Saunders Medical Center
Saunders Medical Center in Wahoo, NE publishes cash prices for 268 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 130 of 262 procedures and below it for 126. By typical cash price it ranks #18 of 34 Nebraska hospitals and #12 of 13 hospitals in the Omaha, NE area, cheapest first. Click a procedure to compare it with other hospitals nearby.
1760 County Road J, Wahoo, NE, 68066 Collected Sep 27, 2026 Source price file (402) 443-4191
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 281307 · CMS hospital register
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 US Segmental Pressures LE 1-2 Lvls Bilat | $471.00 | $628.00 | — | — | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 US Segmental Pressures LE 1-2 Lvls Bilat | $471.00 | $628.00 | — | — | 25% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus | $532.50 | $710.00 | — | 14% above | 25% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus | $532.50 | $710.00 | — | — | 25% |
| Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Imaging Whole Body | $1,661.25 | $2,215.00 | — | 1% above | 25% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Imaging Whole Body | $1,661.25 | $2,215.00 | — | — | 25% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Right | $326.25 | $435.00 | — | 2% below | 25% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Left | $326.25 | $435.00 | — | 2% below | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Left | $326.25 | $435.00 | — | — | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Right | $326.25 | $435.00 | — | — | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest | $3,107.25 | $4,143.00 | — | 7% above | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest | $3,107.25 | $4,143.00 | — | — | 25% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen and Pelvis w/o Contrast | $3,451.50 | $4,602.00 | — | 22% above | 25% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen and Pelvis w/o Contrast | $3,451.50 | $4,602.00 | — | — | 25% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen and Pelvis w/ Contrast | $4,098.00 | $5,464.00 | — | 10% above | 25% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen and Pelvis w/ Contrast | $4,098.00 | $5,464.00 | — | — | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast | $4,606.50 | $6,142.00 | — | 10% above | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast | $4,606.50 | $6,142.00 | — | — | 25% |
| CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast | $2,373.00 | $3,164.00 | — | 5% above | 25% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Contrast | $2,373.00 | $3,164.00 | — | — | 25% |
| CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast | $2,031.75 | $2,709.00 | — | 12% above | 25% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Contrast | $2,031.75 | $2,709.00 | — | — | 25% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Contrast | $1,671.75 | $2,229.00 | — | 9% above | 25% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Contrast | $1,671.75 | $2,229.00 | — | — | 25% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head w/o Contrast | $1,917.00 | $2,556.00 | — | 19% above | 25% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head w/o Contrast | $1,917.00 | $2,556.00 | — | — | 25% |
| CT scan of the head with contrast CPT 70460 CT Head w/ Contrast | $2,231.25 | $2,975.00 | — | 13% above | 25% |
| CT scan of the head with contrast inpatient CPT 70460 CT Head w/ Contrast | $2,231.25 | $2,975.00 | — | — | 25% |
| CT scan of the head without and with contrast CPT 70470 CT Head w/ + w/o Contrast | $2,265.00 | $3,020.00 | — | 7% above | 25% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT Head w/ + w/o Contrast | $2,265.00 | $3,020.00 | — | — | 25% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Contrast | $2,082.75 | $2,777.00 | — | 10% above | 25% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Contrast | $2,082.75 | $2,777.00 | — | — | 25% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Contrast | $2,244.00 | $2,992.00 | — | 17% above | 25% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Contrast | $2,244.00 | $2,992.00 | — | — | 25% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast | $2,268.75 | $3,025.00 | — | at median | 25% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast | $2,268.75 | $3,025.00 | — | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Bilateral | $1,338.75 | $1,785.00 | — | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Duplex Bilateral | $1,338.75 | $1,785.00 | — | — | 25% |
| Chest X-ray, 2 views CPT 71046 XR Chest 2 Views | $316.50 | $422.00 | — | 27% above | 25% |
| Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views | $316.50 | $422.00 | — | — | 25% |
| Chest X-ray, single view CPT 71045 XR Chest 1 View | $244.50 | $326.00 | — | 27% above | 25% |
| Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View | $244.50 | $326.00 | — | — | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete | $765.00 | $1,020.00 | — | at median | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete | $765.00 | $1,020.00 | — | — | 25% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton | $420.75 | $561.00 | — | 12% above | 25% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Density DEXA Axial Skeleton | $420.75 | $561.00 | — | — | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD Bone Density DEXA App Skeleton | $228.00 | $304.00 | — | 33% above | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD Bone Density DEXA App Skeleton | $228.00 | $304.00 | — | — | 25% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB Detailed Complete First Gest | $673.50 | $898.00 | — | 37% above | 25% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB Detailed Complete First Gest | $673.50 | $898.00 | — | — | 25% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Contrast | $2,103.00 | $2,804.00 | — | 11% above | 25% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Contrast | $2,103.00 | $2,804.00 | — | — | 25% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Contrast | $2,373.00 | $3,164.00 | — | 3% above | 25% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Contrast | $2,373.00 | $3,164.00 | — | — | 25% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Digital Diagnostic Bilat. | $372.75 | $497.00 | — | — | 25% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Digital Diagnostic Bilat. | $372.75 | $497.00 | — | — | 25% |
| Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Digital Diagnostic Left. | $307.50 | $410.00 | — | 53% above | 25% |
| Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Digital Diagnostic Right. | $307.50 | $410.00 | — | 53% above | 25% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Digital Diagnostic Right. | $307.50 | $410.00 | — | — | 25% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Digital Diagnostic Left. | $307.50 | $410.00 | — | — | 25% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral | $1,053.00 | $1,404.00 | — | — | 25% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral | $1,053.00 | $1,404.00 | — | — | 25% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Lower Ext Venous Duplex Bilateral | $1,305.00 | $1,740.00 | — | — | 25% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Upper Ext Venous Duplex Bilateral | $1,305.00 | $1,740.00 | — | — | 25% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Lower Ext Venous Duplex Bilateral | $1,305.00 | $1,740.00 | — | — | 25% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Upper Ext Venous Duplex Bilateral | $1,305.00 | $1,740.00 | — | — | 25% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo 2D Complete | $2,003.25 | $2,671.00 | — | at median | 25% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo 2D Complete | $2,003.25 | $2,671.00 | — | — | 25% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary Imaging | $1,008.00 | $1,344.00 | — | 30% below | 25% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary Imaging | $1,008.00 | $1,344.00 | — | — | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY CPAP | $3,915.00 | $5,220.00 | — | 11% above | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY CPAP | $3,915.00 | $5,220.00 | — | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited | $613.50 | $818.00 | — | 19% above | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Limited | $613.50 | $818.00 | — | — | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Cancer Screening | $1,236.00 | $1,648.00 | — | 253% above | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Cancer Screening | $1,236.00 | $1,648.00 | — | — | 25% |
| MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Contrast | $3,190.50 | $4,254.00 | — | 18% above | 25% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Contrast | $3,190.50 | $4,254.00 | — | — | 25% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Contrast | $3,676.50 | $4,902.00 | — | at median | 25% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Contrast | $3,676.50 | $4,902.00 | — | — | 25% |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast | $3,006.00 | $4,008.00 | — | 26% above | 25% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast | $3,006.00 | $4,008.00 | — | — | 25% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ w/o Contrast | $3,666.75 | $4,889.00 | — | 2% below | 25% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ w/o Contrast | $3,666.75 | $4,889.00 | — | — | 25% |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast | $3,074.25 | $4,099.00 | — | 5% above | 25% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast | $3,074.25 | $4,099.00 | — | — | 25% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Contrast | $3,670.50 | $4,894.00 | — | 2% below | 25% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Contrast | $3,670.50 | $4,894.00 | — | — | 25% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast | $2,921.25 | $3,895.00 | — | at median | 25% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Contrast | $2,921.25 | $3,895.00 | — | — | 25% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Contrast | $3,903.75 | $5,205.00 | — | 5% above | 25% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Contrast | $3,903.75 | $5,205.00 | — | — | 25% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast | $3,074.25 | $4,099.00 | — | 2% above | 25% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Contrast | $3,074.25 | $4,099.00 | — | — | 25% |
| MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Contrast | $3,264.75 | $4,353.00 | — | 5% above | 25% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Contrast | $3,264.75 | $4,353.00 | — | — | 25% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast | $2,960.25 | $3,947.00 | — | 25% above | 25% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Contrast | $2,960.25 | $3,947.00 | — | — | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial SPECT Rest and Stress | $3,716.25 | $4,955.00 | — | 1% above | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial SPECT Rest and Stress | $3,716.25 | $4,955.00 | — | — | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic Ltd | $324.75 | $433.00 | — | 7% above | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic Ltd | $324.75 | $433.00 | — | — | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Complete | $717.75 | $957.00 | — | 3% below | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Complete | $717.75 | $957.00 | — | — | 25% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Greater Than 14 Weeks | $651.75 | $869.00 | — | 3% below | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Greater Than 14 Weeks | $651.75 | $869.00 | — | — | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB < 14 weeks | $572.25 | $763.00 | — | 4% below | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB < 14 weeks | $572.25 | $763.00 | — | — | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited | $416.25 | $555.00 | — | 24% above | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited | $416.25 | $555.00 | — | — | 25% |
| Screening mammogram, both breasts both sides CPT 77067 MG Mammo Digital Screening Bilateral. | $306.00 | $408.00 | — | — | 25% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Digital Screening Bilateral. | $306.00 | $408.00 | — | — | 25% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY | $3,574.50 | $4,766.00 | — | 15% above | 25% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY | $3,574.50 | $4,766.00 | — | — | 25% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Swallowing Function w/ Speech | $624.00 | $832.00 | — | 25% above | 25% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Swallowing Function w/ Speech | $624.00 | $832.00 | — | — | 25% |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal non-OB | $603.00 | $804.00 | — | 13% above | 25% |
| Transvaginal pelvic ultrasound CPT 76830 SAMC US Transvaginal non-OB | $603.00 | $804.00 | — | 13% above | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 SAMC US Transvaginal non-OB | $603.00 | $804.00 | — | — | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal non-OB | $603.00 | $804.00 | — | — | 25% |
| Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal | $429.75 | $573.00 | — | 7% below | 25% |
| Transvaginal ultrasound during pregnancy CPT 76817 SAMC US OB Transvaginal | $429.75 | $573.00 | — | 7% below | 25% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal | $429.75 | $573.00 | — | — | 25% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 SAMC US OB Transvaginal | $429.75 | $573.00 | — | — | 25% |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete | $799.50 | $1,066.00 | — | 1% below | 25% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete | $799.50 | $1,066.00 | — | — | 25% |
| Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents) | $615.75 | $821.00 | — | 2% above | 25% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents) | $615.75 | $821.00 | — | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head/Neck Soft Tissue | $543.75 | $725.00 | — | 5% below | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head/Neck Soft Tissue | $543.75 | $725.00 | — | — | 25% |
| X-ray of the abdomen, 1 view CPT 74018 ABDOMEN/KUB | $274.50 | $366.00 | — | 22% above | 25% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN/KUB | $274.50 | $366.00 | — | — | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views | $429.75 | $573.00 | — | 32% above | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views | $429.75 | $573.00 | — | — | 25% |
| X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral 4+ Views | $465.75 | $621.00 | — | 13% above | 25% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral 4+ Views | $465.75 | $621.00 | — | — | 25% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views | $331.50 | $442.00 | — | 23% above | 25% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views | $331.50 | $442.00 | — | — | 25% |
| X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones 3+ Views | $303.00 | $404.00 | — | 15% above | 25% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones 3+ Views | $303.00 | $404.00 | — | — | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 Views | $318.75 | $425.00 | — | 22% above | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical 2 or 3 Views | $318.75 | $425.00 | — | — | 25% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views | $264.00 | $352.00 | — | 16% above | 25% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views | $264.00 | $352.00 | — | — | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx 2+ Views | $350.25 | $467.00 | — | 36% above | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum/Coccyx 2+ Views | $350.25 | $467.00 | — | — | 25% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT ALT | $61.50 | $82.00 | — | 3% above | 25% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT ALT | $61.50 | $82.00 | — | — | 25% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT AST | $61.50 | $82.00 | — | 30% above | 25% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT AST | $61.50 | $82.00 | — | — | 25% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute Hepatitis Panel with Rflx to HepC Confirm MHP | $317.25 | $423.00 | — | 1% above | 25% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute Hepatitis Panel with Rflx to HepC Confirm MHP | $317.25 | $423.00 | — | — | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Bill Only Allergen, Each | $50.25 | $67.00 | — | 19% above | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bill Only Allergen, Each | $50.25 | $67.00 | — | — | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 ANTI-CCP | $159.00 | $212.00 | — | 94% above | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 ANTI-CCP | $159.00 | $212.00 | — | — | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA | $98.25 | $131.00 | — | 122% above | 25% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA | $98.25 | $131.00 | — | — | 25% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP | $258.75 | $345.00 | — | 37% above | 25% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP | $258.75 | $345.00 | — | — | 25% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC | $137.25 | $183.00 | — | 4% above | 25% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC | $137.25 | $183.00 | — | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURG PATH LEVEL 4 | $190.50 | $254.00 | — | at median | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURG PATH LEVEL 4 | $190.50 | $254.00 | — | — | 25% |
| Blood culture for bacteria CPT 87040 CULTURE BLOOD | $210.75 | $281.00 | — | 17% above | 25% |
| Blood culture for bacteria CPT 87040 CUITURE BLOOD SET 2 | $210.75 | $281.00 | — | 17% above | 25% |
| Blood culture for bacteria inpatient CPT 87040 CUITURE BLOOD SET 2 | $210.75 | $281.00 | — | — | 25% |
| Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD | $210.75 | $281.00 | — | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION VENOUS SPECIMN | $6.00 | $8.00 | — | 71% below | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture | $29.25 | $39.00 | — | 41% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE | $29.25 | $39.00 | — | 41% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION VENOUS SPECIMN | $6.00 | $8.00 | — | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture | $29.25 | $39.00 | — | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE | $29.25 | $39.00 | — | — | 25% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE | $57.00 | $76.00 | — | 37% above | 25% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE | $57.00 | $76.00 | — | — | 25% |
| Blood lead test CPT 83655 LEAD CAPILLARY | $74.25 | $99.00 | — | 24% above | 25% |
| Blood lead test CPT 83655 LEAD LEVEL | $74.25 | $99.00 | — | 24% above | 25% |
| Blood lead test inpatient CPT 83655 LEAD LEVEL | $74.25 | $99.00 | — | — | 25% |
| Blood lead test inpatient CPT 83655 LEAD CAPILLARY | $74.25 | $99.00 | — | — | 25% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG-QUALITATIVE SERUM | $123.75 | $165.00 | — | 16% above | 25% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG-QUALITATIVE SERUM | $123.75 | $165.00 | — | — | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 RH BLOOD TYPING^1^8491481 | $60.00 | $80.00 | — | 15% above | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO TYPE | $60.00 | $80.00 | — | 15% above | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 RH BLOOD TYPING^1^8491481 | $60.00 | $80.00 | — | — | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO TYPE | $60.00 | $80.00 | — | — | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 RCRP | $102.00 | $136.00 | — | 9% above | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $107.25 | $143.00 | — | 15% above | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 RCRP | $102.00 | $136.00 | — | — | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN | $107.25 | $143.00 | — | — | 25% |
| C. difficile toxin gene test (stool PCR) CPT 87493 Bill Only C. difficile Toxin Gene(s) Amplification MHP | $84.75 | $113.00 | — | 49% below | 25% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Bill Only C. difficile Toxin Gene(s) Amplification MHP | $84.75 | $113.00 | — | — | 25% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA-19-9 | $182.25 | $243.00 | — | 58% above | 25% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA-19-9 | $182.25 | $243.00 | — | — | 25% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA - 125 | $151.50 | $202.00 | — | 38% above | 25% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA - 125 | $151.50 | $202.00 | — | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Covid-19 PCR Send out | $133.50 | $178.00 | — | 14% above | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Cepheid Covid | $133.50 | $178.00 | — | 14% above | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Cepheid Covid | $133.50 | $178.00 | — | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Covid-19 PCR Send out | $133.50 | $178.00 | — | — | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS | $136.50 | $182.00 | — | 25% above | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS | $136.50 | $182.00 | — | — | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE | $113.25 | $151.00 | — | 15% above | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE | $113.25 | $151.00 | — | — | 25% |
| Complete blood count (CBC) with differential CPT 85025 BLOOD COUNT CBC (AUTO) | $93.75 | $125.00 | — | 13% above | 25% |
| Complete blood count (CBC) with differential CPT 85025 HEMOGRAM AUTO/OUTSIDE FAC | $93.75 | $125.00 | — | 13% above | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HEMOGRAM AUTO/OUTSIDE FAC | $93.75 | $125.00 | — | — | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 BLOOD COUNT CBC (AUTO) | $93.75 | $125.00 | — | — | 25% |
| Complete blood count (CBC), no differential CPT 85027 BLOOD CT AUTO. W/O DIFF | $71.25 | $95.00 | — | 2% above | 25% |
| Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD CT AUTO. W/O DIFF | $71.25 | $95.00 | — | — | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC | $151.50 | $202.00 | — | 4% above | 25% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC | $151.50 | $202.00 | — | — | 25% |
| D-dimer blood test (blood clot marker) CPT 85379 D-DIMER | $161.25 | $215.00 | — | 21% above | 25% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER | $161.25 | $215.00 | — | — | 25% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEAS LEVEL | $205.50 | $274.00 | — | 45% above | 25% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEAS LEVEL | $205.50 | $274.00 | — | — | 25% |
| Estradiol blood test CPT 82670 ESTRADIOL | $157.50 | $210.00 | — | 40% above | 25% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL | $157.50 | $210.00 | — | — | 25% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH | $117.75 | $157.00 | — | 5% above | 25% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH | $117.75 | $157.00 | — | — | 25% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN | $360.00 | $480.00 | — | 3% above | 25% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN | $360.00 | $480.00 | — | — | 25% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $150.00 | $200.00 | — | 46% above | 25% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN | $150.00 | $200.00 | — | — | 25% |
| Folate (folic acid) blood test CPT 82746 FOLATE | $139.50 | $186.00 | — | 32% above | 25% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLATE | $139.50 | $186.00 | — | — | 25% |
| Free T3 thyroid hormone test CPT 84481 T-3 FREE | $198.00 | $264.00 | — | 53% above | 25% |
| Free T3 thyroid hormone test inpatient CPT 84481 T-3 FREE | $198.00 | $264.00 | — | — | 25% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4-FREE | $102.00 | $136.00 | — | 39% above | 25% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4-FREE | $102.00 | $136.00 | — | — | 25% |
| Free testosterone test CPT 84402 TESTOSTERONE FREE | $169.50 | $226.00 | — | 64% above | 25% |
| Free testosterone test CPT 84402 4024402-Test Free | $169.50 | $226.00 | — | 64% above | 25% |
| Free testosterone test inpatient CPT 84402 4024402-Test Free | $169.50 | $226.00 | — | — | 25% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE | $169.50 | $226.00 | — | — | 25% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL | $292.50 | $390.00 | — | 9% above | 25% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL | $292.50 | $390.00 | — | — | 25% |
| Glucose tolerance test, 3 samples CPT 82951 Glucose 1 Hour | $116.25 | $155.00 | — | at median | 25% |
| Glucose tolerance test, 3 samples CPT 82951 Glucose 2 Hour | $116.25 | $155.00 | — | at median | 25% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE | $116.25 | $155.00 | — | at median | 25% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose 2 Hour | $116.25 | $155.00 | — | — | 25% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose 1 Hour | $116.25 | $155.00 | — | — | 25% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE | $116.25 | $155.00 | — | — | 25% |
| H. pylori stool antigen test CPT 87338 HELICOBACTER PHLORI-FECAL | $186.00 | $248.00 | — | 60% above | 25% |
| H. pylori stool antigen test inpatient CPT 87338 HELICOBACTER PHLORI-FECAL | $186.00 | $248.00 | — | — | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1/2 AG/AB COMBO | $81.75 | $109.00 | — | 13% above | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1/2 AG/AB COMBO | $81.75 | $109.00 | — | — | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C | $72.75 | $97.00 | — | 11% above | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C | $72.75 | $97.00 | — | — | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIB | $112.50 | $150.00 | — | 28% above | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIB | $112.50 | $150.00 | — | — | 25% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURF ANTIGEN | $102.75 | $137.00 | — | 18% above | 25% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURF ANTIGEN | $102.75 | $137.00 | — | — | 25% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hep C Ab w/ Rfx to PCR Confirm MHP | $116.25 | $155.00 | — | 35% above | 25% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hep C Ab w/ Rfx to PCR Confirm MHP | $116.25 | $155.00 | — | — | 25% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C RNA PCR QUANT | $353.25 | $471.00 | — | 7% above | 25% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C VIR RFIX GENOTYPE | $353.25 | $471.00 | — | 7% above | 25% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C VIR RFIX GENOTYPE | $353.25 | $471.00 | — | — | 25% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C RNA PCR QUANT | $353.25 | $471.00 | — | — | 25% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE | $260.25 | $347.00 | — | 86% above | 25% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE | $260.25 | $347.00 | — | — | 25% |
| Insulin blood test CPT 83525 INSULIN LEVEL | $157.50 | $210.00 | — | 51% above | 25% |
| Insulin blood test inpatient CPT 83525 INSULIN LEVEL | $157.50 | $210.00 | — | — | 25% |
| Iron blood test (serum iron) CPT 83540 IRON | $64.50 | $86.00 | — | 2% above | 25% |
| Iron blood test (serum iron) CPT 83540 Transferrin Profile MHP | $172.50 | $230.00 | — | 174% above | 25% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON | $64.50 | $86.00 | — | — | 25% |
| Iron blood test (serum iron) inpatient CPT 83540 Transferrin Profile MHP | $172.50 | $230.00 | — | — | 25% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY | $74.25 | $99.00 | — | 15% above | 25% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY | $74.25 | $99.00 | — | — | 25% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $133.50 | $178.00 | — | 2% above | 25% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $133.50 | $178.00 | — | — | 25% |
| LH (luteinizing hormone) test CPT 83002 LUTEINIZING HORMONE | $111.00 | $148.00 | — | 11% below | 25% |
| LH (luteinizing hormone) test inpatient CPT 83002 LUTEINIZING HORMONE | $111.00 | $148.00 | — | — | 25% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $100.50 | $134.00 | — | 8% above | 25% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level MHP | $126.75 | $169.00 | — | 36% above | 25% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE | $100.50 | $134.00 | — | — | 25% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level MHP | $126.75 | $169.00 | — | — | 25% |
| Liver function blood test panel CPT 80076 LIVER FUNCTION PANEL | $136.50 | $182.00 | — | 13% above | 25% |
| Liver function blood test panel inpatient CPT 80076 LIVER FUNCTION PANEL | $136.50 | $182.00 | — | — | 25% |
| Lyme disease antibody test CPT 86618 Lyme EIA IgM and IgG MHP | $21.19 | $28.25 | — | 83% below | 25% |
| Lyme disease antibody test CPT 86618 Lyme (Borrelia burgdorferi) Abs Rflx IgM-IgG MHP | $154.50 | $206.00 | — | 22% above | 25% |
| Lyme disease antibody test CPT 86618 LYME'S TITER-MAYOS | $154.50 | $206.00 | — | 22% above | 25% |
| Lyme disease antibody test inpatient CPT 86618 Lyme EIA IgM and IgG MHP | $21.19 | $28.25 | — | — | 25% |
| Lyme disease antibody test inpatient CPT 86618 Lyme (Borrelia burgdorferi) Abs Rflx IgM-IgG MHP | $154.50 | $206.00 | — | — | 25% |
| Lyme disease antibody test inpatient CPT 86618 LYME'S TITER-MAYOS | $154.50 | $206.00 | — | — | 25% |
| Magnesium blood test CPT 83735 MAGNESIUM1 SERUM | $79.50 | $106.00 | — | 26% above | 25% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM1 SERUM | $79.50 | $106.00 | — | — | 25% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA SCREEN | $108.00 | $144.00 | — | 41% above | 25% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA SCREEN | $108.00 | $144.00 | — | — | 25% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE MONO SCREEN | $9.00 | $12.00 | — | 83% below | 25% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE MONO SCREEN | $9.00 | $12.00 | — | — | 25% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE | $159.00 | $212.00 | — | 25% above | 25% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE | $159.00 | $212.00 | — | — | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECI ANTI TOTAL | $114.75 | $153.00 | — | 23% above | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECI ANTI TOTAL | $114.75 | $153.00 | — | — | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH PAP COLLECT/SCRN | $29.25 | $39.00 | — | 39% below | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP SMEAR | $71.25 | $95.00 | — | 48% above | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATH PAP COLLECT/SCRN | $29.25 | $39.00 | — | — | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP SMEAR | $71.25 | $95.00 | — | — | 25% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE | $275.25 | $367.00 | — | 31% above | 25% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE | $275.25 | $367.00 | — | — | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $77.25 | $103.00 | — | 15% above | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $77.25 | $103.00 | — | 15% above | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PART. THROMBOPLASTIN TIME | $91.50 | $122.00 | — | 36% above | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT | $77.25 | $103.00 | — | — | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $77.25 | $103.00 | — | — | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PART. THROMBOPLASTIN TIME | $91.50 | $122.00 | — | — | 25% |
| Progesterone blood test CPT 84144 PROGESTERONE | $123.75 | $165.00 | — | 16% above | 25% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE | $123.75 | $165.00 | — | — | 25% |
| Prolactin blood test CPT 84146 PROLACTIN LEVELS | $187.50 | $250.00 | — | 118% above | 25% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN LEVELS | $187.50 | $250.00 | — | — | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $54.00 | $72.00 | — | 20% above | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 CAPILLARY PT/INR | $54.00 | $72.00 | — | 20% above | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Lupus Anticoagulant Panel | $61.50 | $82.00 | — | 37% above | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CAPILLARY PT/INR | $54.00 | $72.00 | — | — | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $54.00 | $72.00 | — | — | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Lupus Anticoagulant Panel | $61.50 | $82.00 | — | — | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN QUAL MULTI EA | $192.00 | $256.00 | — | 122% above | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN QUAL MULTI EA | $192.00 | $256.00 | — | — | 25% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA SWAB A | $22.50 | $30.00 | — | 57% below | 25% |
| Rapid flu test (influenza antigen) CPT 87804 FLU B | $93.00 | $124.00 | — | 79% above | 25% |
| Rapid flu test (influenza antigen) CPT 87804 FLU A | $93.00 | $124.00 | — | 79% above | 25% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA SWAB A | $22.50 | $30.00 | — | — | 25% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 FLU B | $93.00 | $124.00 | — | — | 25% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 FLU A | $93.00 | $124.00 | — | — | 25% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP SCREEN GROUP A | $22.50 | $30.00 | — | 54% below | 25% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP SCREEN GROUP A | $22.50 | $30.00 | — | — | 25% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACT-QNT | $69.75 | $93.00 | — | 55% above | 25% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACT-QNT | $69.75 | $93.00 | — | — | 25% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA EIA1 SCREEN-SNGL | $77.25 | $103.00 | — | 3% above | 25% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA EIA1 SCREEN-SNGL | $77.25 | $103.00 | — | — | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESR, Automated | $45.75 | $61.00 | — | 2% above | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESR Automated | $45.75 | $61.00 | — | 2% above | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESR Automated | $45.75 | $61.00 | — | — | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESR, Automated | $45.75 | $61.00 | — | — | 25% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 BLOOD OCCT HEMCL1-3 CARDS | $6.75 | $9.00 | — | 66% below | 25% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 BLOOD OCCLT1HEM 1-3 CARDS | $39.00 | $52.00 | — | 99% above | 25% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Stool POC (RE) | $39.00 | $52.00 | — | 99% above | 25% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 BLOOD OCCT HEMCL1-3 CARDS | $6.75 | $9.00 | — | — | 25% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 BLOOD OCCLT1HEM 1-3 CARDS | $39.00 | $52.00 | — | — | 25% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Stool POC (RE) | $39.00 | $52.00 | — | — | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Bill Only RPR Screen and Titer MHP | $42.75 | $57.00 | — | 12% above | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Bill Only RPR Screen and Titer MHP | $42.75 | $57.00 | — | — | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB INTERFERON ANTIGEN | $213.00 | $284.00 | — | 6% above | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB INTERFERON ANTIGEN | $213.00 | $284.00 | — | — | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE | $129.75 | $173.00 | — | 49% above | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTRN FEMALE OR CHILD | $129.75 | $173.00 | — | 49% above | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total and Free Females or Children (includes S | $129.75 | $173.00 | — | 49% above | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total and Free Females or Children (includes S | $129.75 | $173.00 | — | — | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE | $129.75 | $173.00 | — | — | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTRN FEMALE OR CHILD | $129.75 | $173.00 | — | — | 25% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 TPO THYROID PEROXIDASE AB | $139.50 | $186.00 | — | 126% above | 25% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 TPO THYROID PEROXIDASE AB | $139.50 | $186.00 | — | — | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH with Reflex to FT4 | $108.00 | $144.00 | — | 10% above | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIM HORMONE-TSH | $108.00 | $144.00 | — | 10% above | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH with Reflex to FT4 | $108.00 | $144.00 | — | — | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIM HORMONE-TSH | $108.00 | $144.00 | — | — | 25% |
| Trichomonas test (NAAT) CPT 87661 Trichomonas PCR MHP | $93.75 | $125.00 | — | 4% below | 25% |
| Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas PCR MHP | $93.75 | $125.00 | — | — | 25% |
| Uric acid blood test CPT 84550 URIC ACID | $64.50 | $86.00 | — | 27% above | 25% |
| Uric acid blood test inpatient CPT 84550 URIC ACID | $64.50 | $86.00 | — | — | 25% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSISvROUTINE W/MICR | $6.00 | $8.00 | — | 87% below | 25% |
| Urinalysis with microscope exam, automated CPT 81001 URINE AUTO W/MICROSCOPY | $59.25 | $79.00 | — | 30% above | 25% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSISvROUTINE W/MICR | $6.00 | $8.00 | — | — | 25% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINE AUTO W/MICROSCOPY | $59.25 | $79.00 | — | — | 25% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O MICR | $4.50 | $6.00 | — | 81% below | 25% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, AUTO W/O MICR | $4.50 | $6.00 | — | 81% below | 25% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Macroscopic | $30.75 | $41.00 | — | 28% above | 25% |
| Urinalysis without microscope exam, automated CPT 81003 URINE AUTO W/O MICROSCOPY | $35.25 | $47.00 | — | 47% above | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O MICR | $4.50 | $6.00 | — | — | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS, AUTO W/O MICR | $4.50 | $6.00 | — | — | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Macroscopic | $30.75 | $41.00 | — | — | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINE AUTO W/O MICROSCOPY | $35.25 | $47.00 | — | — | 25% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE UR QT COLONY CT | $86.25 | $115.00 | — | 27% above | 25% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE UR QT COLONY CT | $86.25 | $115.00 | — | — | 25% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY | $12.00 | $16.00 | — | 79% below | 25% |
| Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy HCG Qual | $75.00 | $100.00 | — | 32% above | 25% |
| Urine pregnancy test, read by color change CPT 81025 URINE HCG QUALITATIVE | $77.25 | $103.00 | — | 35% above | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY | $12.00 | $16.00 | — | — | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy HCG Qual | $75.00 | $100.00 | — | — | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE HCG QUALITATIVE | $77.25 | $103.00 | — | — | 25% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 | $146.25 | $195.00 | — | 29% above | 25% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12 | $146.25 | $195.00 | — | — | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D, 25-Hydroxy MHP | $183.00 | $244.00 | — | 40% above | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D HYDROXY | $183.00 | $244.00 | — | 40% above | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D HYDROXY | $183.00 | $244.00 | — | — | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D, 25-Hydroxy MHP | $183.00 | $244.00 | — | — | 25% |
| Zinc blood test CPT 84630 ZINC | $82.50 | $110.00 | — | 132% above | 25% |
| Zinc blood test inpatient CPT 84630 ZINC | $82.50 | $110.00 | — | — | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta-HCG Quantitative - Pregnancy MHP | $126.75 | $169.00 | — | 43% above | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 QUANTITATIVE HcG | $133.50 | $178.00 | — | 51% above | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta-HCG Quantitative - Pregnancy MHP | $126.75 | $169.00 | — | — | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 QUANTITATIVE HcG | $133.50 | $178.00 | — | — | 25% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 PF 42830 ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12 ProFee | $339.75 | $453.00 | — | 22% below | 25% |
| Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 PF 42830 ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12 ProFee | $339.75 | $453.00 | — | — | 25% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 PF Arthroscopy repair ligament | $1,725.00 | $2,300.00 | — | 49% below | 25% |
| Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 PF Arthroscopy repair ligament | $1,725.00 | $2,300.00 | — | — | 25% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 PF Arthroscopy, shoulder | $1,644.75 | $2,193.00 | — | 38% below | 25% |
| Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 PF Arthroscopy, shoulder | $1,644.75 | $2,193.00 | — | — | 25% |
| Botox injections for chronic migraine CPT 64615 PF CHEMODENERVATION MUSCLE MIGRAINE | $234.00 | $312.00 | — | 29% below | 25% |
| Botox injections for chronic migraine CPT 64615 BOTOX FACIAL/TRIGEM/CERV MUSC MIGRAINE | $236.25 | $315.00 | — | 28% below | 25% |
| Botox injections for chronic migraine inpatient CPT 64615 PF CHEMODENERVATION MUSCLE MIGRAINE | $234.00 | $312.00 | — | — | 25% |
| Botox injections for chronic migraine inpatient CPT 64615 BOTOX FACIAL/TRIGEM/CERV MUSC MIGRAINE | $236.25 | $315.00 | — | — | 25% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLSD TX DISTL FIB W/O MAN | $507.75 | $677.00 | — | 27% above | 25% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLSD TX DISTL FIB W/O MAN | $507.75 | $677.00 | — | — | 25% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLSD TX METAT FX WO MN EA | $174.75 | $233.00 | — | 52% below | 25% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLSD TX METAT FX WO MN EA | $174.75 | $233.00 | — | — | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 PF ED Cardioversion | $245.25 | $327.00 | — | 80% below | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERS ELECTIV EXTRNL | $262.50 | $350.00 | — | 79% below | 25% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 PF ED Cardioversion | $245.25 | $327.00 | — | — | 25% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERS ELECTIV EXTRNL | $262.50 | $350.00 | — | — | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 PF/TECH CLSD TX DSTL RAD FX WO MN | $315.75 | $421.00 | — | 17% below | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 PF/TECH CLTX DSTL RDL FX/WO MN | $534.75 | $713.00 | — | 40% above | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 PF/TECH CLSD TX DSTL RAD FX WO MN | $315.75 | $421.00 | — | — | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 PF/TECH CLTX DSTL RDL FX/WO MN | $534.75 | $713.00 | — | — | 25% |
| Colonoscopy with polyp removal CPT 45385 PF/TECH COLONOSCOPY W/SNARE | $711.75 | $949.00 | — | 30% below | 25% |
| Colonoscopy with polyp removal CPT 45385 COLNOSC REM TUMR PLP/SNR | $725.25 | $967.00 | — | 29% below | 25% |
| Colonoscopy with polyp removal CPT 45385 PF COLSC TMR/PLP W/SNAIR | $732.00 | $976.00 | — | 28% below | 25% |
| Colonoscopy with polyp removal inpatient CPT 45385 PF/TECH COLONOSCOPY W/SNARE | $711.75 | $949.00 | — | — | 25% |
| Colonoscopy with polyp removal inpatient CPT 45385 COLNOSC REM TUMR PLP/SNR | $725.25 | $967.00 | — | — | 25% |
| Colonoscopy with polyp removal inpatient CPT 45385 PF COLSC TMR/PLP W/SNAIR | $732.00 | $976.00 | — | — | 25% |
| Colonoscopy with tissue sample CPT 45380 PF/TECH COLONOSCOPY W/BX | $684.75 | $913.00 | — | 35% below | 25% |
| Colonoscopy with tissue sample CPT 45380 PF COLONOSCOPY W/BX =>1 | $693.00 | $924.00 | — | 34% below | 25% |
| Colonoscopy with tissue sample inpatient CPT 45380 PF/TECH COLONOSCOPY W/BX | $684.75 | $913.00 | — | — | 25% |
| Colonoscopy with tissue sample inpatient CPT 45380 PF COLONOSCOPY W/BX =>1 | $693.00 | $924.00 | — | — | 25% |
| Colonoscopy, diagnostic CPT 45378 PF/TECH COLONOSCOPY DIAGNOSTIC | $531.00 | $708.00 | — | 30% below | 25% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLEXIBLE DX | $537.75 | $717.00 | — | 29% below | 25% |
| Colonoscopy, diagnostic CPT 45378 PF COLONSCOPY FLEXIBLE DX | $537.75 | $717.00 | — | 29% below | 25% |
| Colonoscopy, diagnostic inpatient CPT 45378 PF/TECH COLONOSCOPY DIAGNOSTIC | $531.00 | $708.00 | — | — | 25% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLEXIBLE DX | $537.75 | $717.00 | — | — | 25% |
| Colonoscopy, diagnostic inpatient CPT 45378 PF COLONSCOPY FLEXIBLE DX | $537.75 | $717.00 | — | — | 25% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SCOPE | $267.00 | $356.00 | — | 3% below | 25% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 BX/CURETT OF CERVIX W/SCOPE | $267.00 | $356.00 | — | — | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 PF Cystourethroscopy | $373.50 | $498.00 | — | 31% below | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 PF Cystourethroscopy | $373.50 | $498.00 | — | — | 25% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 SP TECH/CLIN PRO DESTR PREMAL LES 1ST LES | $44.25 | $59.00 | — | 65% below | 25% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 SP TECH/CLIN PRO DESTR PREMAL LES 1ST LES | $44.25 | $59.00 | — | — | 25% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 PF BMT | $255.75 | $341.00 | — | 55% below | 25% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 PF BMT | $255.75 | $341.00 | — | — | 25% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 PF/TECH TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA | $148.50 | $198.00 | — | 62% below | 25% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 PF/TECH TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA | $148.50 | $198.00 | — | — | 25% |
| Earwax removal with instruments, one ear CPT 69210 REM IMPCT CERUMEN 1/BOTH | $44.25 | $59.00 | — | 40% below | 25% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REM IMPCT CERUMEN 1/BOTH | $44.25 | $59.00 | — | — | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 PF 58100 ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOU | $159.75 | $213.00 | — | 22% below | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BIOPSY W/O CERVICAL DILATION | $159.75 | $213.00 | — | 22% below | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BIOPSY W/O CERVICAL DILATION | $159.75 | $213.00 | — | — | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 PF 58100 ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOU | $159.75 | $213.00 | — | — | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 FLEXIBLE SIGMOIDOSCOPY DX | $284.25 | $379.00 | — | 28% below | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 PF FLEX SIG DX W/WO SPEC | $284.25 | $379.00 | — | 28% below | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 FLEXIBLE SIGMOIDOSCOPY DX | $284.25 | $379.00 | — | — | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 PF FLEX SIG DX W/WO SPEC | $284.25 | $379.00 | — | — | 25% |
| Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOP CHOLECYSTECTOM | $1,050.00 | $1,400.00 | — | 29% below | 25% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOP CHOLECYSTECTOM | $1,050.00 | $1,400.00 | — | — | 25% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 CHOLECTYSTECTOMY W/CHOLAN | $1,143.00 | $1,524.00 | — | 28% below | 25% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 CHOLECTYSTECTOMY W/CHOLAN | $1,143.00 | $1,524.00 | — | — | 25% |
| IUD insertion (the device itself billed separately) CPT 58300 SP TECH/CLIN PRO INSERTION OF IUD | $44.25 | $59.00 | — | 80% below | 25% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 SP TECH/CLIN PRO INSERTION OF IUD | $44.25 | $59.00 | — | — | 25% |
| Incision and drainage of a simple or single skin abscess CPT 10060 SP TECH/CLIN PRO INCDRAIN ABSC CYST SIMPL | $44.25 | $59.00 | — | 83% below | 25% |
| Incision and drainage of a simple or single skin abscess CPT 10060 PF/TECH INC DRAIN ABSC CYST SIMPLE | $198.00 | $264.00 | — | 24% below | 25% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 SP TECH/CLIN PRO INCDRAIN ABSC CYST SIMPL | $44.25 | $59.00 | — | — | 25% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 PF/TECH INC DRAIN ABSC CYST SIMPLE | $198.00 | $264.00 | — | — | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ 1 TENDN/ LIGMNT APOR | $44.25 | $59.00 | — | 77% below | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ 1 TENDN/ LIGMNT APOR | $44.25 | $59.00 | — | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 PF/TECH ARTHRO ASP/INJ MJR JT/WO US GUIDE | $101.25 | $135.00 | — | 47% below | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 PF/TECH ARTHRO ASP/INJ MJR JT/WO US GUIDE | $101.25 | $135.00 | — | — | 25% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 NEXPLANON PLACEMENT | $166.50 | $222.00 | — | 26% below | 25% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 NEXPLANON PLACEMENT | $166.50 | $222.00 | — | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 PF/TECH ARTHRO ASP/INJ INT JT/BRS WO U/S GUIDE | $44.25 | $59.00 | — | 78% below | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 PF/TECH ARTHRO ASP/INJ INT JT/BRS WO U/S GUIDE | $44.25 | $59.00 | — | — | 25% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHRO ASP/INJ SM JT/BRSA WO U/S GUIDE | $44.25 | $59.00 | — | 70% below | 25% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHRO ASP/INJ SM JT/BRSA WO U/S GUIDE | $44.25 | $59.00 | — | — | 25% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 PF ARTHROSCOPY KNEE W MENISCUS REPAIR | $1,027.50 | $1,370.00 | — | 53% below | 25% |
| Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 PF ARTHROSCOPY KNEE W MENISCUS REPAIR | $1,027.50 | $1,370.00 | — | — | 25% |
| Knee arthroscopy with meniscus trim CPT 29881 PF ARTHROSCOPY KNEE SURG W/MENISCECTOMY CHG | $837.75 | $1,117.00 | — | 52% below | 25% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 PF ARTHROSCOPY KNEE SURG W/MENISCECTOMY CHG | $837.75 | $1,117.00 | — | — | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REP INT S-A-T-EXT<=2.5CM | $408.75 | $545.00 | — | 1% below | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 PF/TECH REP INT S-A-T-EXT<=2.5CM | $408.75 | $545.00 | — | 1% below | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REP INT S-A-T-EXT<=2.5CM | $408.75 | $545.00 | — | — | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 PF/TECH REP INT S-A-T-EXT<=2.5CM | $408.75 | $545.00 | — | — | 25% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BENIGN LESN TRNK .5/< | $204.00 | $272.00 | — | 34% below | 25% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BENIGN LESN TRNK .5/< | $204.00 | $272.00 | — | — | 25% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC BEN LES F-ER-EY- <=.5 | $227.25 | $303.00 | — | 34% below | 25% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC BEN LES F-ER-EY- <=.5 | $227.25 | $303.00 | — | — | 25% |
| Nail removal (partial or complete), one nail CPT 11730 SP TECH REMOVAL OF NAIL PLATE | $44.25 | $59.00 | — | 83% below | 25% |
| Nail removal (partial or complete), one nail CPT 11730 PF/TECH ED AVULSION NAIL PLATE | $149.25 | $199.00 | — | 44% below | 25% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SINGL | $182.25 | $243.00 | — | 32% below | 25% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 SP TECH REMOVAL OF NAIL PLATE | $44.25 | $59.00 | — | — | 25% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 PF/TECH ED AVULSION NAIL PLATE | $149.25 | $199.00 | — | — | 25% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SINGL | $182.25 | $243.00 | — | — | 25% |
| Occipital nerve block (injection for headaches) CPT 64405 INJECT ANES AGENT>OCCIPITAL NERVE | $115.50 | $154.00 | — | 72% below | 25% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 INJECT ANES AGENT>OCCIPITAL NERVE | $115.50 | $154.00 | — | — | 25% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 SP CLIN TECH EXCISION OF NAIL | $60.75 | $81.00 | — | 82% below | 25% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 PF/TECH EXC NAIL MATRX PERM REMOV | $257.25 | $343.00 | — | 23% below | 25% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL MATRX PERM REMOV | $257.25 | $343.00 | — | 23% below | 25% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 SP CLIN TECH EXCISION OF NAIL | $60.75 | $81.00 | — | — | 25% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL MATRX PERM REMOV | $257.25 | $343.00 | — | — | 25% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 PF/TECH EXC NAIL MATRX PERM REMOV | $257.25 | $343.00 | — | — | 25% |
| Removal of a breast lump, open surgery CPT 19120 EXC CYST BRST TISS-DU =>1 | $803.25 | $1,071.00 | — | 33% below | 25% |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXC CYST BRST TISS-DU =>1 | $803.25 | $1,071.00 | — | — | 25% |
| Removal of a foreign object under the skin, simple CPT 10120 INC\REMOVE FOR BODY SMPL | $246.75 | $329.00 | — | 28% below | 25% |
| Removal of a foreign object under the skin, simple CPT 10120 PF/TECH INC\REMOVE FOR BODY SMPL | $246.75 | $329.00 | — | 28% below | 25% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 INC\REMOVE FOR BODY SMPL | $246.75 | $329.00 | — | — | 25% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 PF/TECH INC\REMOVE FOR BODY SMPL | $246.75 | $329.00 | — | — | 25% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 PF/TECH COLONOSCOPY SCREENING | $531.00 | $708.00 | — | 26% below | 25% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 PF COLSC SCRN-MCR N/H RSK | $538.50 | $718.00 | — | 25% below | 25% |
| Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 PF/TECH COLONOSCOPY SCREENING | $531.00 | $708.00 | — | — | 25% |
| Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 PF COLSC SCRN-MCR N/H RSK | $538.50 | $718.00 | — | — | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 PF/TECH COLONOSCOPY SCREENING HIGH RISK | $531.00 | $708.00 | — | 27% below | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 PF COLNSC SCRN-MCR HI RSK | $537.75 | $717.00 | — | 26% below | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 PF/TECH COLONOSCOPY SCREENING HIGH RISK | $531.00 | $708.00 | — | — | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 PF COLNSC SCRN-MCR HI RSK | $537.75 | $717.00 | — | — | 25% |
| Septoplasty to straighten the nasal septum CPT 30520 PF SEPTOPLASTY | $1,048.50 | $1,398.00 | — | 31% below | 25% |
| Septoplasty to straighten the nasal septum inpatient CPT 30520 PF SEPTOPLASTY | $1,048.50 | $1,398.00 | — | — | 25% |
| Short arm cast (elbow to hand) CPT 29075 APP CAST FIG 8 SHORT ARM | $138.75 | $185.00 | — | 28% below | 25% |
| Short arm cast (elbow to hand) inpatient CPT 29075 APP CAST FIG 8 SHORT ARM | $138.75 | $185.00 | — | — | 25% |
| Short arm splint (forearm and hand) CPT 29125 PF/TECH APP SPLNT SHRT ARM;STA | $104.25 | $139.00 | — | 31% below | 25% |
| Short arm splint (forearm and hand) CPT 29125 APP SPLINT SHRT ARM;STATC | $104.25 | $139.00 | — | 31% below | 25% |
| Short arm splint (forearm and hand) inpatient CPT 29125 PF/TECH APP SPLNT SHRT ARM;STA | $104.25 | $139.00 | — | — | 25% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APP SPLINT SHRT ARM;STATC | $104.25 | $139.00 | — | — | 25% |
| Short leg cast (below the knee) CPT 29405 APP CAST SHORT LEG | $129.75 | $173.00 | — | 29% below | 25% |
| Short leg cast (below the knee) inpatient CPT 29405 APP CAST SHORT LEG | $129.75 | $173.00 | — | — | 25% |
| Short leg splint (calf to foot) CPT 29515 APP SPLINT SHORT LEG | $114.75 | $153.00 | — | 26% below | 25% |
| Short leg splint (calf to foot) CPT 29515 PF/TECH APP SPLINT SHORT LEG | $114.75 | $153.00 | — | 26% below | 25% |
| Short leg splint (calf to foot) inpatient CPT 29515 PF/TECH APP SPLINT SHORT LEG | $114.75 | $153.00 | — | — | 25% |
| Short leg splint (calf to foot) inpatient CPT 29515 APP SPLINT SHORT LEG | $114.75 | $153.00 | — | — | 25% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 PF Arthroscopy shoulder distal claviculectomy | $1,047.00 | $1,396.00 | — | 40% below | 25% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 PF Arthroscopy shoulder distal claviculectomy | $1,047.00 | $1,396.00 | — | — | 25% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 PF Arthroscopy shoulder decompress subacromial space | $807.75 | $1,077.00 | — | 24% below | 25% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 PF Arthroscopy shoulder decompress subacromial space | $807.75 | $1,077.00 | — | — | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 PF/TECH REP SMP S-N-A-=<2.5CM | $121.50 | $162.00 | — | 42% below | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REP SMP S-N-A-EG-=<2.5CM | $146.25 | $195.00 | — | 30% below | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 PF/TECH REP SMP S-N-A-=<2.5CM | $121.50 | $162.00 | — | — | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REP SMP S-N-A-EG-=<2.5CM | $146.25 | $195.00 | — | — | 25% |
| Skin biopsy, punch, one lesion CPT 11104 SP TECH PUNCH BX OF SKIN | $44.25 | $59.00 | — | 83% below | 25% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN SINGLE LESION | $204.75 | $273.00 | — | 20% below | 25% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 SP TECH PUNCH BX OF SKIN | $44.25 | $59.00 | — | — | 25% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY OF SKIN SINGLE LESION | $204.75 | $273.00 | — | — | 25% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVE SKIN TAGS=>15LES | $63.00 | $84.00 | — | 68% below | 25% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVE SKIN TAGS=>15LES | $63.00 | $84.00 | — | — | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE DX | $226.50 | $302.00 | — | 39% below | 25% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE DX | $226.50 | $302.00 | — | — | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 PF/TECH REP SMP S-N-2.6-7.5CM | $159.00 | $212.00 | — | 32% below | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REP SMP S-N-A- 2.6-7.5CM | $178.50 | $238.00 | — | 24% below | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 PF/TECH REP SMP S-N-2.6-7.5CM | $159.00 | $212.00 | — | — | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 REP SMP S-N-A- 2.6-7.5CM | $178.50 | $238.00 | — | — | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 PF/TECH REP SMP F-ER-E-=<2.5CM | $149.25 | $199.00 | — | 35% below | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REP SMP F-ER-EY-N-=<2.5CM | $177.75 | $237.00 | — | 22% below | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 PF/TECH REP SMP F-ER-E-=<2.5CM | $149.25 | $199.00 | — | — | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REP SMP F-ER-EY-N-=<2.5CM | $177.75 | $237.00 | — | — | 25% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 SP TECH TANGENT BX OF SKIN | $44.25 | $59.00 | — | 74% below | 25% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY OF SKIN SINGLE LESION | $162.75 | $217.00 | — | 5% below | 25% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 SP TECH TANGENT BX OF SKIN | $44.25 | $59.00 | — | — | 25% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENTIAL BIOPSY OF SKIN SINGLE LESION | $162.75 | $217.00 | — | — | 25% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 PF Tonsil and Adenoid Over Age 12 | $471.00 | $628.00 | — | 24% below | 25% |
| Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 PF Tonsil and Adenoid Over Age 12 | $471.00 | $628.00 | — | — | 25% |
| Tonsil and adenoid removal, child under 12 CPT 42820 PF TONSIL AND ADENOID UNDER 12 | $471.00 | $628.00 | — | 21% below | 25% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 PF TONSIL AND ADENOID UNDER 12 | $471.00 | $628.00 | — | — | 25% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 PF TONSIL UNDER 12 | $429.00 | $572.00 | — | 19% below | 25% |
| Tonsil removal (tonsillectomy) only, child under 12 inpatient CPT 42825 PF TONSIL UNDER 12 | $429.00 | $572.00 | — | — | 25% |
| Total hip replacement CPT 27130 PF Arthroplasty, Total Hip | $1,896.75 | $2,529.00 | — | 54% below | 25% |
| Total hip replacement inpatient CPT 27130 PF Arthroplasty, Total Hip | $1,896.75 | $2,529.00 | — | — | 25% |
| Total knee replacement CPT 27447 PF ARTHROPLASTY, KNEE | $1,990.50 | $2,654.00 | — | 41% below | 25% |
| Total knee replacement inpatient CPT 27447 PF ARTHROPLASTY, KNEE | $1,990.50 | $2,654.00 | — | — | 25% |
| Trigger finger release surgery CPT 26055 TENDON SHEATH INCISION | $882.75 | $1,177.00 | — | 26% below | 25% |
| Trigger finger release surgery inpatient CPT 26055 TENDON SHEATH INCISION | $882.75 | $1,177.00 | — | — | 25% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1-2 MUS | $91.50 | $122.00 | — | 34% below | 25% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1-2 MUS | $91.50 | $122.00 | — | — | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 PF/TECH EGD WITH BALLOON DILATION | $1,749.00 | $2,332.00 | — | 2% below | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 PF UP GI ENDO W/DIL ESPH< | $1,764.75 | $2,353.00 | — | 1% below | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 UPP GI ENDO W/DIL ESPH<30 | $1,764.75 | $2,353.00 | — | 1% below | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 PF/TECH EGD WITH BALLOON DILATION | $1,749.00 | $2,332.00 | — | — | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 UPP GI ENDO W/DIL ESPH<30 | $1,764.75 | $2,353.00 | — | — | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 PF UP GI ENDO W/DIL ESPH< | $1,764.75 | $2,353.00 | — | — | 25% |
| Upper endoscopy (EGD) with biopsy CPT 43239 PF/TECH EGD W/BIOPSY | $598.50 | $798.00 | — | 54% below | 25% |
| Upper endoscopy (EGD) with biopsy CPT 43239 PF UPP GI ENDO W/BX=>1 | $606.00 | $808.00 | — | 53% below | 25% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PF/TECH EGD W/BIOPSY | $598.50 | $798.00 | — | — | 25% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PF UPP GI ENDO W/BX=>1 | $606.00 | $808.00 | — | — | 25% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 PF/TECH EGD W/SNARE TECHNIQUE | $787.50 | $1,050.00 | — | 34% below | 25% |
| Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 PF/TECH EGD W/SNARE TECHNIQUE | $787.50 | $1,050.00 | — | — | 25% |
| Upper endoscopy (EGD), diagnostic CPT 43235 UPPER GASTRO ENDOSCOPY | $455.25 | $607.00 | — | 33% below | 25% |
| Upper endoscopy (EGD), diagnostic CPT 43235 PF UPPER GI ENDOSCOPY | $455.25 | $607.00 | — | 33% below | 25% |
| Upper endoscopy (EGD), diagnostic CPT 43235 PF/TECH ESOPHAGOGASTRODUODENOSCOPY | $468.00 | $624.00 | — | 31% below | 25% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UPPER GASTRO ENDOSCOPY | $455.25 | $607.00 | — | — | 25% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PF UPPER GI ENDOSCOPY | $455.25 | $607.00 | — | — | 25% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PF/TECH ESOPHAGOGASTRODUODENOSCOPY | $468.00 | $624.00 | — | — | 25% |
| Wart removal, up to 14 warts CPT 17110 SP TECH/CLIN PRO DESTR B9 LES/Q VAS=<14LES | $58.50 | $78.00 | — | 66% below | 25% |
| Wart removal, up to 14 warts inpatient CPT 17110 SP TECH/CLIN PRO DESTR B9 LES/Q VAS=<14LES | $58.50 | $78.00 | — | — | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 PF/TECH ED DEBRIDEMENT PART TISSUE | $165.00 | $220.00 | — | 47% below | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT;SUB Q 1ST 20 | $204.00 | $272.00 | — | 34% below | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 PF/TECH ED DEBRIDEMENT PART TISSUE | $165.00 | $220.00 | — | — | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT;SUB Q 1ST 20 | $204.00 | $272.00 | — | — | 25% |
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 TRANSF UP TO 1 UNIT | $935.25 | $1,247.00 | — | 35% above | 25% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSF TO 2 UNITS | $1,009.50 | $1,346.00 | — | 45% above | 25% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSF TO 3+ UNITS | $1,084.50 | $1,446.00 | — | 56% above | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSF UP TO 1 UNIT | $935.25 | $1,247.00 | — | — | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSF TO 2 UNITS | $1,009.50 | $1,346.00 | — | — | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSF TO 3+ UNITS | $1,084.50 | $1,446.00 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 BREATHING TX ACUTE AIRWAY | $29.25 | $39.00 | — | 71% below | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT EzPAP Initial CHARGE | $193.50 | $258.00 | — | 90% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI ADMIN INITIAL | $193.50 | $258.00 | — | 90% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT EzPAP Subsequent CHARGE | $193.50 | $258.00 | — | 90% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI ADMIN SUBSEQUENT | $193.50 | $258.00 | — | 90% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER TX-EACH ADD/DAY | $193.50 | $258.00 | — | 90% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 BREATHING TX ACUTE AIRWAY | $29.25 | $39.00 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI ADMIN SUBSEQUENT | $193.50 | $258.00 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI ADMIN INITIAL | $193.50 | $258.00 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT EzPAP Subsequent CHARGE | $193.50 | $258.00 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT EzPAP Initial CHARGE | $193.50 | $258.00 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER TX-EACH ADD/DAY | $193.50 | $258.00 | — | — | 25% |
| Chemotherapy IV infusion, first hour CPT 96413 COMPLEX IV INFUS 1ST HR TYSABRI-OCREVUS | $378.75 | $505.00 | — | 22% below | 25% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 COMPLEX IV INFUS 1ST HR TYSABRI-OCREVUS | $378.75 | $505.00 | — | — | 25% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 PF BASIC COMP AIR BONE SRT | $65.25 | $87.00 | — | 32% below | 25% |
| Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 PF BASIC COMP AIR BONE SRT | $65.25 | $87.00 | — | — | 25% |
| Critical care, first 30 to 74 minutes CPT 99291 PF ER CR CAR 1ST 30-74MIN | $457.50 | $610.00 | — | 26% below | 25% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 1ST 30-74MN | $457.50 | $610.00 | — | 26% below | 25% |
| Critical care, first 30 to 74 minutes one side CPT 99291 ER CC GT 30-LT 90 MIN | $1,857.00 | $2,476.00 | — | 199% above | 25% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 PF ER CR CAR 1ST 30-74MIN | $457.50 | $610.00 | — | — | 25% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE 1ST 30-74MN | $457.50 | $610.00 | — | — | 25% |
| Critical care, first 30 to 74 minutes inpatient one side CPT 99291 ER CC GT 30-LT 90 MIN | $1,857.00 | $2,476.00 | — | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 CV EKG EO | $289.50 | $386.00 | — | 45% above | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING ONLY W/O I R | $289.50 | $386.00 | — | 45% above | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING ONLY,W/O I R | $289.50 | $386.00 | — | 45% above | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING ONLY,W/O I R | $289.50 | $386.00 | — | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 CV EKG EO | $289.50 | $386.00 | — | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING ONLY W/O I R | $289.50 | $386.00 | — | — | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 PF ER VISIT LEV 1 | $38.25 | $51.00 | — | 67% below | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL I | $177.75 | $237.00 | — | 54% above | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 PF ER VISIT LEV 1 | $38.25 | $51.00 | — | — | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL I | $177.75 | $237.00 | — | — | 25% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 PF ER VISIT LEV 2 | $72.00 | $96.00 | — | 59% below | 25% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL II | $286.50 | $382.00 | — | 62% above | 25% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 PF ER VISIT LEV 2 | $72.00 | $96.00 | — | — | 25% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL II | $286.50 | $382.00 | — | — | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 PF ER VISIT LEV 3 | $108.75 | $145.00 | — | 55% below | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Intermediate Service | $108.75 | $145.00 | — | 55% below | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL III | $471.75 | $629.00 | — | 96% above | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 PF ER VISIT LEV 3 | $108.75 | $145.00 | — | — | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Intermediate Service | $108.75 | $145.00 | — | — | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL III | $471.75 | $629.00 | — | — | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 PF ER VISIT LEV 4 | $196.50 | $262.00 | — | 53% below | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 PF ER Visit Lev 4 | $196.50 | $262.00 | — | 53% below | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL IV | $743.25 | $991.00 | — | 78% above | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 PF ER Visit Lev 4 | $196.50 | $262.00 | — | — | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 PF ER VISIT LEV 4 | $196.50 | $262.00 | — | — | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL IV | $743.25 | $991.00 | — | — | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 PF ER VISIT LEV 5 | $285.00 | $380.00 | — | 51% below | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL V | $1,136.25 | $1,515.00 | — | 94% above | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 PF ER VISIT LEV 5 | $285.00 | $380.00 | — | — | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL V | $1,136.25 | $1,515.00 | — | — | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 SAMC Stress Exercise or Drug | $1,034.25 | $1,379.00 | — | 2% below | 25% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 SAMC Stress Exercise or Drug | $1,034.25 | $1,379.00 | — | — | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 PF Family Therapy w patient 50 min | $161.25 | $215.00 | — | 22% below | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 PF Family Therapy w patient 50 min | $161.25 | $215.00 | — | — | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 PF Family Therapy wo patient 50 min | $154.50 | $206.00 | — | 24% below | 25% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 PF Family Therapy wo patient 50 min | $154.50 | $206.00 | — | — | 25% |
| Group psychotherapy session CPT 90853 PF Behavior Health Eval wo Med Services | $43.50 | $58.00 | — | 79% below | 25% |
| Group psychotherapy session inpatient CPT 90853 PF Behavior Health Eval wo Med Services | $43.50 | $58.00 | — | — | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION 1ST HR | $330.00 | $440.00 | — | at median | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION 1ST HR | $330.00 | $440.00 | — | — | 25% |
| IV infusion of a medicine, first hour CPT 96365 IV INFUSION 1ST HR | $309.00 | $412.00 | — | 1% below | 25% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION 1ST HR | $309.00 | $412.00 | — | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 SP TECH/CLIN PRO ADM THER/PRO/DX INJ NURSE | $28.50 | $38.00 | — | 71% below | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 TRT RM INJ THR/PRO SC/IM | $132.00 | $176.00 | — | 32% above | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 SP TECH/CLIN PRO ADM THER/PRO/DX INJ NURSE | $28.50 | $38.00 | — | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 TRT RM INJ THR/PRO SC/IM | $132.00 | $176.00 | — | — | 25% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 PF Behavior Health Eval wo Med Services | $280.50 | $374.00 | — | 34% above | 25% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PF Behavior Health Eval wo Med Services | $280.50 | $374.00 | — | — | 25% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE VISIT LEVEL 3 NEW PATIENT MS CLINIC | $176.25 | $235.00 | — | 14% below | 25% |
| New patient office visit, about 30 minutes CPT 99203 99203 PF Diabetic Clinic | $176.25 | $235.00 | — | 14% below | 25% |
| New patient office visit, about 30 minutes CPT 99203 LEVEL III NEW PATIENT | $176.25 | $235.00 | — | 14% below | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 LEVEL III NEW PATIENT | $176.25 | $235.00 | — | — | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VISIT LEVEL 3 NEW PATIENT MS CLINIC | $176.25 | $235.00 | — | — | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 PF Diabetic Clinic | $176.25 | $235.00 | — | — | 25% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE VISIT LEVEL 4 NEW PATIENT MS CLINIC | $268.50 | $358.00 | — | 11% below | 25% |
| New patient office visit, about 45 minutes CPT 99204 LEVEL IV NEW PATIENT | $268.50 | $358.00 | — | 11% below | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE VISIT LEVEL 4 NEW PATIENT MS CLINIC | $268.50 | $358.00 | — | — | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 LEVEL IV NEW PATIENT | $268.50 | $358.00 | — | — | 25% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE VISIT LEVEL 5 NEW PATIENT MS CLINIC | $340.50 | $454.00 | — | 8% below | 25% |
| New patient office visit, about 60 minutes CPT 99205 LEVEL V NEW PATIENT | $340.50 | $454.00 | — | 8% below | 25% |
| New patient office visit, about 60 minutes CPT 99205 Office or other outpatient visit | $340.50 | $454.00 | — | 8% below | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office or other outpatient visit | $340.50 | $454.00 | — | — | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 LEVEL V NEW PATIENT | $340.50 | $454.00 | — | — | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE VISIT LEVEL 5 NEW PATIENT MS CLINIC | $340.50 | $454.00 | — | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 LEVEL II NEW PATIENT | $123.75 | $165.00 | — | 9% below | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE VISIT LEVEL 2 NEW PATIENT MS CLINIC | $123.75 | $165.00 | — | 9% below | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE VISIT LEVEL 2 NEW PATIENT MS CLINIC | $123.75 | $165.00 | — | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 LEVEL II NEW PATIENT | $123.75 | $165.00 | — | — | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT-INITIAL/15MIN F-2-F | $63.75 | $85.00 | — | 41% above | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT-INITIAL/15MIN F-2-F | $63.75 | $85.00 | — | — | 25% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PREV MED NEW PT 18-39YRS | $218.25 | $291.00 | — | 9% below | 25% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREV MED NEW PT 18-39YRS | $218.25 | $291.00 | — | — | 25% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PREV MED NEW PAT 40-64YRS | $252.75 | $337.00 | — | 5% below | 25% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Prev Eval New Pt 40-64 yrs | $252.75 | $337.00 | — | 5% below | 25% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Prev Eval New Pt 40-64 yrs | $252.75 | $337.00 | — | — | 25% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREV MED NEW PAT 40-64YRS | $252.75 | $337.00 | — | — | 25% |
| Preventive checkup, new patient aged 65 or older CPT 99387 PREV MED NEW PAT => 65YRS | $273.75 | $365.00 | — | 5% above | 25% |
| Preventive checkup, new patient aged 65 or older inpatient CPT 99387 PREV MED NEW PAT => 65YRS | $273.75 | $365.00 | — | — | 25% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 PREV MED EST PT 18-39YRS | $197.25 | $263.00 | — | 5% below | 25% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 PREVMED ADULT 18 TO 39 YRS ProFee | $197.25 | $263.00 | — | 5% below | 25% |
| Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREVMED ADULT 18 TO 39 YRS ProFee | $197.25 | $263.00 | — | — | 25% |
| Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREV MED EST PT 18-39YRS | $197.25 | $263.00 | — | — | 25% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 PREV MED EST PT 40-64YRS | $209.25 | $279.00 | — | 5% below | 25% |
| Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PREV MED EST PT 40-64YRS | $209.25 | $279.00 | — | — | 25% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 PREV MED EST PT => 65YRS | $225.00 | $300.00 | — | at median | 25% |
| Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PREV MED EST PT => 65YRS | $225.00 | $300.00 | — | — | 25% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 PF Crisis Psychotherapy w patient 60 min | $225.75 | $301.00 | — | 5% above | 25% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PF Crisis Psychotherapy w patient 60 min | $225.75 | $301.00 | — | — | 25% |
| Psychotherapy session, 30 minutes CPT 90832 PF Psychotherapy w patient 16-37 min | $122.25 | $163.00 | — | 23% below | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PF Psychotherapy w patient 16-37 min | $122.25 | $163.00 | — | — | 25% |
| Psychotherapy session, 45 minutes CPT 90834 PF Psychotherapy w patient 38-52 min | $161.25 | $215.00 | — | 13% below | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PF Psychotherapy w patient 38-52 min | $161.25 | $215.00 | — | — | 25% |
| Psychotherapy session, 60 minutes CPT 90837 PF Psychotherapy w patient 53+ min | $237.00 | $316.00 | — | 9% above | 25% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PF Psychotherapy w patient 53+ min | $237.00 | $316.00 | — | — | 25% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING/TOBAC CESS 3-10MN | $27.00 | $36.00 | — | 3% below | 25% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING/TOBAC CESS 3-10MN | $27.00 | $36.00 | — | — | 25% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT LEVEL 5 ESTABLISHED PATIENT MS CLINIC | $240.75 | $321.00 | — | 15% above | 25% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 LEVEL V EST PATIENT | $240.75 | $321.00 | — | 15% above | 25% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE VISIT LEVEL 5 ESTABLISHED PATIENT MS CLINIC | $240.75 | $321.00 | — | — | 25% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 LEVEL V EST PATIENT | $240.75 | $321.00 | — | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OUTPATIENT CLINIC ROOM | $27.75 | $37.00 | — | 78% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT LEVEL 3 ESTABLISHED PATIENT MS CLINIC | $123.00 | $164.00 | — | 2% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 LEVEL III EST PATIENT | $123.00 | $164.00 | — | 2% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OUTPATIENT CLINIC ROOM | $27.75 | $37.00 | — | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE VISIT LEVEL 3 ESTABLISHED PATIENT MS CLINIC | $123.00 | $164.00 | — | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 LEVEL III EST PATIENT | $123.00 | $164.00 | — | — | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PF 99214 OV Establisted | $178.50 | $238.00 | — | 10% above | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 LEVEL IV EST PATIENT | $178.50 | $238.00 | — | 10% above | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT LEVEL 4 ESTABLISHED PATIENT MS CLINIC | $178.50 | $238.00 | — | 10% above | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PF 99214 OV Establisted | $178.50 | $238.00 | — | — | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE VISIT LEVEL 4 ESTABLISHED PATIENT MS CLINIC | $178.50 | $238.00 | — | — | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 LEVEL IV EST PATIENT | $178.50 | $238.00 | — | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PF/TECH LEVEL II EST PATIENT | $73.50 | $98.00 | — | 14% below | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 LEVEL II EST PATIENT | $73.50 | $98.00 | — | 14% below | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT LEVEL 2 ESTABLISHED PATIENT MS CLINIC | $73.50 | $98.00 | — | 14% below | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PF/TECH LEVEL II EST PATIENT | $73.50 | $98.00 | — | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE VISIT LEVEL 2 ESTABLISHED PATIENT MS CLINIC | $73.50 | $98.00 | — | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 LEVEL II EST PATIENT | $73.50 | $98.00 | — | — | 25% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT/PREOP LEVEL III | $203.25 | $271.00 | — | 7% below | 25% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT/PREOP LEVEL III | $203.25 | $271.00 | — | — | 25% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PF CONSULT/PREOP LEVEL IV | $303.75 | $405.00 | — | 8% below | 25% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT/PREOP LEVEL IV | $303.75 | $405.00 | — | 8% below | 25% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT/PREOP LEVEL IV | $303.75 | $405.00 | — | — | 25% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 PF CONSULT/PREOP LEVEL IV | $303.75 | $405.00 | — | — | 25% |
| Spirometry (breathing test) CPT 94010 SPIROMETER PRETEST ONLY | $57.75 | $77.00 | — | 75% below | 25% |
| Spirometry (breathing test) CPT 94010 PFT (SPIROMETRY)-SIMPLE | $267.75 | $357.00 | — | 18% above | 25% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETER PRETEST ONLY | $57.75 | $77.00 | — | — | 25% |
| Spirometry (breathing test) inpatient CPT 94010 PFT (SPIROMETRY)-SIMPLE | $267.75 | $357.00 | — | — | 25% |
| Spirometry before and after a bronchodilator CPT 94060 SPIROMETER PRE/POST-BRONC | $95.25 | $127.00 | — | 78% below | 25% |
| Spirometry before and after a bronchodilator CPT 94060 PFT (PRE-POST)/BRONCO | $558.75 | $745.00 | — | 28% above | 25% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETER PRE/POST-BRONC | $95.25 | $127.00 | — | — | 25% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 PFT (PRE-POST)/BRONCO | $558.75 | $745.00 | — | — | 25% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine, inactivated preservative-free trivalent Sus [SAMC] | $31.90 | $42.53 | — | at median | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine, inactivated preservative-free trivalent Sus | $31.90 | $42.53 | — | at median | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine, inactivated preservative-free trivalent Sus [SAMC] | $31.90 | $42.53 | — | — | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine, inactivated preservative-free trivalent Sus | $31.90 | $42.53 | — | — | 25% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conj vac [SAMC] | $434.57 | $579.42 | — | 11% below | 25% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conj vac [SAMC] | $434.57 | $579.42 | — | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Immunization administration, first vaccine (CLINIC) | $16.50 | $22.00 | — | 52% below | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION X1 VACCINE | $132.75 | $177.00 | — | 288% above | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 Immunization administration, first vaccine (CLINIC) | $16.50 | $22.00 | — | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMINISTRATION X1 VACCINE | $132.75 | $177.00 | — | — | 25% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN EACH ADDT'L IMMUN | $6.00 | $8.00 | — | 86% below | 25% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADMIN EACH ADDT'L IMMUN | $6.00 | $8.00 | — | — | 25% |
Source file: https://Saundersmedicalcenter.com/price-transparency/476007158_Saunders-Medical-Center_standard-charges.csv