Valley County Hospital
Valley County Hospital in Ord, NE publishes cash prices for 299 common procedures listed here, from its own machine-readable price file updated Jun 15, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Nebraska median for 178 of 297 procedures and below it for 116. By typical cash price it ranks #24 of 34 Nebraska hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
2707 L St, Ord, NE 68862 Collected Sep 27, 2026 Source price file (308) 728-4200
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 281353 · CMS hospital register
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Ankle X-ray, complete, 3 or more views CPT 73610 RAD EXAM ANKLE COMPLETE 3 | $333.00 | $370.00 | $74.00–$362.60 | 17% above | 10% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RAD EXAM ANKLE COMPLETE 3 | $333.00 | $370.00 | $336.70–$362.60 | — | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 NON-INV LTD STDY EXT ARTE | $569.70 | $633.00 | $126.60–$620.34 | 54% above | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 NON-INV LTD STDY EXT ARTE | $569.70 | $633.00 | $576.03–$620.34 | — | 10% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 RAD EXAM ESOPHAGUS | $611.10 | $679.00 | $135.80–$665.42 | 21% above | 10% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 RAD EXAM ESOPHAGUS | $611.10 | $679.00 | $617.89–$665.42 | — | 10% |
| Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE IMAGING WHOLE BOD | $1,961.10 | $2,179.00 | $435.80–$2,135.42 | 18% above | 10% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE IMAGING WHOLE BOD | $1,961.10 | $2,179.00 | $1,982.89–$2,135.42 | — | 10% |
| Breast ultrasound, complete, one breast one side CPT 76641 ULS BREAST UNILATERAL COM | $486.00 | $540.00 | $108.00–$529.20 | 8% above | 10% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 ULS BREAST UNILATERAL COM | $486.00 | $540.00 | $491.40–$529.20 | — | 10% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 ULS BREAST UNILATERAL LIM | $486.00 | $540.00 | $108.00–$529.20 | 43% above | 10% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 ULS BREAST UNILATERAL LIM | $486.00 | $540.00 | $491.40–$529.20 | — | 10% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST W/WO (PE CHEST) | $3,451.50 | $3,835.00 | $767.00–$3,758.30 | 13% above | 10% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST W/WO (PE CHEST) | $3,451.50 | $3,835.00 | $3,489.85–$3,758.30 | — | 10% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT SCAN HEART W/O CONT CA | $203.40 | $226.00 | $45.20–$221.48 | 63% above | 10% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT SCAN HEART W/O CONT CA | $203.40 | $226.00 | $205.66–$221.48 | — | 10% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT SCAN-ABDOMEN & PELVIS | $4,521.60 | $5,024.00 | $1,004.80–$4,923.52 | 58% above | 10% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT SCAN-ABDOMEN & PELVIS | $4,521.60 | $5,024.00 | $4,571.84–$4,923.52 | — | 10% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT SCAN-ABDOMEN & PELVIS | $4,903.20 | $5,448.00 | $1,089.60–$5,339.04 | 26% above | 10% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT SCAN-ABDOMEN & PELVIS | $4,903.20 | $5,448.00 | $4,957.68–$5,339.04 | — | 10% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT SCAN-ABDOMEN & PELVIS | $5,211.90 | $5,791.00 | $1,158.20–$5,675.18 | 19% above | 10% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT SCAN-ABDOMEN & PELVIS | $5,211.90 | $5,791.00 | $5,269.81–$5,675.18 | — | 10% |
| CT scan of the abdomen with contrast CPT 74160 CT SCAN-ABDOMEN W/CONTRAS | $2,870.10 | $3,189.00 | $637.80–$3,125.22 | 22% above | 10% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT SCAN-ABDOMEN W/CONTRAS | $2,870.10 | $3,189.00 | $2,901.99–$3,125.22 | — | 10% |
| CT scan of the abdomen without contrast CPT 74150 CT SCAN-ABDOMEN W/O CONTR | $2,436.30 | $2,707.00 | $541.40–$2,652.86 | 25% above | 10% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT SCAN-ABDOMEN W/O CONTR | $2,436.30 | $2,707.00 | $2,463.37–$2,652.86 | — | 10% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT SCAN MAXILLOFACIAL ARE | $1,927.80 | $2,142.00 | $428.40–$2,099.16 | 19% above | 10% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SCAN MAXILLOFACIAL ARE | $1,927.80 | $2,142.00 | $1,949.22–$2,099.16 | — | 10% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT SCAN HEAD/BRAIN W/O CO | $2,173.50 | $2,415.00 | $483.00–$2,366.70 | 28% above | 10% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT SCAN HEAD/BRAIN W/O CO | $2,173.50 | $2,415.00 | $2,197.65–$2,366.70 | — | 10% |
| CT scan of the head with contrast CPT 70460 CT SCAN HEAD BRAIN W/CONT | $2,185.20 | $2,428.00 | $485.60–$2,379.44 | 10% above | 10% |
| CT scan of the head with contrast inpatient CPT 70460 CT SCAN HEAD BRAIN W/CONT | $2,185.20 | $2,428.00 | $2,209.48–$2,379.44 | — | 10% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/WO | $2,601.00 | $2,890.00 | $578.00–$2,832.20 | 11% above | 10% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN W/WO | $2,601.00 | $2,890.00 | $2,629.90–$2,832.20 | — | 10% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SCAN LUMBAR SPINE W/O | $2,601.00 | $2,890.00 | $578.00–$2,832.20 | 28% above | 10% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT SCAN LUMBAR SPINE W/O | $2,601.00 | $2,890.00 | $2,629.90–$2,832.20 | — | 10% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SCAN CERVICAL SPINE W/ | $2,601.00 | $2,890.00 | $578.00–$2,832.20 | 25% above | 10% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT SCAN CERVICAL SPINE W/ | $2,601.00 | $2,890.00 | $2,629.90–$2,832.20 | — | 10% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT SCAN PELVIS W/CONTRAST | $2,734.20 | $3,038.00 | $607.60–$2,977.24 | 17% above | 10% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT SCAN PELVIS W/CONTRAST | $2,734.20 | $3,038.00 | $2,764.58–$2,977.24 | — | 10% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 DUPLEX SCAN EXTRACRANIAL | $1,473.30 | $1,637.00 | $327.40–$1,604.26 | 4% below | 10% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 DUPLEX SCAN EXTRACRANIAL | $1,473.30 | $1,637.00 | $1,489.67–$1,604.26 | — | 10% |
| Chest X-ray, 2 views CPT 71046 RAD EXAM CHEST 2 VIEWS | $403.20 | $448.00 | $89.60–$439.04 | 50% above | 10% |
| Chest X-ray, 2 views inpatient CPT 71046 RAD EXAM CHEST 2 VIEWS | $403.20 | $448.00 | $407.68–$439.04 | — | 10% |
| Chest X-ray, single view CPT 71045 RAD EXAM CHEST SINGLE VIE | $273.60 | $304.00 | $60.80–$297.92 | 42% above | 10% |
| Chest X-ray, single view inpatient CPT 71045 RAD EXAM CHEST SINGLE VIE | $273.60 | $304.00 | $276.64–$297.92 | — | 10% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 ULTRASOUND RETROPERITONEU | $813.60 | $904.00 | $180.80–$885.92 | 5% above | 10% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 ULTRASOUND RETROPERITONEU | $813.60 | $904.00 | $822.64–$885.92 | — | 10% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA AXIAL W/O VFA | $505.80 | $562.00 | $112.40–$550.76 | 31% above | 10% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA AXIAL W/O VFA | $505.80 | $562.00 | $511.42–$550.76 | — | 10% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA BONE DENSITY APPENDI | $235.80 | $262.00 | $52.40–$256.76 | 32% above | 10% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA BONE DENSITY APPENDI | $235.80 | $262.00 | $238.42–$256.76 | — | 10% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT SCAN THORAX DX W/O CON | $2,601.00 | $2,890.00 | $578.00–$2,832.20 | 27% above | 10% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT SCAN THORAX DX W/O CON | $2,601.00 | $2,890.00 | $2,629.90–$2,832.20 | — | 10% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT SCAN THORAX DX WITH C | $2,767.50 | $3,075.00 | $615.00–$3,013.50 | 17% above | 10% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT SCAN THORAX DX WITH C | $2,767.50 | $3,075.00 | $2,798.25–$3,013.50 | — | 10% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DIAGNOSTIC MAMMOGRAPHY BI | $408.60 | $454.00 | $90.80–$444.92 | — | 10% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DIAGNOSTIC MAMMOGRAPHY BI | $408.60 | $454.00 | $413.14–$444.92 | — | 10% |
| Diagnostic mammogram, one breast CPT 77065 DIAGNOSTIC MAMMOGRAPHY UN | $362.70 | $403.00 | $80.60–$394.94 | 77% above | 10% |
| Diagnostic mammogram, one breast inpatient CPT 77065 DIAGNOSTIC MAMMOGRAPHY UN | $362.70 | $403.00 | $366.73–$394.94 | — | 10% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 DUPLEX SCAN LWR EXT ARTER | $1,189.80 | $1,322.00 | $264.40–$1,295.56 | 15% above | 10% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 DUPLEX SCAN LWR EXT ARTER | $1,189.80 | $1,322.00 | $1,203.02–$1,295.56 | — | 10% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 DUPLEX SCAN VEINS EXTREMI | $1,358.10 | $1,509.00 | $301.80–$1,478.82 | 2% below | 10% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 DUPLEX SCAN VEINS EXTREMI | $1,358.10 | $1,509.00 | $1,373.19–$1,478.82 | — | 10% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO COMPLETE (2D M-MODE | $2,110.50 | $2,345.00 | $469.00–$2,298.10 | 5% above | 10% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO COMPLETE (2D M-MODE | $2,110.50 | $2,345.00 | $2,133.95–$2,298.10 | — | 10% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HIDA W/O PHARM INTERVENTI | $1,891.80 | $2,102.00 | $420.40–$2,059.96 | 24% above | 10% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HIDA W/O PHARM INTERVENTI | $1,891.80 | $2,102.00 | $1,912.82–$2,059.96 | — | 10% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATTENDED | $532.80 | $592.00 | $118.40–$580.16 | 26% above | 10% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATTENDED | $532.80 | $592.00 | $538.72–$580.16 | — | 10% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older both sides CPT 95811 POLYSOMNOGRAPHY W/CPAP/BI | $4,437.90 | $4,931.00 | $986.20–$4,832.38 | — | 10% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient both sides CPT 95811 POLYSOMNOGRAPHY W/CPAP/BI | $4,437.90 | $4,931.00 | $4,487.21–$4,832.38 | — | 10% |
| Knee X-ray, 3 views CPT 73562 RAD EXAM KNEE 3 VIEWS | $443.70 | $493.00 | $98.60–$483.14 | 30% above | 10% |
| Knee X-ray, 3 views inpatient CPT 73562 RAD EXAM KNEE 3 VIEWS | $443.70 | $493.00 | $448.63–$483.14 | — | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ULTRASOUND ABDOMEN LIMITE | $675.00 | $750.00 | $150.00–$735.00 | 30% above | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ULTRASOUND ABDOMEN LIMITE | $675.00 | $750.00 | $682.50–$735.00 | — | 10% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT SCAN LUNG CANCER SCREE | $306.90 | $341.00 | $68.20–$334.18 | 29% below | 10% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT SCAN LUNG CANCER SCREE | $306.90 | $341.00 | $310.31–$334.18 | — | 10% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXTREMITY JOINT | $2,970.00 | $3,300.00 | $660.00–$3,234.00 | 21% above | 10% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXTREMITY JOINT | $2,970.00 | $3,300.00 | $3,003.00–$3,234.00 | — | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXTREMITY JOINT | $3,374.10 | $3,749.00 | $749.80–$3,674.02 | at median | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXTREMITY JOINT | $3,374.10 | $3,749.00 | $3,411.59–$3,674.02 | — | 10% |
| MRI of the abdomen without contrast CPT 74181 MRI ADBOMEN W/O CONTRAST | $3,980.70 | $4,423.00 | $884.60–$4,334.54 | 44% above | 10% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI ADBOMEN W/O CONTRAST | $3,980.70 | $4,423.00 | $4,024.93–$4,334.54 | — | 10% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/O & W/ CONT | $4,383.00 | $4,870.00 | $974.00–$4,772.60 | 19% above | 10% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/O & W/ CONT | $4,383.00 | $4,870.00 | $4,431.70–$4,772.60 | — | 10% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST | $3,778.20 | $4,198.00 | $839.60–$4,114.04 | 50% above | 10% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST | $3,778.20 | $4,198.00 | $3,820.18–$4,114.04 | — | 10% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO CONTRAST | $4,182.30 | $4,647.00 | $929.40–$4,554.06 | 9% above | 10% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO CONTRAST | $4,182.30 | $4,647.00 | $4,228.77–$4,554.06 | — | 10% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE WITHOUT | $3,573.90 | $3,971.00 | $794.20–$3,891.58 | 16% above | 10% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE WITHOUT | $3,573.90 | $3,971.00 | $3,613.61–$3,891.58 | — | 10% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE W/WO | $3,980.70 | $4,423.00 | $884.60–$4,334.54 | 3% above | 10% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L SPINE W/WO | $3,980.70 | $4,423.00 | $4,024.93–$4,334.54 | — | 10% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORAC SPINE W/O CONT | $3,573.90 | $3,971.00 | $794.20–$3,891.58 | 14% above | 10% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORAC SPINE W/O CONT | $3,573.90 | $3,971.00 | $3,613.61–$3,891.58 | — | 10% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE W/ WO | $3,980.70 | $4,423.00 | $884.60–$4,334.54 | 4% above | 10% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE W/ WO | $3,980.70 | $4,423.00 | $4,024.93–$4,334.54 | — | 10% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE W/O CO | $3,573.90 | $3,971.00 | $794.20–$3,891.58 | 18% above | 10% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE W/O CO | $3,573.90 | $3,971.00 | $3,613.61–$3,891.58 | — | 10% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS - MRI W/&W/O C | $3,829.50 | $4,255.00 | $851.00–$4,169.90 | 14% above | 10% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS - MRI W/&W/O C | $3,829.50 | $4,255.00 | $3,872.05–$4,169.90 | — | 10% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST | $3,372.30 | $3,747.00 | $749.40–$3,672.06 | 41% above | 10% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST | $3,372.30 | $3,747.00 | $3,409.77–$3,672.06 | — | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXTREMITY JOINT | $2,970.00 | $3,300.00 | $660.00–$3,234.00 | 23% above | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXTREMITY JOINT | $2,970.00 | $3,300.00 | $3,003.00–$3,234.00 | — | 10% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MYOCARDIAL PERF IMAG AT R | $4,586.40 | $5,096.00 | $1,019.20–$4,994.08 | 23% above | 10% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYOCARDIAL PERF IMAG AT R | $4,586.40 | $5,096.00 | $4,637.36–$4,994.08 | — | 10% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET W/CT SKULL BASE/MID T | $6,539.40 | $7,266.00 | $1,453.20–$7,120.68 | 21% above | 10% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET W/CT SKULL BASE/MID T | $6,539.40 | $7,266.00 | $6,612.06–$7,120.68 | — | 10% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 ULTRASOUND PELVIS LIMITED | $252.00 | $280.00 | $56.00–$274.40 | 22% below | 10% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 ULTRASOUND PELVIS LIMITED | $252.00 | $280.00 | $254.80–$274.40 | — | 10% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 ULTRASOUND PELVIC (NON OB | $819.00 | $910.00 | $182.00–$891.80 | 6% above | 10% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 ULTRASOUND PELVIC (NON OB | $819.00 | $910.00 | $828.10–$891.80 | — | 10% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 ULS PREG UTERUS >OR=14WKS | $936.00 | $1,040.00 | $208.00–$1,019.20 | 36% above | 10% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 ULS PREG UTERUS >OR=14WKS | $936.00 | $1,040.00 | $946.40–$1,019.20 | — | 10% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 ULS PREG UTERUS <14WKS SI | $727.20 | $808.00 | $161.60–$791.84 | 23% above | 10% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 ULS PREG UTERUS <14WKS SI | $727.20 | $808.00 | $735.28–$791.84 | — | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED >1 FETUS | $423.90 | $471.00 | $94.20–$461.58 | 20% above | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED >1 FETUS | $423.90 | $471.00 | $428.61–$461.58 | — | 10% |
| Screening mammogram, both breasts both sides CPT 77067 SCREENING MAMMOGRAM BILAT | $359.10 | $399.00 | $79.80–$391.02 | — | 10% |
| Screening mammogram, both breasts CPT 77067 SCREEN MAMMOGRAM UNILATER | $359.10 | $399.00 | $79.80–$391.02 | 78% above | 10% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCREENING MAMMOGRAM BILAT | $359.10 | $399.00 | $363.09–$391.02 | — | 10% |
| Screening mammogram, both breasts inpatient CPT 77067 SCREEN MAMMOGRAM UNILATER | $359.10 | $399.00 | $363.09–$391.02 | — | 10% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 RAD EXAM SHOULDER COMPLET | $380.70 | $423.00 | $84.60–$414.54 | 19% above | 10% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RAD EXAM SHOULDER COMPLET | $380.70 | $423.00 | $384.93–$414.54 | — | 10% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY W/4 + PAR | $3,861.00 | $4,290.00 | $858.00–$4,204.20 | 24% above | 10% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY W/4 + PAR | $3,861.00 | $4,290.00 | $3,903.90–$4,204.20 | — | 10% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 SWALLOWING FUNC WITH CIND | $555.30 | $617.00 | $123.40–$604.66 | 1% above | 10% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 SWALLOWING FUNC WITH CIND | $555.30 | $617.00 | $561.47–$604.66 | — | 10% |
| Transvaginal pelvic ultrasound CPT 76830 ULS TRANSVAGINAL FOLLICUL | $295.20 | $328.00 | $65.60–$321.44 | 49% below | 10% |
| Transvaginal pelvic ultrasound CPT 76830 ULTRASOUND TRANSVAGINAL N | $708.30 | $787.00 | $157.40–$771.26 | 22% above | 10% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 ULS TRANSVAGINAL FOLLICUL | $295.20 | $328.00 | $298.48–$321.44 | — | 10% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 ULTRASOUND TRANSVAGINAL N | $708.30 | $787.00 | $716.17–$771.26 | — | 10% |
| Transvaginal ultrasound during pregnancy CPT 76817 ULTRASOUND PREGNANT UTERU | $502.20 | $558.00 | $111.60–$546.84 | 3% above | 10% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 ULTRASOUND PREGNANT UTERU | $502.20 | $558.00 | $507.78–$546.84 | — | 10% |
| Ultrasound of the abdomen, complete CPT 76700 ULTRASOUND ABDOMINAL COMP | $856.80 | $952.00 | $190.40–$932.96 | 6% above | 10% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 ULTRASOUND ABDOMINAL COMP | $856.80 | $952.00 | $866.32–$932.96 | — | 10% |
| Ultrasound of the scrotum and testicles CPT 76870 ULTRASOUND SCROTUM & CONT | $772.20 | $858.00 | $171.60–$840.84 | 23% above | 10% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 ULTRASOUND SCROTUM & CONT | $772.20 | $858.00 | $780.78–$840.84 | — | 10% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ULTRASOUND HEAD/NECK TISS | $604.80 | $672.00 | $134.40–$658.56 | 4% above | 10% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 ULTRASOUND HEAD/NECK TISS | $604.80 | $672.00 | $611.52–$658.56 | — | 10% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 RAD EXAM UGI W/WO DELAYED | $596.70 | $663.00 | $132.60–$649.74 | 23% above | 10% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 RAD EXAM UGI W/WO DELAYED | $596.70 | $663.00 | $603.33–$649.74 | — | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 DUPLEX SCAN VEINS EXTREMI | $1,016.10 | $1,129.00 | $225.80–$1,106.42 | 3% above | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 DUPLEX SCAN VEINS EXTREMI | $1,016.10 | $1,129.00 | $1,027.39–$1,106.42 | — | 10% |
| Wrist X-ray, complete, 3 or more views CPT 73110 RAD EXAM WRIST COMPLETE 3 | $336.60 | $374.00 | $74.80–$366.52 | 3% above | 10% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RAD EXAM WRIST COMPLETE 3 | $336.60 | $374.00 | $340.34–$366.52 | — | 10% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 RAD EXAM HIP UNIL W/ PLEV | $354.60 | $394.00 | $78.80–$386.12 | 88% above | 10% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 RAD EXAM HIP UNIL W/ PLEV | $354.60 | $394.00 | $358.54–$386.12 | — | 10% |
| X-ray of the abdomen, 1 view CPT 74018 RAD EXAM ABDOMEN SINGLE V | $305.10 | $339.00 | $67.80–$332.22 | 22% above | 10% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 RAD EXAM ABDOMEN SINGLE V | $305.10 | $339.00 | $308.49–$332.22 | — | 10% |
| X-ray of the ankle, 2 views CPT 73600 RAD EXAM ANKLE 2 VIEWS | $261.00 | $290.00 | $58.00–$284.20 | 32% above | 10% |
| X-ray of the ankle, 2 views inpatient CPT 73600 RAD EXAM ANKLE 2 VIEWS | $261.00 | $290.00 | $263.90–$284.20 | — | 10% |
| X-ray of the finger(s), 2 or more views CPT 73140 RAD EXAM FINGER(S) 2+ VIE | $230.40 | $256.00 | $51.20–$250.88 | 4% above | 10% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 RAD EXAM FINGER(S) 2+ VIE | $230.40 | $256.00 | $232.96–$250.88 | — | 10% |
| X-ray of the foot, 2 views CPT 73620 RAD EXAM FOOT 2 VIEWS | $269.10 | $299.00 | $59.80–$293.02 | 32% above | 10% |
| X-ray of the foot, 2 views inpatient CPT 73620 RAD EXAM FOOT 2 VIEWS | $269.10 | $299.00 | $272.09–$293.02 | — | 10% |
| X-ray of the foot, complete, 3 or more views CPT 73630 RAD EXAM FOOT COMPLETE 3+ | $349.20 | $388.00 | $77.60–$380.24 | 15% above | 10% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RAD EXAM FOOT COMPLETE 3+ | $349.20 | $388.00 | $353.08–$380.24 | — | 10% |
| X-ray of the hand, 3 or more views CPT 73130 RAD EXAM HAND 3+ VIEWS | $344.70 | $383.00 | $76.60–$375.34 | 1% above | 10% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 RAD EXAM HAND 3+ VIEWS | $344.70 | $383.00 | $348.53–$375.34 | — | 10% |
| X-ray of the knee, 1 or 2 views CPT 73560 RAD EXAM KNEE 1 OR 2 VIEW | $342.90 | $381.00 | $76.20–$373.38 | 13% above | 10% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 RAD EXAM KNEE 1 OR 2 VIEW | $342.90 | $381.00 | $346.71–$373.38 | — | 10% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RAD EXAM SPINE LUMBOSACRA | $468.00 | $520.00 | $104.00–$509.60 | 37% above | 10% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 RAD EXAM SPINE LUMBOSACRA | $468.00 | $520.00 | $473.20–$509.60 | — | 10% |
| X-ray of the lower back, 4 or more views CPT 72110 RAD EXAM SPINE LUMBOSACRA | $484.20 | $538.00 | $107.60–$527.24 | 14% above | 10% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 RAD EXAM SPINE LUMBOSACRA | $484.20 | $538.00 | $489.58–$527.24 | — | 10% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 RAD EXAM SPINE THORACIC 2 | $381.60 | $424.00 | $84.80–$415.52 | 37% above | 10% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 RAD EXAM SPINE THORACIC 2 | $381.60 | $424.00 | $385.84–$415.52 | — | 10% |
| X-ray of the nasal bones, 3 or more views CPT 70160 RAD EXAM NASAL BONES COMP | $352.80 | $392.00 | $78.40–$384.16 | 25% above | 10% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RAD EXAM NASAL BONES COMP | $352.80 | $392.00 | $356.72–$384.16 | — | 10% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RAD EXAM C SPINE 2 OR 3 V | $355.50 | $395.00 | $79.00–$387.10 | 31% above | 10% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 RAD EXAM C SPINE 2 OR 3 V | $355.50 | $395.00 | $359.45–$387.10 | — | 10% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 RAD EXAM PELVIS 1 OR 2 VI | $302.40 | $336.00 | $67.20–$329.28 | 23% above | 10% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RAD EXAM PELVIS 1 OR 2 VI | $302.40 | $336.00 | $305.76–$329.28 | — | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RAD EXAM SACRUM & COCCYX | $390.60 | $434.00 | $86.80–$425.32 | 50% above | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 RAD EXAM SACRUM & COCCYX | $390.60 | $434.00 | $394.94–$425.32 | — | 10% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE ALANINE AMONO | $14.40 | $16.00 | $3.20–$20.51 | 76% below | 10% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE;ALANINE AMINO | $63.00 | $70.00 | $14.00–$68.60 | 6% above | 10% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE ALANINE AMONO | $14.40 | $16.00 | $14.56–$15.68 | — | 10% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE;ALANINE AMINO | $63.00 | $70.00 | $63.70–$68.60 | — | 10% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE ASPARTATE AMI | $14.40 | $16.00 | $3.20–$15.68 | 69% below | 10% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE;ASPARTATE AMI | $63.90 | $71.00 | $14.20–$69.58 | 35% above | 10% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE ASPARTATE AMI | $14.40 | $16.00 | $14.56–$15.68 | — | 10% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE;ASPARTATE AMI | $63.90 | $71.00 | $64.61–$69.58 | — | 10% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITS PANEL | $116.10 | $129.00 | $25.80–$126.42 | 63% below | 10% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $406.80 | $452.00 | $90.40–$442.96 | 30% above | 10% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITS PANEL | $116.10 | $129.00 | $117.39–$126.42 | — | 10% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL | $406.80 | $452.00 | $411.32–$442.96 | — | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IGE QUA | $14.40 | $16.00 | $3.20–$20.21 | 66% below | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IgE QUA | $66.60 | $74.00 | $14.80–$72.52 | 58% above | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IGE QUA | $14.40 | $16.00 | $14.56–$15.68 | — | 10% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IgE QUA | $66.60 | $74.00 | $67.34–$72.52 | — | 10% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPT | $135.00 | $150.00 | $30.00–$147.00 | 65% above | 10% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPT | $135.00 | $150.00 | $136.50–$147.00 | — | 10% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES AN | $30.60 | $34.00 | $6.80–$46.80 | 31% below | 10% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES (A | $153.00 | $170.00 | $34.00–$166.60 | 245% above | 10% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES AN | $30.60 | $34.00 | $30.94–$33.32 | — | 10% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES (A | $153.00 | $170.00 | $154.70–$166.60 | — | 10% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE | $285.30 | $317.00 | $63.40–$310.66 | 51% above | 10% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE | $285.30 | $317.00 | $288.47–$310.66 | — | 10% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $159.30 | $177.00 | $35.40–$173.46 | 20% above | 10% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $159.30 | $177.00 | $161.07–$173.46 | — | 10% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV SURG PATH GROSS& | $176.40 | $196.00 | $39.20–$206.00 | 8% below | 10% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV-SURGICAL PATH GR | $282.60 | $314.00 | $62.80–$307.72 | 48% above | 10% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV SURG PATH GROSS& | $176.40 | $196.00 | $178.36–$192.08 | — | 10% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV-SURGICAL PATH GR | $282.60 | $314.00 | $285.74–$307.72 | — | 10% |
| Blood culture for bacteria CPT 87040 CULTURE BACTERIAL BLOOD A | $26.10 | $29.00 | $5.80–$39.96 | 86% below | 10% |
| Blood culture for bacteria CPT 87040 CULTURE BACTERIAL BLOOD W | $234.90 | $261.00 | $39.96–$255.78 | 30% above | 10% |
| Blood culture for bacteria inpatient CPT 87040 CULTURE BACTERIAL BLOOD A | $26.10 | $29.00 | $26.39–$28.42 | — | 10% |
| Blood culture for bacteria inpatient CPT 87040 CULTURE BACTERIAL BLOOD W | $234.90 | $261.00 | $237.51–$255.78 | — | 10% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE CLINIC | $9.00 | $10.00 | $2.00–$29.08 | 62% below | 10% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE | $34.20 | $38.00 | $7.60–$37.24 | 46% above | 10% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE CLINIC | $9.00 | $10.00 | $9.10–$9.80 | — | 10% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCTURE | $34.20 | $38.00 | $34.58–$37.24 | — | 10% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE QUANTITATIVE | $11.70 | $13.00 | $2.60–$15.21 | 72% below | 10% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE; QUANTITATIVE, BL | $58.50 | $65.00 | $13.00–$63.70 | 41% above | 10% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANTITATIVE | $11.70 | $13.00 | $11.83–$12.74 | — | 10% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE; QUANTITATIVE, BL | $58.50 | $65.00 | $59.15–$63.70 | — | 10% |
| Blood lead test CPT 83655 LEAD | $116.10 | $129.00 | $25.80–$126.42 | 94% above | 10% |
| Blood lead test inpatient CPT 83655 LEAD | $116.10 | $129.00 | $117.39–$126.42 | — | 10% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN CHORIONIC QU | $19.80 | $22.00 | $4.40–$29.14 | 81% below | 10% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN,CHORIONIC(HC | $125.10 | $139.00 | $27.80–$136.22 | 17% above | 10% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 GONADOTROPIN CHORIONIC QU | $19.80 | $22.00 | $20.02–$21.56 | — | 10% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 GONADOTROPIN,CHORIONIC(HC | $125.10 | $139.00 | $126.49–$136.22 | — | 10% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC AB | $9.00 | $10.00 | $2.00–$11.58 | 83% below | 10% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPE ABO | $65.70 | $73.00 | $11.58–$71.54 | 26% above | 10% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC AB | $9.00 | $10.00 | $9.10–$9.80 | — | 10% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPE ABO | $65.70 | $73.00 | $66.43–$71.54 | — | 10% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN | $14.40 | $16.00 | $3.20–$20.05 | 85% below | 10% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $109.80 | $122.00 | $20.05–$119.56 | 18% above | 10% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN | $14.40 | $16.00 | $14.56–$15.68 | — | 10% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN | $109.80 | $122.00 | $111.02–$119.56 | — | 10% |
| C. difficile toxin gene test (stool PCR) CPT 87493 CLOSTRIDIUM DIFFICLE, TOX | $91.80 | $102.00 | $20.40–$135.92 | 44% below | 10% |
| C. difficile toxin gene test (stool PCR) CPT 87493 CLOSTRIDIUM DIFFICILE, TO | $208.80 | $232.00 | $46.40–$227.36 | 26% above | 10% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CLOSTRIDIUM DIFFICLE, TOX | $91.80 | $102.00 | $92.82–$99.96 | — | 10% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CLOSTRIDIUM DIFFICILE, TO | $208.80 | $232.00 | $211.12–$227.36 | — | 10% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR ANTIGEN | $52.20 | $58.00 | $11.60–$80.62 | 55% below | 10% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY/TUMOR ANTIGEN | $353.70 | $393.00 | $78.60–$385.14 | 207% above | 10% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 IMMUNOASSAY TUMOR ANTIGEN | $52.20 | $58.00 | $52.78–$56.84 | — | 10% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 IMMUNOASSAY/TUMOR ANTIGEN | $353.70 | $393.00 | $357.63–$385.14 | — | 10% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR ANTIGEN | $52.20 | $58.00 | $11.60–$56.84 | 53% below | 10% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IA TUMOR ANTIGEN CA 125 | $180.00 | $200.00 | $40.00–$196.00 | 64% above | 10% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNOASSAY TUMOR ANTIGEN | $52.20 | $58.00 | $52.78–$56.84 | — | 10% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IA TUMOR ANTIGEN CA 125 | $180.00 | $200.00 | $182.00–$196.00 | — | 10% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID 19 | $126.90 | $141.00 | $28.20–$138.18 | 9% above | 10% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID 19 TEST | $126.90 | $141.00 | $28.20–$138.18 | 9% above | 10% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID 19 | $126.90 | $141.00 | $128.31–$138.18 | — | 10% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID 19 TEST | $126.90 | $141.00 | $128.31–$138.18 | — | 10% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS AMP | $166.50 | $185.00 | $37.00–$181.30 | 52% above | 10% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS AMP | $166.50 | $185.00 | $168.35–$181.30 | — | 10% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $149.40 | $166.00 | $33.20–$162.68 | 32% above | 10% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $149.40 | $166.00 | $151.06–$162.68 | — | 10% |
| Complete blood count (CBC) with differential CPT 85025 BLOOD COUNT COMPLETE (CBC | $20.70 | $23.00 | $4.60–$47.03 | 76% below | 10% |
| Complete blood count (CBC) with differential CPT 85025 BLOOD COUNT; COMPLETE AUT | $117.90 | $131.00 | $26.20–$128.38 | 38% above | 10% |
| Complete blood count (CBC) with differential inpatient CPT 85025 BLOOD COUNT COMPLETE (CBC | $20.70 | $23.00 | $20.93–$22.54 | — | 10% |
| Complete blood count (CBC) with differential inpatient CPT 85025 BLOOD COUNT; COMPLETE AUT | $117.90 | $131.00 | $119.21–$128.38 | — | 10% |
| Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT COMPLETE AUTO | $17.10 | $19.00 | $3.80–$25.03 | 76% below | 10% |
| Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT; COMPLETE AUT | $99.90 | $111.00 | $22.20–$108.78 | 42% above | 10% |
| Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT COMPLETE AUTO | $17.10 | $19.00 | $17.29–$18.62 | — | 10% |
| Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT; COMPLETE AUT | $99.90 | $111.00 | $101.01–$108.78 | — | 10% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC P | $179.10 | $199.00 | $39.80–$195.02 | 19% above | 10% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC P | $179.10 | $199.00 | $181.09–$195.02 | — | 10% |
| D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DGRADJ PRODUCTS D- | $25.20 | $28.00 | $5.60–$39.40 | 81% below | 10% |
| D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGR PRODUCTS D-DI | $180.90 | $201.00 | $39.40–$196.98 | 35% above | 10% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DGRADJ PRODUCTS D- | $25.20 | $28.00 | $25.48–$27.44 | — | 10% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGR PRODUCTS D-DI | $180.90 | $201.00 | $182.91–$196.98 | — | 10% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONESUL | $54.90 | $61.00 | $12.20–$59.78 | 61% below | 10% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE-SU | $226.80 | $252.00 | $50.40–$246.96 | 60% above | 10% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONESUL | $54.90 | $61.00 | $55.51–$59.78 | — | 10% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE-SU | $226.80 | $252.00 | $229.32–$246.96 | — | 10% |
| Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL | $70.20 | $78.00 | $15.60–$108.19 | 38% below | 10% |
| Estradiol blood test CPT 82670 ESTRADIOL TOTAL | $208.80 | $232.00 | $46.40–$227.36 | 85% above | 10% |
| Estradiol blood test inpatient CPT 82670 ASSAY OF TOTAL ESTRADIOL | $70.20 | $78.00 | $70.98–$76.44 | — | 10% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL TOTAL | $208.80 | $232.00 | $211.12–$227.36 | — | 10% |
| FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN FOLLICLE STI | $46.80 | $52.00 | $10.40–$71.95 | 58% below | 10% |
| FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN;FOLLICLE STI | $143.10 | $159.00 | $31.80–$155.82 | 27% above | 10% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN FOLLICLE STI | $46.80 | $52.00 | $47.32–$50.96 | — | 10% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN;FOLLICLE STI | $143.10 | $159.00 | $144.69–$155.82 | — | 10% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, FECAL | $349.20 | $388.00 | $77.60–$380.24 | at median | 10% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, FECAL | $349.20 | $388.00 | $353.08–$380.24 | — | 10% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $144.00 | $160.00 | $32.00–$156.80 | 41% above | 10% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN | $144.00 | $160.00 | $145.60–$156.80 | — | 10% |
| Folate (folic acid) blood test CPT 82746 FOLIC ACID SERUM | $37.80 | $42.00 | $8.40–$56.93 | 64% below | 10% |
| Folate (folic acid) blood test CPT 82746 FOLIC ACID; SERUM | $170.10 | $189.00 | $37.80–$185.22 | 61% above | 10% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID SERUM | $37.80 | $42.00 | $38.22–$41.16 | — | 10% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID; SERUM | $170.10 | $189.00 | $171.99–$185.22 | — | 10% |
| Free T3 thyroid hormone test CPT 84481 TRIIODOTHYRONINE T3 FREE | $43.20 | $48.00 | $9.60–$65.62 | 67% below | 10% |
| Free T3 thyroid hormone test CPT 84481 TRIIODOTHYRONINE T3, FREE | $239.40 | $266.00 | $53.20–$260.68 | 85% above | 10% |
| Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINE T3 FREE | $43.20 | $48.00 | $43.68–$47.04 | — | 10% |
| Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINE T3, FREE | $239.40 | $266.00 | $242.06–$260.68 | — | 10% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE | $23.40 | $26.00 | $5.20–$34.91 | 68% below | 10% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE; FREE | $101.70 | $113.00 | $22.60–$110.74 | 39% above | 10% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE | $23.40 | $26.00 | $23.66–$25.48 | — | 10% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE; FREE | $101.70 | $113.00 | $102.83–$110.74 | — | 10% |
| Free testosterone test CPT 84402 TESTOSTERONE FREE | $63.00 | $70.00 | $14.00–$98.65 | 39% below | 10% |
| Free testosterone test CPT 84402 TESTOSTERONE; FREE | $220.50 | $245.00 | $49.00–$240.10 | 113% above | 10% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE | $63.00 | $70.00 | $63.70–$68.60 | — | 10% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE; FREE | $220.50 | $245.00 | $222.95–$240.10 | — | 10% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL | $344.70 | $383.00 | $76.60–$375.34 | 28% above | 10% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL | $344.70 | $383.00 | $348.53–$375.34 | — | 10% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST GLUCOSE DOSE | $13.50 | $15.00 | $3.00–$18.38 | 72% below | 10% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE;POST GLUCOSE (INC | $71.10 | $79.00 | $15.80–$77.42 | 45% above | 10% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST GLUCOSE DOSE | $13.50 | $15.00 | $13.65–$14.70 | — | 10% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE;POST GLUCOSE (INC | $71.10 | $79.00 | $71.89–$77.42 | — | 10% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST | $34.20 | $38.00 | $7.60–$49.85 | 71% below | 10% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST 3 | $168.30 | $187.00 | $37.40–$183.26 | 45% above | 10% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST | $34.20 | $38.00 | $34.58–$37.24 | — | 10% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST 3 | $168.30 | $187.00 | $170.17–$183.26 | — | 10% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE AMP | $164.70 | $183.00 | $36.60–$179.34 | 75% above | 10% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE AMP | $164.70 | $183.00 | $166.53–$179.34 | — | 10% |
| H. pylori antibody blood test CPT 86677 ANTIBODY HELICOBACTER PYL | $180.00 | $200.00 | $40.00–$196.00 | 144% above | 10% |
| H. pylori antibody blood test inpatient CPT 86677 ANTIBODY HELICOBACTER PYL | $180.00 | $200.00 | $182.00–$196.00 | — | 10% |
| H. pylori stool antigen test CPT 87338 HELICOBACTER PYLOR, STOOL | $36.90 | $41.00 | $8.20–$55.71 | 68% below | 10% |
| H. pylori stool antigen test CPT 87338 HELICOBACTER PYLORI STOOL | $184.50 | $205.00 | $41.00–$200.90 | 59% above | 10% |
| H. pylori stool antigen test inpatient CPT 87338 HELICOBACTER PYLOR, STOOL | $36.90 | $41.00 | $37.31–$40.18 | — | 10% |
| H. pylori stool antigen test inpatient CPT 87338 HELICOBACTER PYLORI STOOL | $184.50 | $205.00 | $186.55–$200.90 | — | 10% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 ULTRASENSITIVE RWA | $290.70 | $323.00 | $64.60–$316.54 | 51% below | 10% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 ULTRASENSITIVE RWA | $290.70 | $323.00 | $293.93–$316.54 | — | 10% |
| HIV-1 and HIV-2 antibody test CPT 86703 ANTIBODY HIV-1 & HIV-2 SI | $35.10 | $39.00 | $7.80–$38.22 | 21% below | 10% |
| HIV-1 and HIV-2 antibody test CPT 86703 ANTIBODY HIV-1&HIV-2 SING | $109.80 | $122.00 | $24.40–$119.56 | 147% above | 10% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 ANTIBODY HIV-1 & HIV-2 SI | $35.10 | $39.00 | $35.49–$38.22 | — | 10% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 ANTIBODY HIV-1&HIV-2 SING | $109.80 | $122.00 | $111.02–$119.56 | — | 10% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 ANTIGENS, WITH HIV- | $59.40 | $66.00 | $13.20–$93.26 | 18% below | 10% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV AG/AB COMBO W/ REFLEX | $123.30 | $137.00 | $27.40–$134.26 | 71% above | 10% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 ANTIGENS, WITH HIV- | $59.40 | $66.00 | $60.06–$64.68 | — | 10% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV AG/AB COMBO W/ REFLEX | $123.30 | $137.00 | $124.67–$134.26 | — | 10% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH RISK SCREEN | $86.40 | $96.00 | $19.20–$94.08 | 5% below | 10% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH RISK TYPES | $148.50 | $165.00 | $33.00–$161.70 | 63% above | 10% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HIGH RISK SCREEN | $86.40 | $96.00 | $87.36–$94.08 | — | 10% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HIGH RISK TYPES | $148.50 | $165.00 | $150.15–$161.70 | — | 10% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A | $24.30 | $27.00 | $5.40–$37.61 | 63% below | 10% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN;GLYCOSYLATED | $94.50 | $105.00 | $21.00–$102.90 | 44% above | 10% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A | $24.30 | $27.00 | $24.57–$26.46 | — | 10% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN;GLYCOSYLATED | $94.50 | $105.00 | $95.55–$102.90 | — | 10% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B CORE ANTIBODY | $27.00 | $30.00 | $6.00–$41.60 | 69% below | 10% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPITTIUS B CORE SURFACE | $143.10 | $159.00 | $31.80–$155.82 | 63% above | 10% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B CORE ANTIBODY | $27.00 | $30.00 | $27.30–$29.40 | — | 10% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPITTIUS B CORE SURFACE | $143.10 | $159.00 | $144.69–$155.82 | — | 10% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIG | $26.10 | $29.00 | $5.80–$39.99 | 70% below | 10% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 ENZYME IMMUNOASSAY(EIA)HE | $132.30 | $147.00 | $29.40–$144.06 | 52% above | 10% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTIG | $26.10 | $29.00 | $26.39–$28.42 | — | 10% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 ENZYME IMMUNOASSAY(EIA)HE | $132.30 | $147.00 | $133.77–$144.06 | — | 10% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY | $36.90 | $41.00 | $8.20–$55.23 | 57% below | 10% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPITITIS C ANTIBODY | $175.50 | $195.00 | $39.00–$191.10 | 104% above | 10% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY | $36.90 | $41.00 | $37.31–$40.18 | — | 10% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPITITIS C ANTIBODY | $175.50 | $195.00 | $177.45–$191.10 | — | 10% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C QUANT INC REV | $106.20 | $118.00 | $23.60–$115.64 | 68% below | 10% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C QUANTIFICATIO | $611.10 | $679.00 | $135.80–$665.42 | 84% above | 10% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C QUANT INC REV | $106.20 | $118.00 | $107.38–$115.64 | — | 10% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C QUANTIFICATIO | $611.10 | $679.00 | $617.89–$665.42 | — | 10% |
| Herpes blood test, HSV-1 antibody CPT 86695 ANTIBODY HERPES SMPLX TYP | $35.10 | $39.00 | $7.80–$38.22 | 64% below | 10% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 | $98.10 | $109.00 | $21.80–$106.82 | at median | 10% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 ANTIBODY HERPES SMPLX TYP | $35.10 | $39.00 | $35.49–$38.22 | — | 10% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE 1 | $98.10 | $109.00 | $99.19–$106.82 | — | 10% |
| Herpes blood test, HSV-2 antibody CPT 86696 ANTIBODY HERPES SMPLX TYP | $48.60 | $54.00 | $10.80–$52.92 | 54% below | 10% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 | $109.80 | $122.00 | $24.40–$119.56 | 4% above | 10% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 ANTIBODY HERPES SMPLX TYP | $48.60 | $54.00 | $49.14–$52.92 | — | 10% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE 2 | $109.80 | $122.00 | $111.02–$119.56 | — | 10% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C REACTIVE PROTEIN HIGH S | $34.20 | $38.00 | $7.60–$37.24 | 57% below | 10% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HIGH S | $364.50 | $405.00 | $81.00–$396.90 | 357% above | 10% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C REACTIVE PROTEIN HIGH S | $34.20 | $38.00 | $34.58–$37.24 | — | 10% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HIGH S | $364.50 | $405.00 | $368.55–$396.90 | — | 10% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE | $45.00 | $50.00 | $10.00–$49.00 | 68% below | 10% |
| Homocysteine blood test CPT 83090 HOMOCYSTINE | $193.50 | $215.00 | $43.00–$210.70 | 38% above | 10% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE | $45.00 | $50.00 | $45.50–$49.00 | — | 10% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTINE | $193.50 | $215.00 | $195.65–$210.70 | — | 10% |
| Insulin blood test CPT 83525 INSULIN TOTAL | $28.80 | $32.00 | $6.40–$31.36 | 72% below | 10% |
| Insulin blood test CPT 83525 INSULIN; TOTAL | $179.10 | $199.00 | $39.80–$195.02 | 72% above | 10% |
| Insulin blood test inpatient CPT 83525 INSULIN TOTAL | $28.80 | $32.00 | $29.12–$31.36 | — | 10% |
| Insulin blood test inpatient CPT 83525 INSULIN; TOTAL | $179.10 | $199.00 | $181.09–$195.02 | — | 10% |
| Iron blood test (serum iron) CPT 83540 IRON | $74.70 | $83.00 | $16.60–$81.34 | 19% above | 10% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON | $74.70 | $83.00 | $75.53–$81.34 | — | 10% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY | $101.70 | $113.00 | $22.60–$110.74 | 57% above | 10% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY | $101.70 | $113.00 | $102.83–$110.74 | — | 10% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $22.50 | $25.00 | $5.00–$33.63 | 83% below | 10% |
| Kidney function blood test panel CPT 80069 RENAL PANEL FUNCTION | $168.30 | $187.00 | $33.63–$183.26 | 29% above | 10% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $22.50 | $25.00 | $22.75–$24.50 | — | 10% |
| Kidney function blood test panel inpatient CPT 80069 RENAL PANEL FUNCTION | $168.30 | $187.00 | $170.17–$183.26 | — | 10% |
| LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LUTEINIZING | $46.80 | $52.00 | $10.40–$71.71 | 62% below | 10% |
| LH (luteinizing hormone) test CPT 83002 GONODOTROPIN;LUTEINIZING | $191.70 | $213.00 | $42.60–$208.74 | 54% above | 10% |
| LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN LUTEINIZING | $46.80 | $52.00 | $47.32–$50.96 | — | 10% |
| LH (luteinizing hormone) test inpatient CPT 83002 GONODOTROPIN;LUTEINIZING | $191.70 | $213.00 | $193.83–$208.74 | — | 10% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $120.60 | $134.00 | $26.69–$131.32 | 29% above | 10% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE | $120.60 | $134.00 | $121.94–$131.32 | — | 10% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL (L | $21.60 | $24.00 | $4.80–$31.65 | 82% below | 10% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $152.10 | $169.00 | $31.65–$165.62 | 26% above | 10% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL (L | $21.60 | $24.00 | $21.84–$23.52 | — | 10% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $152.10 | $169.00 | $153.79–$165.62 | — | 10% |
| Lyme disease antibody test CPT 86618 ANTIBODY BORRELIA BURGDOR | $182.70 | $203.00 | $40.60–$198.94 | 44% above | 10% |
| Lyme disease antibody test inpatient CPT 86618 ANTIBODY BORRELIA BURGDOR | $182.70 | $203.00 | $184.73–$198.94 | — | 10% |
| Magnesium blood test CPT 83735 MAGNESIUM | $113.40 | $126.00 | $25.20–$123.48 | 80% above | 10% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM | $113.40 | $126.00 | $114.66–$123.48 | — | 10% |
| Measles (rubeola) antibody test CPT 86765 ANTIBODY RUBEOLA | $34.20 | $38.00 | $7.60–$49.88 | 56% below | 10% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA | $135.00 | $150.00 | $30.00–$147.00 | 76% above | 10% |
| Measles (rubeola) antibody test inpatient CPT 86765 ANTIBODY RUBEOLA | $34.20 | $38.00 | $34.58–$37.24 | — | 10% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA | $135.00 | $150.00 | $136.50–$147.00 | — | 10% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODIES SC | $92.70 | $103.00 | $20.05–$100.94 | 65% above | 10% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODIES SC | $92.70 | $103.00 | $93.73–$100.94 | — | 10% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $267.30 | $297.00 | $59.40–$291.06 | 48% above | 10% |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL | $267.30 | $297.00 | $270.27–$291.06 | — | 10% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PROSTATE SPECIFIC ANTIGEN | $183.60 | $204.00 | $40.80–$199.92 | 44% above | 10% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PROSTATE SPECIFIC ANTIGEN | $183.60 | $204.00 | $185.64–$199.92 | — | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANTIGEN | $145.80 | $162.00 | $32.40–$158.76 | 56% above | 10% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN | $145.80 | $162.00 | $147.42–$158.76 | — | 10% |
| Pap test (liquid-based, automated screening with review) CPT 88175 CYTP C/V AUTO THIN LYR PR | $66.60 | $74.00 | $14.80–$102.60 | 13% below | 10% |
| Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATHOLOGY W/SCREEN BY | $138.60 | $154.00 | $30.80–$150.92 | 80% above | 10% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTP C/V AUTO THIN LYR PR | $66.60 | $74.00 | $67.34–$72.52 | — | 10% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTOPATHOLOGY W/SCREEN BY | $138.60 | $154.00 | $140.14–$150.92 | — | 10% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH, CERVICAL OR VAG | $50.40 | $56.00 | $11.20–$54.88 | 5% above | 10% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATHOLOGY CERVICAL/VA | $94.50 | $105.00 | $21.00–$102.90 | 96% above | 10% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATH, CERVICAL OR VAG | $50.40 | $56.00 | $50.96–$54.88 | — | 10% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATHOLOGY CERVICAL/VA | $94.50 | $105.00 | $95.55–$102.90 | — | 10% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE | $102.60 | $114.00 | $22.80–$111.72 | 51% below | 10% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PARATHYROID | $308.70 | $343.00 | $68.60–$336.14 | 46% above | 10% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE | $102.60 | $114.00 | $103.74–$111.72 | — | 10% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE (PARATHYROID | $308.70 | $343.00 | $312.13–$336.14 | — | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTI | $94.50 | $105.00 | $21.00–$102.90 | 41% above | 10% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTI | $94.50 | $105.00 | $95.55–$102.90 | — | 10% |
| Progesterone blood test CPT 84144 PROGESTERONE | $173.70 | $193.00 | $38.60–$189.14 | 62% above | 10% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE | $173.70 | $193.00 | $175.63–$189.14 | — | 10% |
| Prolactin blood test CPT 84146 PROLACTIN | $164.70 | $183.00 | $36.60–$179.34 | 91% above | 10% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN | $164.70 | $183.00 | $166.53–$179.34 | — | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $11.70 | $13.00 | $2.60–$29.06 | 76% below | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN | $94.50 | $105.00 | $21.00–$102.90 | 96% above | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $11.70 | $13.00 | $11.83–$12.74 | — | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN | $94.50 | $105.00 | $95.55–$102.90 | — | 10% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRESUMPTIVE DIR | $32.40 | $36.00 | $7.20–$42.22 | 65% below | 10% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRESUMPTIVE BY | $206.10 | $229.00 | $42.22–$224.42 | 123% above | 10% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TEST PRESUMPTIVE DIR | $32.40 | $36.00 | $32.76–$35.28 | — | 10% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TEST PRESUMPTIVE BY | $206.10 | $229.00 | $208.39–$224.42 | — | 10% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA | $42.30 | $47.00 | $9.40–$51.92 | 19% below | 10% |
| Rapid flu test (influenza antigen) CPT 87804 INF AGENT ANTIGEN IMMUNOA | $140.40 | $156.00 | $31.20–$152.88 | 170% above | 10% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA | $42.30 | $47.00 | $42.77–$46.06 | — | 10% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INF AGENT ANTIGEN IMMUNOA | $140.40 | $156.00 | $141.96–$152.88 | — | 10% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP GROUP A VISUAL | $42.30 | $47.00 | $9.40–$51.86 | 13% below | 10% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREPTOCOOCCUS | $135.00 | $150.00 | $30.00–$147.00 | 176% above | 10% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP GROUP A VISUAL | $42.30 | $47.00 | $42.77–$46.06 | — | 10% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREPTOCOOCCUS | $135.00 | $150.00 | $136.50–$147.00 | — | 10% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTIT | $15.30 | $17.00 | $3.40–$21.96 | 66% below | 10% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMITOID FACTOR QUANTIT | $79.20 | $88.00 | $17.60–$86.24 | 76% above | 10% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTIT | $15.30 | $17.00 | $15.47–$16.66 | — | 10% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMITOID FACTOR QUANTIT | $79.20 | $88.00 | $80.08–$86.24 | — | 10% |
| Rubella antibody test (immunity check) CPT 86762 ANTIBODY RUBELLA | $105.30 | $117.00 | $23.40–$114.66 | 40% above | 10% |
| Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY RUBELLA | $105.30 | $117.00 | $106.47–$114.66 | — | 10% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE RBC AU | $8.10 | $9.00 | $1.80–$10.44 | 82% below | 10% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE AUTOMATED | $54.90 | $61.00 | $10.44–$59.78 | 23% above | 10% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE RBC AU | $8.10 | $9.00 | $8.19–$8.82 | — | 10% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 RBC SED RATE AUTOMATED | $54.90 | $61.00 | $55.51–$59.78 | — | 10% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS COMPLETE(V | $203.40 | $226.00 | $45.20–$221.48 | 19% below | 10% |
| Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANALYSIS COMPLETE(V | $203.40 | $226.00 | $205.66–$221.48 | — | 10% |
| Stool ova and parasites exam CPT 87177 OVA&PARASITE DIR SMEARS C | $23.40 | $26.00 | $5.20–$34.47 | 64% below | 10% |
| Stool ova and parasites exam CPT 87177 OVA & PARASITES DIRECT SM | $125.10 | $139.00 | $27.80–$136.22 | 93% above | 10% |
| Stool ova and parasites exam inpatient CPT 87177 OVA&PARASITE DIR SMEARS C | $23.40 | $26.00 | $23.66–$25.48 | — | 10% |
| Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES DIRECT SM | $125.10 | $139.00 | $126.49–$136.22 | — | 10% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 HEMOCULT SCREENING | $12.60 | $14.00 | $2.80–$13.74 | 44% below | 10% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 BLOOD OCCULT BY COLORECTA | $54.00 | $60.00 | $12.00–$58.80 | 141% above | 10% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HEMOCULT SCREENING | $12.60 | $14.00 | $12.74–$13.72 | — | 10% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 BLOOD OCCULT BY COLORECTA | $54.00 | $60.00 | $54.60–$58.80 | — | 10% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 BLOOD OCCULT BY FECAL | $51.30 | $57.00 | $11.40–$55.86 | 35% above | 10% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 BLOOD OCCULT BY FECAL | $51.30 | $57.00 | $51.87–$55.86 | — | 10% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NO TREPONEM | $12.60 | $14.00 | $2.80–$13.72 | 67% below | 10% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST QUALTATIVE | $71.10 | $79.00 | $15.80–$77.42 | 86% above | 10% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NO TREPONEM | $12.60 | $14.00 | $12.74–$13.72 | — | 10% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST QUALTATIVE | $71.10 | $79.00 | $71.89–$77.42 | — | 10% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB CELL MEDIATED ANTIGN R | $151.20 | $168.00 | $33.60–$240.03 | 25% below | 10% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUNE MEASU | $283.50 | $315.00 | $63.00–$308.70 | 41% above | 10% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB CELL MEDIATED ANTIGN R | $151.20 | $168.00 | $152.88–$164.64 | — | 10% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL IMMUNE MEASU | $283.50 | $315.00 | $286.65–$308.70 | — | 10% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL | $63.90 | $71.00 | $14.20–$99.97 | 27% below | 10% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE; TOTAL | $180.00 | $200.00 | $40.00–$196.00 | 106% above | 10% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL | $63.90 | $71.00 | $64.61–$69.58 | — | 10% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE; TOTAL | $180.00 | $200.00 | $182.00–$196.00 | — | 10% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES EA | $36.90 | $41.00 | $8.20–$40.18 | 40% below | 10% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES EAC | $155.70 | $173.00 | $34.60–$169.54 | 153% above | 10% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODIES EA | $36.90 | $41.00 | $37.31–$40.18 | — | 10% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODIES EAC | $155.70 | $173.00 | $157.43–$169.54 | — | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH THYROID STIMULATING H | $43.20 | $48.00 | $9.60–$61.72 | 56% below | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMO | $135.00 | $150.00 | $30.00–$147.00 | 37% above | 10% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH THYROID STIMULATING H | $43.20 | $48.00 | $43.68–$47.04 | — | 10% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMO | $135.00 | $150.00 | $136.50–$147.00 | — | 10% |
| Trichomonas test (NAAT) CPT 87661 AMB TRICHOMONAS VAGINALIS | $86.40 | $96.00 | $19.20–$94.08 | 12% below | 10% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMP | $189.90 | $211.00 | $42.20–$206.78 | 94% above | 10% |
| Trichomonas test (NAAT) inpatient CPT 87661 AMB TRICHOMONAS VAGINALIS | $86.40 | $96.00 | $87.36–$94.08 | — | 10% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMP | $189.90 | $211.00 | $192.01–$206.78 | — | 10% |
| Uric acid blood test CPT 84550 URIC ACID BLOOD | $12.60 | $14.00 | $2.80–$17.50 | 75% below | 10% |
| Uric acid blood test CPT 84550 URIC ACID; BLOOD | $77.40 | $86.00 | $17.20–$84.28 | 53% above | 10% |
| Uric acid blood test inpatient CPT 84550 URIC ACID BLOOD | $12.60 | $14.00 | $12.74–$13.72 | — | 10% |
| Uric acid blood test inpatient CPT 84550 URIC ACID; BLOOD | $77.40 | $86.00 | $78.26–$84.28 | — | 10% |
| Urinalysis with microscope exam, automated CPT 81001 UA DIPSTICK/TABLET REAGEN | $9.90 | $11.00 | $2.20–$21.94 | 78% below | 10% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS DIP STICK TABL | $81.90 | $91.00 | $18.20–$89.18 | 79% above | 10% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA DIPSTICK/TABLET REAGEN | $9.90 | $11.00 | $10.01–$10.78 | — | 10% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS DIP STICK TABL | $81.90 | $91.00 | $82.81–$89.18 | — | 10% |
| Urinalysis with microscope exam, manual CPT 81000 UA DIPSTICK/TABLET REAGEN | $11.70 | $13.00 | $2.60–$21.94 | 42% below | 10% |
| Urinalysis with microscope exam, manual CPT 81000 URINALYSIS NONAUTOMATED W | $55.80 | $62.00 | $12.40–$60.76 | 178% above | 10% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 UA DIPSTICK/TABLET REAGEN | $11.70 | $13.00 | $11.83–$12.74 | — | 10% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS NONAUTOMATED W | $55.80 | $62.00 | $56.42–$60.76 | — | 10% |
| Urinalysis without microscope exam, automated CPT 81003 UA DIPSTICK AUTO W/OUT MI | $7.20 | $8.00 | $1.60–$8.69 | 74% below | 10% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIP STICK/TABL | $51.30 | $57.00 | $8.69–$55.86 | 89% above | 10% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA DIPSTICK AUTO W/OUT MI | $7.20 | $8.00 | $7.28–$7.84 | — | 10% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS DIP STICK/TABL | $51.30 | $57.00 | $51.87–$55.86 | — | 10% |
| Urinalysis without microscope exam, manual CPT 81002 UA DIP NON AUT W/0 MICROS | $10.80 | $12.00 | $2.40–$11.76 | 50% below | 10% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTOMATED W | $45.00 | $50.00 | $10.00–$49.00 | 110% above | 10% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 UA DIP NON AUT W/0 MICROS | $10.80 | $12.00 | $10.92–$11.76 | — | 10% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTOMATED W | $45.00 | $50.00 | $45.50–$49.00 | — | 10% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE BACTERIAL Q | $20.70 | $23.00 | $4.60–$31.24 | 69% below | 10% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE BACTERIAL QT COLO | $113.40 | $126.00 | $25.20–$123.48 | 67% above | 10% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE BACTERIAL Q | $20.70 | $23.00 | $20.93–$22.54 | — | 10% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE BACTERIAL QT COLO | $113.40 | $126.00 | $114.66–$123.48 | — | 10% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST VISU | $108.90 | $121.00 | $24.20–$118.58 | 79% above | 10% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST VISU | $108.90 | $121.00 | $110.11–$118.58 | — | 10% |
| Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN VITAMIN B- | $38.70 | $43.00 | $8.60–$58.37 | 66% below | 10% |
| Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN (VITAMIN B | $174.60 | $194.00 | $38.80–$190.12 | 55% above | 10% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBALAMIN VITAMIN B- | $38.70 | $43.00 | $39.13–$42.14 | — | 10% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBALAMIN (VITAMIN B | $174.60 | $194.00 | $176.54–$190.12 | — | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25HYDROXY INCLU | $73.80 | $82.00 | $16.40–$114.65 | 44% below | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROX INCL | $257.40 | $286.00 | $57.20–$280.28 | 96% above | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25HYDROXY INCLU | $73.80 | $82.00 | $74.62–$80.36 | — | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROX INCL | $257.40 | $286.00 | $260.26–$280.28 | — | 10% |
| Zinc blood test CPT 84630 ZINC | $90.00 | $100.00 | $20.00–$98.00 | 154% above | 10% |
| Zinc blood test inpatient CPT 84630 ZINC | $90.00 | $100.00 | $91.00–$98.00 | — | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN CHORIONIC QU | $38.70 | $43.00 | $8.60–$58.31 | 56% below | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN, CHORIONIC ( | $144.00 | $160.00 | $32.00–$156.80 | 62% above | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN CHORIONIC QU | $38.70 | $43.00 | $39.13–$42.14 | — | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN, CHORIONIC ( | $144.00 | $160.00 | $145.60–$156.80 | — | 10% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION IN ER | $1,777.50 | $1,975.00 | $395.00–$1,935.50 | 24% above | 10% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION | $1,882.80 | $2,092.00 | $418.40–$2,050.16 | 32% above | 10% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION IN ER | $1,777.50 | $1,975.00 | $1,797.25–$1,935.50 | — | 10% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION | $1,882.80 | $2,092.00 | $1,903.72–$2,050.16 | — | 10% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 COLPOSCOPY CERVIX W/BIOPS | $385.20 | $428.00 | $85.60–$419.44 | 35% above | 10% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 COLPOSCOPY CERVIX W/BIOPS | $385.20 | $428.00 | $389.48–$419.44 | — | 10% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 CRYOTHERAPY 1 LESION | $155.70 | $173.00 | $34.60–$169.54 | 22% above | 10% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 CRYOTHERAPY 1 LESION | $155.70 | $173.00 | $157.43–$169.54 | — | 10% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 Ord RHC Clinic Visit | $21.60 | $24.00 | $4.80–$469.72 | 57% below | 10% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 Loup City RHC Clinic Visit | $21.60 | $24.00 | $4.80–$469.72 | 57% below | 10% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 Burwell RHC Clinic Visit | $21.60 | $24.00 | $4.80–$469.72 | 57% below | 10% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVAL OF IMPCTD CERUMEN | $21.60 | $24.00 | $4.80–$469.72 | 57% below | 10% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 ORD RHC Clinic Visit | $21.60 | $24.00 | $4.80–$469.72 | 57% below | 10% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVAL OF IMPACTED CERUM | $36.00 | $40.00 | $8.00–$39.20 | 29% below | 10% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVAL OF IMPCTD CERUMEN | $21.60 | $24.00 | $21.84–$23.52 | — | 10% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVAL OF IMPACTED CERUM | $36.00 | $40.00 | $36.40–$39.20 | — | 10% |
| Earwax removal with instruments, one ear CPT 69210 REMOVAL OF IMPCTD CERUMEN | $32.40 | $36.00 | $7.20–$469.72 | 61% below | 10% |
| Earwax removal with instruments, one ear CPT 69210 Burwell RHC Clinic Visit | $32.40 | $36.00 | $7.20–$469.72 | 61% below | 10% |
| Earwax removal with instruments, one ear CPT 69210 Loup City RHC Clinic Visit | $32.40 | $36.00 | $7.20–$469.72 | 61% below | 10% |
| Earwax removal with instruments, one ear CPT 69210 Ord RHC Clinic Visit | $32.40 | $36.00 | $7.20–$469.72 | 61% below | 10% |
| Earwax removal with instruments, one ear CPT 69210 ORD RHC Clinic Visit | $32.40 | $36.00 | $7.20–$469.72 | 61% below | 10% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE CERUMAN IMPACTION | $75.60 | $84.00 | $16.80–$82.32 | 10% below | 10% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REMOVAL OF IMPCTD CERUMEN | $32.40 | $36.00 | $32.76–$35.28 | — | 10% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE CERUMAN IMPACTION | $75.60 | $84.00 | $76.44–$82.32 | — | 10% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BIOPSY | $233.10 | $259.00 | $51.80–$253.82 | 10% above | 10% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BIOPSY | $233.10 | $259.00 | $235.69–$253.82 | — | 10% |
| Gallbladder removal, laparoscopic CPT 47562 LAP CHOLE TECH FEE | $1,108.80 | $1,232.00 | $246.40–$1,207.36 | 25% below | 10% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 LAP CHOLE TECH FEE | $1,108.80 | $1,232.00 | $1,121.12–$1,207.36 | — | 10% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 CHOLECYSTECTOMY W/ CHOLA | $1,207.80 | $1,342.00 | $268.40–$1,315.16 | 25% below | 10% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 CHOLECYSTECTOMY W/ CHOLA | $1,207.80 | $1,342.00 | $1,221.22–$1,315.16 | — | 10% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERT IUD | $256.50 | $285.00 | $57.00–$279.30 | 17% above | 10% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT IUD | $256.50 | $285.00 | $259.35–$279.30 | — | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 AMB INC &DRG OF ABCESS SI | $290.70 | $323.00 | $64.60–$316.54 | 8% above | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D OF ABCESSES | $380.70 | $423.00 | $84.60–$414.54 | 41% above | 10% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 AMB INC &DRG OF ABCESS SI | $290.70 | $323.00 | $293.93–$316.54 | — | 10% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D OF ABCESSES | $380.70 | $423.00 | $384.93–$414.54 | — | 10% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION SINGLE APONEURO | $195.30 | $217.00 | $43.40–$212.66 | at median | 10% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION SINGLE APONEURO | $195.30 | $217.00 | $197.47–$212.66 | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Burwell RHC Clinic Visit | $88.20 | $98.00 | $19.60–$469.72 | 54% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ORD RHC Clinic Visit | $88.20 | $98.00 | $19.60–$469.72 | 54% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Ord RHC Clinic Visit | $88.20 | $98.00 | $19.60–$469.72 | 54% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Loup City RHC Clinic Visit | $88.20 | $98.00 | $19.60–$469.72 | 54% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHRO ASP/INJ MAJOR JOIN | $146.70 | $163.00 | $32.60–$159.74 | 23% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHO ASP/INJ OF MJR JOIN | $261.90 | $291.00 | $58.20–$285.18 | 37% above | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHRO ASP/INJ MAJOR JOIN | $146.70 | $163.00 | $148.33–$159.74 | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHO ASP/INJ OF MJR JOIN | $261.90 | $291.00 | $264.81–$285.18 | — | 10% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION, NONBIODEGRAD D | $292.50 | $325.00 | $65.00–$318.50 | 25% above | 10% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERTION, NONBIODEGRAD D | $292.50 | $325.00 | $295.75–$318.50 | — | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHRO ASP/INJ WRIST/ELBO | $126.00 | $140.00 | $28.00–$137.20 | 50% below | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHO ASP/INJ OF MNR JOIN | $273.60 | $304.00 | $60.80–$297.92 | 8% above | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHRO ASP/INJ WRIST/ELBO | $126.00 | $140.00 | $127.40–$137.20 | — | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHO ASP/INJ OF MNR JOIN | $273.60 | $304.00 | $276.64–$297.92 | — | 10% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHRO ASP/INJ SM JT/BURS | $121.50 | $135.00 | $27.00–$132.30 | 17% below | 10% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHRO ASP/INJ SM JT/BURS | $121.50 | $135.00 | $122.85–$132.30 | — | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERM REPAIR <2.5CM TECH | $595.80 | $662.00 | $132.40–$648.76 | 41% above | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INT RPR S/A/T/E <2.5 CM | $606.60 | $674.00 | $134.80–$660.52 | 44% above | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTERM REPAIR <2.5CM TECH | $595.80 | $662.00 | $602.42–$648.76 | — | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INT RPR S/A/T/E <2.5 CM | $606.60 | $674.00 | $613.34–$660.52 | — | 10% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 AMB EXC B9LES MRGN XCP SK | $295.20 | $328.00 | $65.60–$321.44 | 11% below | 10% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 AMB EXC B9LES MRGN XCP SK | $295.20 | $328.00 | $298.48–$321.44 | — | 10% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC B9LES MGN XCP SKTG F/ | $331.20 | $368.00 | $73.60–$360.64 | 4% below | 10% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC B9LES MGN XCP SKTG F/ | $331.20 | $368.00 | $334.88–$360.64 | — | 10% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLAT PARTIA | $266.40 | $296.00 | $59.20–$290.08 | 1% below | 10% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION OF NAIL PLATE | $283.50 | $315.00 | $63.00–$308.70 | 6% above | 10% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLAT PARTIA | $266.40 | $296.00 | $269.36–$290.08 | — | 10% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION OF NAIL PLATE | $283.50 | $315.00 | $286.65–$308.70 | — | 10% |
| Paracentesis with imaging guidance CPT 49083 ABDOMINAL PARACENTESIS UL | $2,772.90 | $3,081.00 | $616.20–$3,019.38 | 280% above | 10% |
| Paracentesis with imaging guidance inpatient CPT 49083 ABDOMINAL PARACENTESIS UL | $2,772.90 | $3,081.00 | $2,803.71–$3,019.38 | — | 10% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCS NAIL MATRIX PERM REM | $369.00 | $410.00 | $82.00–$401.80 | 10% above | 10% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCS NAIL MATRIX PERM REM | $369.00 | $410.00 | $373.10–$401.80 | — | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 AMB INC & RMVL FOREIGN BO | $346.50 | $385.00 | $77.00–$377.30 | at median | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY | $370.80 | $412.00 | $82.40–$403.76 | 7% above | 10% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 AMB INC & RMVL FOREIGN BO | $346.50 | $385.00 | $350.35–$377.30 | — | 10% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVE FOREIGN BODY | $370.80 | $412.00 | $374.92–$403.76 | — | 10% |
| Short arm cast (elbow to hand) CPT 29075 APPLICATION SHORT ARM CAS | $174.60 | $194.00 | $38.80–$190.12 | 12% below | 10% |
| Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION SHORT ARM CAS | $174.60 | $194.00 | $176.54–$190.12 | — | 10% |
| Short arm splint (forearm and hand) CPT 29125 APPLICATION OF SHORT ARM | $241.20 | $268.00 | $53.60–$262.64 | 57% above | 10% |
| Short arm splint (forearm and hand) CPT 29125 APPLY SHORT ARM STATIC SP | $315.00 | $350.00 | $70.00–$343.00 | 105% above | 10% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION OF SHORT ARM | $241.20 | $268.00 | $243.88–$262.64 | — | 10% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APPLY SHORT ARM STATIC SP | $315.00 | $350.00 | $318.50–$343.00 | — | 10% |
| Short leg cast (below the knee) CPT 29405 APPLICATION SHORT LEG CAS | $161.10 | $179.00 | $35.80–$175.42 | 13% below | 10% |
| Short leg cast (below the knee) inpatient CPT 29405 APPLICATION SHORT LEG CAS | $161.10 | $179.00 | $162.89–$175.42 | — | 10% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPL | $242.10 | $269.00 | $53.80–$263.62 | 50% above | 10% |
| Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION SHORT LEG SPL | $242.10 | $269.00 | $244.79–$263.62 | — | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SMP RPR S/N/A/G/T <2.5 CM | $213.30 | $237.00 | $47.40–$232.26 | 3% above | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR 2.5 CM< TEC | $370.80 | $412.00 | $82.40–$403.76 | 78% above | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SMP RPR S/N/A/G/T <2.5 CM | $213.30 | $237.00 | $215.67–$232.26 | — | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REPAIR 2.5 CM< TEC | $370.80 | $412.00 | $374.92–$403.76 | — | 10% |
| Skin biopsy, punch, one lesion CPT 11104 AMB PUNCH BIOPSY SINGLE | $291.60 | $324.00 | $64.80–$317.52 | 15% above | 10% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN SING | $358.20 | $398.00 | $79.60–$390.04 | 41% above | 10% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 AMB PUNCH BIOPSY SINGLE | $291.60 | $324.00 | $294.84–$317.52 | — | 10% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY OF SKIN SING | $358.20 | $398.00 | $362.18–$390.04 | — | 10% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC MAL LES T/A/L<0.5CM | $453.60 | $504.00 | $100.80–$493.92 | at median | 10% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC MAL LES T/A/L<0.5CM | $453.60 | $504.00 | $458.64–$493.92 | — | 10% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS UP T | $210.60 | $234.00 | $46.80–$229.32 | 7% above | 10% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS UP T | $210.60 | $234.00 | $212.94–$229.32 | — | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SMP RPR S/N/A/G/T 2.6-7.5 | $258.30 | $287.00 | $57.40–$281.26 | 8% above | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE REPAIR 2.6-7.5 CM | $357.30 | $397.00 | $79.40–$389.06 | 49% above | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SMP RPR S/N/A/G/T 2.6-7.5 | $258.30 | $287.00 | $261.17–$281.26 | — | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPLE REPAIR 2.6-7.5 CM | $357.30 | $397.00 | $361.27–$389.06 | — | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SMP RPR F/E/E/N/L <2.5.0C | $256.50 | $285.00 | $57.00–$279.30 | 9% above | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR 2.5 CM<, FA | $334.80 | $372.00 | $74.40–$364.56 | 43% above | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SMP RPR F/E/E/N/L <2.5.0C | $256.50 | $285.00 | $259.35–$279.30 | — | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPLE REPAIR 2.5 CM<, FA | $334.80 | $372.00 | $338.52–$364.56 | — | 10% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 AMB TANGENTIAL BIOPSY SKI | $234.90 | $261.00 | $52.20–$255.78 | 24% above | 10% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 AMB TANGENTIAL BIOPSY SKI | $234.90 | $261.00 | $237.51–$255.78 | — | 10% |
| Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/ IMAGING | $1,098.00 | $1,220.00 | $244.00–$1,195.60 | 49% above | 10% |
| Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/ IMAGING | $1,098.00 | $1,220.00 | $1,110.20–$1,195.60 | — | 10% |
| Trigger point injections, 1 or 2 muscles CPT 20552 TRIGGER POINT INJECTIONS | $121.50 | $135.00 | $27.00–$132.30 | 19% below | 10% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1-2 MUS | $504.00 | $560.00 | $112.00–$548.80 | 235% above | 10% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 TRIGGER POINT INJECTIONS | $121.50 | $135.00 | $122.85–$132.30 | — | 10% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1-2 MUS | $504.00 | $560.00 | $509.60–$548.80 | — | 10% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCTION LESION UP TO | $262.80 | $292.00 | $58.40–$286.16 | 54% above | 10% |
| Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION LESION UP TO | $262.80 | $292.00 | $265.72–$286.16 | — | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 AMB DEBRIDE SUBQ TISSUE | $297.00 | $330.00 | $66.00–$323.40 | 8% below | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SUBQ TISSUE 1ST 2 | $706.50 | $785.00 | $157.00–$769.30 | 119% above | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 AMB DEBRIDE SUBQ TISSUE | $297.00 | $330.00 | $300.30–$323.40 | — | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SUBQ TISSUE 1ST 2 | $706.50 | $785.00 | $714.35–$769.30 | — | 10% |
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 | $934.20 | $1,038.00 | $207.60–$1,017.24 | 34% above | 10% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION | $934.20 | $1,038.00 | $944.58–$1,017.24 | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER | $39.60 | $44.00 | $8.80–$43.12 | 63% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SUBSEQUENT PRESSURE BREAT | $113.40 | $126.00 | $25.20–$123.48 | 7% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INHAL TX SUBS NEB MDI DPI | $191.70 | $213.00 | $42.60–$208.74 | 81% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER | $39.60 | $44.00 | $40.04–$43.12 | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SUBSEQUENT PRESSURE BREAT | $113.40 | $126.00 | $114.66–$123.48 | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHAL TX SUBS NEB MDI DPI | $191.70 | $213.00 | $193.83–$208.74 | — | 10% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO ADMIN IV INF UPTO 1 | $679.50 | $755.00 | $151.00–$739.90 | 39% above | 10% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO ADMIN IV INF UPTO 1 | $679.50 | $755.00 | $687.05–$739.90 | — | 10% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST 30-74 | $634.50 | $705.00 | $141.00–$690.90 | 1% below | 10% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE ER 30-74 MI | $1,899.00 | $2,110.00 | $422.00–$2,067.80 | 196% above | 10% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE FIRST 30-74 | $634.50 | $705.00 | $641.55–$690.90 | — | 10% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE ER 30-74 MI | $1,899.00 | $2,110.00 | $1,920.10–$2,067.80 | — | 10% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG INCLUDING RECORD AWAK | $789.30 | $877.00 | $175.40–$859.46 | 17% above | 10% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG INCLUDING RECORD AWAK | $789.30 | $877.00 | $798.07–$859.46 | — | 10% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG W/ AT LEAST 12 LEADS, | $36.90 | $41.00 | $8.20–$40.18 | 35% below | 10% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG W/ AT LEAST 12 LEADS, | $36.90 | $41.00 | $37.31–$40.18 | — | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM ROUTINE | $341.10 | $379.00 | $75.80–$371.42 | 70% above | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM ROUTINE | $341.10 | $379.00 | $344.89–$371.42 | — | 10% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL 1 | $208.80 | $232.00 | $46.40–$227.36 | 37% above | 10% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL 1 | $208.80 | $232.00 | $211.12–$227.36 | — | 10% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL 2 | $341.10 | $379.00 | $75.80–$371.42 | 52% above | 10% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL 2 | $341.10 | $379.00 | $344.89–$371.42 | — | 10% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL 3 | $659.70 | $733.00 | $146.60–$718.34 | 111% above | 10% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL 3 | $659.70 | $733.00 | $667.03–$718.34 | — | 10% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL 4 | $936.00 | $1,040.00 | $208.00–$1,019.20 | 88% above | 10% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL 4 | $936.00 | $1,040.00 | $946.40–$1,019.20 | — | 10% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL 5 | $1,370.70 | $1,523.00 | $304.60–$1,492.54 | 94% above | 10% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL 5 | $1,370.70 | $1,523.00 | $1,385.93–$1,492.54 | — | 10% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TES | $1,228.50 | $1,365.00 | $273.00–$1,337.70 | 17% above | 10% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVASCULAR STRESS TES | $1,228.50 | $1,365.00 | $1,242.15–$1,337.70 | — | 10% |
| Family therapy with the patient, 50 minutes CPT 90847 PSYCHOTHERAPY FAMILY =>50 | $232.20 | $258.00 | $51.60–$252.84 | 11% above | 10% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY W/ | $424.80 | $472.00 | $94.40–$462.56 | 103% above | 10% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 PSYCHOTHERAPY FAMILY =>50 | $232.20 | $258.00 | $234.78–$252.84 | — | 10% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY W/ | $424.80 | $472.00 | $429.52–$462.56 | — | 10% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHOTHERAPY W/O | $439.20 | $488.00 | $97.60–$478.24 | 117% above | 10% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHOTHERAPY W/O | $439.20 | $488.00 | $444.08–$478.24 | — | 10% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY SUBSE | $354.60 | $394.00 | $78.80–$386.12 | 73% above | 10% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY SUBSQ | $354.60 | $394.00 | $78.80–$386.12 | 73% above | 10% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY PROC | $354.60 | $394.00 | $78.80–$386.12 | 73% above | 10% |
| Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY PROC | $354.60 | $394.00 | $358.54–$386.12 | — | 10% |
| Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY SUBSE | $354.60 | $394.00 | $358.54–$386.12 | — | 10% |
| Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY SUBSQ | $354.60 | $394.00 | $358.54–$386.12 | — | 10% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYDRATION INI | $452.70 | $503.00 | $100.60–$492.94 | 15% above | 10% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION HYDRATION INI | $452.70 | $503.00 | $457.73–$492.94 | — | 10% |
| IV infusion of a medicine, first hour CPT 96365 IV INFUSION TX/PROPHYLAXI | $152.10 | $169.00 | $33.80–$292.77 | 51% below | 10% |
| IV infusion of a medicine, first hour CPT 96365 IV FUSION THERAPY PX/DX I | $452.70 | $503.00 | $100.60–$492.94 | 44% above | 10% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION TX/PROPHYLAXI | $152.10 | $169.00 | $153.79–$165.62 | — | 10% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV FUSION THERAPY PX/DX I | $452.70 | $503.00 | $457.73–$492.94 | — | 10% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC/PROPHYLACTICD | $44.10 | $49.00 | $9.80–$48.02 | 56% below | 10% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION SQ/IM THER, PX, | $135.90 | $151.00 | $30.20–$147.98 | 36% above | 10% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC/PROPHYLACTICD | $44.10 | $49.00 | $44.59–$48.02 | — | 10% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION SQ/IM THER, PX, | $135.90 | $151.00 | $137.41–$147.98 | — | 10% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 INITIAL PSYCHIATRIC DIAGN | $405.90 | $451.00 | $90.20–$441.98 | 95% above | 10% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 INITIAL PSYCHIATRIC DIAGN | $405.90 | $451.00 | $410.41–$441.98 | — | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 THERPEUTIC PX NEUROMUSC R | $99.00 | $110.00 | $22.00–$107.80 | 29% above | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 THERPEUTIC PX, NEUROMUSC | $102.60 | $114.00 | $22.80–$111.72 | 34% above | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 THERPEUTIC PX NEUROMUSC R | $99.00 | $110.00 | $100.10–$107.80 | — | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 THERPEUTIC PX, NEUROMUSC | $102.60 | $114.00 | $103.74–$111.72 | — | 10% |
| New patient office visit, about 30 minutes CPT 99203 Loup City RHC Clinic Visit | $152.10 | $169.00 | $33.80–$469.72 | 26% below | 10% |
| New patient office visit, about 30 minutes CPT 99203 Burwell RHC Clinic Visit | $152.10 | $169.00 | $33.80–$469.72 | 26% below | 10% |
| New patient office visit, about 30 minutes CPT 99203 ORD RHC Clinic Visit | $152.10 | $169.00 | $33.80–$469.72 | 26% below | 10% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE VISIT NEW PT 30-44 | $152.10 | $169.00 | $33.80–$469.72 | 26% below | 10% |
| New patient office visit, about 30 minutes CPT 99203 Ord RHC Clinic Visit | $152.10 | $169.00 | $33.80–$469.72 | 26% below | 10% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE VISIT NEW PATIENT | $254.70 | $283.00 | $56.60–$277.34 | 24% above | 10% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VISIT NEW PT 30-44 | $152.10 | $169.00 | $153.79–$165.62 | — | 10% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VISIT NEW PATIENT | $254.70 | $283.00 | $257.53–$277.34 | — | 10% |
| New patient office visit, about 45 minutes CPT 99204 ORD RHC Clinic Visit | $228.60 | $254.00 | $50.80–$469.72 | 24% below | 10% |
| New patient office visit, about 45 minutes CPT 99204 Ord RHC Clinic Visit | $228.60 | $254.00 | $50.80–$469.72 | 24% below | 10% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE VISIT NEW PT 45-59 | $228.60 | $254.00 | $50.80–$469.72 | 24% below | 10% |
| New patient office visit, about 45 minutes CPT 99204 Loup City RHC Clinic Visit | $228.60 | $254.00 | $50.80–$469.72 | 24% below | 10% |
| New patient office visit, about 45 minutes CPT 99204 Burwell RHC Clinic Visit | $228.60 | $254.00 | $50.80–$469.72 | 24% below | 10% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE VISIT NEW PATIENT | $380.70 | $423.00 | $84.60–$414.54 | 26% above | 10% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE VISIT NEW PT 45-59 | $228.60 | $254.00 | $231.14–$248.92 | — | 10% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE VISIT NEW PATIENT | $380.70 | $423.00 | $384.93–$414.54 | — | 10% |
| New patient office visit, about 60 minutes CPT 99205 Loup City RHC Clinic Visit | $302.40 | $336.00 | $67.20–$469.72 | 18% below | 10% |
| New patient office visit, about 60 minutes CPT 99205 ORD RHC Clinic Visit | $302.40 | $336.00 | $67.20–$469.72 | 18% below | 10% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE VISIT NEW PT 60-74 | $302.40 | $336.00 | $67.20–$469.72 | 18% below | 10% |
| New patient office visit, about 60 minutes CPT 99205 Ord RHC Clinic Visit | $302.40 | $336.00 | $67.20–$469.72 | 18% below | 10% |
| New patient office visit, about 60 minutes CPT 99205 Burwell RHC Clinic Visit | $302.40 | $336.00 | $67.20–$469.72 | 18% below | 10% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE VISIT NEW PATIENT | $504.00 | $560.00 | $112.00–$548.80 | 36% above | 10% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE VISIT NEW PT 60-74 | $302.40 | $336.00 | $305.76–$329.28 | — | 10% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE VISIT NEW PATIENT | $504.00 | $560.00 | $509.60–$548.80 | — | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE VISIT NEW PT 15-29 | $100.80 | $112.00 | $22.40–$469.72 | 26% below | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Loup City RHC Clinic Visit | $100.80 | $112.00 | $22.40–$469.72 | 26% below | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 ORD RHC Clinic Visit | $100.80 | $112.00 | $22.40–$469.72 | 26% below | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Ord RHC Clinic Visit | $100.80 | $112.00 | $22.40–$469.72 | 26% below | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Burwell RHC Clinic Visit | $100.80 | $112.00 | $22.40–$469.72 | 26% below | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE VISIT NEW PATIENT | $167.40 | $186.00 | $37.20–$182.28 | 22% above | 10% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE VISIT NEW PT 15-29 | $100.80 | $112.00 | $101.92–$109.76 | — | 10% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE VISIT NEW PATIENT | $167.40 | $186.00 | $169.26–$182.28 | — | 10% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL ASSESSMENT&IN | $56.70 | $63.00 | $12.60–$61.74 | 19% above | 10% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL ASSESSMENT&IN | $56.70 | $63.00 | $57.33–$61.74 | — | 10% |
| Occupational therapy evaluation, low complexity CPT 97165 OCCUPATIONAL THERAPY EVAL | $193.50 | $215.00 | $43.00–$210.70 | 19% above | 10% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 OCCUPATIONAL THERAPY EVAL | $193.50 | $215.00 | $195.65–$210.70 | — | 10% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PHYSICAL THERAPY EVAL HIG | $344.70 | $383.00 | $76.60–$375.34 | 104% above | 10% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PHYSICAL THERAPY EVAL HIG | $344.70 | $383.00 | $348.53–$375.34 | — | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PHYSICAL THERAPY EVAL LOW | $193.50 | $215.00 | $43.00–$210.70 | 38% above | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PHYSICAL THERAPY EVAL LOW | $193.50 | $215.00 | $195.65–$210.70 | — | 10% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PHYSICAL THERAPY EVAL MOD | $310.50 | $345.00 | $69.00–$338.10 | 84% above | 10% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PHYSICAL THERAPY EVAL MOD | $310.50 | $345.00 | $313.95–$338.10 | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY TECHNIQUES | $119.70 | $133.00 | $26.60–$130.34 | 40% above | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY TECHNIQUES | $119.70 | $133.00 | $121.03–$130.34 | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC PROCEDURE, EX | $99.90 | $111.00 | $22.20–$108.78 | 24% above | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPY PROCEDURE, EXERCI | $103.50 | $115.00 | $23.00–$112.70 | 29% above | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC PROCEDURE, EX | $99.90 | $111.00 | $101.01–$108.78 | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPY PROCEDURE, EXERCI | $103.50 | $115.00 | $104.65–$112.70 | — | 10% |
| Preventive checkup, new patient aged 18–39 CPT 99385 Ord RHC Clinic Visit | $126.00 | $140.00 | $28.00–$469.72 | 48% below | 10% |
| Preventive checkup, new patient aged 18–39 CPT 99385 ORD RHC Clinic Visit | $126.00 | $140.00 | $28.00–$469.72 | 48% below | 10% |
| Preventive checkup, new patient aged 18–39 CPT 99385 Burwell RHC Clinic Visit | $126.00 | $140.00 | $28.00–$469.72 | 48% below | 10% |
| Preventive checkup, new patient aged 18–39 CPT 99385 Loup City RHC Clinic Visit | $126.00 | $140.00 | $28.00–$469.72 | 48% below | 10% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PHYSICAL NEW PATIENT 18-3 | $208.80 | $232.00 | $46.40–$227.36 | 14% below | 10% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PHYSICAL NEW PATIENT 18-3 | $208.80 | $232.00 | $211.12–$227.36 | — | 10% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Burwell RHC Clinic Visit | $144.00 | $160.00 | $32.00–$469.72 | 48% below | 10% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Loup City RHC Clinic Visit | $144.00 | $160.00 | $32.00–$469.72 | 48% below | 10% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Ord RHC Clinic Visit | $144.00 | $160.00 | $32.00–$469.72 | 48% below | 10% |
| Preventive checkup, new patient aged 40–64 CPT 99386 ORD RHC Clinic Visit | $144.00 | $160.00 | $32.00–$469.72 | 48% below | 10% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PHYSICAL NEW PATIENT 40-6 | $240.30 | $267.00 | $53.40–$261.66 | 14% below | 10% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PHYSICAL NEW PATIENT 40-6 | $240.30 | $267.00 | $242.97–$261.66 | — | 10% |
| Preventive checkup, new patient aged 65 or older CPT 99387 Burwell RHC Clinic Visit | $157.50 | $175.00 | $35.00–$469.72 | 42% below | 10% |
| Preventive checkup, new patient aged 65 or older CPT 99387 Ord RHC Clinic Visit | $157.50 | $175.00 | $35.00–$469.72 | 42% below | 10% |
| Preventive checkup, new patient aged 65 or older CPT 99387 ORD RHC Clinic Visit | $157.50 | $175.00 | $35.00–$469.72 | 42% below | 10% |
| Preventive checkup, new patient aged 65 or older CPT 99387 Loup City RHC Clinic Visit | $157.50 | $175.00 | $35.00–$469.72 | 42% below | 10% |
| Preventive checkup, new patient aged 65 or older CPT 99387 PHYSICAL NEW PATIENT 65>Y | $261.00 | $290.00 | $58.00–$284.20 | 5% below | 10% |
| Preventive checkup, new patient aged 65 or older inpatient CPT 99387 PHYSICAL NEW PATIENT 65>Y | $261.00 | $290.00 | $263.90–$284.20 | — | 10% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 Loup City RHC Clinic Visit | $112.50 | $125.00 | $25.00–$469.72 | 48% below | 10% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 Burwell RHC Clinic Visit | $112.50 | $125.00 | $25.00–$469.72 | 48% below | 10% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 Ord RHC Clinic Visit | $112.50 | $125.00 | $25.00–$469.72 | 48% below | 10% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 ORD RHC Clinic Visit | $112.50 | $125.00 | $25.00–$469.72 | 48% below | 10% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 PHYSICAL 18-39 YEARS PB | $112.50 | $125.00 | $25.00–$469.72 | 48% below | 10% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 PHYSICAL 18-39 YEARS | $188.10 | $209.00 | $41.80–$204.82 | 13% below | 10% |
| Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PHYSICAL 18-39 YEARS PB | $112.50 | $125.00 | $113.75–$122.50 | — | 10% |
| Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PHYSICAL 18-39 YEARS | $188.10 | $209.00 | $190.19–$204.82 | — | 10% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 Ord RHC Clinic Visit | $119.70 | $133.00 | $26.60–$469.72 | 48% below | 10% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 ORD RHC Clinic Visit | $119.70 | $133.00 | $26.60–$469.72 | 48% below | 10% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 PHYSICAL 40-64 YEARS PB | $119.70 | $133.00 | $26.60–$469.72 | 48% below | 10% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 Loup City RHC Clinic Visit | $119.70 | $133.00 | $26.60–$469.72 | 48% below | 10% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 Burwell RHC Clinic Visit | $119.70 | $133.00 | $26.60–$469.72 | 48% below | 10% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 PHYSICAL 40-64 YEARS | $199.80 | $222.00 | $44.40–$217.56 | 13% below | 10% |
| Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PHYSICAL 40-64 YEARS PB | $119.70 | $133.00 | $121.03–$130.34 | — | 10% |
| Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PHYSICAL 40-64 YEARS | $199.80 | $222.00 | $202.02–$217.56 | — | 10% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 ORD RHC Clinic Visit | $129.60 | $144.00 | $28.80–$469.72 | 45% below | 10% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 Burwell RHC Clinic Visit | $129.60 | $144.00 | $28.80–$469.72 | 45% below | 10% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 Loup City RHC Clinic Visit | $129.60 | $144.00 | $28.80–$469.72 | 45% below | 10% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 PHYSICAL 65>YEARS PB FACI | $129.60 | $144.00 | $28.80–$469.72 | 45% below | 10% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 Ord RHC Clinic Visit | $129.60 | $144.00 | $28.80–$469.72 | 45% below | 10% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 PHYSICAL 65>YEARS | $214.20 | $238.00 | $47.60–$233.24 | 9% below | 10% |
| Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PHYSICAL 65>YEARS PB FACI | $129.60 | $144.00 | $131.04–$141.12 | — | 10% |
| Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PHYSICAL 65>YEARS | $214.20 | $238.00 | $216.58–$233.24 | — | 10% |
| Psychiatric evaluation with medical services CPT 90792 INITIAL PSYCHIATRIC ASSES | $465.30 | $517.00 | $103.40–$506.66 | 100% above | 10% |
| Psychiatric evaluation with medical services inpatient CPT 90792 INITIAL PSYCHIATRIC ASSES | $465.30 | $517.00 | $470.47–$506.66 | — | 10% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 CRISIS PSYCHOTHERAPY INDI | $326.70 | $363.00 | $72.60–$355.74 | 54% above | 10% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 CRISIS PSYCHOTHERAPY 30-7 | $424.80 | $472.00 | $94.40–$462.56 | 100% above | 10% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 CRISIS PSYCHOTHERAPY INDI | $326.70 | $363.00 | $330.33–$355.74 | — | 10% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 CRISIS PSYCHOTHERAPY 30-7 | $424.80 | $472.00 | $429.52–$462.56 | — | 10% |
| Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY INDIVIDUAL | $215.10 | $239.00 | $47.80–$234.22 | 36% above | 10% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY INDIVIDUAL | $215.10 | $239.00 | $217.49–$234.22 | — | 10% |
| Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY 45 MIN W/PT | $232.20 | $258.00 | $51.60–$252.84 | 23% above | 10% |
| Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY 45 MIN W/ P | $424.80 | $472.00 | $94.40–$462.56 | 126% above | 10% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY 45 MIN W/PT | $232.20 | $258.00 | $234.78–$252.84 | — | 10% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY 45 MIN W/ P | $424.80 | $472.00 | $429.52–$462.56 | — | 10% |
| Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHERAPY INDIVIDUAL | $424.80 | $472.00 | $94.40–$462.56 | 87% above | 10% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY INDIVIDUAL | $424.80 | $472.00 | $429.52–$462.56 | — | 10% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 ORD RHC Clinic Visit | $21.60 | $24.00 | $4.80–$469.72 | 24% below | 10% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Burwell RHC Clinic Visit | $21.60 | $24.00 | $4.80–$469.72 | 24% below | 10% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Loup City RHC Clinic Visit | $21.60 | $24.00 | $4.80–$469.72 | 24% below | 10% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Ord RHC Clinic Visit | $21.60 | $24.00 | $4.80–$469.72 | 24% below | 10% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION DISC 3- | $36.90 | $41.00 | $8.20–$40.18 | 30% above | 10% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION DISC 3- | $36.90 | $41.00 | $37.31–$40.18 | — | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Loup City RHC Clinic Visit | $202.50 | $225.00 | $45.00–$469.72 | 8% below | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 ORD RHC Clinic Visit | $202.50 | $225.00 | $45.00–$469.72 | 8% below | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Burwell RHC Clinic Visit | $202.50 | $225.00 | $45.00–$469.72 | 8% below | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT 40-54 MIN PB | $202.50 | $225.00 | $45.00–$469.72 | 8% below | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Ord RHC Clinic Visit | $202.50 | $225.00 | $45.00–$469.72 | 8% below | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT 40-54 MIN | $336.60 | $374.00 | $74.80–$366.52 | 52% above | 10% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE VISIT 40-54 MIN PB | $202.50 | $225.00 | $204.75–$220.50 | — | 10% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE VISIT 40-54 MIN | $336.60 | $374.00 | $340.34–$366.52 | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Loup City RHC Clinic Visit | $125.10 | $139.00 | $27.80–$469.72 | 2% below | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Ord RHC Clinic Visit | $125.10 | $139.00 | $27.80–$469.72 | 2% below | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT 20-29 MIN PB | $125.10 | $139.00 | $27.80–$469.72 | 2% below | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Burwell RHC Clinic Visit | $125.10 | $139.00 | $27.80–$469.72 | 2% below | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 ORD RHC Clinic Visit | $125.10 | $139.00 | $27.80–$469.72 | 2% below | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT 20-29 MIN | $207.90 | $231.00 | $46.20–$226.38 | 62% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 WOCN E7M ONLY NO PX 60-89 | $305.10 | $339.00 | $67.80–$332.22 | 138% above | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE VISIT 20-29 MIN PB | $125.10 | $139.00 | $126.49–$136.22 | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE VISIT 20-29 MIN | $207.90 | $231.00 | $210.21–$226.38 | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 WOCN E7M ONLY NO PX 60-89 | $305.10 | $339.00 | $308.49–$332.22 | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Ord RHC Clinic Visit | $144.00 | $160.00 | $32.00–$469.72 | 14% below | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT 30-39 MIN PB | $144.00 | $160.00 | $32.00–$469.72 | 14% below | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ORD RHC Clinic Visit | $144.00 | $160.00 | $32.00–$469.72 | 14% below | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Loup City RHC Clinic Visit | $144.00 | $160.00 | $32.00–$469.72 | 14% below | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Burwell RHC Clinic Visit | $144.00 | $160.00 | $32.00–$469.72 | 14% below | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT 30-39 MIN | $240.30 | $267.00 | $53.40–$261.66 | 44% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 WOCN E&M ONLY NO PX GREAT | $506.70 | $563.00 | $112.60–$551.74 | 204% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE VISIT 30-39 MIN PB | $144.00 | $160.00 | $145.60–$156.80 | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE VISIT 30-39 MIN | $240.30 | $267.00 | $242.97–$261.66 | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 WOCN E&M ONLY NO PX GREAT | $506.70 | $563.00 | $512.33–$551.74 | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 SPECIALTY PHYSICIAN VISIT | $76.50 | $85.00 | $17.00–$469.72 | 11% below | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Ord RHC Clinic Visit | $76.50 | $85.00 | $17.00–$469.72 | 11% below | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Loup City RHC Clinic Visit | $76.50 | $85.00 | $17.00–$469.72 | 11% below | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Burwell RHC Clinic Visit | $76.50 | $85.00 | $17.00–$469.72 | 11% below | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ORD RHC Clinic Visit | $76.50 | $85.00 | $17.00–$469.72 | 11% below | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT 10-19 MIN PB | $78.30 | $87.00 | $17.40–$469.72 | 9% below | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PHYSICAL 5-11 YEARS PB FA | $101.70 | $113.00 | $22.60–$469.72 | 18% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT 10-19 MIN | $130.50 | $145.00 | $29.00–$142.10 | 51% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 WOCN E&M ONLY NO PX 31-59 | $202.50 | $225.00 | $45.00–$220.50 | 134% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 SPECIALTY PHYSICIAN VISIT | $76.50 | $85.00 | $77.35–$83.30 | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE VISIT 10-19 MIN PB | $78.30 | $87.00 | $79.17–$85.26 | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PHYSICAL 5-11 YEARS PB FA | $101.70 | $113.00 | $102.83–$110.74 | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE VISIT 10-19 MIN | $130.50 | $145.00 | $131.95–$142.10 | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 WOCN E&M ONLY NO PX 31-59 | $202.50 | $225.00 | $204.75–$220.50 | — | 10% |
| Speech and language evaluation CPT 92523 S T EVAL SOUND PROD W/ LA | $348.30 | $387.00 | $77.40–$379.26 | 25% above | 10% |
| Speech and language evaluation inpatient CPT 92523 S T EVAL SOUND PROD W/ LA | $348.30 | $387.00 | $352.17–$379.26 | — | 10% |
| Speech therapy session, individual CPT 92507 SPEECH THERAPY TREATMENT | $293.40 | $326.00 | $65.20–$319.48 | 37% above | 10% |
| Speech therapy session, individual inpatient CPT 92507 SPEECH THERAPY TREATMENT | $293.40 | $326.00 | $296.66–$319.48 | — | 10% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY W/O MAX VOL VE | $286.20 | $318.00 | $63.60–$311.64 | 16% above | 10% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY W/O MAX VOL VE | $286.20 | $318.00 | $289.38–$311.64 | — | 10% |
| Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY BEFORE & AFTER | $641.70 | $713.00 | $142.60–$698.74 | 42% above | 10% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY BEFORE & AFTER | $641.70 | $713.00 | $648.83–$698.74 | — | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES 15 | $102.60 | $114.00 | $22.80–$111.72 | 26% above | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITIES 15 | $102.60 | $114.00 | $103.74–$111.72 | — | 10% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPUTIC PHLEBOTOMY | $191.70 | $213.00 | $42.60–$208.74 | at median | 10% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPUTIC PHLEBOTOMY | $191.70 | $213.00 | $193.83–$208.74 | — | 10% |
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 FLUAD HD 65+ 25-26 | $106.20 | $118.00 | $23.60–$115.64 | 40% above | 10% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 FLUAD HD 65+ 24-25 | $109.80 | $122.00 | $24.40–$119.56 | 45% above | 10% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 FLUAD HD 65+ 25-26 | $106.20 | $118.00 | $107.38–$115.64 | — | 10% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 FLUAD HD 65+ 24-25 | $109.80 | $122.00 | $111.02–$119.56 | — | 10% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Covid19 Spikevax 24-25 12+ vaccine | $383.40 | $426.00 | $85.20–$417.48 | 42% above | 10% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Covid19 Spikevax 24-25 12+ vaccine | $383.40 | $426.00 | $387.66–$417.48 | — | 10% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE | $324.00 | $360.00 | $72.00–$352.80 | 63% above | 10% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACC LIVE (PF) | $363.60 | $404.00 | $80.80–$395.92 | 83% above | 10% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE | $324.00 | $360.00 | $327.60–$352.80 | — | 10% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACC LIVE (PF) | $363.60 | $404.00 | $367.64–$395.92 | — | 10% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUARIX TRIVALENT 6 MOS UP 2025-2026 | $50.40 | $56.00 | $11.20–$54.88 | 58% above | 10% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUARIX TRIVALENT 6 MOS UP 2024-2025 | $50.40 | $56.00 | $11.20–$54.88 | 58% above | 10% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUARIX TRVALENT 6 MOS UP | $52.20 | $58.00 | $11.60–$56.84 | 63% above | 10% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUARIX TRIVALENT 6 MOS UP 2025-2026 | $50.40 | $56.00 | $50.96–$54.88 | — | 10% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUARIX TRIVALENT 6 MOS UP 2024-2025 | $50.40 | $56.00 | $50.96–$54.88 | — | 10% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUARIX TRVALENT 6 MOS UP | $52.20 | $58.00 | $52.78–$56.84 | — | 10% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS VACC | $298.80 | $332.00 | $66.40–$325.36 | 13% below | 10% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAV VAC 9-VAL PFS | $581.40 | $646.00 | $129.20–$633.08 | 69% above | 10% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS VACC | $298.80 | $332.00 | $302.12–$325.36 | — | 10% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAV VAC 9-VAL PFS | $581.40 | $646.00 | $587.86–$633.08 | — | 10% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPATITUS A VACCINE ADULT | $173.70 | $193.00 | $38.60–$189.14 | 156% above | 10% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPATITUS A VIRUS ADULT 1440 EL U/ML | $193.50 | $215.00 | $43.00–$210.70 | 185% above | 10% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITUS A VACCINE ADULT | $173.70 | $193.00 | $175.63–$189.14 | — | 10% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITUS A VIRUS ADULT 1440 EL U/ML | $193.50 | $215.00 | $195.65–$210.70 | — | 10% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VIRUS VACC 20 MCG / 1 ML PFS ADULT | $152.10 | $169.00 | $33.80–$165.62 | 82% above | 10% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B ADULT (ENGERIX) | $171.90 | $191.00 | $38.20–$187.18 | 106% above | 10% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VIRUS VACC 20 MCG / 1 ML PFS ADULT | $152.10 | $169.00 | $153.79–$165.62 | — | 10% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B ADULT (ENGERIX) | $171.90 | $191.00 | $173.81–$187.18 | — | 10% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR | $74.70 | $83.00 | $16.60–$81.34 | 34% below | 10% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS,RUBELLA VACC (PF) GSK | $193.50 | $215.00 | $43.00–$210.70 | 71% above | 10% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS,RUBELLA VACC (PF) | $211.50 | $235.00 | $47.00–$230.30 | 87% above | 10% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR | $74.70 | $83.00 | $75.53–$81.34 | — | 10% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES,MUMPS,RUBELLA VACC (PF) GSK | $193.50 | $215.00 | $195.65–$210.70 | — | 10% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES,MUMPS,RUBELLA VACC (PF) | $211.50 | $235.00 | $213.85–$230.30 | — | 10% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 Mening Vac A,C,Y,W135 DIP (PF) | $333.90 | $371.00 | $74.20–$363.58 | 82% above | 10% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL CONJ VACCIN | $441.00 | $490.00 | $98.00–$480.20 | 141% above | 10% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Mening Vac A,C,Y,W135 DIP (PF) | $333.90 | $371.00 | $337.61–$363.58 | — | 10% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL CONJ VACCIN | $441.00 | $490.00 | $445.90–$480.20 | — | 10% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B VACCINE ( | $320.40 | $356.00 | $71.20–$348.88 | 2% above | 10% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B VAC, 4-COMP | $475.20 | $528.00 | $105.60–$517.44 | 51% above | 10% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B VACCINE ( | $320.40 | $356.00 | $323.96–$348.88 | — | 10% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B VAC, 4-COMP | $475.20 | $528.00 | $480.48–$517.44 | — | 10% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20VACCINE 0.5 ML | $566.10 | $629.00 | $125.80–$616.42 | 15% above | 10% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20 | $689.40 | $766.00 | $153.20–$750.68 | 40% above | 10% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20VACCINE 0.5 ML | $566.10 | $629.00 | $572.39–$616.42 | — | 10% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20 | $689.40 | $766.00 | $697.06–$750.68 | — | 10% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCCOCAL POLYSACCHARIDE VACCINE | $252.90 | $281.00 | $56.20–$275.38 | 31% above | 10% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCCOCCAL VACCINE | $325.80 | $362.00 | $72.40–$354.76 | 69% above | 10% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCCOCAL POLYSACCHARIDE VACCINE | $252.90 | $281.00 | $255.71–$275.38 | — | 10% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCCOCCAL VACCINE | $325.80 | $362.00 | $329.42–$354.76 | — | 10% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE (RABAVERT) SING DOSE | $625.50 | $695.00 | $139.00–$681.10 | 14% above | 10% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE (RABAVERT) | $625.50 | $695.00 | $139.00–$681.10 | 14% above | 10% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE (RABAVERT) | $625.50 | $695.00 | $632.45–$681.10 | — | 10% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE (RABAVERT) SING DOSE | $625.50 | $695.00 | $632.45–$681.10 | — | 10% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER (SHINGLES) VACCINE | $272.70 | $303.00 | $60.60–$296.94 | 9% below | 10% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 SHINGLES VACCINE RECOMBINANT ADJUVANTED | $350.10 | $389.00 | $77.80–$381.22 | 16% above | 10% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER VACCINE LIVE (PF) | $422.10 | $469.00 | $93.80–$459.62 | 40% above | 10% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 VARICELLAR ZOSTER (SHINGRIX) 50MCG/0.5ML | $3,802.50 | $4,225.00 | $845.00–$4,140.50 | 1163% above | 10% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 ZOSTER (SHINGLES) VACCINE | $272.70 | $303.00 | $275.73–$296.94 | — | 10% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 SHINGLES VACCINE RECOMBINANT ADJUVANTED | $350.10 | $389.00 | $353.99–$381.22 | — | 10% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 ZOSTER VACCINE LIVE (PF) | $422.10 | $469.00 | $426.79–$459.62 | — | 10% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 VARICELLAR ZOSTER (SHINGRIX) 50MCG/0.5ML | $3,802.50 | $4,225.00 | $3,844.75–$4,140.50 | — | 10% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS & DIPTHERIA TOXOI | $70.20 | $78.00 | $15.60–$76.44 | 43% above | 10% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VAX TETANUS-DIPTHERIA TOXOIDS | $84.60 | $94.00 | $18.80–$92.12 | 73% above | 10% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 DT ADULT INJ (OVER 7YRS OF AGE)DECAVAC | $135.90 | $151.00 | $30.20–$147.98 | 178% above | 10% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS & DIPTHERIA TOXOI | $70.20 | $78.00 | $70.98–$76.44 | — | 10% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VAX TETANUS-DIPTHERIA TOXOIDS | $84.60 | $94.00 | $85.54–$92.12 | — | 10% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 DT ADULT INJ (OVER 7YRS OF AGE)DECAVAC | $135.90 | $151.00 | $137.41–$147.98 | — | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDaP >7YEARS ADACEL (BOOS | $94.50 | $105.00 | $21.00–$102.90 | 32% above | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPTHERIA PERTUSSUS(ACELLULAR)TETANUS | $148.50 | $165.00 | $33.00–$161.70 | 107% above | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDaP >7YEARS ADACEL (BOOS | $94.50 | $105.00 | $95.55–$102.90 | — | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPTHERIA PERTUSSUS(ACELLULAR)TETANUS | $148.50 | $165.00 | $150.15–$161.70 | — | 10% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VI POLYSACCH VACCINE | $349.20 | $388.00 | $77.60–$380.24 | 81% above | 10% |
| Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYPHOID VI POLYSACCH VACCINE | $349.20 | $388.00 | $353.08–$380.24 | — | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATI | $44.10 | $49.00 | $9.80–$48.02 | 25% above | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN SQ/IM | $63.00 | $70.00 | $14.00–$68.60 | 78% above | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATI | $44.10 | $49.00 | $44.59–$48.02 | — | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN SQ/IM | $63.00 | $70.00 | $63.70–$68.60 | — | 10% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMINISTRATI | $29.70 | $33.00 | $6.60–$32.34 | 34% below | 10% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN SQ/IM | $48.60 | $54.00 | $10.80–$52.92 | 8% above | 10% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMINISTRATI | $29.70 | $33.00 | $30.03–$32.34 | — | 10% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN SQ/IM | $48.60 | $54.00 | $49.14–$52.92 | — | 10% |