West Holt Memorial Hospital
West Holt Memorial Hospital in Atkinson, NE publishes cash prices for 282 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Nebraska median for 184 of 279 procedures and below it for 86. By typical cash price it ranks #27 of 44 Nebraska hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
406 W Neely St, Atkinson, NE 68713 Collected Sep 27, 2026 Source price file (402) 925-2811
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 281343 · 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 one side CPT 73610 Xr Ankle Left Complete Min 3 Views | $334.00 | $418.00 | $33.00–$393.00 | 3% above | 20% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Ankle Right Complete Min 3 Views | $334.00 | $418.00 | $33.00–$393.00 | 3% above | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Us Abi Upper And Lower | $663.00 | $829.00 | $117.00–$788.00 | 44% above | 20% |
| Bone scan, whole body (nuclear medicine) CPT 78306 Bone Whole Body | $1,857.00 | $2,321.00 | $339.00–$2,205.00 | 10% above | 20% |
| Breast ultrasound, complete, one breast one side CPT 76641 Us Breast Complete Rt | $466.00 | $582.00 | $91.00–$553.00 | 2% below | 20% |
| Breast ultrasound, complete, one breast one side CPT 76641 Us Breast Complete Lt | $466.00 | $582.00 | $91.00–$553.00 | 2% below | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us Breast Limited Rt | $372.00 | $465.00 | $69.00–$442.00 | 4% below | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us Breast Limited Lt | $372.00 | $465.00 | $69.00–$442.00 | 4% below | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Cta Chest/abdomen W/wo Iv Contrast | $3,207.00 | $4,009.00 | $371.00–$3,809.00 | 2% above | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Cta Chest/abdomen W/woc | $3,207.00 | $4,009.00 | $371.00–$3,809.00 | 2% above | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Cta Chest/abd/pelvis W And/or Woc | $3,207.00 | $4,009.00 | $371.00–$3,809.00 | 2% above | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Cta Chest W And/or Woc | $3,207.00 | $4,009.00 | $371.00–$3,809.00 | 2% above | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Cta Chest Pe | $4,048.00 | $5,060.00 | $371.00–$4,807.00 | 28% above | 20% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abd/pelvis Woc | $3,774.00 | $4,717.00 | $210.00–$4,434.00 | 10% above | 20% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast | $4,528.00 | $5,660.00 | $424.00–$5,320.00 | 12% above | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Urogram | $5,253.00 | $6,566.00 | $484.00–$6,172.00 | 8% above | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abd/pelvis W/woc | $5,253.00 | $6,566.00 | $484.00–$6,172.00 | 8% above | 20% |
| CT scan of the abdomen with contrast CPT 74160 Ct Abd With | $2,567.00 | $3,209.00 | $326.00–$3,049.00 | at median | 20% |
| CT scan of the abdomen without contrast CPT 74150 Ct Abd Woc | $2,218.00 | $2,773.00 | $167.00–$2,634.00 | 1% above | 20% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Sinus Woc | $1,784.00 | $2,230.00 | $179.00–$2,119.00 | at median | 20% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Maxillofacial Woc | $1,784.00 | $2,230.00 | $179.00–$2,119.00 | at median | 20% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT scan | $1,974.00 | $2,468.00 | $136.00–$2,320.00 | 6% above | 20% |
| CT scan of the head with contrast CPT 70460 Ct Head With | $2,225.00 | $2,781.00 | $198.00–$2,642.00 | 8% above | 20% |
| CT scan of the head without and with contrast CPT 70470 Ct Head W/woc | $2,497.00 | $3,121.00 | $237.00–$2,934.00 | at median | 20% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct L-spine Woc | $2,269.00 | $2,836.00 | $207.00–$2,694.00 | 6% above | 20% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct C-spine Woc | $2,321.00 | $2,901.00 | $207.00–$2,756.00 | 4% above | 20% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast | $2,566.00 | $3,207.00 | $327.00–$3,047.00 | 7% above | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Us Carotid Bilat Complete | $1,559.00 | $1,949.00 | $257.00–$1,852.00 | — | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Duplex Carotid Bilateral | $1,559.00 | $1,949.00 | $936.00–$1,852.00 | — | 20% |
| Chest X-ray, 2 views CPT 71046 Xr Chest 2 Views | $309.00 | $386.00 | $28.00–$363.00 | 10% above | 20% |
| Chest X-ray, single view CPT 71045 Xr Chest 1 View | $270.00 | $337.00 | $21.00–$320.00 | 19% above | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Us Retroperitoneal Complete | $752.00 | $940.00 | $98.00–$893.00 | 4% below | 20% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 Dx Bone Density Dexa Axial | $490.00 | $613.00 | $38.00–$582.00 | 25% above | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Dx Bone Density Dexa Appendicular | $248.00 | $310.00 | $28.00–$295.00 | 7% above | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest/abd/pelvis Woc | $2,253.00 | $2,816.00 | $186.00–$2,675.00 | 5% above | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest Woc | $2,253.00 | $2,816.00 | $186.00–$2,675.00 | 5% above | 20% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest/abd/pelvis W | $2,519.00 | $3,149.00 | $249.00–$2,960.00 | 2% above | 20% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest With | $2,519.00 | $3,149.00 | $249.00–$2,960.00 | 2% above | 20% |
| Diagnostic mammogram, both breasts CPT 77066 Mammography of both breasts | $384.00 | $480.00 | $153.00–$456.00 | 12% below | 20% |
| Diagnostic mammogram, one breast CPT 77065 Mammography of one breast | $298.00 | $373.00 | $120.00–$354.00 | 4% below | 20% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Us Arterial Duplex Lower Extremity Bilat | $1,076.00 | $1,345.00 | $345.00–$1,278.00 | — | 20% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 Duplex Scan Of Lower Extremity Arteries | $1,076.00 | $1,345.00 | $345.00–$1,278.00 | 1% above | 20% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Venous Duplex Bilateral Complete | $1,444.00 | $1,805.00 | $866.00–$1,715.00 | — | 20% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 Us Venous Duplex Complete | $1,444.00 | $1,805.00 | $256.00–$1,715.00 | 1% above | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Us Echo Complete | $1,990.00 | $2,487.00 | $173.00–$2,363.00 | 6% below | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echocardiogram Complete | $1,990.00 | $2,487.00 | $173.00–$2,363.00 | 6% below | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echo 2d Complete | $2,206.00 | $2,758.00 | $173.00–$2,620.00 | 5% above | 20% |
| Knee X-ray, 3 views one side CPT 73562 Xr Knee Right 3 Views | $397.00 | $496.00 | $38.00–$466.00 | 8% above | 20% |
| Knee X-ray, 3 views one side CPT 73562 Xr Knee Left 3 Views | $397.00 | $496.00 | $38.00–$466.00 | 8% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Abd Limited | $642.00 | $803.00 | $80.00–$763.00 | 15% above | 20% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct Lung Ca Screen | $960.00 | $1,200.00 | $166.00–$1,140.00 | 55% above | 20% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI scan of leg joint | $2,585.00 | $3,231.00 | $307.00–$3,037.00 | 2% above | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri Lower Extremity Joint W/woc | $3,229.00 | $4,036.00 | $657.00–$3,834.00 | 4% below | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Knee Right W/woc | $3,229.00 | $4,036.00 | $657.00–$3,834.00 | 4% below | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Ankle Left W/woc | $3,229.00 | $4,036.00 | $657.00–$3,834.00 | 4% below | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Ankle Right W/woc | $3,229.00 | $4,036.00 | $657.00–$3,834.00 | 4% below | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Hip Left W/woc | $3,229.00 | $4,036.00 | $657.00–$3,834.00 | 4% below | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Hip Right W/woc | $3,229.00 | $4,036.00 | $657.00–$3,834.00 | 4% below | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Knee Left W/woc | $3,229.00 | $4,036.00 | $657.00–$3,834.00 | 4% below | 20% |
| MRI of the abdomen without contrast CPT 74181 Mri Abdomen Woc | $3,112.00 | $3,890.00 | $318.00–$3,696.00 | 5% above | 20% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Abdomen W/woc | $3,874.00 | $4,843.00 | $539.00–$4,601.00 | 5% above | 20% |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain Woc | $3,308.00 | $4,135.00 | $283.00–$3,928.00 | 7% above | 20% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Scan | $3,886.00 | $4,857.00 | $477.00–$4,614.00 | 1% below | 20% |
| MRI of the lower back, no contrast dye CPT 72148 MRI scan of lower spinal canal | $3,273.00 | $4,091.00 | $273.00–$3,846.00 | 5% above | 20% |
| MRI of the lower back, without and then with contrast dye CPT 72158 Mri L-spine W/woc | $3,869.00 | $4,836.00 | $481.00–$4,594.00 | 1% below | 20% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri T-spine Woc | $2,803.00 | $3,504.00 | $273.00–$3,329.00 | 13% below | 20% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri C-spine W/woc | $4,038.00 | $5,047.00 | $482.00–$4,795.00 | 4% above | 20% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri C-spine Woc | $2,370.00 | $2,962.00 | $272.00–$2,814.00 | 23% below | 20% |
| MRI of the pelvis without and with contrast CPT 72197 Mri Pelvis W/woc | $3,613.00 | $4,516.00 | $538.00–$4,290.00 | 2% above | 20% |
| MRI of the pelvis, no contrast dye CPT 72195 Mri Pelvis Woc | $2,563.00 | $3,204.00 | $368.00–$3,044.00 | 4% below | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri Upper Extremity Joint Woc | $2,529.00 | $3,161.00 | $307.00–$3,003.00 | 4% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Shoulder Right Woc | $2,529.00 | $3,161.00 | $307.00–$3,003.00 | 4% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Shoulder Left Woc | $2,529.00 | $3,161.00 | $307.00–$3,003.00 | 4% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Wrist Right Woc | $2,529.00 | $3,161.00 | $307.00–$3,003.00 | 4% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Elbow Right Woc | $2,529.00 | $3,161.00 | $307.00–$3,003.00 | 4% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Elbow Left Woc | $2,529.00 | $3,161.00 | $307.00–$3,003.00 | 4% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Wrist Left Woc | $2,529.00 | $3,161.00 | $307.00–$3,003.00 | 4% above | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocardial Perfusion Im Multstudies | $4,330.00 | $5,412.00 | $511.00–$5,087.00 | 8% above | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nuclear Stress | $4,330.00 | $5,412.00 | $511.00–$5,087.00 | 8% above | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us Pelvis Limited | $357.00 | $446.00 | $30.00–$424.00 | at median | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us Pelvis Complete | $750.00 | $937.00 | $97.00–$890.00 | 3% below | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Abdomial ultrasound of pregnant uterus | $738.00 | $922.00 | $116.00–$876.00 | 6% above | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Us Ob <14 Weeks | $614.00 | $768.00 | $93.00–$730.00 | at median | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Limited | $458.00 | $572.00 | $66.00–$543.00 | 17% above | 20% |
| Screening mammogram, both breasts both sides CPT 77067 Mammography, screening, bilateral | $334.00 | $417.00 | $127.00–$392.00 | — | 20% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder Left Complete Min 2 Views | $366.00 | $457.00 | $30.00–$434.00 | 9% above | 20% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder Right Complete Min 2 Views | $366.00 | $457.00 | $30.00–$434.00 | 9% above | 20% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Us Stress Echo | $1,667.00 | $2,084.00 | $192.00–$1,980.00 | at median | 20% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Stress Echo | $1,667.00 | $2,084.00 | $192.00–$1,980.00 | at median | 20% |
| Transvaginal pelvic ultrasound CPT 76830 Ultrasound pelvis through vagina | $626.00 | $782.00 | $114.00–$743.00 | 4% above | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 Us Ob Transvaginal | $517.00 | $646.00 | $75.00–$614.00 | 3% above | 20% |
| Ultrasound of the abdomen, complete CPT 76700 Ultrasound of abdomen | $838.00 | $1,048.00 | $106.00–$985.00 | 2% above | 20% |
| Ultrasound of the scrotum and testicles CPT 76870 Us Scrotum | $640.00 | $800.00 | $94.00–$760.00 | 1% below | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Thyroid/soft Tissues Of Head And Neck | $563.00 | $704.00 | $113.00–$669.00 | 4% below | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Venous Duplex Limited Rt | $1,037.00 | $1,296.00 | $157.00–$1,231.00 | 1% above | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Venous Duplex Limited Lt | $1,037.00 | $1,296.00 | $157.00–$1,231.00 | 1% above | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Venous Duplex Unilateral Limited | $1,037.00 | $1,296.00 | $622.00–$1,231.00 | 1% above | 20% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Right Complete Min 3 Views | $330.00 | $412.00 | $38.00–$391.00 | at median | 20% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Left Complete Min 3 Views | $330.00 | $412.00 | $38.00–$391.00 | at median | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip W Pelvis Right Min 2 Views | $355.00 | $444.00 | $43.00–$422.00 | 25% above | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip W Pelvis Left Min 2 Views | $355.00 | $444.00 | $43.00–$422.00 | 25% above | 20% |
| X-ray of the abdomen, 1 view CPT 74018 Xr Abdomen 1 View | $304.00 | $380.00 | $25.00–$361.00 | 16% above | 20% |
| X-ray of the ankle, 2 views one side CPT 73600 Xr Ankle Left 2 Views | $262.00 | $328.00 | $30.00–$312.00 | 16% above | 20% |
| X-ray of the ankle, 2 views one side CPT 73600 Xr Ankle Right 2 Views | $262.00 | $328.00 | $30.00–$312.00 | 16% above | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(s) F9 Min 2 Views | $186.00 | $233.00 | $36.00–$221.00 | 17% below | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(s) F8 Min 2 Views | $186.00 | $233.00 | $36.00–$221.00 | 17% below | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(s) F7 Min 2 Views | $186.00 | $233.00 | $36.00–$221.00 | 17% below | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(s) F6 Min 2 Views | $186.00 | $233.00 | $36.00–$221.00 | 17% below | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(s) F5 Min 2 Views | $186.00 | $233.00 | $36.00–$221.00 | 17% below | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(s) F4 Min 2 Views | $186.00 | $233.00 | $36.00–$221.00 | 17% below | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(s) F3 Min 2 Views | $186.00 | $233.00 | $36.00–$221.00 | 17% below | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(s) F2 Min 2 Views | $186.00 | $233.00 | $36.00–$221.00 | 17% below | 20% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger Min 2 Views Rt | $232.00 | $290.00 | $36.00–$276.00 | 4% above | 20% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger Min 2 Views Lt | $232.00 | $290.00 | $36.00–$276.00 | 4% above | 20% |
| X-ray of the foot, 2 views one side CPT 73620 Xr Foot Left 2 Views | $268.00 | $335.00 | $25.00–$318.00 | 24% above | 20% |
| X-ray of the foot, 2 views one side CPT 73620 Xr Foot Right 2 Views | $268.00 | $335.00 | $25.00–$318.00 | 24% above | 20% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Left Complete Min 3 Views | $351.00 | $439.00 | $31.00–$413.00 | 12% above | 20% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Right Complete Min 3 Views | $351.00 | $439.00 | $31.00–$413.00 | 12% above | 20% |
| X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Right Complete Min 3 Views | $342.00 | $428.00 | $33.00–$407.00 | at median | 20% |
| X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Left Complete Min 3 Views | $342.00 | $428.00 | $33.00–$407.00 | at median | 20% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee Left 2 Views | $318.00 | $398.00 | $32.00–$378.00 | at median | 20% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee Right 2 Views | $318.00 | $398.00 | $32.00–$378.00 | at median | 20% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Xr L-spine 2-3 Views | $482.00 | $603.00 | $34.00–$573.00 | 27% above | 20% |
| X-ray of the lower back, 4 or more views CPT 72110 X-Ray of lower back | $518.00 | $647.00 | $45.00–$615.00 | 11% above | 20% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 Xr T-spine 2 Views | $382.00 | $477.00 | $27.00–$453.00 | 25% above | 20% |
| X-ray of the nasal bones, 3 or more views CPT 70160 Xr Nasal Bones Complete Min 3 Views | $345.00 | $431.00 | $35.00–$409.00 | 19% above | 20% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xr C-spine 2-3 Views | $355.00 | $444.00 | $34.00–$422.00 | 16% above | 20% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 Xr Pelvis Ap 1-2 Views | $322.00 | $402.00 | $25.00–$382.00 | 21% above | 20% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Xr Sacrum And Coccyx 2 Views | $334.00 | $417.00 | $29.00–$396.00 | 25% above | 20% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alt | $64.00 | $80.00 | $3.00–$76.00 | 5% above | 20% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Ast | $70.00 | $87.00 | $3.00–$83.00 | 24% above | 20% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel Acute Combine | $345.00 | $431.00 | $29.00–$409.00 | 10% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Panel Ea Allerg | $31.00 | $39.00 | $3.00–$37.00 | 33% below | 21% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Food Ea | $44.00 | $55.00 | $3.00–$52.00 | 4% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Champ Allergy (1) | $46.00 | $58.00 | $3.00–$55.00 | at median | 21% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Latex Ab | $50.00 | $63.00 | $3.00–$60.00 | 9% above | 21% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Grape Allergen | $52.00 | $65.00 | $3.00–$62.00 | 13% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergy-horse Dander | $52.00 | $65.00 | $3.00–$62.00 | 13% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Galactose-alpha 1,3 | $55.00 | $69.00 | $3.00–$66.00 | 20% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Urd Allergens | $57.00 | $71.00 | $3.00–$67.00 | 24% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Gluten Allergen | $64.00 | $80.00 | $3.00–$76.00 | 39% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Yeast Allergen | $64.00 | $80.00 | $3.00–$76.00 | 39% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus Fumigatus Allergen | $64.00 | $80.00 | $3.00–$76.00 | 39% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Carmine Dye/red Dye Cochineal | $92.00 | $115.00 | $3.00–$109.00 | 100% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Egg Yolk Allergen | $114.00 | $143.00 | $3.00–$136.00 | 148% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Milk (Cow) Allergen | $114.00 | $143.00 | $3.00–$136.00 | 148% above | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide (Ccp) Anti | $117.00 | $146.00 | $8.00–$139.00 | 21% above | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinat Peptide (Ccp) | $117.00 | $146.00 | $8.00–$139.00 | 21% above | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Screen | $94.00 | $118.00 | $7.00–$112.00 | 39% above | 20% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Brain Natriuretic Peptide | $203.00 | $254.00 | $24.00–$241.00 | 3% above | 20% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Pro-bnp | $282.00 | $352.00 | $24.00–$334.00 | 44% above | 20% |
| Basic metabolic panel (blood test) CPT 80048 Basic metabolic panel | $167.00 | $209.00 | $5.00–$196.00 | 24% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Ts Surgical Path Level 4 | $146.00 | $182.00 | $29.00–$173.00 | 24% below | 20% |
| Blood culture for bacteria CPT 87040 Culture Blood / 91 | $138.00 | $172.00 | $6.00–$163.00 | 23% below | 20% |
| Blood culture for bacteria CPT 87040 Blood Culture | $151.00 | $189.00 | $6.00–$180.00 | 16% below | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture | $36.00 | $45.00 | $3.00–$42.00 | 36% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Cln Venipuncture | $36.00 | $45.00 | $3.00–$42.00 | 36% above | 20% |
| Blood glucose (sugar) test CPT 82947 2 Hour Glucose | $46.00 | $58.00 | $4.00–$55.00 | 2% below | 21% |
| Blood glucose (sugar) test CPT 82947 1 Hour Glucose | $46.00 | $58.00 | $4.00–$55.00 | 2% below | 21% |
| Blood glucose (sugar) test CPT 82947 5 Hour Glucose | $46.00 | $58.00 | $4.00–$55.00 | 2% below | 21% |
| Blood glucose (sugar) test CPT 82947 4 Hour Gtt | $46.00 | $58.00 | $4.00–$55.00 | 2% below | 21% |
| Blood glucose (sugar) test CPT 82947 Cln Glucose | $59.00 | $74.00 | $4.00–$70.00 | 26% above | 20% |
| Blood glucose (sugar) test CPT 82947 Glucose | $59.00 | $74.00 | $4.00–$70.00 | 26% above | 20% |
| Blood lead test CPT 83655 Leadua | $41.00 | $51.00 | $7.00–$48.00 | 37% below | 20% |
| Blood lead test CPT 83655 Lead Whole Blood Venous | $66.00 | $82.00 | $7.00–$78.00 | 2% above | 20% |
| Blood lead test CPT 83655 Lead Capillary | $66.00 | $82.00 | $7.00–$78.00 | 2% above | 20% |
| Blood lead test CPT 83655 Lead Whole Blood Industrial | $66.00 | $82.00 | $7.00–$78.00 | 2% above | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hcg Serum Qualitative | $120.00 | $150.00 | $5.00–$143.00 | 10% above | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo | $67.00 | $84.00 | $2.00–$80.00 | 25% above | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Crp | $85.00 | $106.00 | $3.00–$101.00 | 6% below | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Crp Quant | $85.00 | $106.00 | $3.00–$101.00 | 6% below | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive Protein | $89.00 | $111.00 | $3.00–$105.00 | 2% below | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium Difficile (Toxin A/b) | $154.00 | $193.00 | $22.00–$183.00 | 4% above | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C-difficile-sanford | $154.00 | $193.00 | $22.00–$183.00 | 4% above | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C-diff | $178.00 | $222.00 | $22.00–$211.00 | 20% above | 20% |
| CA 19-9 blood test (tumor marker) CPT 86301 Ca 19-9 | $220.00 | $275.00 | $12.00–$261.00 | 46% above | 20% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Ca 125 | $187.00 | $234.00 | $12.00–$222.00 | 44% above | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Covid19 Ref Lab | $130.00 | $163.00 | $31.00–$153.00 | 5% above | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Covid-19 Abbott | $157.00 | $196.00 | $31.00–$184.00 | 27% above | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Sars Cov-2 | $166.00 | $208.00 | $31.00–$196.00 | 34% above | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Severe Acute Resp Syndrome (Sars-cov-2) | $208.00 | $260.00 | $31.00–$244.00 | 68% above | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) one side CPT 87635 Sars-cov-2 Rna Qualreal-time Rt-pcr | $130.00 | $163.00 | $31.00–$153.00 | 5% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Screen | $138.00 | $172.00 | $21.00–$163.00 | 25% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C Trachomatis Nuc Acid | $138.00 | $172.00 | $21.00–$163.00 | 25% above | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids | $149.00 | $186.00 | $8.00–$175.00 | 31% above | 20% |
| Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (CBC), with differential white blood cells, automated | $122.00 | $152.00 | $5.00–$143.00 | 35% above | 20% |
| Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (CBC), automated | $98.00 | $123.00 | $4.00–$117.00 | 39% above | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals | $195.00 | $244.00 | $6.00–$229.00 | 27% above | 20% |
| D-dimer blood test (blood clot marker) CPT 85379 D-dimer Quant | $157.00 | $196.00 | $6.00–$186.00 | 18% above | 20% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 Dhea-sulfate | $120.00 | $150.00 | $13.00–$143.00 | 15% below | 20% |
| Estradiol blood test CPT 82670 Estradiol, Ultrasensitive | $43.00 | $54.00 | $17.00–$51.00 | 67% below | 20% |
| Estradiol blood test CPT 82670 Estradiol, Serum (Adolescent) | $51.00 | $64.00 | $17.00–$61.00 | 61% below | 20% |
| Estradiol blood test CPT 82670 Estradiol | $155.00 | $194.00 | $17.00–$184.00 | 20% above | 20% |
| FSH (follicle-stimulating hormone) test CPT 83001 Fsh | $108.00 | $135.00 | $11.00–$128.00 | 4% below | 20% |
| Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin Stool | $367.00 | $459.00 | $12.00–$436.00 | 3% above | 20% |
| Ferritin blood test (iron stores) CPT 82728 Ferritin-sanford | $130.00 | $162.00 | $8.00–$154.00 | 25% above | 20% |
| Ferritin blood test (iron stores) CPT 82728 Ferritin | $134.00 | $168.00 | $8.00–$160.00 | 28% above | 20% |
| Folate (folic acid) blood test CPT 82746 Folate | $97.00 | $121.00 | $9.00–$115.00 | 8% below | 20% |
| Free T3 thyroid hormone test CPT 84481 T3 Free | $156.00 | $195.00 | $10.00–$185.00 | 1% above | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 By Direct Dialysis | $90.00 | $113.00 | $5.00–$107.00 | 6% above | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Free | $104.00 | $130.00 | $5.00–$124.00 | 22% above | 20% |
| Free testosterone test CPT 84402 Testosterone Free | $82.00 | $102.00 | $15.00–$97.00 | 21% below | 20% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 Gen Health Pnl Cmp/cbc/tsh | $432.00 | $540.00 | $26.00–$513.00 | 48% above | 20% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 Gen Health Pnl Cmp/cbcd/tsh | $455.00 | $569.00 | $26.00–$541.00 | 56% above | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Fasting Blood Glucose | $53.00 | $66.00 | $5.00–$63.00 | 3% below | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Fasting Glucose | $58.00 | $72.00 | $5.00–$68.00 | 6% above | 19% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Gtt | $66.00 | $83.00 | $5.00–$79.00 | 21% above | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 1 Hour Gtt | $66.00 | $83.00 | $5.00–$79.00 | 21% above | 20% |
| Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerance 3 Specimens | $132.00 | $165.00 | $13.00–$157.00 | 2% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N Gonorrhea Nuc Acid | $136.00 | $170.00 | $21.00–$162.00 | 25% above | 20% |
| H. pylori stool antigen test CPT 87338 H Pylori Antigen Stool | $166.00 | $208.00 | $9.00–$198.00 | 4% above | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv-1 Rna Detection Quant | $104.00 | $130.00 | $51.00–$147.00 | 80% below | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hiv Screen Reflex To Confirmation | $64.00 | $80.00 | $14.00–$76.00 | 13% below | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hgb A1c | $94.00 | $118.00 | $6.00–$112.00 | 32% above | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surf Antibody | $94.00 | $117.00 | $6.00–$111.00 | 4% above | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag- Pregnant | $82.00 | $102.00 | $6.00–$97.00 | 12% below | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab Reflex Hcv Rna Quant | $99.00 | $124.00 | $9.00–$118.00 | 8% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab | $99.00 | $124.00 | $9.00–$118.00 | 8% above | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Rna Quant, Monitoring | $114.00 | $142.00 | $26.00–$135.00 | 66% below | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Rna Quant | $324.00 | $405.00 | $26.00–$385.00 | 3% below | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 Herpes Type 1 Igg | $107.00 | $134.00 | $8.00–$127.00 | 7% above | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 Herpes Type 2 Igg | $74.00 | $92.00 | $12.00–$87.00 | 30% below | 20% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 Crpcardio | $83.00 | $104.00 | $8.00–$99.00 | 2% above | 20% |
| Homocysteine blood test CPT 83090 Homocysteine | $195.00 | $244.00 | $11.00–$232.00 | 38% above | 20% |
| Insulin blood test CPT 83525 Insulin Level | $118.00 | $148.00 | $7.00–$141.00 | 9% above | 20% |
| Iron blood test (serum iron) CPT 83540 Iron | $46.00 | $57.00 | $4.00–$54.00 | 27% below | 19% |
| Iron-binding capacity (TIBC) test CPT 83550 Tibc | $46.00 | $57.00 | $5.00–$54.00 | 33% below | 19% |
| Kidney function blood test panel CPT 80069 Kidney function panel test | $152.00 | $190.00 | $5.00–$181.00 | 12% above | 20% |
| LH (luteinizing hormone) test CPT 83002 Lh | $101.00 | $126.00 | $11.00–$120.00 | 19% below | 20% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase | $115.00 | $144.00 | $4.00–$137.00 | 20% above | 20% |
| Liver function blood test panel CPT 80076 Liver function blood test | $143.00 | $179.00 | $5.00–$170.00 | 10% above | 20% |
| Lyme disease antibody test CPT 86618 Lyme Disease Antireflex To Confirm | $128.00 | $160.00 | $10.00–$152.00 | 1% below | 20% |
| Magnesium blood test CPT 83735 Rbc Mg | $82.00 | $102.00 | $4.00–$97.00 | 20% above | 20% |
| Magnesium blood test CPT 83735 Magnesium | $89.00 | $111.00 | $4.00–$105.00 | 31% above | 20% |
| Measles (rubeola) antibody test CPT 86765 Rubeola Igm Ab (Measles) | $59.00 | $74.00 | $8.00–$70.00 | 29% below | 20% |
| Measles (rubeola) antibody test CPT 86765 Rubeola Igg Antibody | $59.00 | $74.00 | $8.00–$70.00 | 29% below | 20% |
| Mono test (heterophile antibody, Monospot) CPT 86308 Mono Test | $83.00 | $104.00 | $5.00–$99.00 | 28% above | 20% |
| Obstetric blood test panel CPT 80055 Obstetric blood test panel | $283.00 | $354.00 | $29.00–$336.00 | 43% above | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Total prostate-specific antigen (PSA) test | $119.00 | $149.00 | $11.00–$142.00 | 7% below | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Total prostate-specific antigen (PSA) test | $131.00 | $164.00 | $11.00–$156.00 | 26% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap Smear | $96.00 | $120.00 | $27.00–$114.00 | 16% above | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 Pth | $194.00 | $243.00 | $25.00–$231.00 | 8% below | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test | $99.00 | $124.00 | $4.00–$118.00 | 28% above | 20% |
| Progesterone blood test CPT 84144 Progesterone | $103.00 | $129.00 | $13.00–$123.00 | 5% below | 20% |
| Prolactin blood test CPT 84146 Prolactin | $119.00 | $149.00 | $12.00–$142.00 | 6% above | 20% |
| Prolactin blood test CPT 84146 Macroprolactin | $200.00 | $250.00 | $12.00–$238.00 | 79% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time | $66.00 | $82.00 | $4.00–$77.00 | 31% above | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Nicotine And Cotinine Screen Urine | $140.00 | $175.00 | $8.00–$166.00 | 47% above | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Nicotine And Metabolites Quant | $140.00 | $175.00 | $8.00–$166.00 | 47% above | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug Screen Non-dottesting | $146.00 | $182.00 | $8.00–$173.00 | 54% above | 20% |
| Rapid flu test (influenza antigen) CPT 87804 Cln Influenza B | $37.00 | $46.00 | $14.00–$44.00 | 50% below | 20% |
| Rapid flu test (influenza antigen) CPT 87804 Cln Influenza A | $37.00 | $46.00 | $14.00–$44.00 | 50% below | 20% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 Cln Strep A | $37.00 | $46.00 | $17.00–$44.00 | 24% below | 20% |
| Rheumatoid factor (RF) test CPT 86431 Ra Titer Quant | $56.00 | $70.00 | $3.00–$67.00 | 3% above | 20% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Quant | $64.00 | $80.00 | $3.00–$76.00 | 18% above | 20% |
| Rubella antibody test (immunity check) CPT 86762 Rubella Igg Screen | $62.00 | $78.00 | $9.00–$74.00 | 16% below | 21% |
| Rubella antibody test (immunity check) CPT 86762 Rubella Igg Antibody | $62.00 | $78.00 | $9.00–$74.00 | 16% below | 21% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sed Rate Automated | $63.00 | $79.00 | $2.00–$75.00 | 34% above | 20% |
| Stool ova and parasites exam CPT 87177 O&p-gastric | $80.00 | $100.00 | $5.00–$95.00 | 7% above | 20% |
| Stool ova and parasites exam CPT 87177 O&p | $80.00 | $100.00 | $5.00–$95.00 | 7% above | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Cancer Screen | $46.00 | $58.00 | $4.00–$55.00 | 67% above | 21% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Cln Hematest | $46.00 | $58.00 | $4.00–$55.00 | 67% above | 21% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rpr | $46.00 | $57.00 | $3.00–$54.00 | 10% above | 19% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon Tb | $224.00 | $280.00 | $37.00–$266.00 | 11% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total, Immunoassay | $82.00 | $102.00 | $15.00–$97.00 | 23% below | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Random Draw Females | $82.00 | $102.00 | $15.00–$97.00 | 23% below | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total | $82.00 | $102.00 | $15.00–$97.00 | 23% below | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Total Testosterone Random Draw Female | $82.00 | $102.00 | $15.00–$97.00 | 23% below | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Microsomal Ab | $100.00 | $125.00 | $9.00–$119.00 | 19% above | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Liver Kidney Microsome Ab | $106.00 | $132.00 | $9.00–$125.00 | 27% above | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibody | $160.00 | $200.00 | $9.00–$190.00 | 91% above | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH) | $138.00 | $173.00 | $10.00–$163.00 | 31% above | 20% |
| Uric acid blood test CPT 84550 Uric Acid | $66.00 | $82.00 | $3.00–$78.00 | 26% above | 20% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis test using microscope | $34.00 | $42.00 | $3.00–$39.00 | 32% below | 19% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis test | $65.00 | $81.00 | $2.00–$77.00 | 106% above | 20% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis test | $20.00 | $25.00 | $3.00–$24.00 | 7% below | 20% |
| Urine culture for bacteria, with colony count CPT 87086 Culture Urine | $73.00 | $91.00 | $5.00–$86.00 | 2% above | 20% |
| Urine pregnancy test, read by color change CPT 81025 Hcg Urine (Completed By Nursing) | $79.00 | $99.00 | $9.00–$94.00 | 25% above | 20% |
| Urine pregnancy test, read by color change CPT 81025 Cln Urine Pregnancy Test | $83.00 | $104.00 | $9.00–$99.00 | 31% above | 20% |
| Urine pregnancy test, read by color change CPT 81025 Hcg Urine Qualitative | $86.00 | $108.00 | $9.00–$103.00 | 36% above | 20% |
| Urine pregnancy test, read by color change CPT 81025 Hcg Urine Qual (Completed By Nursing) | $86.00 | $108.00 | $9.00–$103.00 | 36% above | 20% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12-sanford | $41.00 | $51.00 | $9.00–$48.00 | 64% below | 20% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 | $134.00 | $168.00 | $9.00–$160.00 | 19% above | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 3 25 Hydroxy | $125.00 | $156.00 | $18.00–$148.00 | 11% below | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy | $148.00 | $185.00 | $18.00–$176.00 | 6% above | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D2 & D3, 25-oh | $190.00 | $238.00 | $18.00–$226.00 | 36% above | 20% |
| Zinc blood test CPT 84630 Zinc | $118.00 | $148.00 | $7.00–$141.00 | 79% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Tumor Marker | $56.00 | $70.00 | $15.00–$67.00 | 37% below | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Quant | $108.00 | $135.00 | $15.00–$128.00 | 22% above | 20% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Botox injections for chronic migraine both sides CPT 64615 Ent Chemodenervate Muscle Bilat Profe | $337.00 | $421.00 | $94.00–$400.00 | — | 20% |
| Botox injections for chronic migraine both sides CPT 64615 Ent Chemodenervation Muscle Bilat | $629.00 | $786.00 | $153.00–$747.00 | — | 20% |
| Botox injections for chronic migraine both sides CPT 64615 Botox Muscle Bilat | $629.00 | $786.00 | $153.00–$747.00 | — | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Cln Closed Tx Distal Fibular | $507.00 | $634.00 | $304.00–$602.00 | 27% above | 20% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Cln Closed Tx Metatarsal Fx | $494.00 | $618.00 | $268.00–$587.00 | 36% above | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion | $1,330.00 | $1,663.00 | $148.00–$1,580.00 | 7% below | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Closed Tx Distal Radial/ulna Fx No Mprof | $306.00 | $383.00 | $184.00–$364.00 | 33% below | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Cln Closed Tx Distal Radial Fx No Manipu | $547.00 | $684.00 | $328.00–$650.00 | 19% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Closed Tx Distal Radial/ulna Fx No Manip | $547.00 | $684.00 | $328.00–$650.00 | 19% above | 20% |
| Colonoscopy with polyp removal CPT 45385 Removal of polyps or growths of large bowel using an endoscope | $7,975.00 | $9,969.00 | $391.00–$9,471.00 | 616% above | 20% |
| Colonoscopy with tissue sample CPT 45380 Biopsy exam of large bowel using an endoscope | $7,937.00 | $9,921.00 | $308.00–$9,425.00 | 512% above | 20% |
| Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using an endoscope | $8,013.00 | $10,016.00 | $184.00–$9,515.00 | 552% above | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Cln Dest Any Method 1 Lesion | $186.00 | $232.00 | $71.00–$220.00 | 46% above | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruct Premalg Lesion | $186.00 | $232.00 | $71.00–$220.00 | 46% above | 20% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear both sides CPT 69433 Ent Tympanostomy Bilat | $1,768.00 | $2,210.00 | $171.00–$2,100.00 | — | 20% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 Ent Tympanostomy Uni | $886.00 | $1,107.00 | $171.00–$1,052.00 | 88% above | 20% |
| Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 Impacted Cerumen Irrigation Bilateral | $108.00 | $135.00 | $18.00–$128.00 | — | 20% |
| Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 Cln Bilat Ear Cerumen Removal Water Only | $140.00 | $175.00 | $18.00–$166.00 | — | 20% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 Cln Unil Ear Cerumen Removal Water Only | $70.00 | $87.00 | $18.00–$83.00 | 50% above | 20% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Impacted Cerumen Irrigation Unilateral | $97.00 | $121.00 | $18.00–$115.00 | 108% above | 20% |
| Earwax removal with instruments, one ear both sides CPT 69210 Cln Bilat Ear Cerumen Removal Inst/water | $192.00 | $240.00 | $44.00–$228.00 | — | 20% |
| Earwax removal with instruments, one ear CPT 69210 Cln Unil Ear Cerumen Removal Inst/water | $97.00 | $121.00 | $44.00–$115.00 | 13% above | 20% |
| Earwax removal with instruments, one ear CPT 69210 Ent Remove Cerumen 1 Ear | $102.00 | $128.00 | $44.00–$122.00 | 19% above | 20% |
| Earwax removal with instruments, one ear CPT 69210 Ent Remove Cerumen Both Ears | $153.00 | $191.00 | $44.00–$181.00 | 78% above | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Biopsy Of Uterus Lining | $310.00 | $388.00 | $85.00–$369.00 | 41% above | 20% |
| Gallbladder removal, laparoscopic CPT 47562 Removal of gallbladder using an endoscope | $8,585.00 | $10,731.00 | $971.00–$10,194.00 | 395% above | 20% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoidectomy | $852.00 | $1,065.00 | $290.00–$1,012.00 | 42% above | 20% |
| IUD insertion (the device itself billed separately) CPT 58300 Cln Insertion Of Iud | $161.00 | $201.00 | $70.00–$191.00 | 20% below | 20% |
| IUD insertion (the device itself billed separately) CPT 58300 Insert Intrauterine Device | $161.00 | $201.00 | $70.00–$191.00 | 20% below | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Cln I & D Abscess-simple | $258.00 | $323.00 | $133.00–$307.00 | at median | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I & D Abscess Simple/single | $258.00 | $323.00 | $133.00–$307.00 | at median | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Ent I & D Abscess Simple/single | $258.00 | $323.00 | $133.00–$307.00 | at median | 20% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair of groin hernia patient age 5 years or older | $5,340.00 | $6,675.00 | $769.00–$6,341.00 | 288% above | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Ent Inj(s) Tendon Sheath Ligament | $266.00 | $333.00 | $52.00–$316.00 | 55% above | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj(s) Tendon Sheath, Ligament | $266.00 | $333.00 | $52.00–$316.00 | 55% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Er Drain/inj Maj Joint/bursa W/o Us Pro | $137.00 | $171.00 | $36.00–$162.00 | 28% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Cln Drain/inj Maj Joint/bursa W/o Us | $210.00 | $262.00 | $60.00–$249.00 | 10% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Ortho Drain/inj Maj Joint/bursa W/o Us | $363.00 | $454.00 | $60.00–$431.00 | 90% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain/inj Maj Joint/bursa W/o Us-er | $363.00 | $454.00 | $60.00–$431.00 | 90% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain/inj Maj Joint/bursa W/o Us | $363.00 | $454.00 | $60.00–$431.00 | 90% above | 20% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Cln Insert Non-biodegrade Drug Implant | $270.00 | $337.00 | $84.00–$320.00 | 18% above | 20% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insert Drug Implant Device | $270.00 | $337.00 | $84.00–$320.00 | 18% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Cln Drain/inj Intermed.joint/burs W/o Us | $206.00 | $258.00 | $50.00–$245.00 | 12% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Ortho Drain/inj Intermed.joint/bursa W/o | $291.00 | $364.00 | $50.00–$346.00 | 58% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain/inj Intermed.joint/bursa W/o Us | $291.00 | $364.00 | $50.00–$346.00 | 58% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Cln Drain/inj Small Joint/bursa W/o Us | $205.00 | $256.00 | $48.00–$243.00 | 43% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Ent Drain/inj Sm Jnt/bursa W/o Us | $266.00 | $333.00 | $48.00–$316.00 | 85% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Drain/inj Small Joint/bursa W/o Us | $266.00 | $333.00 | $48.00–$316.00 | 85% above | 20% |
| Knee arthroscopy with meniscus trim CPT 29881 Removal of one knee cartilage using an endoscope | $7,381.00 | $9,226.00 | $705.00–$8,765.00 | 218% above | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Cln Excision Benign .5 Or Les | $471.00 | $589.00 | $108.00–$560.00 | 56% above | 20% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Cln Benign .5cm Or L | $453.00 | $566.00 | $136.00–$538.00 | 34% above | 20% |
| Nail removal (partial or complete), one nail CPT 11730 Cln Avulsion Nail Simple Sing | $153.00 | $191.00 | $74.00–$181.00 | 35% below | 20% |
| Nail removal (partial or complete), one nail CPT 11730 Remove/avulsion Of Nail Plate | $229.00 | $286.00 | $74.00–$272.00 | 3% below | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 Nerve Block Inj Occipital | $350.00 | $437.00 | $69.00–$415.00 | 15% below | 20% |
| Paracentesis with imaging guidance CPT 49083 Paracentesis W/imaging | $1,990.00 | $2,488.00 | $167.00–$2,364.00 | 141% above | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Cln Excision Nail Part / Comp,each | $317.00 | $396.00 | $137.00–$376.00 | 4% below | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Partial / Total Matrixecomy, Ea | $525.00 | $656.00 | $137.00–$623.00 | 59% above | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 Cln Remove Foreign Body Simp | $262.00 | $328.00 | $136.00–$312.00 | 20% below | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 Remove Foreign Body-simple Prof | $362.00 | $452.00 | $95.00–$429.00 | 11% above | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 Remove Foreign Body Sq, Simple | $764.00 | $955.00 | $136.00–$907.00 | 134% above | 20% |
| Short arm cast (elbow to hand) CPT 29075 Cln Casting Elbow To Finger | $195.00 | $244.00 | $80.00–$232.00 | 1% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 Apply Forearm Splint | $230.00 | $288.00 | $51.00–$274.00 | 49% above | 20% |
| Short arm splint (forearm and hand) CPT 29125 Ot Splint Application Short Arm Static | $230.00 | $288.00 | $51.00–$274.00 | 49% above | 20% |
| Short arm splint (forearm and hand) CPT 29125 Cln Application Short Arm Spl | $230.00 | $288.00 | $51.00–$274.00 | 49% above | 20% |
| Short leg cast (below the knee) CPT 29405 Cln Application Short Leg Cast | $195.00 | $244.00 | $77.00–$232.00 | 5% above | 20% |
| Short leg splint (calf to foot) CPT 29515 Cln Application Short Leg Spl | $118.00 | $147.00 | $65.00–$140.00 | 26% below | 20% |
| Short leg splint (calf to foot) CPT 29515 Application Of Lower Leg Splint | $270.00 | $337.00 | $65.00–$320.00 | 70% above | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Repair S/n/ax/gen/trk 2.5cm/< | $361.00 | $451.00 | $59.00–$428.00 | 74% above | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Cln Repair Simple 2.5 Or Less | $362.00 | $452.00 | $59.00–$429.00 | 74% above | 20% |
| Skin biopsy, punch, one lesion CPT 11104 Cln Punch Biopsy Single Lesion | $256.00 | $320.00 | $65.00–$304.00 | 1% above | 20% |
| Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy Skin Simple Clos,1 Lesion | $358.00 | $448.00 | $65.00–$426.00 | 41% above | 20% |
| Skin tag removal, up to 15 tags CPT 11200 Cln Remove Skin Tag Up To & Including 15 | $174.00 | $218.00 | $97.00–$207.00 | 8% below | 20% |
| Skin tag removal, up to 15 tags CPT 11200 Remove Skin Tag Up To & Including 15 | $184.00 | $230.00 | $97.00–$219.00 | 3% below | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Cln Repair Simple 2.6-7.5cm | $399.00 | $499.00 | $78.00–$474.00 | 64% above | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Repair S/n/ax/gen/trnk 2.6-7.5cm | $409.00 | $511.00 | $78.00–$485.00 | 68% above | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Repair Simple F/e/e/n/l/m 0.01-2.5profee | $199.00 | $249.00 | $49.00–$237.00 | 13% below | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Cln Repair Simple 2.5 Or Less | $308.00 | $385.00 | $73.00–$366.00 | 35% above | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Repair Simple F/e/e/n/l/m 0.01-2.5cm | $308.00 | $385.00 | $73.00–$366.00 | 35% above | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 Cln Tangntl Bx-skin Single Lesion | $223.00 | $279.00 | $52.00–$265.00 | 17% above | 20% |
| Thoracentesis with imaging guidance CPT 32555 Thoracentesis | $1,990.00 | $2,488.00 | $152.00–$2,364.00 | 141% above | 20% |
| Trigger finger release surgery CPT 26055 Trigger Finger Release Each | $1,699.00 | $2,124.00 | $378.00–$2,018.00 | 42% above | 20% |
| Trigger finger release surgery CPT 26055 Ent Trigger Finger Ea | $2,562.00 | $3,202.00 | $378.00–$3,042.00 | 114% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Cln Inj Single Or Mult Trigg | $205.00 | $256.00 | $51.00–$243.00 | 59% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Er Inj Trigger Point 1or2 Muscles | $493.00 | $616.00 | $51.00–$585.00 | 282% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Ent Inj Trigger Point 1or2 Muscle | $493.00 | $616.00 | $51.00–$585.00 | 282% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Pain Trigger Point Inj 1 Or 2 Muscles | $493.00 | $616.00 | $51.00–$585.00 | 282% above | 20% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Biopsy exam of esophagus, stomach or small bowel using an endoscope | $8,402.00 | $10,503.00 | $212.00–$9,978.00 | 453% above | 20% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Jp Vasectomy | $1,834.00 | $2,293.00 | $304.00–$2,178.00 | 88% above | 20% |
| Wart removal, up to 14 warts CPT 17110 Cln Destoy B9 Lesion 1-14 | $194.00 | $243.00 | $88.00–$231.00 | 11% above | 20% |
| Wart removal, up to 14 warts CPT 17110 Destroy B9 Lesion 1-14 | $194.00 | $243.00 | $88.00–$231.00 | 11% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Cln Debridement Skin & Subcut | $272.00 | $340.00 | $81.00–$323.00 | 9% below | 20% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Bld/bld Products Transfus 1-4hrs Per Day | $503.00 | $629.00 | $51.00–$598.00 | 30% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 Bld/bld Products Transfu 1-8 Hrs Per Day | $898.00 | $1,123.00 | $51.00–$1,067.00 | 26% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 Bld/bld Products Transfu 1-16hrs Per Day | $1,198.00 | $1,498.00 | $51.00–$1,423.00 | 67% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Cln Nebulizer Treatment | $68.00 | $85.00 | $28.00–$81.00 | 36% below | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment Per Episode | $481.00 | $601.00 | $28.00–$571.00 | 355% above | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 Er Level Critical 30-74minutes | $3,042.00 | $3,803.00 | $267.00–$3,613.00 | 367% above | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Dont Useekg W Over Read | $318.00 | $397.00 | $13.00–$373.00 | 34% above | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg W/no Over Read | $334.00 | $418.00 | $201.00–$397.00 | 41% above | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Cln Ekg W Over Read | $365.00 | $456.00 | $13.00–$429.00 | 54% above | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg W/overread Charge | $365.00 | $456.00 | $13.00–$429.00 | 54% above | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Er Level I | $188.00 | $235.00 | $27.00–$223.00 | 23% above | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Er Level Ii | $319.00 | $399.00 | $52.00–$379.00 | 65% above | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Er Level Iii | $509.00 | $636.00 | $78.00–$604.00 | 85% above | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Er Level Iv | $740.00 | $925.00 | $143.00–$879.00 | 57% above | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Er Level V | $1,165.00 | $1,456.00 | $207.00–$1,383.00 | 77% above | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Stress Test-treadmill/pharm Tracing Only | $1,216.00 | $1,520.00 | $43.00–$1,444.00 | 13% above | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Hydr Initial 31-60min96360 | $420.00 | $525.00 | $55.00–$494.00 | 11% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 Iv Inf Initial16-60min96365 | $414.00 | $517.00 | $114.00–$486.00 | 8% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Cln Adm Fee Per Inj | $22.00 | $27.00 | $13.00–$27.00 | 76% below | 19% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Im/sub Q Add96372 | $124.00 | $155.00 | $24.00–$147.00 | 36% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Im/sub Q 1st Inj96372 | $124.00 | $155.00 | $24.00–$147.00 | 36% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inj Sq/im Procedure | $149.00 | $186.00 | $24.00–$177.00 | 64% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Ent Inj Sq/im Procedure | $149.00 | $186.00 | $24.00–$177.00 | 64% above | 20% |
| Neuromuscular re-education, 15 minutes CPT 97112 Pt Neuromuscle Re-ed Per 15min | $105.00 | $131.00 | $34.00–$124.00 | 15% above | 20% |
| Neuromuscular re-education, 15 minutes CPT 97112 Ot Neuromuscular Re-ed 15min | $105.00 | $131.00 | $34.00–$124.00 | 15% above | 20% |
| New patient office visit, about 30 minutes CPT 99203 New patient office or other outpatient visit, 30 min | $242.00 | $303.00 | $91.00–$285.00 | 18% above | 20% |
| New patient office visit, about 45 minutes CPT 99204 New patient office or other outpatient visit, 45 min | $344.00 | $430.00 | $155.00–$404.00 | 14% above | 20% |
| New patient office visit, about 60 minutes CPT 99205 New patient office or other outpatient visit, 60 min | $430.00 | $537.00 | $203.00–$505.00 | 16% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Cln Office Visit New Level Ii | $153.00 | $191.00 | $60.00–$180.00 | 24% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Jp Outreach New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Cardiology Outreach New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Ent Outreach New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Gyn Outreach New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Podiatry Outreach New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Pulmonary Outreach New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Surgery Outreach New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Behavioral Health Outreach New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Pain Mgmt Outreach New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Allergy New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Orthopedic Outreach New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Diabetes Ed Outreach New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Ther Botox New Level 2 | $161.00 | $201.00 | $60.00–$189.00 | 30% above | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Nutrition Ther Assessment Per 15 Min | $105.00 | $131.00 | $48.00–$124.00 | 118% above | 20% |
| Occupational therapy evaluation, low complexity CPT 97165 Ot Evaluation (30) Low | $258.00 | $323.00 | $87.00–$307.00 | 57% above | 20% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Evaluation (45) High | $334.00 | $418.00 | $83.00–$397.00 | 61% above | 20% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Evaluation (20) Low | $232.00 | $290.00 | $83.00–$276.00 | 47% above | 20% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Evaluation (30) Moderate | $283.00 | $354.00 | $83.00–$336.00 | 60% above | 20% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Ot Manual Therapy 15min | $107.00 | $134.00 | $27.00–$126.00 | 11% above | 20% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Pt Manual Therapy 15min | $107.00 | $134.00 | $27.00–$126.00 | 11% above | 20% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Cln Manual Therapy 15min | $107.00 | $134.00 | $27.00–$126.00 | 11% above | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Physical therapy, therapeutic exercise | $105.00 | $131.00 | $30.00–$123.00 | 11% above | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 Initial new patient preventative medicine evaluation (18-39 years) | $247.00 | $309.00 | $120.00–$294.00 | at median | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Initial new patient preventative medicine evaluation (40-64 years) | $268.00 | $335.00 | $145.00–$318.00 | 4% below | 20% |
| Preventive checkup, new patient aged 65 or older CPT 99387 Cln Physical New 65+ | $274.00 | $343.00 | $156.00–$326.00 | at median | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 Cln Physical Est 18-39 | $220.00 | $275.00 | $109.00–$261.00 | 1% above | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 Cln Physical Est 40-64 | $234.00 | $293.00 | $118.00–$278.00 | 1% above | 20% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 Cln Physical Est 65+ | $238.00 | $297.00 | $125.00–$282.00 | at median | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Pain Mgmt Outreach Est Level 5 | $254.00 | $318.00 | $135.00–$299.00 | 7% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Cardiology Outreach Est Level 5 | $254.00 | $318.00 | $135.00–$299.00 | 7% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Ent Outreach Est Level 5 | $254.00 | $318.00 | $135.00–$299.00 | 7% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Gyn Outreach Est Level 5 | $254.00 | $318.00 | $135.00–$299.00 | 7% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Podiatry Outreach Est Level 5 | $254.00 | $318.00 | $135.00–$299.00 | 7% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Surgery Outreach Est Level 5 | $254.00 | $318.00 | $135.00–$299.00 | 7% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Behavioral Health Outreach Est Level 5 | $254.00 | $318.00 | $135.00–$299.00 | 7% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Allergy Est Level 5 | $254.00 | $318.00 | $135.00–$299.00 | 7% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Orthopedic Outreach Est Level 5 | $254.00 | $318.00 | $135.00–$299.00 | 7% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Ther Botox Est Level 5 | $254.00 | $318.00 | $135.00–$299.00 | 7% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Pulmonary Outreach Est Level 5 | $314.00 | $393.00 | $135.00–$369.00 | 33% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Cln Office Visit Est Level V | $329.00 | $411.00 | $135.00–$386.00 | 39% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Op Level V | $642.00 | $803.00 | $135.00–$755.00 | 171% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Allergy Est Level 3 | $120.00 | $150.00 | $62.00–$141.00 | 2% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Gyn Outreach Est Level 3 | $138.00 | $173.00 | $62.00–$163.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Podiatry Outreach Est Level 3 | $138.00 | $173.00 | $62.00–$163.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Pulmonary Outreach Est Level 3 | $138.00 | $173.00 | $62.00–$163.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Surgery Outreach Est Level 3 | $138.00 | $173.00 | $62.00–$163.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Cardiology Outreach Est Level 3 | $138.00 | $173.00 | $62.00–$163.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Ent Outreach Est Level 3 | $138.00 | $173.00 | $62.00–$163.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Behavioral Health Outreach Est Level 3 | $138.00 | $173.00 | $62.00–$163.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Pain Mgmt Outreach Est Level 3 | $138.00 | $173.00 | $62.00–$163.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Jp Outreach Est Level 3 | $138.00 | $173.00 | $62.00–$163.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Ther Botox Est Level 3 | $138.00 | $173.00 | $62.00–$163.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Diabetes Ed Outreach Est Level 3 | $138.00 | $173.00 | $62.00–$163.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Orthopedic Outreach Est Level 3 | $138.00 | $173.00 | $62.00–$163.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Cln Office Visit Est Level Iii | $153.00 | $191.00 | $62.00–$180.00 | 29% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Op Level Iii | $332.00 | $415.00 | $62.00–$390.00 | 181% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Jp Outreach Est Level 4 | $195.00 | $244.00 | $95.00–$229.00 | 12% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Ther Botox Est Level 4 | $195.00 | $244.00 | $95.00–$229.00 | 12% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Orthopedic Outreach Est Level 4 | $195.00 | $244.00 | $95.00–$229.00 | 12% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Allergy Est Level 4 | $195.00 | $244.00 | $95.00–$229.00 | 12% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Pain Mgmt Outreach Est Level 4 | $195.00 | $244.00 | $95.00–$229.00 | 12% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Behavioral Health Outreach Est Level 4 | $195.00 | $244.00 | $95.00–$229.00 | 12% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Surgery Outreach Est Level 4 | $195.00 | $244.00 | $95.00–$229.00 | 12% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Pulmonary Outreach Est Level 4 | $195.00 | $244.00 | $95.00–$229.00 | 12% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Podiatry Outreach Est Level 4 | $195.00 | $244.00 | $95.00–$229.00 | 12% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Gyn Outreach Est Level 4 | $195.00 | $244.00 | $95.00–$229.00 | 12% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Ent Outreach Est Level 4 | $195.00 | $244.00 | $95.00–$229.00 | 12% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Cardiology Outreach Est Level 4 | $195.00 | $244.00 | $95.00–$229.00 | 12% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Cln Office Visit Est Level Iv | $244.00 | $305.00 | $95.00–$287.00 | 40% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Jp Outreach Est Level 5 | $254.00 | $318.00 | $95.00–$299.00 | 45% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Op Level Iv | $460.00 | $575.00 | $95.00–$541.00 | 163% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Cln Suture Removal Outside Global | $50.00 | $62.00 | $30.00–$80.00 | 40% below | 19% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Chiropractic Outreach | $59.00 | $74.00 | $31.00–$80.00 | 30% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Allergy Est Level 2 | $83.00 | $104.00 | $31.00–$98.00 | 1% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Pulmonary Outreach Est Level 2 | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Surgery Outreach Est Level 2 | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Ther Botox Est Level 2 | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Jp Outreach Est Level 2 | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Cln Office Visit Est Level Ii | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Gyn Outreach Est Level 2 | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Podiatry Outreach Est Level 2 | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Behavioral Health Outreach Est Level 2 | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Cardiology Outreach Est Level 2 | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Ent Outreach Est Level 2 | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Diabetes Ed Outreach Est Level 2 | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Orthopedic Outreach Est Level 2 | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Pain Mgmt Outreach Est Level 2 | $97.00 | $121.00 | $31.00–$114.00 | 15% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Op Level Ii | $213.00 | $266.00 | $31.00–$250.00 | 154% above | 20% |
| Speech and language evaluation CPT 92523 St Evaluation Language | $586.00 | $733.00 | $326.00–$696.00 | 90% above | 20% |
| Speech therapy session, individual CPT 92507 St Slp Trmt Of Individual | $304.00 | $380.00 | $131.00–$361.00 | 25% above | 20% |
| Spirometry (breathing test) CPT 94010 Spirometry/wo Bronco Dilator | $350.00 | $437.00 | $43.00–$415.00 | 30% above | 20% |
| Spirometry before and after a bronchodilator CPT 94060 Spirometry W Bronco Dilator | $774.00 | $967.00 | $74.00–$919.00 | 38% above | 20% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Pt Therapeutic Activities Per 15min | $109.00 | $136.00 | $38.00–$129.00 | 27% above | 20% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Ot Therapeutic Activity Direct Per 15min | $109.00 | $136.00 | $38.00–$129.00 | 27% above | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phelbotomy Up To 2hrs | $277.00 | $346.00 | $159.00–$329.00 | 44% above | 20% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Cln Imm Covid-19 (Moderna) Susp >12 Yrs | $162.00 | $203.00 | $97.00–$294.00 | 15% below | 20% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Cln Imm Varicella (Varivax)virus Live | $231.00 | $289.00 | $139.00–$275.00 | 16% above | 20% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Cln Vfc Fluzone | $15.00 | $19.00 | $9.00–$23.00 | 44% below | 21% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza (Fluzone)virus Vaccine 0.5 Ml | $23.00 | $29.00 | $14.00–$28.00 | 15% below | 21% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Cln Imm Flu Vaccine Pres Free >6 Mos | $23.00 | $29.00 | $14.00–$28.00 | 15% below | 21% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Cln Hpv9 (Gardasil) | $245.00 | $306.00 | $147.00–$316.00 | 34% below | 20% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Cln Imm Hpv 9-valent Recomb(gardasil) | $309.00 | $386.00 | $185.00–$367.00 | 16% below | 20% |
| Hepatitis A vaccine, adult dose CPT 90632 Cln Imm Hepatitis A Adult(havrix) | $94.00 | $118.00 | $57.00–$112.00 | at median | 20% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Cln Imm Hepatitis B Adult(engerix) | $79.00 | $99.00 | $48.00–$94.00 | 13% below | 20% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza(fluzone)vaccine High Dose .5ml | $82.00 | $102.00 | $49.00–$97.00 | at median | 20% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Cln Imm Flu Vaccine High Dose >65yrs | $82.00 | $102.00 | $49.00–$97.00 | at median | 20% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 Cln Imm Measles, Mumps, Rubella(mmr) | $112.00 | $140.00 | $67.00–$133.00 | at median | 20% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Cln Imm Meningococcal Group B(bexero) | $246.00 | $308.00 | $148.00–$293.00 | 11% below | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Cln Imm Pneumo 20-val(prevnar 20) Mdcr | $312.00 | $390.00 | $187.00–$371.00 | 28% below | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal (Prevnar)20-valent 0.5ml | $312.00 | $390.00 | $187.00–$371.00 | 28% below | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Cln Imm Pneumococcal 20-val(prevnar 20) | $338.00 | $422.00 | $203.00–$401.00 | 22% below | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Cln Imm Pneumococcal 23(pneumovax 23) | $126.00 | $158.00 | $76.00–$150.00 | 32% below | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal (Pneumovax)23 Inj 0.5ml | $134.00 | $167.00 | $80.00–$159.00 | 28% below | 20% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 Cln Imm Rsv Vaccine (Abrysvo) Non-form | $320.00 | $400.00 | $192.00–$380.00 | 15% below | 20% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 Cln Imm Rsv Vaccine, Adjuvanted (Arexvy) | $368.00 | $460.00 | $221.00–$437.00 | 4% below | 20% |
| Rabies vaccine, one dose CPT 90675 Cln Imm Rabies Vaccine [2.5 U](rabavert) | $425.00 | $531.00 | $255.00–$504.00 | 13% below | 20% |
| Rabies vaccine, one dose CPT 90675 Rabies Vaccine (Rabavert)2.5 Units/1 Ml | $550.00 | $687.00 | $318.00–$653.00 | 13% above | 20% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Cln Imm Shingrix [0.5ml] | $280.00 | $350.00 | $168.00–$333.00 | 2% below | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Cln Vfc Diptheria-tet Toxoids(tenivac) | $15.00 | $19.00 | $9.00–$41.00 | 71% below | 21% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Cln Imm Diptheria-tetanus(tenivac) | $48.00 | $60.00 | $29.00–$57.00 | 8% below | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus/diphtheria (Td) Inj .5ml | $73.00 | $91.00 | $41.00–$86.00 | 40% above | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Cln Vfc Tdap(adacel) | $15.00 | $19.00 | $9.00–$55.00 | 79% below | 21% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Cln Vfc Tdap(boostrix) | $15.00 | $19.00 | $9.00–$55.00 | 79% below | 21% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Cln Imm Tet-dipth-acell Pert(boostrix) | $56.00 | $70.00 | $34.00–$67.00 | 20% below | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus/dipth/apertussis (Tdap) 0.5ml | $79.00 | $99.00 | $48.00–$94.00 | 13% above | 20% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Cln Imm Typhoid Vi Polysaccharid(typhim) | $83.00 | $104.00 | $50.00–$146.00 | 55% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 19+ Im / Sq 1st Vcx (Single Or Combo) | $39.00 | $49.00 | $13.00–$46.00 | 10% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Cln 19+im/sq 1st Vcx (Single Or Combo) | $39.00 | $49.00 | $13.00–$46.00 | 10% above | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 19+ Im/sq Ea Addtl Vcx (Single Or Combo) | $22.00 | $27.00 | $12.00–$26.00 | 34% below | 19% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Cln 19+im/sq Ea Addtl Vcx (Single/combo | $22.00 | $27.00 | $12.00–$26.00 | 34% below | 19% |