Hospital

Providence Medical Center

Providence Medical Center in Wayne, NE publishes cash prices for 301 common procedures listed here, from its own machine-readable price file updated Oct 29, 2025. Compared with other hospitals in the state, its outpatient cash prices are above the Nebraska median for 179 of 300 procedures and below it for 112. By typical cash price it ranks #23 of 34 Nebraska hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1200 Providence Rd, Wayne, NE 68787 Collected Sep 27, 2026 Source price file (402) 375-3800

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 281345 · CMS hospital register

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 3 actions for a hospital named Providence Medical Center in Wayne, NE:

Apr 10, 2026 Warning notice
Jul 21, 2026 Corrective action plan requested
Jul 29, 2026 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 PMC XR Ankle Comp Min 3 Views Bil	$659.30	$694.00	$257.19–$680.12	132% above	5%
Ankle X-ray, complete, 3 or more views CPT 73610 PMC XR Ankle Comp Min 3 Views Bill Only	$659.30	$694.00	$257.19–$680.12	132% above	5%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Comp Min 3 Views Rt	$329.65	$347.00	$204.73–$340.06	16% above	5%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Comp Min 3 Views Lt	$329.65	$347.00	$204.73–$340.06	16% above	5%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 PMC XR Ankle Comp Min 3 Views Bil	$659.30	$694.00	$624.60–$680.12	—	5%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 PMC XR Ankle Comp Min 3 Views Bill Only	$659.30	$694.00	$624.60–$680.12	—	5%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Comp Min 3 Views Rt	$329.65	$347.00	$312.30–$340.06	—	5%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Comp Min 3 Views Lt	$329.65	$347.00	$312.30–$340.06	—	5%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 93922 Ankle Brachial Index	$672.60	$708.00	$417.72–$693.84	82% above	5%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Cardiology ABI	$672.60	$708.00	$417.72–$693.84	82% above	5%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US Ankle Brachial Index	$707.75	$745.00	$439.55–$730.10	91% above	5%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 93922 Ankle Brachial Index	$672.60	$708.00	$637.20–$693.84	—	5%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Cardiology ABI	$672.60	$708.00	$637.20–$693.84	—	5%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US Ankle Brachial Index	$707.75	$745.00	$670.50–$730.10	—	5%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus	$950.95	$1,001.00	$590.59–$980.98	88% above	5%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus	$950.95	$1,001.00	$900.90–$980.98	—	5%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Whole Body	$1,748.95	$1,841.00	$1,086.19–$1,804.18	5% above	5%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Whole Body	$1,748.95	$1,841.00	$1,656.90–$1,804.18	—	5%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Comp Lt.	$672.60	$708.00	$417.72–$693.84	49% above	5%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Comp Rt.	$672.60	$708.00	$417.72–$693.84	49% above	5%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Comp Lt.	$672.60	$708.00	$637.20–$693.84	—	5%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Comp Rt.	$672.60	$708.00	$637.20–$693.84	—	5%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Ltd Lt.	$661.20	$696.00	$410.64–$682.08	95% above	5%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Ltd Rt.	$661.20	$696.00	$410.64–$682.08	95% above	5%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Ltd Lt.	$661.20	$696.00	$626.40–$682.08	—	5%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Ltd Rt.	$661.20	$696.00	$626.40–$682.08	—	5%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest +Abdomen +Pelvis	$4,213.25	$4,435.00	$2,616.65–$4,346.30	38% above	5%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest w/ Cont	$4,213.25	$4,435.00	$2,616.65–$4,346.30	38% above	5%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest PE w/ Cont	$4,213.25	$4,435.00	$2,616.65–$4,346.30	38% above	5%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest PE w/ Cont	$4,213.25	$4,435.00	$3,991.50–$4,346.30	—	5%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest +Abdomen +Pelvis	$4,213.25	$4,435.00	$3,991.50–$4,346.30	—	5%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest w/ Cont	$4,213.25	$4,435.00	$3,991.50–$4,346.30	—	5%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Cardiac Calcium Score	$1,498.15	$1,577.00	$930.43–$1,545.46	1099% above	5%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Cardiac Calcium Score	$1,498.15	$1,577.00	$1,419.30–$1,545.46	—	5%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen +Pelvis w/o Cont	$2,580.20	$2,716.00	$1,602.44–$2,661.68	10% below	5%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 PMC CT Abdomen + Pelvis w/o Cont	$2,580.20	$2,716.00	$1,602.44–$2,661.68	10% below	5%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 PMC CT Abdomen + Pelvis w/o Cont	$2,580.20	$2,716.00	$2,444.40–$2,661.68	—	5%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen +Pelvis w/o Cont	$2,580.20	$2,716.00	$2,444.40–$2,661.68	—	5%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen +Pelvis w/ Cont	$4,655.95	$4,901.00	$2,858.73–$4,802.98	19% above	5%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 PMC CT Abdomen +Pelvis w/ Cont	$4,655.95	$4,901.00	$2,858.73–$4,802.98	19% above	5%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen +Pelvis w/ Cont	$4,655.95	$4,901.00	$4,410.90–$4,802.98	—	5%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 PMC CT Abdomen +Pelvis w/ Cont	$4,655.95	$4,901.00	$4,410.90–$4,802.98	—	5%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 PMC CT Abdomen +Pelvis w/ + w/o Cont	$5,148.05	$5,419.00	$3,197.21–$5,310.62	17% above	5%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen +Pelvis w/ + w/o Cont	$5,148.05	$5,419.00	$3,197.21–$5,310.62	17% above	5%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 PMC CT Abdomen +Pelvis w/ + w/o Cont	$5,148.05	$5,419.00	$4,877.10–$5,310.62	—	5%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen +Pelvis w/ + w/o Cont	$5,148.05	$5,419.00	$4,877.10–$5,310.62	—	5%
CT scan of the abdomen with contrast CPT 74160 PMC CT Abdomen w/ Cont	$3,404.80	$3,584.00	$2,114.56–$3,512.32	45% above	5%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Cont	$3,404.80	$3,584.00	$2,114.56–$3,512.32	45% above	5%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Cont	$3,404.80	$3,584.00	$3,225.60–$3,512.32	—	5%
CT scan of the abdomen with contrast inpatient CPT 74160 PMC CT Abdomen w/ Cont	$3,404.80	$3,584.00	$3,225.60–$3,512.32	—	5%
CT scan of the abdomen without contrast CPT 74150 PMC CT Abdomen w/o Cont	$1,881.95	$1,981.00	$1,168.79–$1,941.38	4% below	5%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Cont	$1,881.95	$1,981.00	$1,168.79–$1,941.38	4% below	5%
CT scan of the abdomen without contrast inpatient CPT 74150 PMC CT Abdomen w/o Cont	$1,881.95	$1,981.00	$1,782.90–$1,941.38	—	5%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Cont	$1,881.95	$1,981.00	$1,782.90–$1,941.38	—	5%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Cont	$2,152.70	$2,266.00	$1,336.94–$2,220.68	33% above	5%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus or Facial w/o Cont	$2,152.70	$2,266.00	$1,336.94–$2,220.68	33% above	5%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus or Facial w/o Cont	$2,152.70	$2,266.00	$2,039.40–$2,220.68	—	5%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Cont	$2,152.70	$2,266.00	$2,039.40–$2,220.68	—	5%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Cont	$1,626.40	$1,712.00	$1,010.08–$1,677.76	4% below	5%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Cont	$1,626.40	$1,712.00	$1,540.80–$1,677.76	—	5%
CT scan of the head with contrast CPT 70460 CT Head or Brain w/ Cont	$1,992.15	$2,097.00	$1,237.23–$2,055.06	1% above	5%
CT scan of the head with contrast inpatient CPT 70460 CT Head or Brain w/ Cont	$1,992.15	$2,097.00	$1,887.30–$2,055.06	—	5%
CT scan of the head without and with contrast CPT 70470 CT Head or Brain w/ + w/o Cont	$2,700.85	$2,843.00	$1,677.37–$2,786.14	15% above	5%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head or Brain w/ + w/o Cont	$2,700.85	$2,843.00	$2,558.70–$2,786.14	—	5%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Cont	$2,639.10	$2,778.00	$1,639.02–$2,722.44	29% above	5%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Cont	$2,639.10	$2,778.00	$2,500.20–$2,722.44	—	5%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Cont	$2,643.85	$2,783.00	$1,641.97–$2,727.34	27% above	5%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Cont	$2,643.85	$2,783.00	$2,504.70–$2,727.34	—	5%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Cont	$3,412.40	$3,592.00	$2,119.28–$3,520.16	46% above	5%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Cont	$3,412.40	$3,592.00	$3,232.80–$3,520.16	—	5%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 93880 Bilateral carotid ultrasound	$1,461.10	$1,538.00	$907.42–$1,507.24	—	5%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Cardiology Carotid Duplex Bilateral	$1,478.20	$1,556.00	$918.04–$1,524.88	—	5%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US Carotid Doppler Bil	$1,522.85	$1,603.00	$945.77–$1,570.94	1% below	5%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 93880 Bilateral carotid ultrasound	$1,461.10	$1,538.00	$1,384.20–$1,507.24	—	5%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Cardiology Carotid Duplex Bilateral	$1,478.20	$1,556.00	$1,400.40–$1,524.88	—	5%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US Carotid Doppler Bil	$1,522.85	$1,603.00	$1,442.70–$1,570.94	—	5%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$275.50	$290.00	$136.73–$284.20	2% above	5%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$275.50	$290.00	$261.00–$284.20	—	5%
Chest X-ray, single view CPT 71045 XR Chest 1 View Portable	$156.75	$165.00	$97.35–$161.70	18% below	5%
Chest X-ray, single view CPT 71045 XR Chest 1 View	$156.75	$165.00	$97.35–$161.70	18% below	5%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View Portable	$156.75	$165.00	$148.50–$161.70	—	5%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View	$156.75	$165.00	$148.50–$161.70	—	5%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Renal Comp FAMC	$711.55	$749.00	$441.91–$734.02	8% below	5%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Renal Comp FAMC	$711.55	$749.00	$674.10–$734.02	—	5%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Cont	$2,184.05	$2,299.00	$1,356.41–$2,253.02	7% above	5%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest Low Dose Diag w/o Cont	$2,184.05	$2,299.00	$1,356.41–$2,253.02	7% above	5%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest +Abdomen w/o Cont	$2,184.05	$2,299.00	$1,356.41–$2,253.02	7% above	5%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest +Abdomen +Pelvis w/o Cont	$2,184.05	$2,299.00	$1,356.41–$2,253.02	7% above	5%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Sternum w/o Cont	$2,184.05	$2,299.00	$1,356.41–$2,253.02	7% above	5%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest +Abdomen w/o Cont	$2,184.05	$2,299.00	$2,069.10–$2,253.02	—	5%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Sternum w/o Cont	$2,184.05	$2,299.00	$2,069.10–$2,253.02	—	5%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest +Abdomen +Pelvis w/o Cont	$2,184.05	$2,299.00	$2,069.10–$2,253.02	—	5%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest Low Dose Diag w/o Cont	$2,184.05	$2,299.00	$2,069.10–$2,253.02	—	5%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Cont	$2,184.05	$2,299.00	$2,069.10–$2,253.02	—	5%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest +Abdomen +Pelvis w/ Cont	$2,835.75	$2,985.00	$1,550.78–$2,925.30	20% above	5%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Cont	$2,835.75	$2,985.00	$1,550.78–$2,925.30	20% above	5%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest +Abdomen w/ Cont	$2,835.75	$2,985.00	$1,550.78–$2,925.30	20% above	5%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Sternum w/ Cont	$2,835.75	$2,985.00	$1,550.78–$2,925.30	20% above	5%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest +Abdomen +Pelvis w/ Cont	$2,835.75	$2,985.00	$2,686.50–$2,925.30	—	5%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Sternum w/ Cont	$2,835.75	$2,985.00	$2,686.50–$2,925.30	—	5%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Cont	$2,835.75	$2,985.00	$2,686.50–$2,925.30	—	5%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest +Abdomen w/ Cont	$2,835.75	$2,985.00	$2,686.50–$2,925.30	—	5%
Diagnostic mammogram, both breasts CPT 77066 MA Diag Bil.	$410.40	$432.00	$254.88–$423.36	8% below	5%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA Diag Bil.	$410.40	$432.00	$388.80–$423.36	—	5%
Diagnostic mammogram, one breast one side CPT 77065 PMC MA Diag Rt	$367.65	$387.00	$228.33–$379.26	79% above	5%
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Ltd Marker Placement Rt	$367.65	$387.00	$228.33–$379.26	79% above	5%
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Rt.	$367.65	$387.00	$228.33–$379.26	79% above	5%
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Lt.	$367.65	$387.00	$228.33–$379.26	79% above	5%
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Breast w/ Tomo Rt.	$367.65	$387.00	$228.33–$379.26	79% above	5%
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Ltd Marker Placement Lt	$367.65	$387.00	$228.33–$379.26	79% above	5%
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Breast w/ Tomo Lt.	$367.65	$387.00	$228.33–$379.26	79% above	5%
Diagnostic mammogram, one breast one side CPT 77065 PMC MA Diag Lt	$367.65	$387.00	$228.33–$379.26	79% above	5%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Ltd Marker Placement Lt	$367.65	$387.00	$348.30–$379.26	—	5%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Ltd Marker Placement Rt	$367.65	$387.00	$348.30–$379.26	—	5%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Lt.	$367.65	$387.00	$348.30–$379.26	—	5%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Breast w/ Tomo Rt.	$367.65	$387.00	$348.30–$379.26	—	5%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Breast w/ Tomo Lt.	$367.65	$387.00	$348.30–$379.26	—	5%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Rt.	$367.65	$387.00	$348.30–$379.26	—	5%
Diagnostic mammogram, one breast inpatient one side CPT 77065 PMC MA Diag Rt	$367.65	$387.00	$348.30–$379.26	—	5%
Diagnostic mammogram, one breast inpatient one side CPT 77065 PMC MA Diag Lt	$367.65	$387.00	$348.30–$379.26	—	5%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 93925 Bilateral lower extremity arterial duplex	$944.30	$994.00	$586.46–$974.12	—	5%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US LE Art Duplex Bil	$1,031.70	$1,086.00	$640.74–$1,064.28	at median	5%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 93925 Bilateral lower extremity arterial duplex	$944.30	$994.00	$894.60–$974.12	—	5%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US LE Art Duplex Bil	$1,031.70	$1,086.00	$977.40–$1,064.28	—	5%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 93970 Bilateral Venous Reflux	$1,448.75	$1,525.00	$899.75–$1,494.50	—	5%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 93970 Bilateral Venous Duplex	$1,448.75	$1,525.00	$899.75–$1,494.50	—	5%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Cardiology Venous Duplex Bilateral	$1,448.75	$1,525.00	$899.75–$1,494.50	—	5%
Duplex ultrasound of the leg veins, both legs CPT 93970 US UE Veins Duplex Bil	$1,133.35	$1,193.00	$703.87–$1,169.14	18% below	5%
Duplex ultrasound of the leg veins, both legs CPT 93970 93970 Vein Mapping for Bypass	$1,448.75	$1,525.00	$899.75–$1,494.50	5% above	5%
Duplex ultrasound of the leg veins, both legs CPT 93970 US LE Vein Doppler Bil	$1,539.00	$1,620.00	$955.80–$1,587.60	11% above	5%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 93970 Bilateral Venous Duplex	$1,448.75	$1,525.00	$1,372.50–$1,494.50	—	5%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 93970 Bilateral Venous Reflux	$1,448.75	$1,525.00	$1,372.50–$1,494.50	—	5%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Cardiology Venous Duplex Bilateral	$1,448.75	$1,525.00	$1,372.50–$1,494.50	—	5%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US UE Veins Duplex Bil	$1,133.35	$1,193.00	$1,073.70–$1,169.14	—	5%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 93970 Vein Mapping for Bypass	$1,448.75	$1,525.00	$1,372.50–$1,494.50	—	5%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US LE Vein Doppler Bil	$1,539.00	$1,620.00	$1,458.00–$1,587.60	—	5%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 93306 Echo complete PMC	$2,771.15	$2,917.00	$1,721.03–$2,858.66	38% above	5%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echo Complete	$2,771.15	$2,917.00	$1,721.03–$2,858.66	38% above	5%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Echo Complete	$2,771.15	$2,917.00	$2,625.30–$2,858.66	—	5%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 93306 Echo complete PMC	$2,771.15	$2,917.00	$2,625.30–$2,858.66	—	5%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepa Duct System	$2,339.85	$2,463.00	$1,453.17–$2,413.74	53% above	5%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepa Duct System	$2,339.85	$2,463.00	$2,216.70–$2,413.74	—	5%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 Polysomnography; with initiation of CPAP, attended by a technologist 981	$1,308.15	$1,377.00	$812.43–$1,349.46	63% below	5%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 SLEEP STUDY W CPAP CHARGE	$3,947.25	$4,155.00	$2,451.45–$4,071.90	12% above	5%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 95811 Polysomnography; with initiation of CPAP, attended by a technologist 981	$1,308.15	$1,377.00	$1,239.30–$1,349.46	—	5%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 95811 SLEEP STUDY W CPAP CHARGE	$3,947.25	$4,155.00	$3,739.50–$4,071.90	—	5%
Knee X-ray, 3 views CPT 73562 XR Knee 3 Views Bil	$761.90	$802.00	$275.40–$785.96	123% above	5%
Knee X-ray, 3 views CPT 73562 PMC XR Knee 3 Views Bil	$761.90	$802.00	$275.40–$785.96	123% above	5%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Rt	$380.95	$401.00	$236.59–$392.98	12% above	5%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Lt	$380.95	$401.00	$236.59–$392.98	12% above	5%
Knee X-ray, 3 views inpatient CPT 73562 XR Knee 3 Views Bil	$761.90	$802.00	$721.80–$785.96	—	5%
Knee X-ray, 3 views inpatient CPT 73562 PMC XR Knee 3 Views Bil	$761.90	$802.00	$721.80–$785.96	—	5%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Lt	$380.95	$401.00	$360.90–$392.98	—	5%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Rt	$380.95	$401.00	$360.90–$392.98	—	5%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Ltd	$931.95	$981.00	$578.79–$961.38	79% above	5%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Gallbladder FAMC	$931.95	$981.00	$578.79–$961.38	79% above	5%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Gallbladder FAMC	$931.95	$981.00	$882.90–$961.38	—	5%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Ltd	$931.95	$981.00	$882.90–$961.38	—	5%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Thorax Low Dose Lung Cancer Screening w/o Cont	$237.50	$250.00	$147.50–$245.00	45% below	5%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Thorax Low Dose Lung Cancer Screening w/o Cont	$237.50	$250.00	$225.00–$245.00	—	5%
MRI of both breasts, without and then with contrast dye CPT 77049 MRI Breast w/ + w/o Cont Bil	$1,695.75	$1,785.00	$1,053.15–$1,749.30	40% below	5%
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 MRI Breast w/ + w/o Cont Bil	$1,695.75	$1,785.00	$1,606.50–$1,749.30	—	5%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Cont Lt	$2,432.00	$2,560.00	$1,510.40–$2,508.80	1% below	5%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Cont Rt	$2,432.00	$2,560.00	$1,510.40–$2,508.80	1% below	5%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Cont Rt	$2,432.00	$2,560.00	$1,510.40–$2,508.80	1% below	5%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Cont Rt	$2,432.00	$2,560.00	$1,510.40–$2,508.80	1% below	5%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Cont Lt	$2,432.00	$2,560.00	$1,510.40–$2,508.80	1% below	5%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Cont Lt	$2,432.00	$2,560.00	$1,510.40–$2,508.80	1% below	5%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Cont Rt	$2,432.00	$2,560.00	$2,304.00–$2,508.80	—	5%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Cont Lt	$2,432.00	$2,560.00	$2,304.00–$2,508.80	—	5%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Cont Lt	$2,432.00	$2,560.00	$2,304.00–$2,508.80	—	5%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Cont Lt	$2,432.00	$2,560.00	$2,304.00–$2,508.80	—	5%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Cont Rt	$2,432.00	$2,560.00	$2,304.00–$2,508.80	—	5%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Cont Rt	$2,432.00	$2,560.00	$2,304.00–$2,508.80	—	5%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Cont Rt	$5,029.30	$5,294.00	$3,123.46–$5,188.12	49% above	5%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Cont Lt	$5,029.30	$5,294.00	$3,123.46–$5,188.12	49% above	5%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Cont Rt	$5,029.30	$5,294.00	$3,123.46–$5,188.12	49% above	5%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Cont Lt	$5,029.30	$5,294.00	$3,123.46–$5,188.12	49% above	5%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Cont Rt	$5,029.30	$5,294.00	$3,123.46–$5,188.12	49% above	5%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Cont Lt	$5,029.30	$5,294.00	$3,123.46–$5,188.12	49% above	5%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Cont Lt	$5,029.30	$5,294.00	$4,764.60–$5,188.12	—	5%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Cont Rt	$5,029.30	$5,294.00	$4,764.60–$5,188.12	—	5%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Cont Lt	$5,029.30	$5,294.00	$4,764.60–$5,188.12	—	5%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Cont Rt	$5,029.30	$5,294.00	$4,764.60–$5,188.12	—	5%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Cont Lt	$5,029.30	$5,294.00	$4,764.60–$5,188.12	—	5%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Cont Rt	$5,029.30	$5,294.00	$4,764.60–$5,188.12	—	5%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Cont	$3,285.10	$3,458.00	$2,040.22–$3,388.84	19% above	5%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Cont	$3,285.10	$3,458.00	$3,112.20–$3,388.84	—	5%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Cont	$4,353.85	$4,583.00	$2,703.97–$4,491.34	18% above	5%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Cont	$4,353.85	$4,583.00	$4,124.70–$4,491.34	—	5%
MRI of the brain, no contrast dye CPT 70551 MRI IAC w/o Contrast	$2,247.70	$2,366.00	$1,395.94–$2,318.68	11% below	5%
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Cont	$2,247.70	$2,366.00	$1,395.94–$2,318.68	11% below	5%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI IAC w/o Contrast	$2,247.70	$2,366.00	$2,129.40–$2,318.68	—	5%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Cont	$2,247.70	$2,366.00	$2,129.40–$2,318.68	—	5%
MRI of the brain, with and without contrast dye CPT 70553 MRI Pituitary Gland w/ + w/o Cont	$3,791.45	$3,991.00	$2,354.69–$3,911.18	1% below	5%
MRI of the brain, with and without contrast dye CPT 70553 MRI IAC w/ + w/o Cont	$3,791.45	$3,991.00	$2,354.69–$3,911.18	1% below	5%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Cont	$3,791.45	$3,991.00	$2,354.69–$3,911.18	1% below	5%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI IAC w/ + w/o Cont	$3,791.45	$3,991.00	$3,591.90–$3,911.18	—	5%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Cont	$3,791.45	$3,991.00	$3,591.90–$3,911.18	—	5%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Pituitary Gland w/ + w/o Cont	$3,791.45	$3,991.00	$3,591.90–$3,911.18	—	5%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Cont	$2,210.65	$2,327.00	$1,372.93–$2,280.46	28% below	5%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Cont	$2,210.65	$2,327.00	$2,094.30–$2,280.46	—	5%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Cont	$3,807.60	$4,008.00	$2,364.72–$3,927.84	2% below	5%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Cont	$3,807.60	$4,008.00	$3,607.20–$3,927.84	—	5%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Cont	$2,145.10	$2,258.00	$1,332.22–$2,212.84	32% below	5%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Cont	$2,145.10	$2,258.00	$2,032.20–$2,212.84	—	5%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Cont	$3,824.70	$4,026.00	$2,375.34–$3,945.48	at median	5%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Cont	$3,824.70	$4,026.00	$3,623.40–$3,945.48	—	5%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Cont	$2,141.30	$2,254.00	$1,329.86–$2,208.92	29% below	5%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Cont	$2,141.30	$2,254.00	$2,028.60–$2,208.92	—	5%
MRI of the pelvis without and with contrast CPT 72197 MRI Sacrum w/ + w/o Contrast	$4,297.80	$4,524.00	$2,669.16–$4,433.52	28% above	5%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Cont	$4,297.80	$4,524.00	$2,669.16–$4,433.52	28% above	5%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Sacrum w/ + w/o Contrast	$4,297.80	$4,524.00	$4,071.60–$4,433.52	—	5%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Cont	$4,297.80	$4,524.00	$4,071.60–$4,433.52	—	5%
MRI of the pelvis, no contrast dye CPT 72195 MRI Sacrum w/o Contrast - FAMC	$3,406.70	$3,586.00	$2,115.74–$3,514.28	43% above	5%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Cont	$3,406.70	$3,586.00	$2,115.74–$3,514.28	43% above	5%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Cont	$3,406.70	$3,586.00	$3,227.40–$3,514.28	—	5%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Sacrum w/o Contrast - FAMC	$3,406.70	$3,586.00	$3,227.40–$3,514.28	—	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Cont Rt	$2,432.00	$2,560.00	$1,510.40–$2,508.80	1% above	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Cont Lt	$2,432.00	$2,560.00	$1,510.40–$2,508.80	1% above	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Cont Rt	$2,432.00	$2,560.00	$1,510.40–$2,508.80	1% above	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Cont Rt	$2,432.00	$2,560.00	$1,510.40–$2,508.80	1% above	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Cont Lt	$2,432.00	$2,560.00	$1,510.40–$2,508.80	1% above	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Cont Lt	$2,432.00	$2,560.00	$1,510.40–$2,508.80	1% above	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Cont Lt	$2,432.00	$2,560.00	$2,304.00–$2,508.80	—	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Cont Rt	$2,432.00	$2,560.00	$2,304.00–$2,508.80	—	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Cont Rt	$2,432.00	$2,560.00	$2,304.00–$2,508.80	—	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Cont Lt	$2,432.00	$2,560.00	$2,304.00–$2,508.80	—	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Cont Lt	$2,432.00	$2,560.00	$2,304.00–$2,508.80	—	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Cont Rt	$2,432.00	$2,560.00	$2,304.00–$2,508.80	—	5%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Cardiolite 33M	$2,626.75	$2,765.00	$1,631.35–$2,709.70	29% below	5%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocard Perf Mult Rest or Stress	$2,626.75	$2,765.00	$1,631.35–$2,709.70	29% below	5%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Cardiolite 33M	$2,626.75	$2,765.00	$2,488.50–$2,709.70	—	5%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocard Perf Mult Rest or Stress	$2,626.75	$2,765.00	$2,488.50–$2,709.70	—	5%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET Skull Base to Midthigh w/ CT Scan	$6,247.20	$6,576.00	$3,879.84–$6,444.48	16% above	5%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET Skull Base to Midthigh w/ CT Scan	$6,247.20	$6,576.00	$5,918.40–$6,444.48	—	5%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic Non-OB Ltd	$485.45	$511.00	$301.49–$500.78	51% above	5%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Patient Care	$485.45	$511.00	$301.49–$500.78	51% above	5%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic Non-OB Ltd	$485.45	$511.00	$459.90–$500.78	—	5%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Patient Care	$485.45	$511.00	$459.90–$500.78	—	5%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Non-OB Comp	$855.00	$900.00	$531.00–$882.00	10% above	5%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PMC US Pelvic Non-OB Comp	$855.00	$900.00	$531.00–$882.00	10% above	5%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 PMC US Pelvic Non-OB Comp	$855.00	$900.00	$810.00–$882.00	—	5%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Non-OB Comp	$855.00	$900.00	$810.00–$882.00	—	5%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pregnant Complete	$898.70	$946.00	$558.14–$927.08	31% above	5%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pregnant Complete	$898.70	$946.00	$851.40–$927.08	—	5%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Pregnant < 14 Weeks 1st Gest	$993.70	$1,046.00	$617.14–$1,025.08	68% above	5%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Pregnant < 14 Weeks 1st Gest	$993.70	$1,046.00	$941.40–$1,025.08	—	5%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pregnant Ltd	$608.95	$641.00	$378.19–$628.18	73% above	5%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Patient Care	$608.95	$641.00	$378.19–$628.18	73% above	5%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Patient Care	$608.95	$641.00	$576.90–$628.18	—	5%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Pregnant Ltd	$608.95	$641.00	$576.90–$628.18	—	5%
Screening mammogram, both breasts CPT 77067 MA Routine Screen Bil.	$352.45	$371.00	$218.89–$363.58	75% above	5%
Screening mammogram, both breasts inpatient CPT 77067 MA Routine Screen Bil.	$352.45	$371.00	$333.90–$363.58	—	5%
Shoulder X-ray, complete, 2 or more views CPT 73030 PMC XR Shoulder Comp Min 2 Views Bil Bill Only	$596.60	$628.00	$370.52–$615.44	86% above	5%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Comp Min 2 Views Rt	$298.30	$314.00	$185.26–$307.72	7% below	5%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Comp Min 2 Views Lt	$298.30	$314.00	$185.26–$307.72	7% below	5%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 PMC XR Shoulder Comp Min 2 Views Bil Bill Only	$596.60	$628.00	$565.20–$615.44	—	5%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Comp Min 2 Views Lt	$298.30	$314.00	$282.60–$307.72	—	5%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Comp Min 2 Views Rt	$298.30	$314.00	$282.60–$307.72	—	5%
Sleep study in a lab (polysomnography) CPT 95810 95810 Polysomnography; attended by a technologist 981	$1,245.45	$1,311.00	$773.49–$1,284.78	60% below	5%
Sleep study in a lab (polysomnography) CPT 95810 95810 SLEEP STUDY CHARGE	$3,803.80	$4,004.00	$2,362.36–$3,923.92	22% above	5%
Sleep study in a lab (polysomnography) inpatient CPT 95810 95810 Polysomnography; attended by a technologist 981	$1,245.45	$1,311.00	$1,179.90–$1,284.78	—	5%
Sleep study in a lab (polysomnography) inpatient CPT 95810 95810 SLEEP STUDY CHARGE	$3,803.80	$4,004.00	$3,603.60–$3,923.92	—	5%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Cardiac Echocardiogram w/ Stress	$3,222.40	$3,392.00	$2,001.28–$3,324.16	91% above	5%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Cardiac Echocardiogram w/ Stress	$3,222.40	$3,392.00	$3,052.80–$3,324.16	—	5%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Swallowing Funct w/ Video (Fluoro) FAMC	$1,481.05	$1,559.00	$919.81–$1,527.82	170% above	5%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Fluoro Modified Esophagram	$1,481.05	$1,559.00	$919.81–$1,527.82	170% above	5%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Swallowing Funct w/ Video (Fluoro) FAMC	$1,481.05	$1,559.00	$1,403.10–$1,527.82	—	5%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Fluoro Modified Esophagram	$1,481.05	$1,559.00	$1,403.10–$1,527.82	—	5%
Transvaginal pelvic ultrasound CPT 76830 PMC US Transvaginal	$828.40	$872.00	$514.48–$854.56	43% above	5%
Transvaginal pelvic ultrasound CPT 76830 US Pelvis Transvaginal	$828.40	$872.00	$514.48–$854.56	43% above	5%
Transvaginal pelvic ultrasound inpatient CPT 76830 PMC US Transvaginal	$828.40	$872.00	$784.80–$854.56	—	5%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Pelvis Transvaginal	$828.40	$872.00	$784.80–$854.56	—	5%
Transvaginal ultrasound during pregnancy CPT 76817 US Pregnant Transvaginal	$612.75	$645.00	$380.55–$632.10	26% above	5%
Transvaginal ultrasound during pregnancy CPT 76817 PMC US Pregnant Transvaginal	$612.75	$645.00	$380.55–$632.10	26% above	5%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 PMC US Pregnant Transvaginal	$612.75	$645.00	$580.50–$632.10	—	5%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Pregnant Transvaginal	$612.75	$645.00	$580.50–$632.10	—	5%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Comp	$808.45	$851.00	$502.09–$833.98	at median	5%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Comp	$808.45	$851.00	$765.90–$833.98	—	5%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum +Contents	$766.65	$807.00	$476.13–$790.86	22% above	5%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum +Contents	$766.65	$807.00	$726.30–$790.86	—	5%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid	$837.90	$882.00	$520.38–$864.36	44% above	5%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Soft Tissue Neck	$837.90	$882.00	$520.38–$864.36	44% above	5%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head +Neck Soft Tissue	$837.90	$882.00	$520.38–$864.36	44% above	5%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head +Neck Soft Tissue	$837.90	$882.00	$793.80–$864.36	—	5%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid	$837.90	$882.00	$793.80–$864.36	—	5%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Soft Tissue Neck	$837.90	$882.00	$793.80–$864.36	—	5%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UGI w/ SB	$1,070.65	$1,127.00	$664.93–$1,104.46	120% above	5%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UGI w/ KUB	$1,070.65	$1,127.00	$664.93–$1,104.46	120% above	5%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UGI w/ KUB	$1,070.65	$1,127.00	$1,014.30–$1,104.46	—	5%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UGI w/ SB	$1,070.65	$1,127.00	$1,014.30–$1,104.46	—	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Cardiology Venous Duplex Unilateral	$963.30	$1,014.00	$598.26–$993.72	3% below	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Veins Duplex Rt	$963.30	$1,014.00	$598.26–$993.72	3% below	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Veins Duplex Lt	$963.30	$1,014.00	$598.26–$993.72	3% below	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Veins Duplex Rt	$963.30	$1,014.00	$598.26–$993.72	3% below	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Veins Duplex Lt	$963.30	$1,014.00	$598.26–$993.72	3% below	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 93971 Unilateral Venous Duplex	$963.30	$1,014.00	$598.26–$993.72	3% below	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 93971 Unilateral Venous Reflux	$963.30	$1,014.00	$598.26–$993.72	3% below	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Cardiology Venous Duplex Unilateral	$963.30	$1,014.00	$912.60–$993.72	—	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Veins Duplex Lt	$963.30	$1,014.00	$912.60–$993.72	—	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 93971 Unilateral Venous Duplex	$963.30	$1,014.00	$912.60–$993.72	—	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 93971 Unilateral Venous Reflux	$963.30	$1,014.00	$912.60–$993.72	—	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Veins Duplex Rt	$963.30	$1,014.00	$912.60–$993.72	—	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Veins Duplex Lt	$963.30	$1,014.00	$912.60–$993.72	—	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Veins Duplex Rt	$963.30	$1,014.00	$912.60–$993.72	—	5%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Comp Min 3 Views Lt	$380.95	$401.00	$236.59–$392.98	17% above	5%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Comp Min 3 Views Rt	$380.95	$401.00	$236.59–$392.98	17% above	5%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Comp Min 3 Views Rt	$380.95	$401.00	$360.90–$392.98	—	5%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Comp Min 3 Views Lt	$380.95	$401.00	$360.90–$392.98	—	5%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Comp Min 2 Views Lt +Pelvis	$455.05	$479.00	$282.61–$469.42	141% above	5%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Comp Min 2 Views Rt	$455.05	$479.00	$282.61–$469.42	141% above	5%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Comp Min 2 Views Lt	$455.05	$479.00	$282.61–$469.42	141% above	5%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Comp Min 2 Views Rt +Pelvis	$455.05	$479.00	$282.61–$469.42	141% above	5%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Comp Min 2 Views Lt	$455.05	$479.00	$431.10–$469.42	—	5%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Comp Min 2 Views Rt	$455.05	$479.00	$431.10–$469.42	—	5%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Comp Min 2 Views Rt +Pelvis	$455.05	$479.00	$431.10–$469.42	—	5%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Comp Min 2 Views Lt +Pelvis	$455.05	$479.00	$431.10–$469.42	—	5%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View	$256.50	$270.00	$159.30–$264.60	2% above	5%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen Upright Only	$256.50	$270.00	$159.30–$264.60	2% above	5%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen Flat Plate 1 View	$256.50	$270.00	$159.30–$264.60	2% above	5%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen Lat Decub 1 View	$256.50	$270.00	$159.30–$264.60	2% above	5%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen Lat Decub 1 View	$256.50	$270.00	$243.00–$264.60	—	5%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen Upright Only	$256.50	$270.00	$243.00–$264.60	—	5%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View	$256.50	$270.00	$243.00–$264.60	—	5%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen Flat Plate 1 View	$256.50	$270.00	$243.00–$264.60	—	5%
X-ray of the ankle, 2 views CPT 73600 PMC XR Ankle 2 Views Bil	$615.60	$648.00	$382.32–$635.04	212% above	5%
X-ray of the ankle, 2 views CPT 73600 PMC XR Ankle 2 Views Bil Bill Only	$615.60	$648.00	$382.32–$635.04	212% above	5%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Rt	$307.80	$324.00	$191.16–$317.52	56% above	5%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Lt	$307.80	$324.00	$191.16–$317.52	56% above	5%
X-ray of the ankle, 2 views inpatient CPT 73600 PMC XR Ankle 2 Views Bil	$615.60	$648.00	$583.20–$635.04	—	5%
X-ray of the ankle, 2 views inpatient CPT 73600 PMC XR Ankle 2 Views Bil Bill Only	$615.60	$648.00	$583.20–$635.04	—	5%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Rt	$307.80	$324.00	$291.60–$317.52	—	5%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Lt	$307.80	$324.00	$291.60–$317.52	—	5%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 5th Digit Rt	$364.80	$384.00	$226.56–$376.32	64% above	5%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views Thumb Rt	$364.80	$384.00	$226.56–$376.32	64% above	5%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 3rd Digit Rt	$364.80	$384.00	$226.56–$376.32	64% above	5%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views Rt	$364.80	$384.00	$226.56–$376.32	64% above	5%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 4th Digit Lt	$364.80	$384.00	$226.56–$376.32	64% above	5%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views Thumb Lt	$364.80	$384.00	$226.56–$376.32	64% above	5%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 2nd Digit Rt	$364.80	$384.00	$226.56–$376.32	64% above	5%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views Lt	$364.80	$384.00	$226.56–$376.32	64% above	5%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 4th Digit Rt	$364.80	$384.00	$226.56–$376.32	64% above	5%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 3rd Digit Lt	$364.80	$384.00	$226.56–$376.32	64% above	5%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 2nd Digit Lt	$364.80	$384.00	$226.56–$376.32	64% above	5%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views 5th Digit Lt	$364.80	$384.00	$226.56–$376.32	64% above	5%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views Thumb Rt	$364.80	$384.00	$345.60–$376.32	—	5%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views Thumb Lt	$364.80	$384.00	$345.60–$376.32	—	5%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 2nd Digit Lt	$364.80	$384.00	$345.60–$376.32	—	5%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 4th Digit Rt	$364.80	$384.00	$345.60–$376.32	—	5%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 4th Digit Lt	$364.80	$384.00	$345.60–$376.32	—	5%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 2nd Digit Rt	$364.80	$384.00	$345.60–$376.32	—	5%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 3rd Digit Lt	$364.80	$384.00	$345.60–$376.32	—	5%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views Lt	$364.80	$384.00	$345.60–$376.32	—	5%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 3rd Digit Rt	$364.80	$384.00	$345.60–$376.32	—	5%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views Rt	$364.80	$384.00	$345.60–$376.32	—	5%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 5th Digit Rt	$364.80	$384.00	$345.60–$376.32	—	5%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views 5th Digit Lt	$364.80	$384.00	$345.60–$376.32	—	5%
X-ray of the foot, 2 views CPT 73620 PMC XR Foot 2 Views Bil	$532.00	$560.00	$330.40–$548.80	162% above	5%
X-ray of the foot, 2 views CPT 73620 PMC XR Foot 2 Views Bil Bill Only	$532.00	$560.00	$330.40–$548.80	162% above	5%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Lt	$266.00	$280.00	$165.20–$274.40	31% above	5%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Rt	$266.00	$280.00	$165.20–$274.40	31% above	5%
X-ray of the foot, 2 views inpatient CPT 73620 PMC XR Foot 2 Views Bil Bill Only	$532.00	$560.00	$504.00–$548.80	—	5%
X-ray of the foot, 2 views inpatient CPT 73620 PMC XR Foot 2 Views Bil	$532.00	$560.00	$504.00–$548.80	—	5%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Rt	$266.00	$280.00	$252.00–$274.40	—	5%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Lt	$266.00	$280.00	$252.00–$274.40	—	5%
X-ray of the foot, complete, 3 or more views CPT 73630 PMC XR Foot Comp Min 3 Views Bill Only	$608.00	$640.00	$267.90–$627.20	100% above	5%
X-ray of the foot, complete, 3 or more views CPT 73630 PMC XR Foot Comp Min 3 Views Bil	$608.00	$640.00	$267.90–$627.20	100% above	5%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Comp Min 3 Views Lt	$304.00	$320.00	$188.80–$313.60	at median	5%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Comp Min 3 Views Rt	$304.00	$320.00	$188.80–$313.60	at median	5%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 PMC XR Foot Comp Min 3 Views Bil	$608.00	$640.00	$576.00–$627.20	—	5%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 PMC XR Foot Comp Min 3 Views Bill Only	$608.00	$640.00	$576.00–$627.20	—	5%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Comp Min 3 Views Lt	$304.00	$320.00	$288.00–$313.60	—	5%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Comp Min 3 Views Rt	$304.00	$320.00	$288.00–$313.60	—	5%
X-ray of the hand, 3 or more views CPT 73130 PMC XR Hand Min 3 Views Bill Only	$668.80	$704.00	$415.36–$689.92	96% above	5%
X-ray of the hand, 3 or more views CPT 73130 PMC XR Hand Min 3 Views Bil	$668.80	$704.00	$415.36–$689.92	96% above	5%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Min 3 Views Rt	$334.40	$352.00	$207.68–$344.96	2% below	5%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Min 3 Views Lt	$334.40	$352.00	$207.68–$344.96	2% below	5%
X-ray of the hand, 3 or more views inpatient CPT 73130 PMC XR Hand Min 3 Views Bill Only	$668.80	$704.00	$633.60–$689.92	—	5%
X-ray of the hand, 3 or more views inpatient CPT 73130 PMC XR Hand Min 3 Views Bil	$668.80	$704.00	$633.60–$689.92	—	5%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Min 3 Views Lt	$334.40	$352.00	$316.80–$344.96	—	5%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Min 3 Views Rt	$334.40	$352.00	$316.80–$344.96	—	5%
X-ray of the knee, 1 or 2 views CPT 73560 PMC XR Knee 1 or 2 Views Bil	$659.30	$694.00	$409.46–$680.12	117% above	5%
X-ray of the knee, 1 or 2 views CPT 73560 XR Knee 1 or 2 Views Bil	$659.30	$694.00	$409.46–$680.12	117% above	5%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Rt	$329.65	$347.00	$204.73–$340.06	9% above	5%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Patella 1 or 2 Views Rt	$329.65	$347.00	$204.73–$340.06	9% above	5%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Patella 1 or 2 Views Lt	$329.65	$347.00	$204.73–$340.06	9% above	5%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Lt	$329.65	$347.00	$204.73–$340.06	9% above	5%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 PMC XR Knee 1 or 2 Views Bil	$659.30	$694.00	$624.60–$680.12	—	5%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR Knee 1 or 2 Views Bil	$659.30	$694.00	$624.60–$680.12	—	5%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Patella 1 or 2 Views Rt	$329.65	$347.00	$312.30–$340.06	—	5%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Lt	$329.65	$347.00	$312.30–$340.06	—	5%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Rt	$329.65	$347.00	$312.30–$340.06	—	5%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Patella 1 or 2 Views Lt	$329.65	$347.00	$312.30–$340.06	—	5%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$343.90	$362.00	$213.58–$354.76	at median	5%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$343.90	$362.00	$325.80–$354.76	—	5%
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Min 4 Views w/ Obl	$423.70	$446.00	$263.14–$437.08	at median	5%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Min 4 Views w/ Obl	$423.70	$446.00	$401.40–$437.08	—	5%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views	$329.65	$347.00	$204.73–$340.06	19% above	5%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views	$329.65	$347.00	$312.30–$340.06	—	5%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Comp Min 3 Views	$329.65	$347.00	$204.73–$340.06	16% above	5%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones Comp Min 3 Views	$329.65	$347.00	$312.30–$340.06	—	5%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cerv 2-3 Views	$318.25	$335.00	$197.65–$328.30	17% above	5%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cerv 2 or 3 Views	$318.25	$335.00	$197.65–$328.30	17% above	5%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cerv Flex/Ext Only	$318.25	$335.00	$197.65–$328.30	17% above	5%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cerv Flex/Ext Only	$318.25	$335.00	$301.50–$328.30	—	5%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cerv 2 or 3 Views	$318.25	$335.00	$301.50–$328.30	—	5%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cerv 2-3 Views	$318.25	$335.00	$301.50–$328.30	—	5%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views	$330.60	$348.00	$205.32–$341.04	35% above	5%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views	$330.60	$348.00	$313.20–$341.04	—	5%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum +Coccyx Min 2 Views	$292.60	$308.00	$181.72–$301.84	12% above	5%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum +Coccyx Min 2 Views	$292.60	$308.00	$277.20–$301.84	—	5%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT	$57.95	$61.00	$35.99–$59.78	3% below	5%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT	$57.95	$61.00	$54.90–$59.78	—	5%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST	$57.00	$60.00	$35.40–$58.80	21% above	5%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST	$57.00	$60.00	$54.00–$58.80	—	5%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Profile UP	$55.10	$58.00	$34.22–$56.84	82% below	5%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel, Acute w/ Confirm QST	$55.10	$58.00	$34.22–$56.84	82% below	5%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Panel, Acute w/ Confirm QST	$55.10	$58.00	$52.20–$56.84	—	5%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Profile UP	$55.10	$58.00	$52.20–$56.84	—	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Marsh Elder (W16) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Dander (E5) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Dander (E1) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda Grass (G2) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophagoides Farinae IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Common Ragweed (Short) (W1) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Cottonwood (T14) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus Fumigatus IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Hickory/Pecan Tree (T22) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Elm (T8) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus Niger IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium Herbarum IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach (I6) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Oak (T7) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium Notatum IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria Alternata IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Maple (Box Elder) (T1) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Cow's Milk (f2) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophagoides Pteronyssinus IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Mountain Cedar (t6) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 White Ash (T15) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Sycamore (T11) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 White Mulberry (t70) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut Tree (T10) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass (G6) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Russian Thistle (W11) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Pigweed (W14) IgE QST	$29.45	$31.00	$18.29–$30.38	30% below	5%
Allergy blood test, specific IgE, per allergen CPT 86003 Respiratory Region IX UP	$286.90	$302.00	$178.18–$295.96	579% above	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus Niger IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cockroach (I6) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Elm (T8) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough Pigweed (W14) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough Marsh Elder (W16) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dermatophagoides Farinae IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hickory/Pecan Tree (T22) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cat Dander (E1) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cladosporium Herbarum IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dermatophagoides Pteronyssinus IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cottonwood (T14) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillium Notatum IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cow's Milk (f2) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus Fumigatus IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Common Ragweed (Short) (W1) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dog Dander (E5) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Maple (Box Elder) (T1) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oak (T7) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Alternaria Alternata IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mountain Cedar (t6) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bermuda Grass (G2) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Russian Thistle (W11) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Mulberry (t70) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Timothy Grass (G6) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Ash (T15) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut Tree (T10) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sycamore (T11) IgE QST	$29.45	$31.00	$27.90–$30.38	—	5%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Respiratory Region IX UP	$286.90	$302.00	$271.80–$295.96	—	5%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide Ab IgG (CCP) QST	$63.65	$67.00	$39.53–$65.66	22% below	5%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Antibody UP	$138.70	$146.00	$86.14–$143.08	69% above	5%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrullinated Peptide Ab IgG (CCP) QST	$63.65	$67.00	$60.30–$65.66	—	5%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP Antibody UP	$138.70	$146.00	$131.40–$143.08	—	5%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Multiplex with Reflex to 11 Antibody Cascade QST	$28.50	$30.00	$17.70–$29.40	36% below	5%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibody Screen QST	$28.50	$30.00	$17.70–$29.40	36% below	5%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Screen UP	$45.60	$48.00	$28.32–$47.04	3% above	5%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Antibody Screen QST	$28.50	$30.00	$27.00–$29.40	—	5%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Multiplex with Reflex to 11 Antibody Cascade QST	$28.50	$30.00	$27.00–$29.40	—	5%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Screen UP	$45.60	$48.00	$43.20–$47.04	—	5%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT Pro-BNP	$348.65	$367.00	$216.53–$359.66	84% above	5%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT Pro-BNP	$348.65	$367.00	$330.30–$359.66	—	5%
Basic metabolic panel (blood test) CPT 80048 BMP Standard	$133.00	$140.00	$82.60–$137.20	at median	5%
Basic metabolic panel (blood test) CPT 80048 Bill BMP	$133.00	$140.00	$82.60–$137.20	at median	5%
Basic metabolic panel (blood test) inpatient CPT 80048 BMP Standard	$133.00	$140.00	$126.00–$137.20	—	5%
Basic metabolic panel (blood test) inpatient CPT 80048 Bill BMP	$133.00	$140.00	$126.00–$137.20	—	5%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bill Gross & Micro - Multiple	$52.25	$55.00	$32.45–$53.90	73% below	5%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Bill Gross & Micro - Multiple	$52.25	$55.00	$49.50–$53.90	—	5%
Blood culture for bacteria CPT 87040 Cult Blood Routine UP	$16.15	$17.00	$10.03–$16.66	91% below	5%
Blood culture for bacteria CPT 87040 Blood Culture MB QST	$34.20	$36.00	$21.24–$35.28	81% below	5%
Blood culture for bacteria inpatient CPT 87040 Cult Blood Routine UP	$16.15	$17.00	$15.30–$16.66	—	5%
Blood culture for bacteria inpatient CPT 87040 Blood Culture MB QST	$34.20	$36.00	$32.40–$35.28	—	5%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Quest Blood Draw	$11.40	$12.00	$7.08–$29.81	51% below	5%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$32.30	$34.00	$20.06–$33.32	38% above	5%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture Manual	$35.15	$37.00	$21.83–$36.26	50% above	5%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Venipuncture	$36.10	$38.00	$22.42–$37.24	54% above	5%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Quest Blood Draw	$11.40	$12.00	$10.80–$11.76	—	5%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$35.15	$37.00	$33.30–$36.26	—	5%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture Manual	$35.15	$37.00	$33.30–$36.26	—	5%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Venipuncture	$36.10	$38.00	$34.20–$37.24	—	5%
Blood glucose (sugar) test CPT 82947 Glucose Level	$56.05	$59.00	$34.81–$57.82	35% above	5%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level	$56.05	$59.00	$53.10–$57.82	—	5%
Blood lead test CPT 83655 Lead Level QST	$31.35	$33.00	$19.47–$32.34	48% below	5%
Blood lead test CPT 83655 Lead level UP	$81.70	$86.00	$50.74–$84.28	36% above	5%
Blood lead test inpatient CPT 83655 Lead Level QST	$31.35	$33.00	$29.70–$32.34	—	5%
Blood lead test inpatient CPT 83655 Lead level UP	$81.70	$86.00	$77.40–$84.28	—	5%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Qualitative HCG UP	$16.15	$17.00	$10.03–$16.66	85% below	5%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Pregnancy Test Urine	$59.85	$63.00	$37.17–$61.74	44% below	5%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG Screen Serum UP	$104.50	$110.00	$64.90–$107.80	2% below	5%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Qualitative HCG UP	$16.15	$17.00	$15.30–$16.66	—	5%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Pregnancy Test Urine	$59.85	$63.00	$56.70–$61.74	—	5%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG Screen Serum UP	$104.50	$110.00	$99.00–$107.80	—	5%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Type & Screen UP	$43.70	$46.00	$27.14–$45.08	16% below	5%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh 8	$173.85	$183.00	$107.97–$179.34	233% above	5%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord ABO/Rh 1	$173.85	$183.00	$107.97–$179.34	233% above	5%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Type & Screen UP	$43.70	$46.00	$41.40–$45.08	—	5%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Cord ABO/Rh 1	$173.85	$183.00	$164.70–$179.34	—	5%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh 8	$173.85	$183.00	$164.70–$179.34	—	5%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$102.60	$108.00	$63.72–$105.84	10% above	5%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$102.60	$108.00	$97.20–$105.84	—	5%
C. difficile toxin gene test (stool PCR) CPT 87493 C. Difficile 1	$366.70	$386.00	$227.74–$378.28	122% above	5%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C. Difficile 1	$366.70	$386.00	$347.40–$378.28	—	5%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 QST	$38.00	$40.00	$23.60–$39.20	67% below	5%
CA 19-9 blood test (tumor marker) CPT 86301 Carbohydrate Ag 19-9 UP	$50.35	$53.00	$31.27–$51.94	56% below	5%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 QST	$38.00	$40.00	$36.00–$39.20	—	5%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Carbohydrate Ag 19-9 UP	$50.35	$53.00	$47.70–$51.94	—	5%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 UP	$33.25	$35.00	$20.65–$34.30	70% below	5%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 QST	$36.10	$38.00	$22.42–$37.24	67% below	5%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 UP	$33.25	$35.00	$31.50–$34.30	—	5%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 QST	$36.10	$38.00	$34.20–$37.24	—	5%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert)	$116.85	$123.00	$67.99–$120.54	at median	5%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Novel Coronavirus UP	$147.25	$155.00	$67.99–$151.90	26% above	5%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert)	$116.85	$123.00	$110.70–$120.54	—	5%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Novel Coronavirus UP	$147.25	$155.00	$139.50–$151.90	—	5%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Screen	$121.60	$128.00	$75.52–$125.44	11% above	5%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 SurePath CT/NG UP	$123.50	$130.00	$76.70–$127.40	13% above	5%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Screen	$121.60	$128.00	$115.20–$125.44	—	5%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 SurePath CT/NG UP	$123.50	$130.00	$117.00–$127.40	—	5%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Screen UP	$183.35	$193.00	$102.88–$189.14	62% above	5%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel 2	$183.35	$193.00	$102.88–$189.14	62% above	5%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel 2	$183.35	$193.00	$173.70–$189.14	—	5%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Screen UP	$183.35	$193.00	$173.70–$189.14	—	5%
Complete blood count (CBC) with differential CPT 85025 Bill CBC w/auto diff	$85.50	$90.00	$53.10–$88.20	at median	5%
Complete blood count (CBC) with differential CPT 85025 Complete Blood Count with Automated Differential	$89.30	$94.00	$55.46–$92.12	5% above	5%
Complete blood count (CBC) with differential inpatient CPT 85025 Bill CBC w/auto diff	$85.50	$90.00	$81.00–$88.20	—	5%
Complete blood count (CBC) with differential inpatient CPT 85025 Complete Blood Count with Automated Differential	$89.30	$94.00	$84.60–$92.12	—	5%
Complete blood count (CBC), no differential CPT 85027 CBC	$75.05	$79.00	$46.61–$77.42	6% above	5%
Complete blood count (CBC), no differential CPT 85027 Bill CBC	$75.05	$79.00	$46.61–$77.42	6% above	5%
Complete blood count (CBC), no differential inpatient CPT 85027 Bill CBC	$75.05	$79.00	$71.10–$77.42	—	5%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC	$75.05	$79.00	$71.10–$77.42	—	5%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel Standard	$156.75	$165.00	$97.35–$161.70	4% above	5%
Comprehensive metabolic panel (blood test) CPT 80053 Bill CMP	$156.75	$165.00	$97.35–$161.70	4% above	5%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel Standard	$156.75	$165.00	$148.50–$161.70	—	5%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Bill CMP	$156.75	$165.00	$148.50–$161.70	—	5%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$154.85	$163.00	$96.17–$159.74	16% above	5%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer	$154.85	$163.00	$146.70–$159.74	—	5%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA Sulfate UP	$100.70	$106.00	$62.54–$103.88	29% below	5%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA Sulfate UP	$100.70	$106.00	$95.40–$103.88	—	5%
Estradiol blood test CPT 82670 Estradiol QST	$39.90	$42.00	$24.78–$41.16	65% below	5%
Estradiol blood test CPT 82670 Estradiol UP	$50.35	$53.00	$31.27–$51.94	55% below	5%
Estradiol blood test inpatient CPT 82670 Estradiol QST	$39.90	$42.00	$37.80–$41.16	—	5%
Estradiol blood test inpatient CPT 82670 Estradiol UP	$50.35	$53.00	$47.70–$51.94	—	5%
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone QST	$30.40	$32.00	$18.88–$31.36	73% below	5%
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stm Hormone UP	$31.35	$33.00	$19.47–$32.34	72% below	5%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stimulating Hormone QST	$30.40	$32.00	$28.80–$31.36	—	5%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stm Hormone UP	$31.35	$33.00	$29.70–$32.34	—	5%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin QST	$172.90	$182.00	$107.38–$178.36	50% below	5%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Fecal UPH	$336.30	$354.00	$208.86–$346.92	4% below	5%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin QST	$172.90	$182.00	$163.80–$178.36	—	5%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Fecal UPH	$336.30	$354.00	$318.60–$346.92	—	5%
Ferritin blood test (iron stores) CPT 82728 Ferritin Level	$134.90	$142.00	$83.78–$139.16	32% above	5%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$147.25	$155.00	$91.45–$151.90	44% above	5%
Ferritin blood test (iron stores) CPT 82728 Ferritin Level 1	$147.25	$155.00	$91.45–$151.90	44% above	5%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin Level	$134.90	$142.00	$127.80–$139.16	—	5%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$134.90	$142.00	$127.80–$139.16	—	5%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin Level 1	$147.25	$155.00	$139.50–$151.90	—	5%
Folate (folic acid) blood test CPT 82746 Folic Acid/Serum UP	$19.95	$21.00	$12.39–$20.58	81% below	5%
Folate (folic acid) blood test CPT 82746 Folate QST	$29.45	$31.00	$18.29–$30.38	72% below	5%
Folate (folic acid) blood test inpatient CPT 82746 Folic Acid/Serum UP	$19.95	$21.00	$18.90–$20.58	—	5%
Folate (folic acid) blood test inpatient CPT 82746 Folate QST	$29.45	$31.00	$27.90–$30.38	—	5%
Free T3 thyroid hormone test CPT 84481 Free T3 QST	$30.40	$32.00	$18.88–$31.36	77% below	5%
Free T3 thyroid hormone test CPT 84481 Free T3 UP	$31.35	$33.00	$19.47–$32.34	76% below	5%
Free T3 thyroid hormone test inpatient CPT 84481 Free T3 QST	$30.40	$32.00	$28.80–$31.36	—	5%
Free T3 thyroid hormone test inpatient CPT 84481 Free T3 UP	$31.35	$33.00	$29.70–$32.34	—	5%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4	$97.85	$103.00	$60.77–$100.94	33% above	5%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4	$97.85	$103.00	$92.70–$100.94	—	5%
Free testosterone test CPT 84402 Testosterone Group UP	$29.45	$31.00	$18.29–$30.38	71% below	5%
Free testosterone test CPT 84402 Testosterone, Free QST	$69.35	$73.00	$43.07–$71.54	33% below	5%
Free testosterone test inpatient CPT 84402 Testosterone Group UP	$29.45	$31.00	$27.90–$30.38	—	5%
Free testosterone test inpatient CPT 84402 Testosterone, Free QST	$69.35	$73.00	$65.70–$71.54	—	5%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 Bill 80050 General health panel	$459.80	$484.00	$285.56–$474.32	71% above	5%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 Bill 80050 General health panel	$459.80	$484.00	$435.60–$474.32	—	5%
Glucose tolerance test, 3 samples CPT 82951 .GTT Fasting Glucose 1	$52.25	$55.00	$32.45–$53.90	55% below	5%
Glucose tolerance test, 3 samples CPT 82951 .GTT-30 Min	$127.30	$134.00	$79.06–$131.32	10% above	5%
Glucose tolerance test, 3 samples CPT 82951 .GTT-1 Hr	$133.95	$141.00	$83.19–$138.18	15% above	5%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT Fasting Glucose 1	$52.25	$55.00	$49.50–$53.90	—	5%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT-30 Min	$127.30	$134.00	$120.60–$131.32	—	5%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT-1 Hr	$133.95	$141.00	$126.90–$138.18	—	5%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhoeae, amplified probe technique	$117.80	$124.00	$73.16–$121.52	25% above	5%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC Screen	$121.60	$128.00	$75.52–$125.44	29% above	5%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria gonorrhoeae, amplified probe technique	$117.80	$124.00	$111.60–$121.52	—	5%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC Screen	$121.60	$128.00	$115.20–$125.44	—	5%
H. pylori stool antigen test CPT 87338 H. Pylori Ag, Stool QST	$65.55	$69.00	$40.71–$67.62	44% below	5%
H. pylori stool antigen test inpatient CPT 87338 H. Pylori Ag, Stool QST	$65.55	$69.00	$62.10–$67.62	—	5%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 Ag/Ab QST	$77.90	$82.00	$48.38–$80.36	8% above	5%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 Ag/Ab QST	$77.90	$82.00	$73.80–$80.36	—	5%
HPV test for high-risk types, one combined (pooled) result CPT 87624 SurePath HPV UP	$81.70	$86.00	$50.74–$84.28	10% below	5%
HPV test for high-risk types, one combined (pooled) result CPT 87624 87624	$345.80	$364.00	$214.76–$356.72	280% above	5%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 SurePath HPV UP	$81.70	$86.00	$77.40–$84.28	—	5%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 87624	$345.80	$364.00	$327.60–$356.72	—	5%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c w/ Avg. Glucose	$100.70	$106.00	$62.54–$103.88	53% above	5%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c w/ Avg. Glucose	$100.70	$106.00	$95.40–$103.88	—	5%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab Qual QST	$31.35	$33.00	$19.47–$32.34	64% below	5%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Suf Ab UP	$33.25	$35.00	$20.65–$34.30	62% below	5%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Ab Qual QST	$31.35	$33.00	$29.70–$32.34	—	5%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Suf Ab UP	$33.25	$35.00	$31.50–$34.30	—	5%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Sur Ag UP	$22.80	$24.00	$14.16–$23.52	74% below	5%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag w/ Confirm QST	$30.40	$32.00	$18.88–$31.36	65% below	5%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Sur Ag UP	$22.80	$24.00	$21.60–$23.52	—	5%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Ag w/ Confirm QST	$30.40	$32.00	$28.80–$31.36	—	5%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab UP	$25.65	$27.00	$15.93–$26.46	70% below	5%
Hepatitis C antibody blood test (screening) one side CPT 86803 Hepatitis C w/ Reflex to HCV, RNA, Qnt, RT PCR QST	$31.35	$33.00	$19.47–$32.34	64% below	5%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Ab UP	$25.65	$27.00	$24.30–$26.46	—	5%
Hepatitis C antibody blood test (screening) inpatient one side CPT 86803 Hepatitis C w/ Reflex to HCV, RNA, Qnt, RT PCR QST	$31.35	$33.00	$29.70–$32.34	—	5%
High-sensitivity CRP (hs-CRP) test CPT 86141 Crp High Sensit UP	$29.45	$31.00	$18.29–$30.38	63% below	5%
High-sensitivity CRP (hs-CRP) test CPT 86141 HS CRP QST	$35.15	$37.00	$21.83–$36.26	56% below	5%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 Crp High Sensit UP	$29.45	$31.00	$27.90–$30.38	—	5%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HS CRP QST	$35.15	$37.00	$33.30–$36.26	—	5%
Homocysteine blood test CPT 83090 Homocysteine Cardiovascular QST	$43.70	$46.00	$27.14–$45.08	69% below	5%
Homocysteine blood test inpatient CPT 83090 Homocysteine Cardiovascular QST	$43.70	$46.00	$41.40–$45.08	—	5%
Insulin blood test CPT 83525 Insulin UP	$26.60	$28.00	$16.52–$27.44	75% below	5%
Insulin blood test CPT 83525 Insluin UP	$26.60	$28.00	$16.52–$27.44	75% below	5%
Insulin blood test CPT 83525 Insulin QST	$31.35	$33.00	$19.47–$32.34	70% below	5%
Insulin blood test inpatient CPT 83525 Insulin UP	$26.60	$28.00	$25.20–$27.44	—	5%
Insulin blood test inpatient CPT 83525 Insluin UP	$26.60	$28.00	$25.20–$27.44	—	5%
Insulin blood test inpatient CPT 83525 Insulin QST	$31.35	$33.00	$29.70–$32.34	—	5%
Iron blood test (serum iron) CPT 83540 Iron Level	$70.30	$74.00	$43.66–$72.52	12% above	5%
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$70.30	$74.00	$66.60–$72.52	—	5%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity	$86.45	$91.00	$53.69–$89.18	33% above	5%
Iron-binding capacity (TIBC) test CPT 83550 TIBC	$86.45	$91.00	$53.69–$89.18	33% above	5%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity Total	$94.05	$99.00	$58.41–$97.02	45% above	5%
Iron-binding capacity (TIBC) test CPT 83550 TIBC 3	$95.95	$101.00	$59.59–$98.98	48% above	5%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity	$86.45	$91.00	$81.90–$89.18	—	5%
Iron-binding capacity (TIBC) test inpatient CPT 83550 TIBC	$86.45	$91.00	$81.90–$89.18	—	5%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity Total	$94.05	$99.00	$89.10–$97.02	—	5%
Iron-binding capacity (TIBC) test inpatient CPT 83550 TIBC 3	$95.95	$101.00	$90.90–$98.98	—	5%
Kidney function blood test panel CPT 80069 Bill Renal	$125.40	$132.00	$77.88–$129.36	4% below	5%
Kidney function blood test panel CPT 80069 Renal Panel Standard	$125.40	$132.00	$77.88–$129.36	4% below	5%
Kidney function blood test panel inpatient CPT 80069 Bill Renal	$125.40	$132.00	$118.80–$129.36	—	5%
Kidney function blood test panel inpatient CPT 80069 Renal Panel Standard	$125.40	$132.00	$118.80–$129.36	—	5%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone UP	$23.75	$25.00	$14.75–$24.50	81% below	5%
LH (luteinizing hormone) test CPT 83002 LH. Qst	$32.30	$34.00	$20.06–$33.32	74% below	5%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone UP	$23.75	$25.00	$22.50–$24.50	—	5%
LH (luteinizing hormone) test inpatient CPT 83002 LH. Qst	$32.30	$34.00	$30.60–$33.32	—	5%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$100.70	$106.00	$62.54–$103.88	8% above	5%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$100.70	$106.00	$95.40–$103.88	—	5%
Liver function blood test panel CPT 80076 Liver Panel	$118.75	$125.00	$73.75–$122.50	2% below	5%
Liver function blood test panel CPT 80076 Bill Hepatic	$118.75	$125.00	$73.75–$122.50	2% below	5%
Liver function blood test panel inpatient CPT 80076 Bill Hepatic	$118.75	$125.00	$112.50–$122.50	—	5%
Liver function blood test panel inpatient CPT 80076 Liver Panel	$118.75	$125.00	$112.50–$122.50	—	5%
Lyme disease antibody test CPT 86618 Lyme Disease Ab, Total w/Refl WB (IgG, IgM) QST	$38.00	$40.00	$23.60–$39.20	70% below	5%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Ab, Total w/Refl WB (IgG, IgM) QST	$38.00	$40.00	$36.00–$39.20	—	5%
Magnesium blood test CPT 83735 Magnesium Level	$73.15	$77.00	$45.43–$75.46	16% above	5%
Magnesium blood test inpatient CPT 83735 Magnesium Level	$73.15	$77.00	$69.30–$75.46	—	5%
Measles (rubeola) antibody test CPT 86765 Measles Ab IgM QST	$59.85	$63.00	$37.17–$61.74	22% below	5%
Measles (rubeola) antibody test CPT 86765 Rubeola Ab IgG UP	$92.15	$97.00	$57.23–$95.06	20% above	5%
Measles (rubeola) antibody test inpatient CPT 86765 Measles Ab IgM QST	$59.85	$63.00	$56.70–$61.74	—	5%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola Ab IgG UP	$92.15	$97.00	$87.30–$95.06	—	5%
Mono test (heterophile antibody, Monospot) CPT 86308 Heterophile, Mono Screen QST	$27.55	$29.00	$17.11–$28.42	51% below	5%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen PROV	$38.00	$40.00	$23.60–$39.20	33% below	5%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$51.30	$54.00	$31.86–$52.92	9% below	5%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen UP	$54.15	$57.00	$33.63–$55.86	4% below	5%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Heterophile, Mono Screen QST	$27.55	$29.00	$26.10–$28.42	—	5%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen PROV	$38.00	$40.00	$36.00–$39.20	—	5%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen	$51.30	$54.00	$48.60–$52.92	—	5%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen UP	$54.15	$57.00	$51.30–$55.86	—	5%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, Free QST	$27.55	$29.00	$17.11–$28.42	78% below	5%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, Free QST	$27.55	$29.00	$26.10–$28.42	—	5%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (Free and Total) QST	$36.10	$38.00	$22.42–$37.24	61% below	5%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic	$155.80	$164.00	$96.76–$160.72	67% above	5%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Screen	$155.80	$164.00	$96.76–$160.72	67% above	5%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA (Free and Total) QST	$36.10	$38.00	$34.20–$37.24	—	5%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic	$155.80	$164.00	$147.60–$160.72	—	5%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Screen	$155.80	$164.00	$147.60–$160.72	—	5%
Pap test (liquid-based, automated screening with review) CPT 88175 Cytology Cervical Vaginal Interp UP	$139.65	$147.00	$86.73–$144.06	82% above	5%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Cytology Cervical Vaginal Interp UP	$139.65	$147.00	$132.30–$144.06	—	5%
Parathyroid hormone (PTH) blood test CPT 83970 PTH, Intact w/o Calcium QST	$42.75	$45.00	$26.55–$44.10	80% below	5%
Parathyroid hormone (PTH) blood test CPT 83970 PTH Intact UP	$67.45	$71.00	$41.89–$69.58	68% below	5%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, Intact w/o Calcium QST	$42.75	$45.00	$40.50–$44.10	—	5%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH Intact UP	$67.45	$71.00	$63.90–$69.58	—	5%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT LA Screen QST	$18.05	$19.00	$11.21–$18.62	73% below	5%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time, Active QST	$27.55	$29.00	$17.11–$28.42	59% below	5%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$82.65	$87.00	$51.33–$85.26	23% above	5%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT LA Screen QST	$18.05	$19.00	$17.10–$18.62	—	5%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time, Active QST	$27.55	$29.00	$26.10–$28.42	—	5%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time	$82.65	$87.00	$78.30–$85.26	—	5%
Progesterone blood test CPT 84144 Progesterone UP	$33.25	$35.00	$20.65–$34.30	69% below	5%
Progesterone blood test CPT 84144 Progesterone Level QST	$34.20	$36.00	$21.24–$35.28	68% below	5%
Progesterone blood test CPT 84144 Progesterone, LC/MS QST	$36.10	$38.00	$22.42–$37.24	66% below	5%
Progesterone blood test inpatient CPT 84144 Progesterone UP	$33.25	$35.00	$31.50–$34.30	—	5%
Progesterone blood test inpatient CPT 84144 Progesterone Level QST	$34.20	$36.00	$32.40–$35.28	—	5%
Progesterone blood test inpatient CPT 84144 Progesterone, LC/MS QST	$36.10	$38.00	$34.20–$37.24	—	5%
Prolactin blood test CPT 84146 Prolactin UP	$32.30	$34.00	$20.06–$33.32	62% below	5%
Prolactin blood test CPT 84146 Prolactin Level QST	$32.30	$34.00	$20.06–$33.32	62% below	5%
Prolactin blood test inpatient CPT 84146 Prolactin UP	$32.30	$34.00	$30.60–$33.32	—	5%
Prolactin blood test inpatient CPT 84146 Prolactin Level QST	$32.30	$34.00	$30.60–$33.32	—	5%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time	$61.75	$65.00	$32.01–$63.70	28% above	5%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time	$61.75	$65.00	$58.50–$63.70	—	5%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 UDS Standard	$76.00	$80.00	$47.20–$78.40	18% below	5%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 UDS Standard	$76.00	$80.00	$72.00–$78.40	—	5%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep A Screen	$139.65	$147.00	$86.73–$144.06	186% above	5%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Strep A Screen	$139.65	$147.00	$132.30–$144.06	—	5%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor QST	$29.45	$31.00	$18.29–$30.38	34% below	5%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Fact UP	$33.25	$35.00	$20.65–$34.30	26% below	5%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor QST	$29.45	$31.00	$27.90–$30.38	—	5%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Fact UP	$33.25	$35.00	$31.50–$34.30	—	5%
Rubella antibody test (immunity check) CPT 86762 Rubella Ab IgG UP	$16.15	$17.00	$10.03–$16.66	78% below	5%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Ab IgG UP	$16.15	$17.00	$15.30–$16.66	—	5%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation Rate	$43.70	$46.00	$27.14–$45.08	2% below	5%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sedimentation Rate	$43.70	$46.00	$41.40–$45.08	—	5%
Stool ova and parasites exam CPT 87177 Ova&Parasites Direct Smears Concentration & Id	$84.55	$89.00	$52.51–$87.22	31% above	5%
Stool ova and parasites exam CPT 87177 Traveler's O&P UP	$87.40	$92.00	$54.28–$90.16	35% above	5%
Stool ova and parasites exam inpatient CPT 87177 Ova&Parasites Direct Smears Concentration & Id	$84.55	$89.00	$80.10–$87.22	—	5%
Stool ova and parasites exam inpatient CPT 87177 Traveler's O&P UP	$87.40	$92.00	$82.80–$90.16	—	5%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR UP	$8.55	$9.00	$5.31–$8.82	78% below	5%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR w/Reflex Titer QST	$26.60	$28.00	$16.52–$27.44	30% below	5%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL QST	$38.00	$40.00	$23.60–$39.20	1% below	5%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL CSF QST	$39.90	$42.00	$24.78–$41.16	4% above	5%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR UP	$8.55	$9.00	$8.10–$8.82	—	5%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR w/Reflex Titer QST	$26.60	$28.00	$25.20–$27.44	—	5%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL QST	$38.00	$40.00	$36.00–$39.20	—	5%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL CSF QST	$39.90	$42.00	$37.80–$41.16	—	5%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon-TB Gold QST	$74.10	$78.00	$46.02–$76.44	63% below	5%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON(R)-TB Gold Plus, 1 Tube, QST 36970	$74.10	$78.00	$46.02–$76.44	63% below	5%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon Gold UP	$81.70	$86.00	$50.74–$84.28	59% below	5%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QuantiFERON(R)-TB Gold Plus, 1 Tube, QST 36970	$74.10	$78.00	$70.20–$76.44	—	5%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon-TB Gold QST	$74.10	$78.00	$70.20–$76.44	—	5%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon Gold UP	$81.70	$86.00	$77.40–$84.28	—	5%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Level Total QST	$34.20	$36.00	$21.24–$35.28	61% below	5%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone,Total UP	$48.45	$51.00	$30.09–$49.98	45% below	5%
Testosterone blood test, total (not free testosterone) CPT 84403 Assay Of Testosterone Total	$254.60	$268.00	$158.12–$262.64	192% above	5%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Level Total QST	$34.20	$36.00	$32.40–$35.28	—	5%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone,Total UP	$48.45	$51.00	$45.90–$49.98	—	5%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Assay Of Testosterone Total	$254.60	$268.00	$241.20–$262.64	—	5%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Ab QST	$34.20	$36.00	$21.24–$35.28	44% below	5%
Thyroid peroxidase (TPO) antibody test CPT 86376 Chronic Urticaria bill 1	$114.00	$120.00	$70.80–$117.60	85% above	5%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroperoxidase (TPO) Antibodies UP	$188.10	$198.00	$116.82–$194.04	205% above	5%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Ab QST	$34.20	$36.00	$32.40–$35.28	—	5%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Chronic Urticaria bill 1	$114.00	$120.00	$108.00–$117.60	—	5%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroperoxidase (TPO) Antibodies UP	$188.10	$198.00	$178.20–$194.04	—	5%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Chronic Urticaria Panel	$114.00	$120.00	$70.80–$117.60	16% above	5%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$174.80	$184.00	$88.94–$180.32	78% above	5%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Chronic Urticaria Panel	$114.00	$120.00	$108.00–$117.60	—	5%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$174.80	$184.00	$165.60–$180.32	—	5%
Uric acid blood test CPT 84550 Uric Acid	$64.60	$68.00	$40.12–$66.64	27% above	5%
Uric acid blood test inpatient CPT 84550 Uric Acid	$64.60	$68.00	$61.20–$66.64	—	5%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Microscopic	$57.00	$60.00	$30.91–$58.80	25% above	5%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Microscopic	$57.00	$60.00	$54.00–$58.80	—	5%
Urinalysis without microscope exam, automated CPT 81003 UA Dip Standard	$55.10	$58.00	$34.22–$56.84	103% above	5%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA Dip Standard	$55.10	$58.00	$52.20–$56.84	—	5%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture MB QST	$36.10	$38.00	$22.42–$37.24	47% below	5%
Urine culture for bacteria, with colony count CPT 87086 Cult Urine UP	$44.65	$47.00	$27.73–$46.06	34% below	5%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture MB QST	$36.10	$38.00	$34.20–$37.24	—	5%
Urine culture for bacteria, with colony count inpatient CPT 87086 Cult Urine UP	$44.65	$47.00	$42.30–$46.06	—	5%
Urine pregnancy test, read by color change CPT 81025 Pregnancy Test Urine 3	$96.90	$102.00	$60.18–$99.96	59% above	5%
Urine pregnancy test, read by color change inpatient CPT 81025 Pregnancy Test Urine 3	$96.90	$102.00	$91.80–$99.96	—	5%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 UP	$19.95	$21.00	$12.39–$20.58	82% below	5%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level QST	$29.45	$31.00	$18.29–$30.38	74% below	5%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 UP	$19.95	$21.00	$18.90–$20.58	—	5%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level QST	$29.45	$31.00	$27.90–$30.38	—	5%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D, 25-Hydroxy QST	$40.85	$43.00	$25.37–$42.14	69% below	5%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D, 25 Hydroxy UP	$55.10	$58.00	$34.22–$56.84	58% below	5%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25 Oh Vit D2/D3 UP	$167.20	$176.00	$103.84–$172.48	28% above	5%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D, 25-Hydroxy QST	$40.85	$43.00	$38.70–$42.14	—	5%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D, 25 Hydroxy UP	$55.10	$58.00	$52.20–$56.84	—	5%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25 Oh Vit D2/D3 UP	$167.20	$176.00	$158.40–$172.48	—	5%
Zinc blood test CPT 84630 Zinc Level QST	$36.10	$38.00	$22.42–$37.24	2% above	5%
Zinc blood test CPT 84630 Zinc, Serum UP	$78.85	$83.00	$48.97–$81.34	122% above	5%
Zinc blood test inpatient CPT 84630 Zinc Level QST	$36.10	$38.00	$34.20–$37.24	—	5%
Zinc blood test inpatient CPT 84630 Zinc, Serum UP	$78.85	$83.00	$74.70–$81.34	—	5%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 hCG Qnt QST	$30.40	$32.00	$18.88–$31.36	66% below	5%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG Tumor Marker UP	$55.10	$58.00	$34.22–$56.84	38% below	5%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 hCG Quantitative	$157.70	$166.00	$97.94–$162.68	78% above	5%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 hCG Qnt QST	$30.40	$32.00	$28.80–$31.36	—	5%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG Tumor Marker UP	$55.10	$58.00	$52.20–$56.84	—	5%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 hCG Quantitative	$157.70	$166.00	$149.40–$162.68	—	5%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Botox injections for chronic migraine both sides CPT 64615 Chemodenervation of muscle, bilateral (eg. chronic migraine)	$284.05	$299.00	$176.41–$293.02	—	5%
Botox injections for chronic migraine both sides CPT 64615 64615 Chemodenervation Of Muscles Innervated By Facial/Trigem/Cerv For Migraine Bilateral	$556.70	$586.00	$345.74–$574.28	—	5%
Botox injections for chronic migraine inpatient both sides CPT 64615 Chemodenervation of muscle, bilateral (eg. chronic migraine)	$284.05	$299.00	$269.10–$293.02	—	5%
Botox injections for chronic migraine inpatient both sides CPT 64615 64615 Chemodenervation Of Muscles Innervated By Facial/Trigem/Cerv For Migraine Bilateral	$556.70	$586.00	$527.40–$574.28	—	5%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Closed treatment of distal fibular fracture; without manipulation	$388.55	$409.00	$241.31–$400.82	3% below	5%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 27786 Closed treatment of distal fibular fracture; without manipulation	$388.55	$409.00	$368.10–$400.82	—	5%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Synchronized Cardioversion - Outpatient Only	$566.20	$596.00	$351.64–$584.08	60% below	5%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Surgery	$1,425.00	$1,500.00	$885.00–$1,470.00	at median	5%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 Cardioversion, elective, electrical conversion of arrhythmia; external	$1,461.10	$1,538.00	$907.42–$1,507.24	2% above	5%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Synchronized Cardioversion - Outpatient Only	$566.20	$596.00	$536.40–$584.08	—	5%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Surgery	$1,425.00	$1,500.00	$1,350.00–$1,470.00	—	5%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 Cardioversion, elective, electrical conversion of arrhythmia; external	$1,461.10	$1,538.00	$1,384.20–$1,507.24	—	5%
Carpal tunnel release, open surgery CPT 64721 Carpal Tunnel Release	$4,646.45	$4,891.00	$2,885.69–$4,793.18	223% above	5%
Carpal tunnel release, open surgery inpatient CPT 64721 Carpal Tunnel Release	$4,646.45	$4,891.00	$4,401.90–$4,793.18	—	5%
Cataract surgery with lens implant CPT 66984 Cataract Extraction with Intraocular Lens Implantation	$4,258.85	$4,483.00	$2,644.97–$4,393.34	31% above	5%
Cataract surgery with lens implant CPT 66984 Cataract Extraction with Intraocular Lens Implantation CHARGE	$4,533.40	$4,772.00	$2,815.48–$4,676.56	40% above	5%
Cataract surgery with lens implant inpatient CPT 66984 Cataract Extraction with Intraocular Lens Implantation	$4,258.85	$4,483.00	$4,034.70–$4,393.34	—	5%
Cataract surgery with lens implant inpatient CPT 66984 Cataract Extraction with Intraocular Lens Implantation CHARGE	$4,533.40	$4,772.00	$4,294.80–$4,676.56	—	5%
Cervical biopsy CPT 57500 57500 Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration	$316.35	$333.00	$196.47–$326.34	25% below	5%
Cervical biopsy inpatient CPT 57500 57500 Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration	$316.35	$333.00	$299.70–$326.34	—	5%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Circumcision	$1,381.30	$1,454.00	$857.86–$1,424.92	at median	5%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 Circumcision	$1,381.30	$1,454.00	$1,308.60–$1,424.92	—	5%
Circumcision, surgical, older than a newborn CPT 54160 Circumcision	$927.20	$976.00	$575.84–$956.48	19% above	5%
Circumcision, surgical, older than a newborn inpatient CPT 54160 Circumcision	$927.20	$976.00	$878.40–$956.48	—	5%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Cltx Dstl Radial FX/Epiphysl Sep W/O Manj	$340.10	$358.00	$211.22–$350.84	11% below	5%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Cltx Dstl Radial FX/Epiphysl Sep W/O Manj	$340.10	$358.00	$322.20–$350.84	—	5%
Colonoscopy with polyp removal CPT 45385 45385 Colonoscopy W/ Removal of Tumor Polyp Lesion by Snare	$3,014.35	$3,173.00	$1,872.07–$3,109.54	194% above	5%
Colonoscopy with polyp removal inpatient CPT 45385 45385 Colonoscopy W/ Removal of Tumor Polyp Lesion by Snare	$3,014.35	$3,173.00	$2,855.70–$3,109.54	—	5%
Colonoscopy with tissue sample CPT 45380 45380 Colonoscopy W/Biopsy Single/Multiple	$3,654.65	$3,847.00	$2,269.73–$3,770.06	244% above	5%
Colonoscopy with tissue sample inpatient CPT 45380 45380 Colonoscopy W/Biopsy Single/Multiple	$3,654.65	$3,847.00	$3,462.30–$3,770.06	—	5%
Colonoscopy, diagnostic CPT 45378 Screening: Colonoscopy on Individual NOT meeting high risk criteria	$2,277.15	$2,397.00	$1,414.23–$2,349.06	198% above	5%
Colonoscopy, diagnostic CPT 45378 Screening: Colonoscopy on HIGH Risk Individual	$2,277.15	$2,397.00	$1,414.23–$2,349.06	198% above	5%
Colonoscopy, diagnostic CPT 45378 45378 Colonoscopy (diagnostic)	$2,320.85	$2,443.00	$1,441.37–$2,394.14	204% above	5%
Colonoscopy, diagnostic inpatient CPT 45378 Screening: Colonoscopy on HIGH Risk Individual	$2,277.15	$2,397.00	$2,157.30–$2,349.06	—	5%
Colonoscopy, diagnostic inpatient CPT 45378 Screening: Colonoscopy on Individual NOT meeting high risk criteria	$2,277.15	$2,397.00	$2,157.30–$2,349.06	—	5%
Colonoscopy, diagnostic inpatient CPT 45378 45378 Colonoscopy (diagnostic)	$2,320.85	$2,443.00	$2,198.70–$2,394.14	—	5%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 57454 Colposcopy with cervical biopsy and endocervical curettage	$616.55	$649.00	$382.91–$636.02	116% above	5%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 57454 Colposcopy with cervical biopsy and endocervical curettage	$616.55	$649.00	$584.10–$636.02	—	5%
Complex cataract surgery with lens implant CPT 66982 Cataract Extraction with Intraocular Lens Implantation, Complex	$2,627.70	$2,766.00	$1,631.94–$2,710.68	at median	5%
Complex cataract surgery with lens implant inpatient CPT 66982 Cataract Extraction with Intraocular Lens Implantation, Complex	$2,627.70	$2,766.00	$2,489.40–$2,710.68	—	5%
Cystoscopy with ureteral stent placement CPT 52332 Cystoscopy with Stent Placement	$3,187.25	$3,355.00	$1,979.45–$3,287.90	17% above	5%
Cystoscopy with ureteral stent placement CPT 52332 Cystoscopy with Stent Exchange	$4,732.90	$4,982.00	$2,939.38–$4,882.36	74% above	5%
Cystoscopy with ureteral stent placement inpatient CPT 52332 Cystoscopy with Stent Placement	$3,187.25	$3,355.00	$3,019.50–$3,287.90	—	5%
Cystoscopy with ureteral stent placement inpatient CPT 52332 Cystoscopy with Stent Exchange	$4,732.90	$4,982.00	$4,483.80–$4,882.36	—	5%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystoscopy with TRUS	$371.45	$391.00	$230.69–$383.18	32% below	5%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystoscopy with bladder wash	$643.15	$677.00	$399.43–$663.46	18% above	5%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystoscopy	$1,140.00	$1,200.00	$708.00–$1,176.00	108% above	5%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Cystoscopy with TRUS	$371.45	$391.00	$351.90–$383.18	—	5%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Cystoscopy with bladder wash	$643.15	$677.00	$609.30–$663.46	—	5%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Cystoscopy	$1,140.00	$1,200.00	$1,080.00–$1,176.00	—	5%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Destruction, premalignant lesions; first lesion	$214.70	$226.00	$133.34–$221.48	68% above	5%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 17000 Destruction, premalignant lesions; first lesion	$214.70	$226.00	$203.40–$221.48	—	5%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 69433 Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia	$497.80	$524.00	$309.16–$513.52	22% above	5%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 69433 Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia	$497.80	$524.00	$471.60–$513.52	—	5%
Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 69209-Removal Impacted Ear Wax w/ Irrigation; Bilateral	$110.20	$116.00	$68.44–$113.68	—	5%
Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 69209-Removal Impacted Ear Wax-Bilateral	$110.20	$116.00	$68.44–$113.68	—	5%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 Removal impacted cerumen irrigation/lavage, unilateral - PMC	$54.61	$57.48	$33.91–$56.33	8% above	5%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209-Removal Impacted Ear Wax-Unilateral	$55.10	$58.00	$34.22–$56.84	9% above	5%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209-Removal Impacted Ear Wax w/ Irrigation; Unilateral	$55.10	$58.00	$34.22–$56.84	9% above	5%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 Removal impacted cerumen irrigation/lavage, unilateral 981 - PMC	$76.00	$80.00	$47.20–$78.40	50% above	5%
Earwax removal by irrigation (rinsing), one ear inpatient both sides CPT 69209 69209-Removal Impacted Ear Wax-Bilateral	$110.20	$116.00	$104.40–$113.68	—	5%
Earwax removal by irrigation (rinsing), one ear inpatient both sides CPT 69209 69209-Removal Impacted Ear Wax w/ Irrigation; Bilateral	$110.20	$116.00	$104.40–$113.68	—	5%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 69209 Removal impacted cerumen irrigation/lavage, unilateral - PMC	$54.61	$57.48	$51.73–$56.33	—	5%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 69209-Removal Impacted Ear Wax-Unilateral	$55.10	$58.00	$52.20–$56.84	—	5%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 69209-Removal Impacted Ear Wax w/ Irrigation; Unilateral	$55.10	$58.00	$52.20–$56.84	—	5%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 69209 Removal impacted cerumen irrigation/lavage, unilateral 981 - PMC	$76.00	$80.00	$72.00–$78.40	—	5%
Earwax removal with instruments, one ear both sides CPT 69210 69210-Removal Impacted Ear Wax w/ Instrument; Bilateral	$218.50	$230.00	$135.70–$225.40	—	5%
Earwax removal with instruments, one ear one side CPT 69210 69210 Removal Impacted Cerumen requiring instrumentation, unilat	$214.70	$226.00	$133.34–$221.48	156% above	5%
Earwax removal with instruments, one ear inpatient both sides CPT 69210 69210-Removal Impacted Ear Wax w/ Instrument; Bilateral	$218.50	$230.00	$207.00–$225.40	—	5%
Earwax removal with instruments, one ear inpatient one side CPT 69210 69210 Removal Impacted Cerumen requiring instrumentation, unilat	$214.70	$226.00	$203.40–$221.48	—	5%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 58100 ENDOMETRIAL BX	$271.70	$286.00	$168.74–$280.28	28% above	5%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 58100 Endometrial biopsy without cervical dilation	$437.95	$461.00	$271.99–$451.78	107% above	5%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 58100 ENDOMETRIAL BX	$271.70	$286.00	$257.40–$280.28	—	5%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 58100 Endometrial biopsy without cervical dilation	$437.95	$461.00	$414.90–$451.78	—	5%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 62321 Cervical,Thoracic injection with Image guidance	$1,421.20	$1,496.00	$882.64–$1,466.08	34% above	5%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 ESI-C or T	$1,496.25	$1,575.00	$929.25–$1,543.50	41% above	5%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 62321 Cervical,Thoracic injection with Image guidance	$1,421.20	$1,496.00	$1,346.40–$1,466.08	—	5%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 ESI-C or T	$1,496.25	$1,575.00	$1,417.50–$1,543.50	—	5%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 Facet L or S Single Level Bilateral	$1,718.55	$1,809.00	$1,067.31–$1,772.82	—	5%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 64493 Inj Facet L or S 1st Level	$816.05	$859.00	$506.81–$841.82	36% below	5%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Facet L or S 1st level	$1,237.85	$1,303.00	$768.77–$1,276.94	3% below	5%
Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 Facet L or S Single Level Bilateral	$1,718.55	$1,809.00	$1,628.10–$1,772.82	—	5%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 64493 Inj Facet L or S 1st Level	$816.05	$859.00	$773.10–$841.82	—	5%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Facet L or S 1st level	$1,237.85	$1,303.00	$1,172.70–$1,276.94	—	5%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Screening: Flexible Sigmoidoscopy	$1,596.00	$1,680.00	$991.20–$1,646.40	261% above	5%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330 Sigmoidoscopy W/ Specimen When Performed	$2,015.90	$2,122.00	$1,251.98–$2,079.56	356% above	5%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Screening: Flexible Sigmoidoscopy	$1,596.00	$1,680.00	$1,512.00–$1,646.40	—	5%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 45330 Sigmoidoscopy W/ Specimen When Performed	$2,015.90	$2,122.00	$1,909.80–$2,079.56	—	5%
Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoid Banding	$600.40	$632.00	$372.88–$619.36	at median	5%
Hemorrhoid banding (rubber band ligation) CPT 46221 46221 Hemorrhoid Banding	$672.60	$708.00	$417.72–$693.84	12% above	5%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 Hemorrhoid Banding	$600.40	$632.00	$568.80–$619.36	—	5%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 46221 Hemorrhoid Banding	$672.60	$708.00	$637.20–$693.84	—	5%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 PMC Catheterization	$662.15	$697.00	$411.23–$683.06	57% above	5%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 PMC Catheterization	$662.15	$697.00	$627.30–$683.06	—	5%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 58558 Hysteroscopy w/ biopsy, w or w/o D&C	$5,990.70	$6,306.00	$3,720.54–$6,179.88	267% above	5%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 58558 Hysteroscopy w/ biopsy, w or w/o D&C	$5,990.70	$6,306.00	$5,675.40–$6,179.88	—	5%
IUD insertion (the device itself billed separately) CPT 58300 58300 INSERTION, IUD	$183.35	$193.00	$113.87–$189.14	17% below	5%
IUD insertion (the device itself billed separately) CPT 58300 Insertion Intrauterine Device Iud	$266.00	$280.00	$165.20–$274.40	21% above	5%
IUD insertion (the device itself billed separately) inpatient CPT 58300 58300 INSERTION, IUD	$183.35	$193.00	$173.70–$189.14	—	5%
IUD insertion (the device itself billed separately) inpatient CPT 58300 Insertion Intrauterine Device Iud	$266.00	$280.00	$252.00–$274.40	—	5%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 Incision and drainage of abscess	$410.40	$432.00	$254.88–$423.36	52% above	5%
Incision and drainage of a simple or single skin abscess CPT 10060 Incision & Drainage Abscess Simple/Single 981	$542.45	$571.00	$336.89–$559.58	101% above	5%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 Incision & Drainage Abscess Simple/Single	$712.50	$750.00	$442.50–$735.00	164% above	5%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 Incision and drainage of abscess	$410.40	$432.00	$388.80–$423.36	—	5%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Incision & Drainage Abscess Simple/Single 981	$542.45	$571.00	$513.90–$559.58	—	5%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 Incision & Drainage Abscess Simple/Single	$712.50	$750.00	$675.00–$735.00	—	5%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Inj 1 tendon sheath/ligament (eg, plantar fascia)	$154.85	$163.00	$96.17–$159.74	21% below	5%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 ANESTH INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG. PLANTAR FASCIA)	$399.95	$421.00	$248.39–$412.58	105% above	5%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection- single tendon sheath or ligament	$401.85	$423.00	$249.57–$414.54	106% above	5%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550 Inj 1 tendon sheath/ligament (eg, plantar fascia)	$154.85	$163.00	$146.70–$159.74	—	5%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550 ANESTH INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG. PLANTAR FASCIA)	$399.95	$421.00	$378.90–$412.58	—	5%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Injection- single tendon sheath or ligament	$401.85	$423.00	$380.70–$414.54	—	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 Joint Injection-Major/bursa Bilateral	$486.40	$512.00	$302.08–$501.76	—	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Shldr, hip, knee, back joint aspir &/or inj w/o us	$179.55	$189.00	$111.51–$185.22	6% below	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Drain/Inj Major Joint/Bursa/Intra-Articular	$243.20	$256.00	$151.04–$250.88	27% above	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O Us 981	$255.55	$269.00	$158.71–$263.62	34% above	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Joint Injection - Major/Bursa	$270.75	$285.00	$168.15–$279.30	42% above	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O Us	$279.30	$294.00	$173.46–$288.12	46% above	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 ARTHRO/ASPIR/INJ/MAJOR JOINT	$401.85	$423.00	$249.57–$414.54	110% above	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient both sides CPT 20610 Joint Injection-Major/bursa Bilateral	$486.40	$512.00	$460.80–$501.76	—	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 Shldr, hip, knee, back joint aspir &/or inj w/o us	$179.55	$189.00	$170.10–$185.22	—	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 Drain/Inj Major Joint/Bursa/Intra-Articular	$243.20	$256.00	$230.40–$250.88	—	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O Us 981	$255.55	$269.00	$242.10–$263.62	—	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Joint Injection - Major/Bursa	$270.75	$285.00	$256.50–$279.30	—	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O Us	$279.30	$294.00	$264.60–$288.12	—	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 ARTHRO/ASPIR/INJ/MAJOR JOINT	$401.85	$423.00	$380.70–$414.54	—	5%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insj Non-Biodegradable Drug Delivery Implant	$234.65	$247.00	$145.73–$242.06	at median	5%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 INSERTION NON-BIODEGRADABLE DEVICE	$351.50	$370.00	$218.30–$362.60	50% above	5%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Insj Non-Biodegradable Drug Delivery Implant	$234.65	$247.00	$222.30–$242.06	—	5%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 11981 INSERTION NON-BIODEGRADABLE DEVICE	$351.50	$370.00	$333.00–$362.60	—	5%
Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 Joint Injection-Intermediate/bursa Bilateral	$448.40	$472.00	$278.48–$462.56	—	5%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Wrst, elb, hand, ankle, foot joint aspir &/or inj w/o us	$146.30	$154.00	$90.86–$150.92	42% below	5%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Joint Injection- Intermediate/bursa	$270.75	$285.00	$168.15–$279.30	7% above	5%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Arthrocentesis Aspir&/Inj Interm Jt/Burs W/O Us	$401.85	$423.00	$249.57–$414.54	59% above	5%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient both sides CPT 20605 Joint Injection-Intermediate/bursa Bilateral	$448.40	$472.00	$424.80–$462.56	—	5%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 Wrst, elb, hand, ankle, foot joint aspir &/or inj w/o us	$146.30	$154.00	$138.60–$150.92	—	5%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Joint Injection- Intermediate/bursa	$270.75	$285.00	$256.50–$279.30	—	5%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 Arthrocentesis Aspir&/Inj Interm Jt/Burs W/O Us	$401.85	$423.00	$380.70–$414.54	—	5%
Joint injection or drainage, small joint (fingers, toes) both sides CPT 20600 Joint Injection- Small/Bursa Bilateral	$286.90	$302.00	$178.18–$295.96	—	5%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Joint Injection- Small/Bursa	$143.45	$151.00	$89.09–$147.98	2% below	5%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Arthrocentesis Aspir&/Inj Small Jt/Bursa W/O Us	$279.30	$294.00	$173.46–$288.12	91% above	5%
Joint injection or drainage, small joint (fingers, toes) inpatient both sides CPT 20600 Joint Injection- Small/Bursa Bilateral	$286.90	$302.00	$271.80–$295.96	—	5%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Joint Injection- Small/Bursa	$143.45	$151.00	$135.90–$147.98	—	5%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600 Arthrocentesis Aspir&/Inj Small Jt/Bursa W/O Us	$279.30	$294.00	$264.60–$288.12	—	5%
Laser treatment of clouding after cataract surgery (YAG) both sides CPT 66821 YAG Laser Bilateral	$2,264.80	$2,384.00	$1,406.56–$2,336.32	—	5%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 66821 YAG; Discission of secondary membranous cataract ; laser surgery	$1,132.40	$1,192.00	$703.28–$1,168.16	56% above	5%
Laser treatment of clouding after cataract surgery (YAG) one side CPT 66821 YAG Laser, Right	$1,132.40	$1,192.00	$703.28–$1,168.16	56% above	5%
Laser treatment of clouding after cataract surgery (YAG) one side CPT 66821 YAG Laser, Left	$1,132.40	$1,192.00	$703.28–$1,168.16	56% above	5%
Laser treatment of clouding after cataract surgery (YAG) inpatient both sides CPT 66821 YAG Laser Bilateral	$2,264.80	$2,384.00	$2,145.60–$2,336.32	—	5%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 66821 YAG; Discission of secondary membranous cataract ; laser surgery	$1,132.40	$1,192.00	$1,072.80–$1,168.16	—	5%
Laser treatment of clouding after cataract surgery (YAG) inpatient one side CPT 66821 YAG Laser, Left	$1,132.40	$1,192.00	$1,072.80–$1,168.16	—	5%
Laser treatment of clouding after cataract surgery (YAG) inpatient one side CPT 66821 YAG Laser, Right	$1,132.40	$1,192.00	$1,072.80–$1,168.16	—	5%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Repair Intermediate S/A/T/E 2.5 Cm/<	$591.85	$623.00	$367.57–$610.54	40% above	5%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Repair Intermediate S/A/T/E 2.5 Cm/< 981	$846.45	$891.00	$525.69–$873.18	100% above	5%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Repair Intermediate S/A/T/E 2.5 Cm/<	$591.85	$623.00	$560.70–$610.54	—	5%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Repair Intermediate S/A/T/E 2.5 Cm/< 981	$846.45	$891.00	$801.90–$873.18	—	5%
Lower-back epidural injection, with imaging guidance CPT 62323 62323 Lumbar,Caudal,Sacral injection with Image guidance	$1,470.60	$1,548.00	$913.32–$1,517.04	38% above	5%
Lower-back epidural injection, with imaging guidance CPT 62323 ESI-L or S (caudal)	$1,548.50	$1,630.00	$961.70–$1,597.40	45% above	5%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 62323 Lumbar,Caudal,Sacral injection with Image guidance	$1,470.60	$1,548.00	$1,393.20–$1,517.04	—	5%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 ESI-L or S (caudal)	$1,548.50	$1,630.00	$1,467.00–$1,597.40	—	5%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 64483 Inj Transforaminal Epidural, L or S, Single	$1,066.85	$1,123.00	$662.57–$1,100.54	7% below	5%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Transforaminal epidural L or S single injection	$1,176.10	$1,238.00	$730.42–$1,213.24	3% above	5%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 64483 Inj Transforaminal Epidural, L or S, Single	$1,066.85	$1,123.00	$1,010.70–$1,100.54	—	5%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Transforaminal epidural L or S single injection	$1,176.10	$1,238.00	$1,114.20–$1,213.24	—	5%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 17311 Mohs micrographic H/N/H/F/G 1st stage, up to 5 blocks	$1,235.00	$1,300.00	$767.00–$1,274.00	24% above	5%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 17311 Mohs micrographic H/N/H/F/G 1st stage, up to 5 blocks	$1,235.00	$1,300.00	$1,170.00–$1,274.00	—	5%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Excision, benign lesion including margins, except skin trunk, arms legs, excised diameter of 0.5 cm	$1,702.40	$1,792.00	$1,057.28–$1,756.16	412% above	5%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Excision benign lesion, except skin tag , trunk, arms or legs; 0.5 cm or less	$1,702.40	$1,792.00	$1,057.28–$1,756.16	412% above	5%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Excision, benign lesion including margins, except skin trunk, arms legs, excised diameter of 0.5 cm	$1,702.40	$1,792.00	$1,612.80–$1,756.16	—	5%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 11400 Excision benign lesion, except skin tag , trunk, arms or legs; 0.5 cm or less	$1,702.40	$1,792.00	$1,612.80–$1,756.16	—	5%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Exc, other benign lesion except skin tag face, ear, eyelid, nose, lips, 0.5 cm or less	$317.30	$334.00	$197.06–$327.32	8% below	5%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 11440 Exc, other benign lesion except skin tag face, ear, eyelid, nose, lips, 0.5 cm or less	$317.30	$334.00	$300.60–$327.32	—	5%
Nail removal (partial or complete), one nail CPT 11730 11730 Avulsion of nail plate, partial or complete, simple; single	$267.90	$282.00	$166.38–$276.36	at median	5%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 Avulsion of nail plate, partial or complete, simple; single	$267.90	$282.00	$253.80–$276.36	—	5%
Occipital nerve block (injection for headaches) CPT 64405 64405 Occipital Nerve Block	$209.00	$220.00	$129.80–$215.60	50% below	5%
Occipital nerve block (injection for headaches) CPT 64405 Nerve Block- Greater occipital	$393.30	$414.00	$244.26–$405.72	5% below	5%
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405 Occipital Nerve Block	$209.00	$220.00	$198.00–$215.60	—	5%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Nerve Block- Greater occipital	$393.30	$414.00	$372.60–$405.72	—	5%
Paracentesis with imaging guidance CPT 49083 Paracentesis	$660.25	$695.00	$410.05–$681.10	10% below	5%
Paracentesis with imaging guidance CPT 49083 49083 Abdominal paracentesis with imaging guidance	$740.05	$779.00	$459.61–$763.42	1% above	5%
Paracentesis with imaging guidance CPT 49083 US Guide Paracentesis	$1,776.50	$1,870.00	$1,103.30–$1,832.60	143% above	5%
Paracentesis with imaging guidance inpatient CPT 49083 Paracentesis	$660.25	$695.00	$625.50–$681.10	—	5%
Paracentesis with imaging guidance inpatient CPT 49083 49083 Abdominal paracentesis with imaging guidance	$740.05	$779.00	$701.10–$763.42	—	5%
Paracentesis with imaging guidance inpatient CPT 49083 US Guide Paracentesis	$1,776.50	$1,870.00	$1,683.00–$1,832.60	—	5%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for perm	$387.60	$408.00	$240.72–$399.84	16% above	5%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for perm	$387.60	$408.00	$367.20–$399.84	—	5%
Prostate biopsy CPT 55700 55700 - Biopsy, prostate; needle or punch, single or multiple, any approach	$628.90	$662.00	$390.58–$648.76	43% below	5%
Prostate biopsy inpatient CPT 55700 55700 - Biopsy, prostate; needle or punch, single or multiple, any approach	$628.90	$662.00	$595.80–$648.76	—	5%
Radiofrequency ablation of facet joint nerves, lower back, one level both sides CPT 64635 Radiofrequency ablation-L or S Bilateral	$4,085.95	$4,301.00	$2,537.59–$4,214.98	—	5%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 64635 RF Ablation - Lumbar 1 Level	$2,022.55	$2,129.00	$1,256.11–$2,086.42	1% below	5%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Radiofrequency ablation-L or S	$2,621.05	$2,759.00	$1,627.81–$2,703.82	29% above	5%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient both sides CPT 64635 Radiofrequency ablation-L or S Bilateral	$4,085.95	$4,301.00	$3,870.90–$4,214.98	—	5%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 64635 RF Ablation - Lumbar 1 Level	$2,022.55	$2,129.00	$1,916.10–$2,086.42	—	5%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Radiofrequency ablation-L or S	$2,621.05	$2,759.00	$2,483.10–$2,703.82	—	5%
Removal of a breast lump, open surgery CPT 19120 19120 Exc of cyst, tumor, or breast tissue, open 1 or more lesions	$1,207.45	$1,271.00	$749.89–$1,245.58	1% above	5%
Removal of a breast lump, open surgery inpatient CPT 19120 19120 Exc of cyst, tumor, or breast tissue, open 1 or more lesions	$1,207.45	$1,271.00	$1,143.90–$1,245.58	—	5%
Removal of a foreign object under the skin, simple CPT 10120 Incision & Removal Foreign Body Subq Tiss Simple 981	$574.75	$605.00	$356.95–$592.90	66% above	5%
Removal of a foreign object under the skin, simple CPT 10120 Incision & Removal Foreign Body Subq Tiss Simple	$576.65	$607.00	$358.13–$594.86	67% above	5%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision & Removal Foreign Body Subq Tiss Simple 981	$574.75	$605.00	$544.50–$592.90	—	5%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision & Removal Foreign Body Subq Tiss Simple	$576.65	$607.00	$546.30–$594.86	—	5%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Screening: Colonoscopy on Individual NOT meeting high risk criteria	$2,277.15	$2,397.00	$1,414.23–$2,349.06	204% above	5%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 Screening: Colonoscopy on Individual NOT meeting high risk criteria	$2,277.15	$2,397.00	$2,157.30–$2,349.06	—	5%
Septoplasty to straighten the nasal septum CPT 30520 30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replaceme	$2,436.75	$2,565.00	$1,513.35–$2,513.70	23% above	5%
Septoplasty to straighten the nasal septum inpatient CPT 30520 30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replaceme	$2,436.75	$2,565.00	$2,308.50–$2,513.70	—	5%
Short arm cast (elbow to hand) CPT 29075 Application, cast; elbow to finger (short arm)	$216.60	$228.00	$134.52–$223.44	10% above	5%
Short arm cast (elbow to hand) inpatient CPT 29075 Application, cast; elbow to finger (short arm)	$216.60	$228.00	$205.20–$223.44	—	5%
Short arm splint (forearm and hand) CPT 29125 29125 Application of short arm splint (forearm to hand); static	$154.85	$163.00	$96.17–$159.74	1% above	5%
Short arm splint (forearm and hand) CPT 29125 Application of short arm splint (forearm to hand); static	$163.40	$172.00	$101.48–$168.56	6% above	5%
Short arm splint (forearm and hand) CPT 29125 29125 OT APPLICATION SHORT ARM SPLINT STATIC Charge	$164.35	$173.00	$102.07–$169.54	7% above	5%
Short arm splint (forearm and hand) CPT 29125 Application of short arm splint (forearm to hand); static 981	$219.45	$231.00	$136.29–$226.38	43% above	5%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 Application of short arm splint (forearm to hand); static	$154.85	$163.00	$146.70–$159.74	—	5%
Short arm splint (forearm and hand) inpatient CPT 29125 Application of short arm splint (forearm to hand); static	$163.40	$172.00	$154.80–$168.56	—	5%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 OT APPLICATION SHORT ARM SPLINT STATIC Charge	$164.35	$173.00	$155.70–$169.54	—	5%
Short arm splint (forearm and hand) inpatient CPT 29125 Application of short arm splint (forearm to hand); static 981	$219.45	$231.00	$207.90–$226.38	—	5%
Short leg cast (below the knee) CPT 29405 29405 Application of short leg cast (below knee to toes)	$203.30	$214.00	$126.26–$209.72	10% above	5%
Short leg cast (below the knee) CPT 29405 29405 Application of short leg cast (below knee to toes)	$203.30	$214.00	$126.26–$209.72	10% above	5%
Short leg cast (below the knee) inpatient CPT 29405 29405 Application of short leg cast (below knee to toes)	$203.30	$214.00	$192.60–$209.72	—	5%
Short leg cast (below the knee) inpatient CPT 29405 29405 Application of short leg cast (below knee to toes)	$203.30	$214.00	$192.60–$209.72	—	5%
Short leg splint (calf to foot) CPT 29515 Application Of Short Leg Splint (Calf To Foot)	$181.45	$191.00	$112.69–$187.18	12% above	5%
Short leg splint (calf to foot) inpatient CPT 29515 Application Of Short Leg Splint (Calf To Foot)	$181.45	$191.00	$171.90–$187.18	—	5%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Simple Repair Wound; scalp, neck, trunk, or extremity (<2.5cm)	$93.10	$98.00	$57.82–$96.04	55% below	5%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple repair scalp/neck/ax/genit/trunk/ and/or extremities 2.5 cm or less 981	$246.05	$259.00	$152.81–$253.82	18% above	5%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5Cm/<	$250.80	$264.00	$155.76–$258.72	21% above	5%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 Simple Repair Wound; scalp, neck, trunk, or extremity (<2.5cm)	$93.10	$98.00	$88.20–$96.04	—	5%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple repair scalp/neck/ax/genit/trunk/ and/or extremities 2.5 cm or less 981	$246.05	$259.00	$233.10–$253.82	—	5%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5Cm/<	$250.80	$264.00	$237.60–$258.72	—	5%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch biopsy of skin; single lesion	$118.75	$125.00	$73.75–$122.50	53% below	5%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch biopsy of skin - single lesion	$189.05	$199.00	$117.41–$195.02	26% below	5%
Skin biopsy, punch, one lesion CPT 11104 Punch biopsy of skin (including simple closure, when performed); single lesion	$189.05	$199.00	$117.41–$195.02	26% below	5%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch biopsy of skin; single lesion	$118.75	$125.00	$112.50–$122.50	—	5%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch biopsy of skin (including simple closure, when performed); single lesion	$189.05	$199.00	$179.10–$195.02	—	5%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch biopsy of skin - single lesion	$189.05	$199.00	$179.10–$195.02	—	5%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 Excision, malignant lesion including margins, trunk, arms or legs, diameter 0.5 cm or less	$755.25	$795.00	$469.05–$779.10	67% above	5%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 11600 Excision, malignant lesion including margins, trunk, arms or legs, diameter 0.5 cm or less	$755.25	$795.00	$715.50–$779.10	—	5%
Skin tag removal, up to 15 tags CPT 11200 11200 Removal of skin tags, multiple, any area; up to and including 15 lesions	$224.20	$236.00	$139.24–$231.28	14% above	5%
Skin tag removal, up to 15 tags inpatient CPT 11200 11200 Removal of skin tags, multiple, any area; up to and including 15 lesions	$224.20	$236.00	$212.40–$231.28	—	5%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 SPINAL PUNCTURE LUMBAR DIAG Charge	$351.50	$370.00	$218.30–$362.60	8% below	5%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Lumbar Puncture, Diagnost	$394.25	$415.00	$244.85–$406.70	3% above	5%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Puncture Lumbar Diagnostic	$549.10	$578.00	$341.02–$566.44	43% above	5%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Spinal Puncture, Lumbar, Diagnostic	$698.25	$735.00	$433.65–$720.30	82% above	5%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 SPINAL PUNCTURE LUMBAR DIAG Charge	$351.50	$370.00	$333.00–$362.60	—	5%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 Lumbar Puncture, Diagnost	$394.25	$415.00	$373.50–$406.70	—	5%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal Puncture Lumbar Diagnostic	$549.10	$578.00	$520.20–$566.44	—	5%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 Spinal Puncture, Lumbar, Diagnostic	$698.25	$735.00	$661.50–$720.30	—	5%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5Cm	$302.10	$318.00	$187.62–$311.64	26% above	5%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5Cm 981	$324.90	$342.00	$201.78–$335.16	35% above	5%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5Cm	$302.10	$318.00	$286.20–$311.64	—	5%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5Cm 981	$324.90	$342.00	$307.80–$335.16	—	5%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple Repair F/E/E/N/L/M 2.5Cm/<	$305.90	$322.00	$189.98–$315.56	30% above	5%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple Repair F/E/E/N/L/M 2.5Cm/< 981	$305.90	$322.00	$189.98–$315.56	30% above	5%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Simple Repair F/E/E/N/L/M 2.5Cm/<	$305.90	$322.00	$289.80–$315.56	—	5%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Simple Repair F/E/E/N/L/M 2.5Cm/< 981	$305.90	$322.00	$289.80–$315.56	—	5%
TURP (transurethral resection of the prostate) CPT 52601 Prostate Resection Transurethral	$5,082.50	$5,350.00	$3,156.50–$5,243.00	97% above	5%
TURP (transurethral resection of the prostate) inpatient CPT 52601 Prostate Resection Transurethral	$5,082.50	$5,350.00	$4,815.00–$5,243.00	—	5%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential biopsy of skin; single lesion	$152.00	$160.00	$94.40–$156.80	20% below	5%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Shave biopsy - single lesion	$152.00	$160.00	$94.40–$156.80	20% below	5%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential biopsy of skin; single lesion	$152.00	$160.00	$144.00–$156.80	—	5%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 11102 Shave biopsy - single lesion	$152.00	$160.00	$144.00–$156.80	—	5%
Thoracentesis with imaging guidance CPT 32555 US Guide Thoracentesis	$737.20	$776.00	$457.84–$760.48	at median	5%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis	$1,167.55	$1,229.00	$725.11–$1,204.42	58% above	5%
Thoracentesis with imaging guidance inpatient CPT 32555 US Guide Thoracentesis	$737.20	$776.00	$698.40–$760.48	—	5%
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis	$1,167.55	$1,229.00	$1,106.10–$1,204.42	—	5%
Trigger finger release surgery CPT 26055 26055 Tendon sheath incision (for trigger finger)	$2,218.25	$2,335.00	$1,377.65–$2,288.30	85% above	5%
Trigger finger release surgery inpatient CPT 26055 26055 Tendon sheath incision (for trigger finger)	$2,218.25	$2,335.00	$2,101.50–$2,288.30	—	5%
Trigger point injections, 1 or 2 muscles both sides CPT 20552 SI joint injection w/o Fluoro Bilateral	$598.50	$630.00	$371.70–$617.40	—	5%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Inj trigger pt 1-2 muscles	$150.10	$158.00	$93.22–$154.84	at median	5%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)	$258.30	$271.89	$160.42–$266.45	72% above	5%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Inj, Trigger Point 1 or 2 Muscles	$299.25	$315.00	$185.85–$308.70	99% above	5%
Trigger point injections, 1 or 2 muscles CPT 20552 SI joint injection w/o Fluoro	$303.05	$319.00	$188.21–$312.62	101% above	5%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Inj; single or multiple trigger point, 1 or 2 muscles	$303.05	$319.00	$188.21–$312.62	101% above	5%
Trigger point injections, 1 or 2 muscles CPT 20552 Trigger Point Injection (1 or 2 muscles)	$401.85	$423.00	$249.57–$414.54	167% above	5%
Trigger point injections, 1 or 2 muscles inpatient both sides CPT 20552 SI joint injection w/o Fluoro Bilateral	$598.50	$630.00	$567.00–$617.40	—	5%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 Inj trigger pt 1-2 muscles	$150.10	$158.00	$142.20–$154.84	—	5%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)	$258.30	$271.89	$244.70–$266.45	—	5%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 Inj, Trigger Point 1 or 2 Muscles	$299.25	$315.00	$283.50–$308.70	—	5%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 SI joint injection w/o Fluoro	$303.05	$319.00	$287.10–$312.62	—	5%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 Inj; single or multiple trigger point, 1 or 2 muscles	$303.05	$319.00	$287.10–$312.62	—	5%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Trigger Point Injection (1 or 2 muscles)	$401.85	$423.00	$380.70–$414.54	—	5%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Rt	$2,089.05	$2,199.00	$1,297.41–$2,155.02	1% above	5%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Lt	$2,089.05	$2,199.00	$1,297.41–$2,155.02	1% above	5%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Lt	$2,089.05	$2,199.00	$1,979.10–$2,155.02	—	5%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Rt	$2,089.05	$2,199.00	$1,979.10–$2,155.02	—	5%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 43249 EGD Balloon Dilation Esophagus <30 Mm Diam.	$3,420.00	$3,600.00	$2,124.00–$3,528.00	70% above	5%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 43249 EGD Balloon Dilation Esophagus <30 Mm Diam.	$3,420.00	$3,600.00	$3,240.00–$3,528.00	—	5%
Upper endoscopy (EGD) with biopsy CPT 43239 43239 EGD Transoral Biopsy Single/Multiple	$2,385.45	$2,511.00	$1,481.49–$2,460.78	73% above	5%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 43239 EGD Transoral Biopsy Single/Multiple	$2,385.45	$2,511.00	$2,259.90–$2,460.78	—	5%
Upper endoscopy (EGD), diagnostic CPT 43235 43235 EGD Transoral Diagnostic	$1,620.70	$1,706.00	$1,006.54–$1,671.88	127% above	5%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 43235 EGD Transoral Diagnostic	$1,620.70	$1,706.00	$1,535.40–$1,671.88	—	5%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Vasectomy	$2,765.45	$2,911.00	$1,717.49–$2,852.78	216% above	5%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 Vasectomy	$2,765.45	$2,911.00	$2,619.90–$2,852.78	—	5%
Wart removal, up to 14 warts CPT 17110 17110 Destruction benign lesions up to 14 lesions	$261.25	$275.00	$162.25–$269.50	53% above	5%
Wart removal, up to 14 warts inpatient CPT 17110 17110 Destruction benign lesions up to 14 lesions	$261.25	$275.00	$247.50–$269.50	—	5%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 WC Debridement, subcutaneous tissue; first 20 sq cm or less	$714.40	$752.00	$443.68–$736.96	122% above	5%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 WC Debridement, subcutaneous tissue; first 20 sq cm or less	$714.40	$752.00	$676.80–$736.96	—	5%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 25607 Open tx of distal radial extra-artic fx w internal fixation	$1,821.15	$1,917.00	$1,131.03–$1,878.66	2% below	5%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 25607 Open tx of distal radial extra-artic fx w internal fixation	$1,821.15	$1,917.00	$1,725.30–$1,878.66	—	5%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Blood administration	$804.65	$847.00	$499.73–$830.06	16% above	5%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood administration	$804.65	$847.00	$762.30–$830.06	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZPAP INLINE SUBSEQUENT	$145.35	$153.00	$90.27–$149.94	37% above	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZPAP INLINE INITIAL	$145.35	$153.00	$90.27–$149.94	37% above	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Sputum Induction	$145.35	$153.00	$90.27–$149.94	37% above	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZPAP INITIAL	$148.20	$156.00	$92.04–$152.88	40% above	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZPAP SUBSEQUENT	$148.20	$156.00	$92.04–$152.88	40% above	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 PRESS/NONPRESS INHL, CHARGE	$155.80	$164.00	$96.76–$160.72	47% above	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler (MDI) Subsequent	$155.80	$164.00	$96.76–$160.72	47% above	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler (MDI) Initial	$181.93	$191.50	$112.99–$187.67	72% above	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Initial	$194.75	$205.00	$120.95–$200.90	84% above	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 PRESS/NONPRESS INHL SBSQNT, CHARGE	$194.75	$205.00	$120.95–$200.90	84% above	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Nebulizer treatment charge	$289.75	$305.00	$179.95–$298.90	174% above	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 Sputum Induction - RT Charge	$145.35	$153.00	$90.27–$149.94	37% above	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 EZPAP INLINE SUBSEQUENT	$145.35	$153.00	$137.70–$149.94	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Sputum Induction	$145.35	$153.00	$137.70–$149.94	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 EZPAP INLINE INITIAL	$145.35	$153.00	$137.70–$149.94	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 EZPAP INITIAL	$148.20	$156.00	$140.40–$152.88	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 EZPAP SUBSEQUENT	$148.20	$156.00	$140.40–$152.88	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 PRESS/NONPRESS INHL, CHARGE	$155.80	$164.00	$147.60–$160.72	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Meter Dose Inhaler (MDI) Subsequent	$155.80	$164.00	$147.60–$160.72	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Meter Dose Inhaler (MDI) Initial	$181.93	$191.50	$172.35–$187.67	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 PRESS/NONPRESS INHL SBSQNT, CHARGE	$194.75	$205.00	$184.50–$200.90	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Initial	$194.75	$205.00	$184.50–$200.90	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 Nebulizer treatment charge	$289.75	$305.00	$274.50–$298.90	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient one side CPT 94640 Sputum Induction - RT Charge	$145.35	$153.00	$137.70–$149.94	—	5%
Chemotherapy IV infusion, first hour CPT 96413 96413 CHEMO ADMINISTRATION-INFUSED Charge	$871.15	$917.00	$541.03–$898.66	78% above	5%
Chemotherapy IV infusion, first hour inpatient CPT 96413 96413 CHEMO ADMINISTRATION-INFUSED Charge	$871.15	$917.00	$825.30–$898.66	—	5%
Critical care, first 30 to 74 minutes CPT 99291 99291 - Critical Care - Lynx Visit Level	$1,258.75	$1,325.00	$781.75–$1,298.50	96% above	5%
Critical care, first 30 to 74 minutes CPT 99291 99291 - FAC ED Critical Care	$1,554.20	$1,636.00	$965.24–$1,603.28	142% above	5%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 - Critical Care - Lynx Visit Level	$1,258.75	$1,325.00	$1,192.50–$1,298.50	—	5%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 - FAC ED Critical Care	$1,554.20	$1,636.00	$1,472.40–$1,603.28	—	5%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG - CVI Clinic Only	$220.40	$232.00	$136.88–$227.36	289% above	5%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG - CVI Clinic Only	$220.40	$232.00	$208.80–$227.36	—	5%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG - no overread	$190.00	$200.00	$118.00–$196.00	5% below	5%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram	$190.00	$200.00	$118.00–$196.00	5% below	5%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram	$190.00	$200.00	$180.00–$196.00	—	5%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG - no overread	$190.00	$200.00	$180.00–$196.00	—	5%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 FAC ED Level 1 -Room Charge	$170.05	$179.00	$105.61–$175.42	12% above	5%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 - ED Level 1 BCE	$170.05	$179.00	$105.61–$175.42	12% above	5%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 - ED Level 1 BCE	$170.05	$179.00	$161.10–$175.42	—	5%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 FAC ED Level 1 -Room Charge	$170.05	$179.00	$161.10–$175.42	—	5%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 - Level 2 - Lynx Visit Level	$271.70	$286.00	$168.74–$280.28	21% above	5%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 - FAC ED Level 2 Room Charge	$304.00	$320.00	$188.80–$313.60	35% above	5%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 - Level 2 - Lynx Visit Level	$271.70	$286.00	$257.40–$280.28	—	5%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 - FAC ED Level 2 Room Charge	$304.00	$320.00	$288.00–$313.60	—	5%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 - Level 3 - Lynx Visit Level	$428.45	$451.00	$266.09–$441.98	37% above	5%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 - FAC ED Level 3 - Room Charge	$455.05	$479.00	$282.61–$469.42	45% above	5%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 - Level 3 - Lynx Visit Level	$428.45	$451.00	$405.90–$441.98	—	5%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 - FAC ED Level 3 - Room Charge	$455.05	$479.00	$431.10–$469.42	—	5%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 - Level 4 - Lynx Visit Level	$643.15	$677.00	$399.43–$663.46	29% above	5%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 - FAC ED Level 4 Room Charge	$862.60	$908.00	$535.72–$889.84	73% above	5%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 - Level 4 - Lynx Visit Level	$643.15	$677.00	$609.30–$663.46	—	5%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 - FAC ED Level 4 Room Charge	$862.60	$908.00	$817.20–$889.84	—	5%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 - Level 5 - Lynx Visit Level	$971.85	$1,023.00	$603.57–$1,002.54	38% above	5%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 - FAC ED Level 5 - Room Charge	$1,270.15	$1,337.00	$788.83–$1,310.26	80% above	5%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 - Level 5 - Lynx Visit Level	$971.85	$1,023.00	$920.70–$1,002.54	—	5%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 - FAC ED Level 5 - Room Charge	$1,270.15	$1,337.00	$1,203.30–$1,310.26	—	5%
Exercise stress test, tracing only, the hospital charge CPT 93017 Lexiscan Stress Test	$1,167.55	$1,229.00	$725.11–$1,204.42	11% above	5%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiolite Stress Test	$1,178.95	$1,241.00	$732.19–$1,216.18	12% above	5%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiac Stress Test	$1,178.95	$1,241.00	$732.19–$1,216.18	12% above	5%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Lexiscan Stress Test	$1,167.55	$1,229.00	$1,106.10–$1,204.42	—	5%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiac Stress Test	$1,178.95	$1,241.00	$1,116.90–$1,216.18	—	5%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiolite Stress Test	$1,178.95	$1,241.00	$1,116.90–$1,216.18	—	5%
Family therapy with the patient, 50 minutes CPT 90847 90847 Family Psychotherapy w/ Patient Present (conjoint) SLS	$399.00	$420.00	$247.80–$411.60	91% above	5%
Family therapy with the patient, 50 minutes inpatient CPT 90847 90847 Family Psychotherapy w/ Patient Present (conjoint) SLS	$399.00	$420.00	$378.00–$411.60	—	5%
Family therapy without the patient, 50 minutes CPT 90846 90846 Family Psychotherapy w/o Patient Present SLS	$399.00	$420.00	$247.80–$411.60	97% above	5%
Family therapy without the patient, 50 minutes CPT 90846 Family psychotherapy (without the patient present)	$477.85	$503.00	$296.77–$492.94	136% above	5%
Family therapy without the patient, 50 minutes inpatient CPT 90846 90846 Family Psychotherapy w/o Patient Present SLS	$399.00	$420.00	$378.00–$411.60	—	5%
Family therapy without the patient, 50 minutes inpatient CPT 90846 Family psychotherapy (without the patient present)	$477.85	$503.00	$452.70–$492.94	—	5%
Group psychotherapy session CPT 90853 90853 Group psychotherapy SLS	$343.90	$362.00	$213.58–$354.76	68% above	5%
Group psychotherapy session inpatient CPT 90853 90853 Group psychotherapy SLS	$343.90	$362.00	$325.80–$354.76	—	5%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 IV HYDRATION 1ST HR. Charge	$303.05	$319.00	$188.21–$312.62	23% below	5%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 IV HYDRAION 1ST HR. Charge 2nd Site	$303.05	$319.00	$188.21–$312.62	23% below	5%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 - ED IV INFUSION HYDRATION INITIAL HOUR	$312.55	$329.00	$194.11–$322.42	21% below	5%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 IV HYDRAION 1ST HR. Charge 2nd Site	$303.05	$319.00	$287.10–$312.62	—	5%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 IV HYDRATION 1ST HR. Charge	$303.05	$319.00	$287.10–$312.62	—	5%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 - ED IV INFUSION HYDRATION INITIAL HOUR	$312.55	$329.00	$296.10–$322.42	—	5%
IV infusion of a medicine, first hour CPT 96365 96365 IV INFUSION 1ST HOUR CHARGE 2ND SITE	$288.80	$304.00	$179.36–$300.05	8% below	5%
IV infusion of a medicine, first hour CPT 96365 96365 IV INFUSION 1ST HOUR CHARGE	$454.10	$478.00	$282.02–$468.44	45% above	5%
IV infusion of a medicine, first hour CPT 96365 96365 ED IV Infusion Initial up to 1 hour	$472.15	$497.00	$293.23–$487.06	51% above	5%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 IV INFUSION 1ST HOUR CHARGE 2ND SITE	$288.80	$304.00	$273.60–$297.92	—	5%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 IV INFUSION 1ST HOUR CHARGE	$454.10	$478.00	$430.20–$468.44	—	5%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 ED IV Infusion Initial up to 1 hour	$472.15	$497.00	$447.30–$487.06	—	5%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372- IM/SQ Inj Charge	$142.50	$150.00	$88.50–$147.00	43% above	5%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372- IM/SQ Additional Inj Charge	$142.50	$150.00	$88.50–$147.00	43% above	5%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Admin Rabies Immune Globulin	$142.50	$150.00	$88.50–$147.00	43% above	5%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 IM/SQ Additional Inj Charge	$142.50	$150.00	$88.50–$147.00	43% above	5%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 IM/SQ INJ CHARGE	$142.50	$150.00	$88.50–$147.00	43% above	5%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 - ED Subq/IM Injection	$142.50	$150.00	$88.50–$147.00	43% above	5%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372- IM/SQ Additional Inj Charge	$142.50	$150.00	$135.00–$147.00	—	5%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 IM/SQ INJ CHARGE	$142.50	$150.00	$135.00–$147.00	—	5%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372- IM/SQ Inj Charge	$142.50	$150.00	$135.00–$147.00	—	5%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 IM/SQ Additional Inj Charge	$142.50	$150.00	$135.00–$147.00	—	5%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 - ED Subq/IM Injection	$142.50	$150.00	$135.00–$147.00	—	5%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Admin Rabies Immune Globulin	$142.50	$150.00	$135.00–$147.00	—	5%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 95910 Nerve conduction, 7-8 studies	$805.60	$848.00	$500.32–$831.04	14% above	5%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 95910 Nerve conduction, 7-8 studies	$805.60	$848.00	$763.20–$831.04	—	5%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Assistant Units	$108.30	$114.00	$67.26–$111.72	42% above	5%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation Charges	$113.05	$119.00	$70.21–$116.62	48% above	5%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Reeducation Charges	$85.50	$90.00	$81.00–$88.20	—	5%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducation Assistant Units	$108.30	$114.00	$102.60–$111.72	—	5%
New patient office visit, about 30 minutes CPT 99203 OFFICE/OUTPATIENT VISIT NEW 3	$191.90	$202.00	$116.62–$197.96	7% below	5%
New patient office visit, about 30 minutes CPT 99203 Level 3 New O/P 99203	$191.90	$202.00	$116.62–$197.96	7% below	5%
New patient office visit, about 30 minutes CPT 99203 Level 3-New-Surgical O/P-99203	$191.90	$202.00	$116.62–$197.96	7% below	5%
New patient office visit, about 30 minutes CPT 99203 99203-Level 3 New - 0516	$191.90	$202.00	$116.62–$197.96	7% below	5%
New patient office visit, about 30 minutes CPT 99203 99203-Level 3 Visit - New - 983	$260.30	$274.00	$116.62–$268.52	26% above	5%
New patient office visit, about 30 minutes inpatient CPT 99203 Level 3-New-Surgical O/P-99203	$191.90	$202.00	$181.80–$197.96	—	5%
New patient office visit, about 30 minutes inpatient CPT 99203 99203-Level 3 New - 0516	$191.90	$202.00	$181.80–$197.96	—	5%
New patient office visit, about 30 minutes inpatient CPT 99203 Level 3 New O/P 99203	$191.90	$202.00	$181.80–$197.96	—	5%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OUTPATIENT VISIT NEW 3	$191.90	$202.00	$181.80–$197.96	—	5%
New patient office visit, about 30 minutes inpatient CPT 99203 99203-Level 3 Visit - New - 983	$260.30	$274.00	$246.60–$268.52	—	5%
New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPATIENT VISIT NEW 4	$327.75	$345.00	$155.02–$338.10	9% above	5%
New patient office visit, about 45 minutes CPT 99204 Level 4-New-Surgical O/P-99204	$327.75	$345.00	$155.02–$338.10	9% above	5%
New patient office visit, about 45 minutes CPT 99204 99204-Level 4 New - 0516	$327.75	$345.00	$155.02–$338.10	9% above	5%
New patient office visit, about 45 minutes CPT 99204 Level 4 New O/P 99204	$327.75	$345.00	$155.02–$338.10	9% above	5%
New patient office visit, about 45 minutes CPT 99204 99204-Level 4 Visit - New - 981	$383.80	$404.00	$155.02–$395.92	27% above	5%
New patient office visit, about 45 minutes inpatient CPT 99204 99204-Level 4 New - 0516	$327.75	$345.00	$310.50–$338.10	—	5%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPATIENT VISIT NEW 4	$327.75	$345.00	$310.50–$338.10	—	5%
New patient office visit, about 45 minutes inpatient CPT 99204 Level 4-New-Surgical O/P-99204	$327.75	$345.00	$310.50–$338.10	—	5%
New patient office visit, about 45 minutes inpatient CPT 99204 Level 4 New O/P 99204	$327.75	$345.00	$310.50–$338.10	—	5%
New patient office visit, about 45 minutes inpatient CPT 99204 99204-Level 4 Visit - New - 981	$383.80	$404.00	$363.60–$395.92	—	5%
New patient office visit, about 60 minutes CPT 99205 99205-Level 5 New - 0516	$429.40	$452.00	$210.16–$442.96	16% above	5%
New patient office visit, about 60 minutes CPT 99205 Level 5 New O/P 99205	$429.40	$452.00	$210.16–$442.96	16% above	5%
New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPATIENT VISIT NEW 5..	$429.40	$452.00	$210.16–$442.96	16% above	5%
New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPATIENT VISIT NEW - 5	$429.40	$452.00	$210.16–$442.96	16% above	5%
New patient office visit, about 60 minutes CPT 99205 Level 5-New-Surgical O/P-99205	$429.40	$452.00	$210.16–$442.96	16% above	5%
New patient office visit, about 60 minutes CPT 99205 99205-Level 5 Visit - New - 981	$513.00	$540.00	$210.16–$529.20	39% above	5%
New patient office visit, about 60 minutes inpatient CPT 99205 Level 5-New-Surgical O/P-99205	$429.40	$452.00	$406.80–$442.96	—	5%
New patient office visit, about 60 minutes inpatient CPT 99205 99205-Level 5 New - 0516	$429.40	$452.00	$406.80–$442.96	—	5%
New patient office visit, about 60 minutes inpatient CPT 99205 Level 5 New O/P 99205	$429.40	$452.00	$406.80–$442.96	—	5%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPATIENT VISIT NEW - 5	$429.40	$452.00	$406.80–$442.96	—	5%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPATIENT VISIT NEW 5..	$429.40	$452.00	$406.80–$442.96	—	5%
New patient office visit, about 60 minutes inpatient CPT 99205 99205-Level 5 Visit - New - 981	$513.00	$540.00	$486.00–$529.20	—	5%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202-Level 2 New - 0516	$128.25	$135.00	$79.65–$132.30	6% below	5%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Level 2 New O/P 99202	$128.25	$135.00	$79.65–$132.30	6% below	5%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE/OUTPATIENT VISIT NEW 2	$128.25	$135.00	$79.65–$132.30	6% below	5%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Level 2 New O/P 99202	$128.25	$135.00	$121.50–$132.30	—	5%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE/OUTPATIENT VISIT NEW 2	$128.25	$135.00	$121.50–$132.30	—	5%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202-Level 2 New - 0516	$128.25	$135.00	$121.50–$132.30	—	5%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 97802 MNT INDIVIDUAL INITIAL ASSESS EA 15 MIN CHARGE	$68.40	$72.00	$42.48–$70.56	43% above	5%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 97802 MNT INDIVIDUAL INITIAL ASSESS EA 15 MIN CHARGE	$68.40	$72.00	$64.80–$70.56	—	5%
Occupational therapy evaluation, low complexity CPT 97165 OT Low Complex Units	$278.35	$293.00	$172.87–$287.14	71% above	5%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT Low Complex Units	$278.35	$293.00	$263.70–$287.14	—	5%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT High Complex Units	$258.40	$272.00	$160.48–$266.56	53% above	5%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT High Complex Units	$258.40	$272.00	$244.80–$266.56	—	5%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Low Complex Units	$258.40	$272.00	$160.48–$266.56	84% above	5%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT Low Complex Units	$258.40	$272.00	$244.80–$266.56	—	5%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Moderate Complex Units	$258.40	$272.00	$160.48–$266.56	53% above	5%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT Moderate Complex Units	$258.40	$272.00	$244.80–$266.56	—	5%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Joint Mobilization Charges	$85.50	$90.00	$53.10–$88.20	at median	5%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Soft Tissue Mobilization Charges	$85.50	$90.00	$53.10–$88.20	at median	5%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Assistant Units	$86.45	$91.00	$53.69–$89.18	1% above	5%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Myofacial Release Charges	$86.45	$91.00	$53.69–$89.18	1% above	5%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy Charge Units	$86.45	$91.00	$53.69–$89.18	1% above	5%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Joint Mobilization Charges	$85.50	$90.00	$81.00–$88.20	—	5%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Soft Tissue Mobilization Charges	$85.50	$90.00	$81.00–$88.20	—	5%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy Charge Units	$86.45	$91.00	$81.90–$89.18	—	5%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Assistant Units	$86.45	$91.00	$81.90–$89.18	—	5%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Myofacial Release Charges	$86.45	$91.00	$81.90–$89.18	—	5%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 PT THERAPEUTIC EXERCISE 15 MIN	$95.00	$100.00	$59.00–$98.00	18% above	5%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Assistant Units	$95.00	$100.00	$59.00–$98.00	18% above	5%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges	$103.55	$109.00	$64.31–$106.82	29% above	5%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 PT THERAPEUTIC EXERCISE 15 MIN	$95.00	$100.00	$90.00–$98.00	—	5%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Charges	$95.00	$100.00	$90.00–$98.00	—	5%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Assistant Units	$95.00	$100.00	$90.00–$98.00	—	5%
Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 minutes with patient and/or family member	$297.35	$313.00	$184.67–$306.74	88% above	5%
Psychotherapy session, 30 minutes CPT 90832 90832 16-37 mins. Individual Psychotherapy SLS	$363.85	$383.00	$225.97–$375.34	130% above	5%
Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy, 30 minutes with patient and/or family member	$297.35	$313.00	$281.70–$306.74	—	5%
Psychotherapy session, 30 minutes inpatient CPT 90832 90832 16-37 mins. Individual Psychotherapy SLS	$363.85	$383.00	$344.70–$375.34	—	5%
Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 minutes with patient and/or family member	$250.80	$264.00	$155.76–$258.72	33% above	5%
Psychotherapy session, 45 minutes CPT 90834 90834 38-52 mins. Individual Psychotherapy SLS	$388.55	$409.00	$241.31–$400.82	106% above	5%
Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy, 45 minutes with patient and/or family member	$250.80	$264.00	$237.60–$258.72	—	5%
Psychotherapy session, 45 minutes inpatient CPT 90834 90834 38-52 mins. Individual Psychotherapy SLS	$388.55	$409.00	$368.10–$400.82	—	5%
Psychotherapy session, 60 minutes CPT 90837 90837 53-67 mins. Individual Psychotherapy SLS	$416.10	$438.00	$258.42–$429.24	83% above	5%
Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 minutes with patient and/or family member	$593.75	$625.00	$368.75–$612.50	161% above	5%
Psychotherapy session, 60 minutes inpatient CPT 90837 90837 53-67 mins. Individual Psychotherapy SLS	$416.10	$438.00	$394.20–$429.24	—	5%
Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy, 60 minutes with patient and/or family member	$593.75	$625.00	$562.50–$612.50	—	5%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 99406 TOBACCO CESSATION 3-10 CHARGE	$37.05	$39.00	$23.01–$38.22	30% above	5%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 99406 TOBACCO CESSATION 3-10 CHARGE	$37.05	$39.00	$35.10–$38.22	—	5%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215-Level 5 Established - 0516	$285.95	$301.00	$177.59–$294.98	29% above	5%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Level 5 Established 99215	$285.95	$301.00	$177.59–$294.98	29% above	5%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE/OUTPATIENT VISIT EST - 5	$285.95	$301.00	$177.59–$294.98	29% above	5%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OB Level 5 Established 99215	$285.95	$301.00	$177.59–$294.98	29% above	5%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE/OUTPATIENT VISIT EST 5..	$285.95	$301.00	$177.59–$294.98	29% above	5%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Level 5-Established-Surgical O/P-99215	$285.95	$301.00	$177.59–$294.98	29% above	5%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Level 5 Established Psychiatry	$300.20	$316.00	$186.44–$309.68	36% above	5%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Level 5-Established-Surgical O/P-99215	$285.95	$301.00	$270.90–$294.98	—	5%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE/OUTPATIENT VISIT EST 5..	$285.95	$301.00	$270.90–$294.98	—	5%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OB Level 5 Established 99215	$285.95	$301.00	$270.90–$294.98	—	5%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215-Level 5 Established - 0516	$285.95	$301.00	$270.90–$294.98	—	5%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE/OUTPATIENT VISIT EST - 5	$285.95	$301.00	$270.90–$294.98	—	5%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Level 5 Established 99215	$285.95	$301.00	$270.90–$294.98	—	5%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 Level 5 Established Psychiatry	$300.20	$316.00	$284.40–$309.68	—	5%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Level 3-Established-Surgical O/P-99213	$131.10	$138.00	$81.42–$135.24	2% above	5%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OB Level 3 Established 99213	$131.10	$138.00	$81.42–$135.24	2% above	5%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Level 3 Established 99213	$131.10	$138.00	$81.42–$135.24	2% above	5%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213-Level 3 Established - 0516	$131.10	$138.00	$81.42–$135.24	2% above	5%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OUTPATIENT VISIT EST 3	$131.10	$138.00	$81.42–$135.24	2% above	5%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Level 3 Established Psychiatry	$137.75	$145.00	$85.55–$142.10	8% above	5%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OB Level 3 Established 99213	$131.10	$138.00	$124.20–$135.24	—	5%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Level 3 Established 99213	$131.10	$138.00	$124.20–$135.24	—	5%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OUTPATIENT VISIT EST 3	$131.10	$138.00	$124.20–$135.24	—	5%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213-Level 3 Established - 0516	$131.10	$138.00	$124.20–$135.24	—	5%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Level 3-Established-Surgical O/P-99213	$131.10	$138.00	$124.20–$135.24	—	5%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Level 3 Established Psychiatry	$137.75	$145.00	$130.50–$142.10	—	5%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Level 4 Established 99214	$201.40	$212.00	$125.08–$207.76	21% above	5%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OB Level 4 Established 99214	$201.40	$212.00	$125.08–$207.76	21% above	5%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214-Level 4 Established - 0516	$201.40	$212.00	$125.08–$207.76	21% above	5%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Level 4 Established Psychiatry	$201.40	$212.00	$125.08–$207.76	21% above	5%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE/OUTPATIENT VISIT EST 4	$201.40	$212.00	$125.08–$207.76	21% above	5%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Level 4-Established-Surgical O/P-99214	$201.40	$212.00	$125.08–$207.76	21% above	5%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214-Level 4 Visit - Established - 983	$241.30	$254.00	$146.70–$248.92	45% above	5%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE/OUTPATIENT VISIT EST 4	$201.40	$212.00	$190.80–$207.76	—	5%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OB Level 4 Established 99214	$201.40	$212.00	$190.80–$207.76	—	5%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Level 4-Established-Surgical O/P-99214	$201.40	$212.00	$190.80–$207.76	—	5%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214-Level 4 Established - 0516	$201.40	$212.00	$190.80–$207.76	—	5%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Level 4 Established 99214	$201.40	$212.00	$190.80–$207.76	—	5%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 Level 4 Established Psychiatry	$201.40	$212.00	$190.80–$207.76	—	5%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214-Level 4 Visit - Established - 983	$241.30	$254.00	$228.60–$248.92	—	5%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212-Level 2 Established - 0516	$65.55	$69.00	$40.71–$80.11	24% below	5%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE/OUTPATIENT VISIT EST 2	$65.55	$69.00	$40.71–$80.11	24% below	5%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OB Level 2 Established 99212	$65.55	$69.00	$40.71–$80.11	24% below	5%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Level 2 Established 99212	$65.55	$69.00	$40.71–$80.11	24% below	5%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Level 2 Established Psychiatry	$68.40	$72.00	$42.48–$80.11	21% below	5%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212-Level 2 Visit - Established - 983	$120.65	$127.00	$74.93–$124.46	40% above	5%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Level 2 Established 99212	$65.55	$69.00	$62.10–$67.62	—	5%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE/OUTPATIENT VISIT EST 2	$65.55	$69.00	$62.10–$67.62	—	5%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212-Level 2 Established - 0516	$65.55	$69.00	$62.10–$67.62	—	5%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OB Level 2 Established 99212	$65.55	$69.00	$62.10–$67.62	—	5%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 Level 2 Established Psychiatry	$68.40	$72.00	$64.80–$70.56	—	5%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212-Level 2 Visit - Established - 983	$120.65	$127.00	$114.30–$124.46	—	5%
Speech and language evaluation CPT 92523 Speech Sound Prod w/ Language Charge - 92523 Speech Sound Prod w/ Language Charge	$543.40	$572.00	$337.48–$560.56	94% above	5%
Speech and language evaluation inpatient CPT 92523 Speech Sound Prod w/ Language Charge - 92523 Speech Sound Prod w/ Language Charge	$543.40	$572.00	$514.80–$560.56	—	5%
Speech therapy session, individual CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg - 92507 Tx of Speech/Lang/Voice/Comm/Auditory	$216.60	$228.00	$134.52–$223.44	1% above	5%
Speech therapy session, individual CPT 92507 Yes - Speech Therapy Charge	$228.00	$240.00	$141.60–$235.20	7% above	5%
Speech therapy session, individual CPT 92507 Yes - zzTx of Speech/Lang/Voice/Comm/Auditory Chg	$228.00	$240.00	$141.60–$235.20	7% above	5%
Speech therapy session, individual CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg Medicaid	$255.55	$269.00	$158.71–$263.62	20% above	5%
Speech therapy session, individual inpatient CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg - 92507 Tx of Speech/Lang/Voice/Comm/Auditory	$216.60	$228.00	$205.20–$223.44	—	5%
Speech therapy session, individual inpatient CPT 92507 Yes - zzTx of Speech/Lang/Voice/Comm/Auditory Chg	$228.00	$240.00	$216.00–$235.20	—	5%
Speech therapy session, individual inpatient CPT 92507 Yes - Speech Therapy Charge	$228.00	$240.00	$216.00–$235.20	—	5%
Speech therapy session, individual inpatient CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg Medicaid	$255.55	$269.00	$242.10–$263.62	—	5%
Spirometry (breathing test) CPT 94010 RT FVC Charge	$236.55	$249.00	$146.91–$244.02	4% below	5%
Spirometry (breathing test) CPT 94010 94010 SPIR W/ VC EXPIRATORY FLOW W/WO MXML VOL VNTJ CHARGE	$236.55	$249.00	$146.91–$244.02	4% below	5%
Spirometry (breathing test) CPT 94010 Spirometry	$255.55	$269.00	$158.71–$263.62	3% above	5%
Spirometry (breathing test) CPT 94010 Spirometry.	$255.55	$269.00	$158.71–$263.62	3% above	5%
Spirometry (breathing test) inpatient CPT 94010 RT FVC Charge	$236.55	$249.00	$224.10–$244.02	—	5%
Spirometry (breathing test) inpatient CPT 94010 94010 SPIR W/ VC EXPIRATORY FLOW W/WO MXML VOL VNTJ CHARGE	$236.55	$249.00	$224.10–$244.02	—	5%
Spirometry (breathing test) inpatient CPT 94010 Spirometry.	$255.55	$269.00	$242.10–$263.62	—	5%
Spirometry (breathing test) inpatient CPT 94010 Spirometry	$255.55	$269.00	$242.10–$263.62	—	5%
Spirometry before and after a bronchodilator CPT 94060 Disability Spirometry	$86.45	$91.00	$53.69–$89.18	81% below	5%
Spirometry before and after a bronchodilator CPT 94060 Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn	$145.35	$153.00	$90.27–$149.94	68% below	5%
Spirometry before and after a bronchodilator CPT 94060 94060 BRONCHOSPASM EVAL SPIROMETRY	$526.30	$554.00	$326.86–$542.92	17% above	5%
Spirometry before and after a bronchodilator CPT 94060 RT Pre & Post Spiro Charge	$526.30	$554.00	$326.86–$542.92	17% above	5%
Spirometry before and after a bronchodilator CPT 94060 Spirometry Pre & Post BD	$561.45	$591.00	$348.69–$579.18	24% above	5%
Spirometry before and after a bronchodilator CPT 94060 Spirometry Pre/Post BD	$561.45	$591.00	$348.69–$579.18	24% above	5%
Spirometry before and after a bronchodilator inpatient CPT 94060 Disability Spirometry	$86.45	$91.00	$81.90–$89.18	—	5%
Spirometry before and after a bronchodilator inpatient CPT 94060 Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn	$145.35	$153.00	$137.70–$149.94	—	5%
Spirometry before and after a bronchodilator inpatient CPT 94060 RT Pre & Post Spiro Charge	$526.30	$554.00	$498.60–$542.92	—	5%
Spirometry before and after a bronchodilator inpatient CPT 94060 94060 BRONCHOSPASM EVAL SPIROMETRY	$526.30	$554.00	$498.60–$542.92	—	5%
Spirometry before and after a bronchodilator inpatient CPT 94060 Spirometry Pre & Post BD	$561.45	$591.00	$531.90–$579.18	—	5%
Spirometry before and after a bronchodilator inpatient CPT 94060 Spirometry Pre/Post BD	$561.45	$591.00	$531.90–$579.18	—	5%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activity Assistant Units	$81.70	$86.00	$50.74–$84.28	1% above	5%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Charges	$96.90	$102.00	$60.18–$99.96	19% above	5%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Charge	$101.65	$107.00	$63.13–$104.86	25% above	5%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activity Assistant Units	$81.70	$86.00	$77.40–$84.28	—	5%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Charges	$96.90	$102.00	$91.80–$99.96	—	5%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Charge	$101.65	$107.00	$96.30–$104.86	—	5%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy 5	$295.45	$311.00	$183.49–$304.78	54% above	5%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Therapeutic Phlebotomy 5	$295.45	$311.00	$279.90–$304.78	—	5%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 influenza virus vaccine, 65+ TIV 2526 PFS 0.5 mL FLUAD [PMC]	$315.40	$331.99	$195.87–$325.35	316% above	5%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 influenza virus vaccine, 65+ TIV 2526 PFS 0.5 mL FLUAD [PMC]	$315.40	$331.99	$298.79–$325.35	—	5%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine, TIV 2526 PFS 0.5 mL FLUARIX [PMC]	$90.02	$94.75	$55.90–$92.86	181% above	5%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine, TIV 2526 PFS 0.5 mL AFLURIA [PMC]	$101.71	$107.06	$63.17–$104.92	218% above	5%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine, TIV 2526 PFS 0.5 mL FLUARIX [PMC]	$90.02	$94.75	$85.28–$92.86	—	5%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine, TIV 2526 PFS 0.5 mL AFLURIA [PMC]	$101.71	$107.06	$96.35–$104.92	—	5%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B adult vaccine 20 mcg/mL Sus 1 mL [PMC]	$50.99	$53.67	$31.67–$52.60	39% below	5%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B adult vaccine 20 mcg/mL Sus 1 mL [PMC]	$50.99	$53.67	$48.30–$52.60	—	5%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles/mumps/rubella virus vaccine SubQ Inj [PMC]	$358.15	$377.00	$222.43–$369.46	217% above	5%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles/mumps/rubella virus vaccine SubQ Inj [PMC]	$358.15	$377.00	$339.30–$369.46	—	5%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate vaccine Sus [PMC]	$936.57	$985.86	$581.66–$966.14	91% above	5%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conjugate vaccine Sus [PMC]	$936.57	$985.86	$887.27–$966.14	—	5%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 nirsevimab-alip 50 mg/0.5 mL Inj [PMC]	$1,901.97	$2,002.07	$1,181.22–$1,962.03	161% above	5%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 nirsevimab-alip 50 mg/0.5 mL Inj [PMC]	$1,901.97	$2,002.07	$1,801.86–$1,962.03	—	5%
Rabies vaccine, one dose CPT 90675 rabies vaccine, purified chick embryo cell 2.5 intl units Pow [PMC]	$1,296.33	$1,364.55	$805.08–$1,337.26	135% above	5%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, purified chick embryo cell 2.5 intl units Pow [PMC]	$1,415.57	$1,490.07	$1,341.06–$1,460.27	—	5%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphtheria/pertussis, acel (Tdap) [PMC]	$48.31	$50.85	$30.00–$49.83	33% below	5%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphtheria/pertussis, acel (Tdap) [PMC]	$48.31	$50.85	$45.77–$49.83	—	5%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Immunization 1 Vaccine	$74.10	$78.00	$46.02–$76.44	109% above	5%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Admin Immunization 1 Vaccine	$92.15	$97.00	$87.30–$95.06	—	5%

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/10169/470566524_providence-medical-center_standardcharges.csv