.00	$70.00	$25.00–$67.00	111% above	—

Source file: https://secure.claraprice.net/price-transparency/QSJB-1666892650444/machine-readable/476000803_chase-county-hospital_standardcharges.json