Hospital Omaha, NE-IA

CHI Health Bergan Mercy

Listed in its price file as “Alegent Health Bergan Mercy Health System”.

CHI Health Bergan Mercy in Omaha, NE publishes cash prices for 414 common procedures listed here, from its own machine-readable price file updated Feb 28, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Nebraska median for 278 of 410 procedures and above it for 73. By typical cash price it ranks #10 of 52 Nebraska hospitals and #8 of 14 hospitals in the Omaha, NE area, cheapest first. Click a procedure to compare it with other hospitals nearby.

7500 Mercy Road, Omaha, NE 68124 Collected Sep 23, 2026 Source price file (402) 398-6020

Acute care hospital Emergency department CMS star rating 4 of 5 CCN 280060 · CMS hospital register NPI 1508941097

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN W WO CONTRAST	$1,396.08	$3,324.00	$150.18–$2,825.40	54% below	58%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN W WO CONTRAST	$1,396.08	$3,324.00	$1,994.40–$2,825.40	—	58%
Abdominal X-ray, 2 views CPT 74019 HC ABDOMEN COMPLETE 2V	$254.52	$606.00	$48.76–$515.10	29% below	58%
Abdominal X-ray, 2 views inpatient CPT 74019 HC ABDOMEN COMPLETE 2V	$254.52	$606.00	$363.60–$515.10	—	58%
Ankle X-ray, complete, 3 or more views CPT 73610 HC ANKLE COMPLETE	$229.32	$546.00	$53.17–$464.10	30% below	58%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC ANKLE COMPLETE	$229.32	$546.00	$327.60–$464.10	—	58%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC ANKLE BRACHIAL INDEX	$200.34	$477.00	$81.09–$405.45	64% below	58%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC LASER DOPPLER	$334.74	$797.00	$108.74–$677.45	39% below	58%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC ANKLE BRACHIAL INDEX	$200.34	$477.00	$286.20–$405.45	—	58%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC LASER DOPPLER	$334.74	$797.00	$478.20–$677.45	—	58%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXT WO CONTRAST	$893.34	$2,127.00	$89.71–$1,807.95	56% below	58%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXT WO CONTRAST	$893.34	$2,127.00	$1,276.20–$1,807.95	—	58%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC ESOPHAGRAM	$358.68	$854.00	$130.73–$725.90	43% below	58%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC ESOPHAGRAM	$358.68	$854.00	$512.40–$725.90	—	58%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE SCAN WHOLE BODY	$978.18	$2,329.00	$339.00–$1,979.65	44% below	58%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE SCAN WHOLE BODY	$978.18	$2,329.00	$1,397.40–$1,979.65	—	58%
Breast ultrasound, complete, one breast CPT 76641 HC ULTRASOUND BREAST COMPLETE	$139.02	$331.00	$56.27–$331.00	71% below	58%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC ULTRASOUND BREAST COMPLETE	$139.02	$331.00	$198.60–$281.35	—	58%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC ULTRASOUND BREAST LIMITED	$139.02	$331.00	$56.27–$289.36	67% below	58%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC ULTRASOUND BREAST LIMITED	$139.02	$331.00	$198.60–$281.35	—	58%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CT ANGIO AB PELV W WO CONTR	$1,408.26	$3,353.00	$301.29–$2,850.05	71% below	58%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CT ANGIO AB PELV W WO CONTR	$1,408.26	$3,353.00	$2,011.80–$2,850.05	—	58%
CT angiography (CTA) of the head CPT 70496 HC CT ANGIO HEAD W WO CONTRAST	$1,198.68	$2,854.00	$150.18–$2,425.90	58% below	58%
CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIO HEAD W WO CONTRAST	$1,198.68	$2,854.00	$1,712.40–$2,425.90	—	58%
CT angiography (CTA) of the neck CPT 70498 HC CT ANGIO NECK W WO CONTRAST	$1,260.42	$3,001.00	$150.18–$2,550.85	56% below	58%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIO NECK W WO CONTRAST	$1,260.42	$3,001.00	$1,800.60–$2,550.85	—	58%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIO CHEST W WO CONTRST	$1,197.84	$2,852.00	$150.18–$2,424.20	63% below	58%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIO CHEST W WO CONTRST	$1,197.84	$2,852.00	$1,711.20–$2,424.20	—	58%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CTA HEART ARTERIES W CONTRA	$1,309.56	$3,118.00	$301.29–$2,650.30	at median	58%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CTA HEART ARTERIES W CONTRA	$1,309.56	$3,118.00	$1,870.80–$2,650.30	—	58%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT HEART CALCIUM SCORING	$109.20	$260.00	$44.20–$236.03	19% below	58%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT HEART CALCIUM SCORING	$109.20	$260.00	$156.00–$221.00	—	58%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD PELVIS WO CONTRAST	$1,559.04	$3,712.00	$200.30–$3,155.20	58% below	58%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD PELVIS WO CONTRAST	$1,559.04	$3,712.00	$2,227.20–$3,155.20	—	58%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN PELVIS W CONTRST	$2,051.28	$4,884.00	$301.29–$4,151.40	51% below	58%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN PELVIS W CONTRST	$2,051.28	$4,884.00	$2,930.40–$4,151.40	—	58%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD PELVIS W WO CONTRAST	$2,933.70	$6,985.00	$301.29–$5,937.25	42% below	58%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABD PELVIS W WO CONTRAST	$2,933.70	$6,985.00	$4,191.00–$5,937.25	—	58%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST	$1,257.90	$2,995.00	$150.18–$2,545.75	52% below	58%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W CONTRAST	$1,257.90	$2,995.00	$1,797.00–$2,545.75	—	58%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CONTRAST	$943.32	$2,246.00	$89.71–$1,909.10	58% below	58%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN WO CONTRAST	$943.32	$2,246.00	$1,347.60–$1,909.10	—	58%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CONTRST	$808.50	$1,925.00	$89.71–$1,636.25	56% below	58%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL WO CONTRST	$808.50	$1,925.00	$1,155.00–$1,636.25	—	58%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD WO CONTRAST	$673.68	$1,604.00	$89.71–$1,363.40	65% below	58%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD WO CONTRAST	$673.68	$1,604.00	$962.40–$1,363.40	—	58%
CT scan of the head with contrast CPT 70460 HC CT HEAD W CONTRAST	$916.02	$2,181.00	$150.18–$1,853.85	56% below	58%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD W CONTRAST	$916.02	$2,181.00	$1,308.60–$1,853.85	—	58%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD W WO CONTRAST	$1,104.60	$2,630.00	$150.18–$2,235.50	56% below	58%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD W WO CONTRAST	$1,104.60	$2,630.00	$1,578.00–$2,235.50	—	58%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR WO CONTRAST	$935.34	$2,227.00	$89.71–$1,892.95	59% below	58%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR WO CONTRAST	$935.34	$2,227.00	$1,336.20–$1,892.95	—	58%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL WO CONTRAST	$915.18	$2,179.00	$89.71–$1,852.15	61% below	58%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT CERVICAL WO CONTRAST	$915.18	$2,179.00	$1,307.40–$1,852.15	—	58%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST	$1,051.68	$2,504.00	$150.18–$2,128.40	58% below	58%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST	$1,051.68	$2,504.00	$1,502.40–$2,128.40	—	58%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC CAROTID DUPLEX BILATERAL	$660.24	$1,572.00	$203.92–$1,336.20	—	58%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC CAROTID DUPLEX BILATERAL	$660.24	$1,572.00	$943.20–$1,336.20	—	58%
Chest CT scan without and with contrast CPT 71270 HC CT CHEST W WO CONTRAST	$1,265.04	$3,012.00	$150.18–$2,560.20	54% below	58%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT CHEST W WO CONTRAST	$1,265.04	$3,012.00	$1,807.20–$2,560.20	—	58%
Chest X-ray, 2 views CPT 71046 HC CHEST FIREMAN POLICE	$45.36	$108.00	$18.36–$183.63	85% below	58%
Chest X-ray, 2 views CPT 71046 HC CHEST PA LATERAL OHS	$98.28	$234.00	$39.78–$198.90	68% below	58%
Chest X-ray, 2 views CPT 71046 HC CHEST SPECIAL VIEW	$192.36	$458.00	$43.72–$389.30	37% below	58%
Chest X-ray, 2 views CPT 71046 HC CHEST 2 VIEWS PA LAT	$204.12	$486.00	$43.72–$413.10	33% below	58%
Chest X-ray, 2 views inpatient CPT 71046 HC CHEST FIREMAN POLICE	$45.36	$108.00	$64.80–$91.80	—	58%
Chest X-ray, 2 views inpatient CPT 71046 HC CHEST PA LATERAL OHS	$98.28	$234.00	$140.40–$198.90	—	58%
Chest X-ray, 2 views inpatient CPT 71046 HC CHEST SPECIAL VIEW	$192.36	$458.00	$274.80–$389.30	—	58%
Chest X-ray, 2 views inpatient CPT 71046 HC CHEST 2 VIEWS PA LAT	$204.12	$486.00	$291.60–$413.10	—	58%
Chest X-ray, single view CPT 71045 HC CHEST OHS 1 VIEW PA ONLY	$137.76	$328.00	$32.36–$278.80	44% below	58%
Chest X-ray, single view CPT 71045 HC CHEST 1 VIEW PA OR AP ONLY	$143.64	$342.00	$32.36–$290.70	42% below	58%
Chest X-ray, single view inpatient CPT 71045 HC CHEST OHS 1 VIEW PA ONLY	$137.76	$328.00	$196.80–$278.80	—	58%
Chest X-ray, single view inpatient CPT 71045 HC CHEST 1 VIEW PA OR AP ONLY	$143.64	$342.00	$205.20–$290.70	—	58%
Collarbone (clavicle) X-ray, complete CPT 73000 HC CLAVICLE	$166.32	$396.00	$46.24–$336.60	41% below	58%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC CLAVICLE	$166.32	$396.00	$237.60–$336.60	—	58%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE	$488.04	$1,162.00	$89.71–$987.70	38% below	58%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE	$488.04	$1,162.00	$697.20–$987.70	—	58%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DEXA BONE DENSITY	$280.14	$667.00	$55.69–$566.95	35% below	58%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DEXA BONE DENSITY	$280.14	$667.00	$400.20–$566.95	—	58%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL	$57.96	$138.00	$23.46–$183.63	75% below	58%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL	$57.96	$138.00	$82.80–$117.30	—	58%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US PREG DTL TRANSABDOMINAL	$490.98	$1,169.00	$165.84–$993.65	at median	58%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US PREG DTL TRANSABDOMINAL	$490.98	$1,169.00	$701.40–$993.65	—	58%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT CHEST WO CONTRAST	$754.74	$1,797.00	$89.71–$1,527.45	65% below	58%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT CHEST WO CONTRAST	$754.74	$1,797.00	$1,078.20–$1,527.45	—	58%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT CHEST W CONTRAST	$1,110.06	$2,643.00	$150.18–$2,246.55	56% below	58%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT CHEST W CONTRAST	$1,110.06	$2,643.00	$1,585.80–$2,246.55	—	58%
Diagnostic mammogram, both breasts both sides CPT 77066 HC MAMMOGRAM DIGITAL BILATERAL	$128.10	$305.00	$51.85–$394.18	—	58%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC MAMMOGRAM DIGITAL BILATERAL	$128.10	$305.00	$183.00–$259.25	—	58%
Diagnostic mammogram, one breast CPT 77065 HC MAMMOGRAM DIGITAL UNILATERL	$91.14	$217.00	$36.89–$308.16	72% below	58%
Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO INCL CAD UNI	$97.02	$231.00	$39.27–$308.16	70% below	58%
Diagnostic mammogram, one breast one side CPT 77065 HC MAMMO DR UNILATERAL W 3D	$100.38	$239.00	$40.63–$308.16	69% below	58%
Diagnostic mammogram, one breast inpatient CPT 77065 HC MAMMOGRAM DIGITAL UNILATERL	$91.14	$217.00	$130.20–$184.45	—	58%
Diagnostic mammogram, one breast inpatient CPT 77065 HC DX MAMMO INCL CAD UNI	$97.02	$231.00	$138.60–$196.35	—	58%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MAMMO DR UNILATERAL W 3D	$100.38	$239.00	$143.40–$203.15	—	58%
Duplex ultrasound of the leg arteries, both legs CPT 93925 HC ART DUPLEX LOW EXT BIL	$744.66	$1,773.00	$203.92–$1,507.05	34% below	58%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 HC ART DUPLEX LOW EXT BIL	$744.66	$1,773.00	$1,063.80–$1,507.05	—	58%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC VENOUS DUPLEX BILATERAL	$1,451.94	$3,457.00	$203.92–$2,938.45	—	58%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC VENOUS DUPLEX BILATERAL	$1,451.94	$3,457.00	$2,074.20–$2,938.45	—	58%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO W PW CW CF DOPPLER	$1,481.34	$3,527.00	$242.76–$2,997.95	32% below	58%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO W PW CW CF DOPPLER	$1,481.34	$3,527.00	$2,116.20–$2,997.95	—	58%
Elbow X-ray, 2 views CPT 73070 HC ELBOW 2 VIEWS	$164.64	$392.00	$39.94–$333.20	38% below	58%
Elbow X-ray, 2 views inpatient CPT 73070 HC ELBOW 2 VIEWS	$164.64	$392.00	$235.20–$333.20	—	58%
Elbow X-ray, complete, 3 or more views CPT 73080 HC ELBOW COMPLETE	$205.80	$490.00	$46.24–$416.50	38% below	58%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC ELBOW COMPLETE	$205.80	$490.00	$294.00–$416.50	—	58%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT WO CONTRAST	$1,029.00	$2,450.00	$89.71–$2,082.50	52% below	58%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT WO CONTRAST	$1,029.00	$2,450.00	$1,470.00–$2,082.50	—	58%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC FACIAL BONES COMPLETE	$259.56	$618.00	$65.79–$525.30	36% below	58%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC FACIAL BONES COMPLETE	$259.56	$618.00	$370.80–$525.30	—	58%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC FOREARM	$194.46	$463.00	$40.57–$393.55	28% below	58%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC FOREARM	$194.46	$463.00	$277.80–$393.55	—	58%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC HEPATOBILRY IMG W GALL BLAD	$857.64	$2,042.00	$339.00–$1,735.70	44% below	58%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC HEPATOBILRY IMG W GALL BLAD	$857.64	$2,042.00	$1,225.20–$1,735.70	—	58%
Hand X-ray, 2 views CPT 73120 HC HAND 2 VIEW	$171.78	$409.00	$44.35–$347.65	34% below	58%
Hand X-ray, 2 views inpatient CPT 73120 HC HAND 2 VIEW	$171.78	$409.00	$245.40–$347.65	—	58%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC CALCANEUS	$145.32	$346.00	$39.31–$294.10	30% below	58%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC CALCANEUS	$145.32	$346.00	$207.60–$294.10	—	58%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STUDY UNATTENDED	$320.88	$764.00	$96.26–$649.40	34% below	58%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STUDY UNATTENDED	$320.88	$764.00	$458.40–$649.40	—	58%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMNOGRPHY=>6 YR CPAP	$2,164.68	$5,154.00	$858.30–$4,380.90	46% below	58%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMNOGRPHY=>6 YR CPAP	$2,164.68	$5,154.00	$3,092.40–$4,380.90	—	58%
Knee X-ray, 3 views CPT 73562 HC KNEE 3 VIEW	$264.18	$629.00	$60.10–$534.65	29% below	58%
Knee X-ray, 3 views inpatient CPT 73562 HC KNEE 3 VIEW	$264.18	$629.00	$377.40–$534.65	—	58%
Knee X-ray, complete, 4 or more views CPT 73564 HC KNEE 4 OR> VIEWS	$268.80	$640.00	$68.31–$544.00	30% below	58%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC KNEE 4 OR> VIEWS	$268.80	$640.00	$384.00–$544.00	—	58%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXT WO CONTRAST	$805.98	$1,919.00	$89.71–$1,631.15	62% below	58%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXT WO CONTRAST	$805.98	$1,919.00	$1,151.40–$1,631.15	—	58%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED	$320.04	$762.00	$89.71–$647.70	45% below	58%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMEN LIMITED	$320.04	$762.00	$457.20–$647.70	—	58%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US LMTD JT/FCL EVL NVASC XTR	$316.68	$754.00	$30.04–$640.90	39% below	58%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US LMTD JT/FCL EVL NVASC XTR	$316.68	$754.00	$452.40–$640.90	—	58%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC LUNG CT SCREEN ANNUAL FU	$99.96	$238.00	$40.46–$288.01	84% below	58%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC LUNG CT SCREEN INITIAL	$99.96	$238.00	$40.46–$288.01	84% below	58%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC LUNG CT SCREEN ANNUAL FU	$99.96	$238.00	$142.80–$202.30	—	58%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC LUNG CT SCREEN INITIAL	$99.96	$238.00	$142.80–$202.30	—	58%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC TIBIA FIBULA	$214.20	$510.00	$44.98–$433.50	30% below	58%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC TIBIA FIBULA	$214.20	$510.00	$306.00–$433.50	—	58%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD WO CONTRAST	$1,452.36	$3,458.00	$203.92–$2,939.30	52% below	58%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA HEAD WO CONTRAST	$1,452.36	$3,458.00	$2,074.80–$2,939.30	—	58%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL	$1,505.70	$3,585.00	$461.56–$3,047.25	—	58%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 HC MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL	$1,505.70	$3,585.00	$2,151.00–$3,047.25	—	58%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MR JOINT LOWER EXT WO CONT	$1,257.90	$2,995.00	$203.92–$2,545.75	50% below	58%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MR JOINT LOWER EXT WO CONT	$1,257.90	$2,995.00	$1,797.00–$2,545.75	—	58%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MR JNT LOWER EXT W WO CONT	$1,647.66	$3,923.00	$301.29–$3,334.55	51% below	58%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MR JNT LOWER EXT W WO CONT	$1,647.66	$3,923.00	$2,353.80–$3,334.55	—	58%
MRI of the abdomen without contrast CPT 74181 HC MR ABDOMEN WO CONTRAST	$1,406.58	$3,349.00	$203.92–$2,846.65	54% below	58%
MRI of the abdomen without contrast inpatient CPT 74181 HC MR ABDOMEN WO CONTRAST	$1,406.58	$3,349.00	$2,009.40–$2,846.65	—	58%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MR ABDOMEN W WO CONTRAST	$1,803.06	$4,293.00	$301.29–$3,649.05	54% below	58%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MR ABDOMEN W WO CONTRAST	$1,803.06	$4,293.00	$2,575.80–$3,649.05	—	58%
MRI of the brain, no contrast dye CPT 70551 HC MR BRAIN WO CONTRAST	$1,454.04	$3,462.00	$203.92–$2,942.70	57% below	58%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MR BRAIN WO CONTRAST	$1,454.04	$3,462.00	$2,077.20–$2,942.70	—	58%
MRI of the brain, with and without contrast dye CPT 70553 HC MR BRAIN W WO CONTRAST	$1,863.96	$4,438.00	$301.29–$3,772.30	53% below	58%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MR BRAIN W WO CONTRAST	$1,863.96	$4,438.00	$2,662.80–$3,772.30	—	58%
MRI of the lower back, no contrast dye CPT 72148 HC MR LUMBAR WO CONTRAST	$1,424.64	$3,392.00	$203.92–$2,883.20	56% below	58%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MR LUMBAR WO CONTRAST	$1,424.64	$3,392.00	$2,035.20–$2,883.20	—	58%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MR LUMBAR W WO CONTRAST	$1,966.02	$4,681.00	$301.29–$3,978.85	50% below	58%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MR LUMBAR W WO CONTRAST	$1,966.02	$4,681.00	$2,808.60–$3,978.85	—	58%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MR THORACIC WO CONTRAST	$1,561.56	$3,718.00	$203.92–$3,160.30	54% below	58%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MR THORACIC WO CONTRAST	$1,561.56	$3,718.00	$2,230.80–$3,160.30	—	58%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MR CERVICAL W WO CONTRAST	$2,094.12	$4,986.00	$301.29–$4,238.10	48% below	58%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MR CERVICAL W WO CONTRAST	$2,094.12	$4,986.00	$2,991.60–$4,238.10	—	58%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MR CERVICAL WO CONTRAST	$1,424.64	$3,392.00	$203.92–$2,883.20	57% below	58%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MR CERVICAL WO CONTRAST	$1,424.64	$3,392.00	$2,035.20–$2,883.20	—	58%
MRI of the pelvis without and with contrast CPT 72197 HC MR PELVIS W WO CONTRAST	$1,687.98	$4,019.00	$301.29–$3,416.15	53% below	58%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MR PELVIS W WO CONTRAST	$1,687.98	$4,019.00	$2,411.40–$3,416.15	—	58%
MRI of the pelvis, no contrast dye CPT 72195 HC MR PELVIS WO CONTRAST	$1,435.14	$3,417.00	$203.92–$2,904.45	51% below	58%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MR PELVIS WO CONTRAST	$1,435.14	$3,417.00	$2,050.20–$2,904.45	—	58%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MR JOINT UP EXT WO CONTRAST	$1,173.48	$2,794.00	$203.92–$2,374.90	53% below	58%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MR JOINT UP EXT WO CONTRAST	$1,173.48	$2,794.00	$1,676.40–$2,374.90	—	58%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC CERVICAL SPINE 4 OR 5 VIEWS	$338.52	$806.00	$77.13–$685.10	24% below	58%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC CERVICAL SPINE 4 OR 5 VIEWS	$338.52	$806.00	$483.60–$685.10	—	58%
Neck soft tissue CT scan with contrast CPT 70491 HC CT NECK W CONTRAST	$1,128.54	$2,687.00	$150.18–$2,283.95	52% below	58%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT NECK W CONTRAST	$1,128.54	$2,687.00	$1,612.20–$2,283.95	—	58%
Neck soft tissue CT scan without contrast CPT 70490 HC CT NECK WO CONT	$1,071.84	$2,552.00	$89.71–$2,169.20	46% below	58%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT NECK WO CONT	$1,071.84	$2,552.00	$1,531.20–$2,169.20	—	58%
Neck soft tissue X-ray CPT 70360 HC NECK SOFT TISSUE	$186.48	$444.00	$42.46–$377.40	36% below	58%
Neck soft tissue X-ray inpatient CPT 70360 HC NECK SOFT TISSUE	$186.48	$444.00	$266.40–$377.40	—	58%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC MYOCARDIAL SPCT STDY MUL	$2,045.82	$4,871.00	$675.74–$4,140.35	52% below	58%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC MYOCARDIAL SPECT STDY MULTI	$2,168.88	$5,164.00	$675.74–$4,389.40	49% below	58%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC MYOCARDIAL SPCT STDY MUL	$2,045.82	$4,871.00	$2,922.60–$4,140.35	—	58%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC MYOCARDIAL SPECT STDY MULTI	$2,168.88	$5,164.00	$3,098.40–$4,389.40	—	58%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC NM PET CT SK TO M THGH SUB	$3,220.98	$7,669.00	$1,230.50–$6,518.65	41% below	58%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC NM PET CT SK TO M THGH INT	$3,220.98	$7,669.00	$1,230.50–$6,518.65	41% below	58%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC NM PET CT SK TO M THGH INT	$3,220.98	$7,669.00	$4,601.40–$6,518.65	—	58%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC NM PET CT SK TO M THGH SUB	$3,220.98	$7,669.00	$4,601.40–$6,518.65	—	58%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CONTRAST	$847.98	$2,019.00	$89.71–$1,716.15	61% below	58%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS WO CONTRAST	$847.98	$2,019.00	$1,211.40–$1,716.15	—	58%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIS GYN LIMITED	$231.42	$551.00	$49.39–$468.35	43% below	58%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIS GYN LIMITED	$231.42	$551.00	$330.60–$468.35	—	58%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIS GYN	$471.66	$1,123.00	$89.71–$954.55	40% below	58%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIS GYN	$471.66	$1,123.00	$673.80–$954.55	—	58%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC ULTRASOUND COMPLETE	$551.04	$1,312.00	$89.71–$1,115.20	25% below	58%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US PREGNANCY >14 WKS	$568.68	$1,354.00	$89.71–$1,150.90	23% below	58%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC ULTRASOUND COMPLETE	$551.04	$1,312.00	$787.20–$1,115.20	—	58%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US PREGNANCY >14 WKS	$568.68	$1,354.00	$812.40–$1,150.90	—	58%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US PREG < 14 WKS TRANSABD	$444.36	$1,058.00	$89.71–$899.30	28% below	58%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US PREG < 14 WKS TRANSABD	$444.36	$1,058.00	$634.80–$899.30	—	58%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC ULTRASOUND LIMITED	$251.16	$598.00	$89.71–$508.30	39% below	58%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC ULTRASOUND LIMITED	$251.16	$598.00	$358.80–$508.30	—	58%
Rib X-ray, one side, 2 views one side CPT 71100 HC RIBS UNILATERAL	$169.26	$403.00	$49.39–$342.55	42% below	58%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC RIBS UNILATERAL	$169.26	$403.00	$241.80–$342.55	—	58%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC RIBS UNI PA CHEST	$228.90	$545.00	$55.69–$463.25	41% below	58%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC RIBS UNI PA CHEST	$228.90	$545.00	$327.00–$463.25	—	58%
Screening mammogram, both breasts CPT 77067 HC MAMMOGRAM DIGITAL SCREEN	$128.10	$305.00	$51.85–$325.59	53% below	58%
Screening mammogram, both breasts inpatient CPT 77067 HC MAMMOGRAM DIGITAL SCREEN	$128.10	$305.00	$183.00–$259.25	—	58%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC SHOULDER COMPLETE	$214.62	$511.00	$48.76–$434.35	37% below	58%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC SHOULDER COMPLETE	$214.62	$511.00	$306.60–$434.35	—	58%
Sinus X-ray, complete, 3 or more views CPT 70220 HC SINUSES COMPLETE	$242.76	$578.00	$51.28–$491.30	24% below	58%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC SINUSES COMPLETE	$242.76	$578.00	$346.80–$491.30	—	58%
Skull X-ray, fewer than 4 views CPT 70250 HC SKULL PARTIAL <4	$143.64	$342.00	$51.91–$290.70	48% below	58%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC SKULL PARTIAL <4	$143.64	$342.00	$205.20–$290.70	—	58%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAPHY=> 6 YR	$1,991.22	$4,741.00	$805.97–$4,029.85	47% below	58%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAPHY=> 6 YR	$1,991.22	$4,741.00	$2,844.60–$4,029.85	—	58%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC STRESS ECHO W EKG MNTR	$1,762.32	$4,196.00	$284.59–$3,566.60	at median	58%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC STRESS ECHO W EKG MNTR	$1,762.32	$4,196.00	$2,517.60–$3,566.60	—	58%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC SWALLOWING STUDY FOR SPEECH	$317.94	$757.00	$128.69–$643.45	46% below	58%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC SWALLOWING STUDY FOR SPEECH	$317.94	$757.00	$454.20–$643.45	—	58%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-RAY EXAM OF FEMUR 2/>	$65.52	$156.00	$26.52–$183.63	79% below	58%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC X-RAY EXAM OF FEMUR 2/>	$65.52	$156.00	$93.60–$132.60	—	58%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT THORACIC WO CONTRAST	$958.44	$2,282.00	$89.71–$1,939.70	58% below	58%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT THORACIC WO CONTRAST	$958.44	$2,282.00	$1,369.20–$1,939.70	—	58%
Toe X-ray, 2 or more views CPT 73660 HC TOE S	$146.58	$349.00	$43.09–$296.65	39% below	58%
Toe X-ray, 2 or more views inpatient CPT 73660 HC TOE S	$146.58	$349.00	$209.40–$296.65	—	58%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL	$416.64	$992.00	$89.71–$843.20	35% below	58%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL	$416.64	$992.00	$595.20–$843.20	—	58%
Transvaginal ultrasound during pregnancy CPT 76817 HC US PREG UTERUS TRANSVAGINAL	$398.58	$949.00	$89.71–$806.65	22% below	58%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US PREG UTERUS TRANSVAGINAL	$398.58	$949.00	$569.40–$806.65	—	58%
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMEN	$524.58	$1,249.00	$89.71–$1,061.65	38% below	58%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMEN	$524.58	$1,249.00	$749.40–$1,061.65	—	58%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM TESTICLE	$416.22	$991.00	$89.71–$842.35	37% below	58%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM TESTICLE	$416.22	$991.00	$594.60–$842.35	—	58%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US THYROID PARATHYROID NECK	$367.92	$876.00	$89.71–$744.60	39% below	58%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US THYROID PARATHYROID NECK	$367.92	$876.00	$525.60–$744.60	—	58%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC UGI WO AIR W KUB	$279.72	$666.00	$113.22–$566.10	44% below	58%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC UGI	$325.08	$774.00	$131.58–$657.90	35% below	58%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC UGI WO AIR W KUB	$279.72	$666.00	$399.60–$566.10	—	58%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC UGI	$325.08	$774.00	$464.40–$657.90	—	58%
Upper arm X-ray (humerus), 2 views CPT 73060 HC HUMERUS	$204.12	$486.00	$45.61–$413.10	33% below	58%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC HUMERUS	$204.12	$486.00	$291.60–$413.10	—	58%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC VENOUS DUPLEX UNILATERAL	$726.18	$1,729.00	$89.71–$1,469.65	30% below	58%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC VENOUS DUPLEX UNILATERAL	$726.18	$1,729.00	$1,037.40–$1,469.65	—	58%
Wrist X-ray, 2 views CPT 73100 HC WRIST 2 VIEW	$145.32	$346.00	$48.76–$294.10	38% below	58%
Wrist X-ray, 2 views inpatient CPT 73100 HC WRIST 2 VIEW	$145.32	$346.00	$207.60–$294.10	—	58%
Wrist X-ray, complete, 3 or more views CPT 73110 HC WRIST COMPLETE	$217.14	$517.00	$62.01–$439.45	34% below	58%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC WRIST COMPLETE	$217.14	$517.00	$310.20–$439.45	—	58%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VIEWS	$65.52	$156.00	$26.52–$183.63	80% below	58%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VIEWS	$65.52	$156.00	$93.60–$132.60	—	58%
X-ray of the abdomen, 1 view CPT 74018 HC ABDOMEN 1 VIEW	$205.38	$489.00	$40.57–$415.65	26% below	58%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC ABDOMEN 1 VIEW	$205.38	$489.00	$293.40–$415.65	—	58%
X-ray of the ankle, 2 views CPT 73600 HC ANKLE 2 VIEWS	$167.58	$399.00	$46.24–$339.15	35% below	58%
X-ray of the ankle, 2 views inpatient CPT 73600 HC ANKLE 2 VIEWS	$167.58	$399.00	$239.40–$339.15	—	58%
X-ray of the finger(s), 2 or more views CPT 73140 HC FINGER	$141.54	$337.00	$57.29–$286.45	39% below	58%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC FINGER	$141.54	$337.00	$202.20–$286.45	—	58%
X-ray of the foot, 2 views CPT 73620 HC FOOT 2 VIEW	$157.08	$374.00	$39.94–$317.90	34% below	58%
X-ray of the foot, 2 views inpatient CPT 73620 HC FOOT 2 VIEW	$157.08	$374.00	$224.40–$317.90	—	58%
X-ray of the foot, complete, 3 or more views CPT 73630 HC FOOT COMPLETE	$189.00	$450.00	$49.39–$382.50	44% below	58%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC FOOT COMPLETE	$189.00	$450.00	$270.00–$382.50	—	58%
X-ray of the hand, 3 or more views CPT 73130 HC HAND COMPLETE	$223.02	$531.00	$54.43–$451.35	33% below	58%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC HAND COMPLETE	$223.02	$531.00	$318.60–$451.35	—	58%
X-ray of the knee, 1 or 2 views CPT 73560 HC KNEE 2 VIEW AP LAT	$231.84	$552.00	$49.39–$469.20	29% below	58%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC KNEE 2 VIEW AP LAT	$231.84	$552.00	$331.20–$469.20	—	58%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC LUMBAR SPINE 2 OR 3V	$311.22	$741.00	$55.06–$629.85	28% below	58%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC LUMBAR SPINE 2 OR 3V	$311.22	$741.00	$444.60–$629.85	—	58%
X-ray of the lower back, 4 or more views CPT 72110 HC LUMBR SPINE W OBLIQUES 4OR>	$351.54	$837.00	$74.61–$711.45	30% below	58%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC LUMBR SPINE W OBLIQUES 4OR>	$351.54	$837.00	$502.20–$711.45	—	58%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC THORACIC SPINE 2 VIEW	$183.96	$438.00	$43.72–$372.30	44% below	58%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC THORACIC SPINE 2 VIEW	$183.96	$438.00	$262.80–$372.30	—	58%
X-ray of the nasal bones, 3 or more views CPT 70160 HC NASAL BONES =>3 VIEWS	$204.96	$488.00	$55.69–$414.80	33% below	58%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC NASAL BONES =>3 VIEWS	$204.96	$488.00	$292.80–$414.80	—	58%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC CERVICAL SPINE =<3 VIEWS	$211.68	$504.00	$54.43–$428.40	38% below	58%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC CERVICAL SPINE =<3 VIEWS	$211.68	$504.00	$302.40–$428.40	—	58%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC PELVIS	$168.42	$401.00	$36.77–$340.85	43% below	58%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC PELVIS	$168.42	$401.00	$240.60–$340.85	—	58%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC SACRUM AND COCCYX	$102.06	$243.00	$41.31–$206.55	68% below	58%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC SACRUM AND COCCYX	$102.06	$243.00	$145.80–$206.55	—	58%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
ACTH blood test CPT 82024 HC ACTH	$146.58	$349.00	$37.42–$303.87	32% below	58%
ACTH blood test inpatient CPT 82024 HC ACTH	$146.58	$349.00	$209.40–$296.65	—	58%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALT SGPT	$60.90	$145.00	$5.14–$123.25	at median	58%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC ALT SGPT	$60.90	$145.00	$87.00–$123.25	—	58%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC AST SGOT	$45.36	$108.00	$5.02–$91.80	20% below	58%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC AST SGOT	$45.36	$108.00	$64.80–$91.80	—	58%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC ACUTE HEPATITIS PANEL	$319.62	$761.00	$46.16–$646.85	at median	58%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC ACUTE HEPATITIS PANEL	$319.62	$761.00	$456.60–$646.85	—	58%
Albumin blood test CPT 82040 HC ALBUMIN	$34.44	$82.00	$4.79–$69.70	25% below	58%
Albumin blood test inpatient CPT 82040 HC ALBUMIN	$34.44	$82.00	$49.20–$69.70	—	58%
Aldosterone blood test CPT 82088 HC ALDOSTERONE	$210.84	$502.00	$39.48–$426.70	8% below	58%
Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE	$210.84	$502.00	$301.20–$426.70	—	58%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ALKALINE PHOSPHATASE	$52.50	$125.00	$5.02–$106.25	at median	58%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ALKALINE PHOSPHATASE	$52.50	$125.00	$75.00–$106.25	—	58%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH	$55.44	$132.00	$5.06–$112.20	10% above	58%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH	$55.44	$132.00	$79.20–$112.20	—	58%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA FETOPROTEIN MATERNAL	$94.50	$225.00	$16.25–$191.25	at median	58%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA FETOPROTN TUMR MARKR	$103.74	$247.00	$16.25–$209.95	10% above	58%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA FETOPROTEIN MATERNAL	$94.50	$225.00	$135.00–$191.25	—	58%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA FETOPROTN TUMR MARKR	$103.74	$247.00	$148.20–$209.95	—	58%
Ammonia blood test CPT 82140 HC AMMONIA	$119.70	$285.00	$14.12–$242.25	6% below	58%
Ammonia blood test inpatient CPT 82140 HC AMMONIA	$119.70	$285.00	$171.00–$242.25	—	58%
Amylase blood test CPT 82150 HC AMYLASE SERUM	$85.26	$203.00	$6.28–$172.55	at median	58%
Amylase blood test CPT 82150 HC AMYLASE URINE	$89.04	$212.00	$6.28–$180.20	4% above	58%
Amylase blood test inpatient CPT 82150 HC AMYLASE SERUM	$85.26	$203.00	$121.80–$172.55	—	58%
Amylase blood test inpatient CPT 82150 HC AMYLASE URINE	$89.04	$212.00	$127.20–$180.20	—	58%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CYCLIC CITRUL PEPTIDE ANTB	$51.66	$123.00	$12.55–$104.55	54% below	58%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CYCLIC CITRUL PEPTIDE ANTB	$51.66	$123.00	$73.80–$104.55	—	58%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANA	$29.40	$70.00	$11.72–$70.00	64% below	58%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANA	$29.40	$70.00	$42.00–$59.50	—	58%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC CHF PEPTIDE	$172.62	$411.00	$38.05–$349.35	22% below	58%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC CHF PEPTIDE	$172.62	$411.00	$246.60–$349.35	—	58%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE - SPUTUM	$57.12	$136.00	$8.35–$115.60	26% below	58%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE NASAL OR THROAT	$105.00	$250.00	$8.35–$212.50	36% above	58%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE - SPUTUM	$57.12	$136.00	$81.60–$115.60	—	58%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE NASAL OR THROAT	$105.00	$250.00	$150.00–$212.50	—	58%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL	$164.64	$392.00	$8.20–$333.20	15% above	58%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL	$164.64	$392.00	$235.20–$333.20	—	58%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL	$54.60	$130.00	$4.87–$110.50	8% below	58%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL	$54.60	$130.00	$78.00–$110.50	—	58%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC LEVEL 4 GROSS EXAM	$186.06	$443.00	$45.07–$376.55	6% below	58%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC LEVEL 4 GROSS EXAM	$186.06	$443.00	$265.80–$376.55	—	58%
Blood culture for bacteria CPT 87040 HC CULTURE BLOOD	$180.18	$429.00	$10.00–$364.65	at median	58%
Blood culture for bacteria inpatient CPT 87040 HC CULTURE BLOOD	$180.18	$429.00	$257.40–$364.65	—	58%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC VENIPUNCTURE COLLECTION	$27.72	$66.00	$8.81–$56.10	at median	58%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC LEGAL BLOOD ALCOHOL DRAW	$40.74	$97.00	$8.81–$82.45	47% above	58%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC VENIPUNCTURE COLLECTION	$27.72	$66.00	$39.60–$56.10	—	58%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC LEGAL BLOOD ALCOHOL DRAW	$40.74	$97.00	$58.20–$82.45	—	58%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE	$34.02	$81.00	$3.80–$68.85	35% below	58%
Blood glucose (sugar) test CPT 82947 HC POCT GLUCOSE	$36.96	$88.00	$3.80–$74.80	30% below	58%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE	$34.02	$81.00	$48.60–$68.85	—	58%
Blood glucose (sugar) test inpatient CPT 82947 HC POCT GLUCOSE	$36.96	$88.00	$52.80–$74.80	—	58%
Blood lead test CPT 83655 HC LEAD	$64.68	$154.00	$11.73–$130.90	at median	58%
Blood lead test inpatient CPT 83655 HC LEAD	$64.68	$154.00	$92.40–$130.90	—	58%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC HCG QUAL	$122.22	$291.00	$7.28–$247.35	at median	58%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC HCG QUAL	$122.22	$291.00	$174.60–$247.35	—	58%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC REF PRO LAB ABO TYPE	$53.76	$128.00	$5.67–$268.83	9% below	58%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC ABO TYPE	$58.80	$140.00	$5.67–$268.83	at median	58%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC REF PRO LAB ABO TYPE	$53.76	$128.00	$76.80–$108.80	—	58%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC ABO TYPE	$58.80	$140.00	$84.00–$119.00	—	58%
Blood urea nitrogen (BUN) test CPT 84520 HC BUN	$36.54	$87.00	$3.83–$73.95	27% below	58%
Blood urea nitrogen (BUN) test CPT 84520 HC POCT BUN	$39.90	$95.00	$3.83–$80.75	20% below	58%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC BUN	$36.54	$87.00	$52.20–$73.95	—	58%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC POCT BUN	$39.90	$95.00	$57.00–$80.75	—	58%
C-peptide blood test CPT 84681 HC C PEPTIDE	$110.04	$262.00	$20.17–$222.70	15% below	58%
C-peptide blood test inpatient CPT 84681 HC C PEPTIDE	$110.04	$262.00	$157.20–$222.70	—	58%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC CRP PROM SEROLOGY	$114.66	$273.00	$5.02–$232.05	12% above	58%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC CRP PROM SEROLOGY	$114.66	$273.00	$163.80–$232.05	—	58%
C. difficile toxin gene test (stool PCR) CPT 87493 HC C DIFFICILE DNA DETECTION	$174.72	$416.00	$36.12–$353.60	2% above	58%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC C DIFFICILE DNA DETECTION	$174.72	$416.00	$249.60–$353.60	—	58%
CA 19-9 blood test (tumor marker) CPT 86301 HC CA 19 09	$237.30	$565.00	$20.17–$480.25	31% above	58%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC CA 19 09	$237.30	$565.00	$339.00–$480.25	—	58%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC CA 125	$110.04	$262.00	$20.17–$222.70	25% below	58%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC CA 125	$110.04	$262.00	$157.20–$222.70	—	58%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC INFECTIOUS AGENT SARS-COV-2 AMP PROBE	$70.98	$169.00	$28.73–$157.58	46% below	58%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC INFECTIOUS AGENT SARS-COV-2 AMP PROBE	$70.98	$169.00	$101.40–$143.65	—	58%
Calcium blood test, total CPT 82310 HC CALCIUM	$86.94	$207.00	$5.00–$175.95	50% above	58%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM	$86.94	$207.00	$124.20–$175.95	—	58%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CEA	$99.96	$238.00	$18.37–$202.30	20% below	58%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CEA	$99.96	$238.00	$142.80–$202.30	—	58%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER	$65.52	$156.00	$12.48–$132.60	34% below	58%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER	$65.52	$156.00	$93.60–$132.60	—	58%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYD TRACHOMATS AMP PROB	$94.50	$225.00	$34.01–$225.00	19% below	58%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYD TRACHOMATS AMP PROB	$94.50	$225.00	$135.00–$191.25	—	58%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$129.36	$308.00	$12.97–$261.80	7% above	58%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL	$129.36	$308.00	$184.80–$261.80	—	58%
Complete blood count (CBC) with differential CPT 85025 HC CBC W AUTO DIFF	$91.98	$219.00	$7.53–$186.15	at median	58%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC W AUTO DIFF	$91.98	$219.00	$131.40–$186.15	—	58%
Complete blood count (CBC), no differential CPT 85027 HC HEMOGRAM CBC WITHOUT DIFF	$70.56	$168.00	$6.27–$142.80	4% below	58%
Complete blood count (CBC), no differential inpatient CPT 85027 HC HEMOGRAM CBC WITHOUT DIFF	$70.56	$168.00	$100.80–$142.80	—	58%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE PANEL	$204.96	$488.00	$10.23–$414.80	24% above	58%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHENSIVE PANEL	$204.96	$488.00	$292.80–$414.80	—	58%
Cortisol blood test, total CPT 82533 HC CORTISOL	$130.62	$311.00	$15.80–$264.35	6% above	58%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL	$130.62	$311.00	$186.60–$264.35	—	58%
Creatine kinase (CK) blood test, total CPT 82550 HC CPK	$103.74	$247.00	$6.30–$209.95	5% above	58%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CPK	$103.74	$247.00	$148.20–$209.95	—	58%
Creatinine blood test CPT 82565 HC CREATININE	$47.88	$114.00	$4.96–$96.90	12% below	58%
Creatinine blood test CPT 82565 HC POCT CREATININE	$53.34	$127.00	$4.96–$107.95	2% below	58%
Creatinine blood test inpatient CPT 82565 HC CREATININE	$47.88	$114.00	$68.40–$96.90	—	58%
Creatinine blood test inpatient CPT 82565 HC POCT CREATININE	$53.34	$127.00	$76.20–$107.95	—	58%
Cytomegalovirus (CMV) antibody test CPT 86644 HC CMV IGG ANTIBODY	$70.98	$169.00	$13.94–$143.65	20% below	58%
Cytomegalovirus (CMV) antibody test CPT 86644 HC REF PRO CMV SCREEN	$73.50	$175.00	$13.94–$148.75	17% below	58%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC CMV IGG ANTIBODY	$70.98	$169.00	$101.40–$143.65	—	58%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC REF PRO CMV SCREEN	$73.50	$175.00	$105.00–$148.75	—	58%
D-dimer blood test (blood clot marker) CPT 85379 HC D DIMER QUANTITATIVE	$165.90	$395.00	$9.86–$335.75	9% above	58%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC D DIMER QUANTITATIVE	$165.90	$395.00	$237.00–$335.75	—	58%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DHEA S	$141.96	$338.00	$21.54–$287.30	at median	58%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DHEA S	$141.96	$338.00	$202.80–$287.30	—	58%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC OPIATES	$48.72	$116.00	$19.72–$244.70	65% below	58%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCRN ONE MULT CLS PROC	$112.56	$268.00	$45.56–$244.70	20% below	58%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN LIST A 5	$183.12	$436.00	$60.21–$370.60	30% above	58%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN LIST A 6	$241.08	$574.00	$60.21–$487.90	72% above	58%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN LIST A 7	$279.30	$665.00	$60.21–$565.25	99% above	58%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN LIST A 8	$321.30	$765.00	$60.21–$650.25	129% above	58%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN LIST A 9	$359.52	$856.00	$60.21–$727.60	156% above	58%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN LIST A 10	$401.10	$955.00	$60.21–$811.75	186% above	58%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC OPIATES	$48.72	$116.00	$69.60–$98.60	—	58%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG SCRN ONE MULT CLS PROC	$112.56	$268.00	$160.80–$227.80	—	58%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG SCREEN LIST A 5	$183.12	$436.00	$261.60–$370.60	—	58%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG SCREEN LIST A 6	$241.08	$574.00	$344.40–$487.90	—	58%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG SCREEN LIST A 7	$279.30	$665.00	$399.00–$565.25	—	58%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG SCREEN LIST A 8	$321.30	$765.00	$459.00–$650.25	—	58%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG SCREEN LIST A 9	$359.52	$856.00	$513.60–$727.60	—	58%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG SCREEN LIST A 10	$401.10	$955.00	$573.00–$811.75	—	58%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTES	$104.16	$248.00	$6.79–$210.80	at median	58%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC POCT ELECTROLYTES	$108.36	$258.00	$6.79–$219.30	4% above	58%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTES	$104.16	$248.00	$148.80–$210.80	—	58%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC POCT ELECTROLYTES	$108.36	$258.00	$154.80–$219.30	—	58%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EBV VIRAL CAPSID	$71.82	$171.00	$17.57–$145.35	27% below	58%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EBV ANTIBODY SCREEN	$74.76	$178.00	$17.57–$151.30	24% below	58%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EBV VIRAL CAPSID	$71.82	$171.00	$102.60–$145.35	—	58%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EBV ANTIBODY SCREEN	$74.76	$178.00	$106.80–$151.30	—	58%
Estradiol blood test CPT 82670 HC ESTRADIOL	$137.34	$327.00	$27.07–$277.95	at median	58%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL	$137.34	$327.00	$196.20–$277.95	—	58%
FSH (follicle-stimulating hormone) test CPT 83001 HC FSH	$112.56	$268.00	$18.00–$227.80	1% below	58%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC FSH	$112.56	$268.00	$160.80–$227.80	—	58%
Fecal calprotectin (stool inflammation test) CPT 83993 HC CALPROTECTIN FECAL	$432.60	$1,030.00	$19.02–$875.50	11% above	58%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC CALPROTECTIN FECAL	$432.60	$1,030.00	$618.00–$875.50	—	58%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN	$102.48	$244.00	$13.21–$207.40	5% below	58%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN	$102.48	$244.00	$146.40–$207.40	—	58%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN	$108.36	$258.00	$9.41–$219.30	at median	58%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN	$108.36	$258.00	$154.80–$219.30	—	58%
Folate (folic acid) blood test CPT 82746 HC FOLIC ACID	$105.42	$251.00	$14.25–$213.35	2% below	58%
Folate (folic acid) blood test inpatient CPT 82746 HC FOLIC ACID	$105.42	$251.00	$150.60–$213.35	—	58%
Free T3 thyroid hormone test CPT 84481 HC T3 FREE	$237.72	$566.00	$16.41–$481.10	46% above	58%
Free T3 thyroid hormone test inpatient CPT 84481 HC T3 FREE	$237.72	$566.00	$339.60–$481.10	—	58%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC T4 FREE	$63.84	$152.00	$8.74–$129.20	29% below	58%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC T4 FREE	$63.84	$152.00	$91.20–$129.20	—	58%
Free testosterone test CPT 84402 HC TESTOSTERONE FREE	$103.32	$246.00	$24.68–$209.10	19% below	58%
Free testosterone test inpatient CPT 84402 HC TESTOSTERONE FREE	$103.32	$246.00	$147.60–$209.10	—	58%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GGTP	$57.54	$137.00	$6.98–$116.45	6% below	58%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GGTP	$57.54	$137.00	$82.20–$116.45	—	58%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PANEL	$464.52	$1,106.00	$52.42–$940.10	50% above	58%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC GENERAL HEALTH PANEL	$464.52	$1,106.00	$663.60–$940.10	—	58%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC POST GLUCOSE DOSE	$55.44	$132.00	$4.60–$112.20	at median	58%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC POST GLUCOSE DOSE	$55.44	$132.00	$79.20–$112.20	—	58%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST	$261.24	$622.00	$12.47–$528.70	91% above	58%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE TEST	$261.24	$622.00	$373.20–$528.70	—	58%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC NEISSERIA GONORRHO AMP PROB	$83.16	$198.00	$33.66–$198.00	29% below	58%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC NEISSERIA GONORRHO AMP PROB	$83.16	$198.00	$118.80–$168.30	—	58%
H. pylori antibody blood test CPT 86677 HC H PYLORI	$73.92	$176.00	$16.33–$149.60	10% below	58%
H. pylori antibody blood test inpatient CPT 86677 HC H PYLORI	$73.92	$176.00	$105.60–$149.60	—	58%
H. pylori stool antigen test CPT 87338 HC HELICOBCTR PY STOOL ANTIGEN	$95.34	$227.00	$13.93–$192.95	41% below	58%
H. pylori stool antigen test inpatient CPT 87338 HC HELICOBCTR PY STOOL ANTIGEN	$95.34	$227.00	$136.20–$192.95	—	58%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV 1 RNA QUANT PCR	$687.12	$1,636.00	$82.47–$1,390.60	35% above	58%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV 1 RNA QUANT PCR	$687.12	$1,636.00	$981.60–$1,390.60	—	58%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV1 HIV2 ANTIBODY SNGL RES	$44.52	$106.00	$13.28–$90.10	39% below	58%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV1 HIV2 ANTIBODY SNGL RES	$44.52	$106.00	$63.60–$90.10	—	58%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV1 AG W HIV1 HIV2 AB	$113.82	$271.00	$23.34–$230.35	38% above	58%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV1 AG W HIV1 HIV2 AB	$113.82	$271.00	$162.60–$230.35	—	58%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC HPV HIGH RISK TYPES	$141.96	$338.00	$34.01–$287.30	23% above	58%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC HPV HIGH RISK TYPES	$141.96	$338.00	$202.80–$287.30	—	58%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLATED HEMOGLOBIN	$81.06	$193.00	$9.40–$164.05	at median	58%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCOSYLATED HEMOGLOBIN	$81.06	$193.00	$115.80–$164.05	—	58%
Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN POC	$27.72	$66.00	$2.29–$56.10	18% below	58%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN	$29.40	$70.00	$2.29–$59.50	14% below	58%
Hemoglobin blood test inpatient CPT 85018 HC BLOOD COUNT HEMOGLOBIN POC	$27.72	$66.00	$39.60–$56.10	—	58%
Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN	$29.40	$70.00	$42.00–$59.50	—	58%
Hepatitis B core antibody test (total) CPT 86704 HC HEPATITIS B CORE AB TOTAL	$86.52	$206.00	$11.68–$175.10	17% below	58%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEPATITIS B CORE AB TOTAL	$86.52	$206.00	$123.60–$175.10	—	58%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE AB	$90.72	$216.00	$10.40–$183.60	1% below	58%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURFACE AB	$90.72	$216.00	$129.60–$183.60	—	58%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC HEPATITIS B SURFACE AG	$81.06	$193.00	$10.01–$164.05	14% below	58%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC HEPATITIS B SURFACE AG	$81.06	$193.00	$115.80–$164.05	—	58%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C AB	$91.56	$218.00	$13.83–$185.30	at median	58%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C AB	$91.56	$218.00	$130.80–$185.30	—	58%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C QUANT	$337.26	$803.00	$41.51–$682.55	at median	58%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C QUANT	$337.26	$803.00	$481.80–$682.55	—	58%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX TYPE I	$140.28	$334.00	$12.78–$283.90	40% above	58%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES SIMPLEX TYPE I	$140.28	$334.00	$200.40–$283.90	—	58%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TYPE II	$140.70	$335.00	$18.75–$284.75	31% above	58%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX TYPE II	$140.70	$335.00	$201.00–$284.75	—	58%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C REACTIVE PROTEIN HS	$110.88	$264.00	$12.55–$224.40	16% above	58%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C REACTIVE PROTEIN HS	$110.88	$264.00	$158.40–$224.40	—	58%
Homocysteine blood test CPT 83090 HC HOMOCYSTEINE	$139.86	$333.00	$17.36–$283.05	13% below	58%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTEINE	$139.86	$333.00	$199.80–$283.05	—	58%
Insulin blood test CPT 83525 HC INSULIN	$126.00	$300.00	$11.08–$255.00	16% above	58%
Insulin blood test inpatient CPT 83525 HC INSULIN	$126.00	$300.00	$180.00–$255.00	—	58%
Iron blood test (serum iron) CPT 83540 HC IRON	$63.00	$150.00	$6.27–$127.50	at median	58%
Iron blood test (serum iron) CPT 83540 HC IRON LIVER TISSUE	$65.52	$156.00	$6.27–$132.60	4% above	58%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON	$63.00	$150.00	$90.00–$127.50	—	58%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON LIVER TISSUE	$65.52	$156.00	$93.60–$132.60	—	58%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY	$79.38	$189.00	$8.47–$160.65	1% above	58%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY	$79.38	$189.00	$113.40–$160.65	—	58%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL	$151.62	$361.00	$8.41–$306.85	2% above	58%
Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL	$151.62	$361.00	$216.60–$306.85	—	58%
LH (luteinizing hormone) test CPT 83002 HC LUTEINIZING HORMONE	$124.32	$296.00	$17.94–$251.60	at median	58%
LH (luteinizing hormone) test inpatient CPT 83002 HC LUTEINIZING HORMONE	$124.32	$296.00	$177.60–$251.60	—	58%
Lactate (lactic acid) blood test CPT 83605 HC POCT LACTIC ACID	$99.96	$238.00	$11.21–$202.30	20% below	58%
Lactate (lactic acid) blood test CPT 83605 HC LACTIC ACID	$110.04	$262.00	$11.21–$222.70	12% below	58%
Lactate (lactic acid) blood test one side CPT 83605 HC RT POC LACTIC ACID	$89.46	$213.00	$11.21–$181.05	28% below	58%
Lactate (lactic acid) blood test inpatient CPT 83605 HC POCT LACTIC ACID	$99.96	$238.00	$142.80–$202.30	—	58%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTIC ACID	$110.04	$262.00	$157.20–$222.70	—	58%
Lactate (lactic acid) blood test inpatient one side CPT 83605 HC RT POC LACTIC ACID	$89.46	$213.00	$127.80–$181.05	—	58%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH	$50.82	$121.00	$5.85–$102.85	8% below	58%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH	$50.82	$121.00	$72.60–$102.85	—	58%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE	$95.76	$228.00	$6.68–$193.80	4% below	58%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE	$95.76	$228.00	$136.80–$193.80	—	58%
Liver function blood test panel CPT 80076 HC HEPATIC PROFILE	$133.56	$318.00	$7.92–$270.30	at median	58%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC PROFILE	$133.56	$318.00	$190.80–$270.30	—	58%
Lyme disease antibody test CPT 86618 HC LYME DISEASE	$120.96	$288.00	$16.50–$244.80	11% below	58%
Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE	$120.96	$288.00	$172.80–$244.80	—	58%
Magnesium blood test CPT 83735 HC MAGNESIUM	$63.00	$150.00	$6.50–$127.50	13% below	58%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM	$63.00	$150.00	$90.00–$127.50	—	58%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA IGG IGM	$76.86	$183.00	$12.48–$155.55	15% below	58%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA IGG IGM	$76.86	$183.00	$109.80–$155.55	—	58%
Mono test (heterophile antibody, Monospot) CPT 86308 HC MONONUCLEOSIS	$64.68	$154.00	$5.02–$130.90	1% below	58%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC MONONUCLEOSIS	$64.68	$154.00	$92.40–$130.90	—	58%
Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL	$267.54	$637.00	$46.33–$541.45	3% above	58%
Obstetric blood test panel inpatient CPT 80055 HC OBSTETRIC PANEL	$267.54	$637.00	$382.20–$541.45	—	58%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA FREE	$154.98	$369.00	$17.82–$313.65	13% above	58%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PSA FREE	$154.98	$369.00	$221.40–$313.65	—	58%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA	$93.24	$222.00	$17.82–$188.70	14% below	58%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA	$93.24	$222.00	$133.20–$188.70	—	58%
Pap test (liquid-based, automated screening with review) CPT 88175 HC PAP SCRN AUTO W MAN RESCRN	$76.86	$183.00	$25.79–$172.17	7% below	58%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC PAP SCRN AUTO W MAN RESCRN	$76.86	$183.00	$109.80–$155.55	—	58%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC THIN PREP PAP	$68.04	$162.00	$19.64–$137.70	at median	58%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC THIN PREP PAP	$68.04	$162.00	$97.20–$137.70	—	58%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHYROID	$210.84	$502.00	$40.00–$426.70	at median	58%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHYROID	$210.84	$502.00	$301.20–$426.70	—	58%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT	$67.20	$160.00	$5.82–$136.00	15% below	58%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT	$67.20	$160.00	$96.00–$136.00	—	58%
Phosphorus (phosphate) blood test CPT 84100 HC PHOSPHORUS	$47.46	$113.00	$4.59–$96.05	9% below	58%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC PHOSPHORUS	$47.46	$113.00	$67.80–$96.05	—	58%
Potassium blood test CPT 84132 HC POTASSIUM	$43.26	$103.00	$4.61–$87.55	10% below	58%
Potassium blood test CPT 84132 HC POCT POTASSIUM	$47.88	$114.00	$4.61–$96.90	at median	58%
Potassium blood test inpatient CPT 84132 HC POTASSIUM	$43.26	$103.00	$61.80–$87.55	—	58%
Potassium blood test inpatient CPT 84132 HC POCT POTASSIUM	$47.88	$114.00	$68.40–$96.90	—	58%
Progesterone blood test CPT 84144 HC PROGESTERONE	$105.42	$251.00	$20.22–$213.35	9% below	58%
Progesterone blood test inpatient CPT 84144 HC PROGESTERONE	$105.42	$251.00	$150.60–$213.35	—	58%
Prolactin blood test CPT 84146 HC PROLACTIN	$86.10	$205.00	$18.78–$174.25	31% below	58%
Prolactin blood test inpatient CPT 84146 HC PROLACTIN	$86.10	$205.00	$123.00–$174.25	—	58%
Prothrombin time (PT/INR) clotting test CPT 85610 HC INR	$49.98	$119.00	$4.16–$101.15	2% below	58%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PT	$55.02	$131.00	$4.16–$111.35	7% above	58%
Prothrombin time (PT/INR) clotting test CPT 85610 HC POCT PT	$57.54	$137.00	$4.16–$116.45	12% above	58%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC INR	$49.98	$119.00	$71.40–$101.15	—	58%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PT	$55.02	$131.00	$78.60–$111.35	—	58%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC POCT PT	$57.54	$137.00	$82.20–$116.45	—	58%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG SCREEN QUAL EA PROC	$83.16	$198.00	$12.21–$168.30	13% below	58%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC DRUG SCREEN QUAL EA PROC	$83.16	$198.00	$118.80–$168.30	—	58%
Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA AB	$158.34	$377.00	$16.03–$320.45	103% above	58%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFLUENZA AB	$158.34	$377.00	$226.20–$320.45	—	58%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP SCREEN	$125.58	$299.00	$16.01–$254.15	157% above	58%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREP SCREEN	$125.58	$299.00	$179.40–$254.15	—	58%
Renin blood test CPT 84244 HC RENIN	$114.24	$272.00	$21.31–$231.20	24% below	58%
Renin blood test inpatient CPT 84244 HC RENIN	$114.24	$272.00	$163.20–$231.20	—	58%
Rh blood typing CPT 86901 HC REF PRO RH TYPE	$44.94	$107.00	$5.67–$90.95	14% below	58%
Rh blood typing CPT 86901 HC RH TYPE	$49.98	$119.00	$5.67–$101.15	4% below	58%
Rh blood typing inpatient CPT 86901 HC REF PRO RH TYPE	$44.94	$107.00	$64.20–$90.95	—	58%
Rh blood typing inpatient CPT 86901 HC RH TYPE	$49.98	$119.00	$71.40–$101.15	—	58%
Rheumatoid factor (RF) test CPT 86431 HC RA QUANT	$44.94	$107.00	$5.50–$90.95	18% below	58%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RA QUANT	$44.94	$107.00	$64.20–$90.95	—	58%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA	$76.86	$183.00	$13.94–$155.55	at median	58%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA	$76.86	$183.00	$109.80–$155.55	—	58%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SED RATE AUTOMATED	$53.76	$128.00	$2.62–$108.80	at median	58%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SED RATE AUTOMATED	$53.76	$128.00	$76.80–$108.80	—	58%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS	$251.16	$598.00	$11.92–$508.30	at median	58%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC SEMEN ANALYSIS	$251.16	$598.00	$358.80–$508.30	—	58%
Sodium blood test CPT 84295 HC SODIUM	$53.76	$128.00	$4.66–$108.80	1% above	58%
Sodium blood test inpatient CPT 84295 HC SODIUM	$53.76	$128.00	$76.80–$108.80	—	58%
Stool ova and parasites exam CPT 87177 HC OVA PARASITES	$64.68	$154.00	$8.63–$130.90	24% below	58%
Stool ova and parasites exam inpatient CPT 87177 HC OVA PARASITES	$64.68	$154.00	$92.40–$130.90	—	58%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC HEMOCCULT	$27.72	$66.00	$4.24–$56.10	at median	58%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC HEMOCCULT	$27.72	$66.00	$39.60–$56.10	—	58%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLOOD OCCULT FECL HEMO	$33.60	$80.00	$13.60–$80.00	20% below	58%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC BLOOD OCCULT FECL HEMO	$33.60	$80.00	$48.00–$68.00	—	58%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM	$41.16	$98.00	$12.83–$83.30	20% below	58%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM	$41.16	$98.00	$58.80–$83.30	—	58%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST QUALITATIVE	$38.22	$91.00	$4.14–$77.35	13% below	58%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST QUALITATIVE	$38.22	$91.00	$54.60–$77.35	—	58%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB TEST CELL IMMUN MEASURE	$201.60	$480.00	$60.06–$480.00	2% below	58%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB TEST CELL IMMUN MEASURE	$201.60	$480.00	$288.00–$408.00	—	58%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$127.26	$303.00	$25.01–$257.55	8% above	58%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL	$127.26	$303.00	$181.80–$257.55	—	58%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODY	$108.78	$259.00	$14.10–$220.15	9% above	58%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODY	$108.78	$259.00	$155.40–$220.15	—	58%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH	$112.98	$269.00	$16.28–$228.65	at median	58%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH	$112.98	$269.00	$161.40–$228.65	—	58%
Total IgE blood test CPT 82785 HC IGE	$91.56	$218.00	$15.95–$185.30	9% below	58%
Total IgE blood test inpatient CPT 82785 HC IGE	$91.56	$218.00	$130.80–$185.30	—	58%
Total cholesterol blood test CPT 82465 HC CHOLESTEROL	$43.26	$103.00	$4.21–$87.55	18% below	58%
Total cholesterol blood test inpatient CPT 82465 HC CHOLESTEROL	$43.26	$103.00	$61.80–$87.55	—	58%
Total thyroxine (T4) blood test CPT 84436 HC T4	$28.98	$69.00	$6.66–$58.65	49% below	58%
Total thyroxine (T4) blood test inpatient CPT 84436 HC T4	$28.98	$69.00	$41.40–$58.65	—	58%
Total triiodothyronine (T3) blood test CPT 84480 HC T3 TOTAL	$86.52	$206.00	$13.74–$175.10	3% below	58%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC T3 TOTAL	$86.52	$206.00	$123.60–$175.10	—	58%
Transferrin blood test CPT 84466 HC TRANSFERRIN	$81.48	$194.00	$12.36–$164.90	22% below	58%
Transferrin blood test inpatient CPT 84466 HC TRANSFERRIN	$81.48	$194.00	$116.40–$164.90	—	58%
Trichomonas test (NAAT) CPT 87661 HC TRICHOMONAS VAGINALIS AMPLIF	$85.68	$204.00	$34.01–$204.00	9% below	58%
Trichomonas test (NAAT) inpatient CPT 87661 HC TRICHOMONAS VAGINALIS AMPLIF	$85.68	$204.00	$122.40–$173.40	—	58%
Triglycerides blood test CPT 84478 HC TRIGLYCERIDE	$60.90	$145.00	$5.56–$123.25	at median	58%
Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDE	$60.90	$145.00	$87.00–$123.25	—	58%
Troponin test, quantitative CPT 84484 HC TROPONIN	$165.06	$393.00	$12.09–$334.05	13% below	58%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN	$165.06	$393.00	$235.80–$334.05	—	58%
Uric acid blood test CPT 84550 HC URIC ACID	$52.92	$126.00	$4.38–$107.10	at median	58%
Uric acid blood test inpatient CPT 84550 HC URIC ACID	$52.92	$126.00	$75.60–$107.10	—	58%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS	$58.38	$139.00	$3.07–$118.15	1% above	58%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTOMATD W MICRO	$61.32	$146.00	$3.07–$124.10	6% above	58%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS	$58.38	$139.00	$83.40–$118.15	—	58%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS AUTOMATD W MICRO	$61.32	$146.00	$87.60–$124.10	—	58%
Urinalysis with microscope exam, manual CPT 81000 HC URINALYSIS DIPSTICK W MICRO	$36.12	$86.00	$3.90–$73.10	3% above	58%
Urinalysis with microscope exam, manual inpatient CPT 81000 HC URINALYSIS DIPSTICK W MICRO	$36.12	$86.00	$51.60–$73.10	—	58%
Urinalysis without microscope exam, automated CPT 81003 HC POC URINE AUTO WO MICRO	$31.50	$75.00	$2.18–$63.75	7% below	58%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO WO MICRO	$34.02	$81.00	$2.18–$68.85	at median	58%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC POC URINE AUTO WO MICRO	$31.50	$75.00	$45.00–$63.75	—	58%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO WO MICRO	$34.02	$81.00	$48.60–$68.85	—	58%
Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS MANUAL	$21.42	$51.00	$3.38–$43.35	at median	58%
Urinalysis without microscope exam, manual CPT 81002 HC POCT MANUAL URINALYSIS	$24.36	$58.00	$3.38–$49.30	14% above	58%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINALYSIS MANUAL	$21.42	$51.00	$30.60–$43.35	—	58%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC POCT MANUAL URINALYSIS	$24.36	$58.00	$34.80–$49.30	—	58%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE URINE	$71.82	$171.00	$7.82–$145.35	at median	58%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE URINE	$71.82	$171.00	$102.60–$145.35	—	58%
Urine microalbumin (albumin) test CPT 82043 HC ALBUMIN URINE MICROALBUMIN QUANTIATIVE	$55.02	$131.00	$5.60–$111.35	35% below	58%
Urine microalbumin (albumin) test inpatient CPT 82043 HC ALBUMIN URINE MICROALBUMIN QUANTIATIVE	$55.02	$131.00	$78.60–$111.35	—	58%
Urine pregnancy test, read by color change CPT 81025 HC HCG URINE	$63.42	$151.00	$8.34–$128.35	2% below	58%
Urine pregnancy test, read by color change inpatient CPT 81025 HC HCG URINE	$63.42	$151.00	$90.60–$128.35	—	58%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B12	$112.98	$269.00	$14.62–$228.65	3% below	58%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B12	$112.98	$269.00	$161.40–$228.65	—	58%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D 25OH	$233.10	$555.00	$28.68–$471.75	50% above	58%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D 25OH	$233.10	$555.00	$333.00–$471.75	—	58%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC VITAMIN D 1 25	$256.62	$611.00	$37.31–$519.35	at median	58%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC VITAMIN D 1 25	$256.62	$611.00	$366.60–$519.35	—	58%
Zinc blood test CPT 84630 HC ZINC	$31.50	$75.00	$11.04–$63.75	57% below	58%
Zinc blood test inpatient CPT 84630 HC ZINC	$31.50	$75.00	$45.00–$63.75	—	58%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG QUANT	$88.62	$211.00	$14.59–$179.35	21% below	58%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG QUANT	$88.62	$211.00	$126.60–$179.35	—	58%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESN STRTCTC	$2,259.60	$5,380.00	$306.89–$4,573.00	17% below	58%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST W/ DEVICE 1ST LESION STEREOTACTIC GUID	$2,485.56	$5,918.00	$306.89–$5,030.30	9% below	58%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST 1ST LESN STRTCTC	$2,259.60	$5,380.00	$3,228.00–$4,573.00	—	58%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST W/ DEVICE 1ST LESION STEREOTACTIC GUID	$2,485.56	$5,918.00	$3,550.80–$5,030.30	—	58%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC DIST FIB FX CLSD WO MANIP	$399.00	$950.00	$161.50–$3,259.25	4% below	58%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC DIST FIB FX CLSD WO MANIP	$399.00	$950.00	$570.00–$807.50	—	58%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC CLO TX METATRSL FX WO MANIP	$587.16	$1,398.00	$202.37–$3,259.25	54% above	58%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC CLO TX METATRSL FX WO MANIP	$587.16	$1,398.00	$838.80–$1,188.30	—	58%
Cardiac catheterization with coronary angiogram one side CPT 93458 HC LEFT HEART CATH	$12,812.52	$30,506.00	$1,395.83–$25,930.10	at median	58%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 HC LEFT HEART CATH	$12,812.52	$30,506.00	$18,303.60–$25,930.10	—	58%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTRIC EXT	$1,431.36	$3,408.00	$205.61–$2,896.80	at median	58%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTRIC EXT	$1,431.36	$3,408.00	$2,044.80–$2,896.80	—	58%
Catheter ablation for atrial fibrillation CPT 93656 HC ABL SVT W EP STDY TRANSEPT	$16,863.42	$40,151.00	$1,679.90–$50,446.30	at median	58%
Catheter ablation for atrial fibrillation CPT 93656 HC ABL AF W EP STDY TRANSEPT	$19,162.92	$45,626.00	$1,679.90–$50,446.30	14% above	58%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC ABL SVT W EP STDY TRANSEPT	$16,863.42	$40,151.00	$24,090.60–$34,128.35	—	58%
Catheter ablation for atrial fibrillation inpatient CPT 93656 HC ABL AF W EP STDY TRANSEPT	$19,162.92	$45,626.00	$27,375.60–$38,782.10	—	58%
Cervical biopsy CPT 57500 HC CERVICAL POLYP	$473.34	$1,127.00	$140.93–$3,259.25	30% above	58%
Cervical biopsy inpatient CPT 57500 HC CERVICAL POLYP	$473.34	$1,127.00	$676.20–$957.95	—	58%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION W CLAMP OTH DEV W BLOCK	$1,358.70	$3,235.00	$180.43–$5,081.00	81% above	58%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC CIRCUMCISION W CLAMP OTH DEV W BLOCK	$1,358.70	$3,235.00	$1,941.00–$2,749.75	—	58%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC CLS DST RAD FX WWO UL SYLD	$280.14	$667.00	$113.39–$3,259.25	40% below	58%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC CLS DST RAD FX WWO UL SYLD	$280.14	$667.00	$400.20–$566.95	—	58%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC COLPOSCOPY W BX W ECC	$200.34	$477.00	$81.09–$3,489.13	34% below	58%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC COLPOSCOPY W BX W ECC	$200.34	$477.00	$286.20–$405.45	—	58%
Coronary stent placement, one artery CPT 92928 HC COR STENT SINGLE	$9,813.30	$23,365.00	$1,041.94–$23,319.87	14% below	58%
Coronary stent placement, one artery inpatient CPT 92928 HC COR STENT SINGLE	$9,813.30	$23,365.00	$14,019.00–$19,860.25	—	58%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOURETHROSCOPY	$513.66	$1,223.00	$150.80–$3,259.25	6% below	58%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC CYSTOURETHROSCOPY	$513.66	$1,223.00	$733.80–$1,039.55	—	58%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DESTRUCTION/LN ONE LESION	$127.68	$304.00	$51.68–$3,259.25	at median	58%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DESTRUCTION/LN ONE LESION	$127.68	$304.00	$182.40–$258.40	—	58%
Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 HC REM IMP EAR WAX IRR/LAV BI	$93.24	$222.00	$29.84–$3,259.25	—	58%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC REM IMP EAR WAX IRR/LAV UNI	$46.62	$111.00	$18.87–$3,259.25	18% below	58%
Earwax removal by irrigation (rinsing), one ear inpatient both sides CPT 69209 HC REM IMP EAR WAX IRR/LAV BI	$93.24	$222.00	$133.20–$188.70	—	58%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC REM IMP EAR WAX IRR/LAV UNI	$46.62	$111.00	$66.60–$94.35	—	58%
Earwax removal with instruments, one ear both sides CPT 69210 HC REM IMP EAR WAX INST BI	$97.02	$231.00	$39.27–$3,259.25	—	58%
Earwax removal with instruments, one ear CPT 69210 HC REM IMP EAR WAX INST UNI	$46.62	$111.00	$18.87–$3,259.25	45% below	58%
Earwax removal with instruments, one ear inpatient both sides CPT 69210 HC REM IMP EAR WAX INST BI	$97.02	$231.00	$138.60–$196.35	—	58%
Earwax removal with instruments, one ear inpatient CPT 69210 HC REM IMP EAR WAX INST UNI	$46.62	$111.00	$66.60–$94.35	—	58%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC ENDOMET BX WO CERVICAL DILA	$123.48	$294.00	$49.98–$3,259.25	42% below	58%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC ENDOMET BX WO CERVICAL DILA	$123.48	$294.00	$176.40–$249.90	—	58%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC NJX INTRLMNR CRV THRC W IMG GDN	$1,098.30	$2,615.00	$204.90–$3,259.25	at median	58%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC NJX INTRLMNR CRV THRC W IMG GDN	$1,098.30	$2,615.00	$1,569.00–$2,222.75	—	58%
Eye injection into the vitreous (intravitreal injection) CPT 67028 HC INJECTION EYE DRUG	$246.19	$586.15	$99.65–$3,259.25	at median	58%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HC INJECTION EYE DRUG	$246.19	$586.15	$351.69–$498.23	—	58%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC FACET LUMBOSACRAL SINGLE	$876.54	$2,087.00	$172.60–$3,259.25	41% below	58%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC FACET LUMBOSACRAL SINGLE	$876.54	$2,087.00	$1,252.20–$1,773.95	—	58%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC HEMORRHOID BANDING	$585.06	$1,393.00	$236.81–$3,259.25	6% below	58%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC HEMORRHOID BANDING	$585.06	$1,393.00	$835.80–$1,184.05	—	58%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC INJECT HYSTERO	$240.66	$573.00	$97.41–$3,259.25	43% below	58%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC INJECT HYSTERO	$240.66	$573.00	$343.80–$487.05	—	58%
IUD insertion (the device itself billed separately) CPT 58300 HC INSERTION OF IUD	$126.42	$301.00	$51.17–$3,259.25	35% below	58%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC INSERTION OF IUD	$126.42	$301.00	$180.60–$255.85	—	58%
Incision and drainage of a simple or single skin abscess CPT 10060 HC DRAIN SKIN ABSCESS SMPL SNGL	$805.98	$1,919.00	$167.64–$3,259.25	178% above	58%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC DRAIN SKIN ABSCESS SMPL SNGL	$805.98	$1,919.00	$1,151.40–$1,631.15	—	58%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ TENDON/LIG/TR PT/GANGLI	$519.96	$1,238.00	$73.21–$3,259.25	161% above	58%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ TENDON/LIG/TR PT/GANGLI	$519.96	$1,238.00	$742.80–$1,052.30	—	58%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC DRAIN INJ JOINT BURSA MAJOR	$374.22	$891.00	$84.78–$3,259.25	96% above	58%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC DRAIN INJ JOINT BURSA MAJOR M50	$748.02	$1,781.00	$84.78–$3,259.25	291% above	58%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC ASPIR/INJ MAJOR JNT/BUR RT HHP	$191.10	$455.00	$77.35–$3,259.25	at median	58%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC DRAIN INJ JOINT BURSA MAJOR	$374.22	$891.00	$534.60–$757.35	—	58%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC DRAIN INJ JOINT BURSA MAJOR M50	$748.02	$1,781.00	$1,068.60–$1,513.85	—	58%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC ASPIR/INJ MAJOR JNT/BUR RT HHP	$191.10	$455.00	$273.00–$386.75	—	58%
Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 HC ASPIRATE INJ INTERMED JOINT- BILATERAL	$400.26	$953.00	$69.45–$3,259.25	—	58%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ASPIRATE INJ INTERMED JOINT	$258.30	$615.00	$69.45–$3,259.25	23% above	58%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient both sides CPT 20605 HC ASPIRATE INJ INTERMED JOINT- BILATERAL	$400.26	$953.00	$571.80–$810.05	—	58%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ASPIRATE INJ INTERMED JOINT	$258.30	$615.00	$369.00–$522.75	—	58%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC DRAIN INJ ASP JNT BURSA SM	$217.14	$517.00	$67.45–$3,259.25	19% above	58%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC DRAIN INJ ASP JNT BURSA SM	$217.14	$517.00	$310.20–$439.45	—	58%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 HC LAPAROSCOPY APENDECTOMY	$3,937.08	$9,374.00	$701.00–$12,807.00	at median	58%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 HC LAPAROSCOPY APENDECTOMY	$3,937.08	$9,374.00	$5,624.40–$7,967.90	—	58%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC LCW INTER H/T/E <2.5CM	$304.08	$724.00	$123.08–$3,259.25	30% below	58%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC INTMD RPR S/A/T/EXT <=2.5 CM	$308.70	$735.00	$124.95–$3,259.25	29% below	58%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC LCW INTER H/T/E <2.5CM	$304.08	$724.00	$434.40–$615.40	—	58%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC INTMD RPR S/A/T/EXT <=2.5 CM	$308.70	$735.00	$441.00–$624.75	—	58%
Left heart catheterization, diagnostic one side CPT 93452 HC LEFT HEART CATH NO ANGIO	$4,317.18	$10,279.00	$1,235.68–$14,441.69	31% below	58%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC LEFT HEART CATH NO ANGIO	$4,317.18	$10,279.00	$6,167.40–$8,737.15	—	58%
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ ANE DRG LUM SAC W IMG GDN	$1,144.08	$2,724.00	$189.34–$3,259.25	15% below	58%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ ANE DRG LUM SAC W IMG GDN	$1,144.08	$2,724.00	$1,634.40–$2,315.40	—	58%
Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX INTERLAMINAR LMBR SAC WO IMG GDN	$629.16	$1,498.00	$150.49–$3,259.25	15% below	58%
Lower-back epidural injection, without imaging guidance CPT 62322 HC INJ ANE DRG LUM SAC W O IMG GDN	$686.28	$1,634.00	$150.49–$3,259.25	8% below	58%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC NJX INTERLAMINAR LMBR SAC WO IMG GDN	$629.16	$1,498.00	$898.80–$1,273.30	—	58%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC INJ ANE DRG LUM SAC W O IMG GDN	$686.28	$1,634.00	$980.40–$1,388.90	—	58%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ TRNSFRM LUM SNGL W IMAG	$1,143.66	$2,723.00	$212.60–$3,259.25	22% below	58%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ TRNSFRM LUM SNGL W IMAG	$1,143.66	$2,723.00	$1,633.80–$2,314.55	—	58%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXCN BENIGN LESN TAL <0.5CM	$603.54	$1,437.00	$160.86–$3,259.25	101% above	58%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXCN BENIGN LESN TAL <0.5CM	$603.54	$1,437.00	$862.20–$1,221.45	—	58%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXC BEN FA/EY/NOS <.5CM	$1,544.34	$3,677.00	$205.65–$3,489.13	346% above	58%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC EXC BEN FA/EY/NOS <.5CM	$1,544.34	$3,677.00	$2,206.20–$3,125.45	—	58%
Nail removal (partial or complete), one nail CPT 11730 HC AVULSION NAIL PL SMPL SNGL	$301.98	$719.00	$103.09–$3,259.25	24% above	58%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC AVULSION NAIL PL SMPL SNGL	$301.98	$719.00	$431.40–$611.15	—	58%
Occipital nerve block (injection for headaches) CPT 64405 HC OCCIPITAL BLOCK STERIOD	$414.12	$986.00	$95.72–$3,259.25	at median	58%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC OCCIPITAL BLOCK STERIOD	$414.12	$986.00	$591.60–$838.10	—	58%
Pacemaker implant (dual chamber) CPT 33208 HC PACER DUAL INSERTION	$11,134.62	$26,511.00	$928.87–$28,966.00	at median	58%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC PACER DUAL INSERTION	$11,134.62	$26,511.00	$15,906.60–$22,534.35	—	58%
Paracentesis with imaging guidance CPT 49083 HC ABD PARACENTESIS W IMAGING	$730.38	$1,739.00	$199.71–$3,489.13	29% below	58%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABD PARACENTESIS W IMAGING	$730.38	$1,739.00	$1,043.40–$1,478.15	—	58%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC PERMANENT REMOVAL NAILBED	$260.82	$621.00	$105.57–$3,259.25	24% below	58%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC PERMANENT REMOVAL NAILBED	$260.82	$621.00	$372.60–$527.85	—	58%
Prostate biopsy CPT 55700 HC BIOPSY PROSTATE	$1,347.36	$3,208.00	$244.59–$4,212.40	4% above	58%
Prostate biopsy inpatient CPT 55700 HC BIOPSY PROSTATE	$1,347.36	$3,208.00	$1,924.80–$2,726.80	—	58%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTROY LUMB/SAC FACET JNT	$1,509.48	$3,594.00	$368.03–$5,081.00	32% below	58%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DESTROY LUMB/SAC FACET JNT	$1,509.48	$3,594.00	$2,156.40–$3,054.90	—	58%
Removal of a foreign object under the skin, simple CPT 10120 HC RFB SUBQ TISSUE SIMPLE	$473.76	$1,128.00	$191.76–$3,259.25	38% above	58%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC RFB SUBQ TISSUE SIMPLE	$473.76	$1,128.00	$676.80–$958.80	—	58%
Short arm cast (elbow to hand) CPT 29075 HC OT CASTING OF SHORT ARM	$163.80	$390.00	$66.30–$1,302.00	21% below	58%
Short arm cast (elbow to hand) CPT 29075 HC PT CASTING OF ARM SHORT	$163.80	$390.00	$66.30–$1,302.00	21% below	58%
Short arm cast (elbow to hand) CPT 29075 HC CASTING OF ARM SHORT	$163.80	$390.00	$66.30–$1,302.00	21% below	58%
Short arm cast (elbow to hand) inpatient CPT 29075 HC CASTING OF ARM SHORT	$163.80	$390.00	$234.00–$331.50	—	58%
Short arm cast (elbow to hand) inpatient CPT 29075 HC PT CASTING OF ARM SHORT	$163.80	$390.00	$234.00–$331.50	—	58%
Short arm cast (elbow to hand) inpatient CPT 29075 HC OT CASTING OF SHORT ARM	$163.80	$390.00	$234.00–$331.50	—	58%
Short arm splint (forearm and hand) CPT 29125 HC SPLINTING OF FOREARM	$157.08	$374.00	$63.58–$1,302.00	at median	58%
Short arm splint (forearm and hand) CPT 29125 HC PT SPLINTING OF FOREARM	$157.08	$374.00	$63.58–$1,302.00	at median	58%
Short arm splint (forearm and hand) CPT 29125 HC OT SPLINTING OF FOREARM	$157.08	$374.00	$63.58–$1,302.00	at median	58%
Short arm splint (forearm and hand) inpatient CPT 29125 HC SPLINTING OF FOREARM	$157.08	$374.00	$224.40–$317.90	—	58%
Short arm splint (forearm and hand) inpatient CPT 29125 HC PT SPLINTING OF FOREARM	$157.08	$374.00	$224.40–$317.90	—	58%
Short arm splint (forearm and hand) inpatient CPT 29125 HC OT SPLINTING OF FOREARM	$157.08	$374.00	$224.40–$317.90	—	58%
Short leg cast (below the knee) CPT 29405 HC APPL SHORT LEG CAST	$151.62	$361.00	$61.37–$1,302.00	24% below	58%
Short leg cast (below the knee) inpatient CPT 29405 HC APPL SHORT LEG CAST	$151.62	$361.00	$216.60–$306.85	—	58%
Short leg splint (calf to foot) CPT 29515 HC PT SPLINTING OF LOWER LEG	$150.78	$359.00	$61.03–$1,302.00	8% below	58%
Short leg splint (calf to foot) CPT 29515 HC OT SPLINTING OF LOWER LEG	$150.78	$359.00	$61.03–$1,302.00	8% below	58%
Short leg splint (calf to foot) CPT 29515 HC SPLINTING OF LOWER LEG	$150.78	$359.00	$61.03–$1,302.00	8% below	58%
Short leg splint (calf to foot) inpatient CPT 29515 HC SPLINTING OF LOWER LEG	$150.78	$359.00	$215.40–$305.15	—	58%
Short leg splint (calf to foot) inpatient CPT 29515 HC PT SPLINTING OF LOWER LEG	$150.78	$359.00	$215.40–$305.15	—	58%
Short leg splint (calf to foot) inpatient CPT 29515 HC OT SPLINTING OF LOWER LEG	$150.78	$359.00	$215.40–$305.15	—	58%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC RSW SIMPLE H/N/T/E <2.5CM	$195.72	$466.00	$79.22–$3,259.25	6% below	58%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC RSW SIMPLE H/N/T/E <2.5CM	$195.72	$466.00	$279.60–$396.10	—	58%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION	$254.52	$606.00	$88.18–$3,259.25	at median	58%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION	$254.52	$606.00	$363.60–$515.10	—	58%
Skin tag removal, up to 15 tags CPT 11200 HC REMOVE SKIN TAGS <=15 LESIONS	$209.16	$498.00	$84.66–$3,259.25	8% above	58%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC REMOVE SKIN TAGS <=15 LESIONS	$209.16	$498.00	$298.80–$423.30	—	58%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL PUNCTURE LUMBAR DX	$343.14	$817.00	$115.40–$3,259.25	15% below	58%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC LUMB PUNCTURE FOR DIAGNOSIS	$556.92	$1,326.00	$115.40–$3,259.25	38% above	58%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC LUMBAR PUNCTURE DIAGNOSTIC	$647.64	$1,542.00	$115.40–$3,259.25	60% above	58%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL PUNCTURE LUMBAR DX	$343.14	$817.00	$490.20–$694.45	—	58%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC LUMB PUNCTURE FOR DIAGNOSIS	$556.92	$1,326.00	$795.60–$1,127.10	—	58%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC LUMBAR PUNCTURE DIAGNOSTIC	$647.64	$1,542.00	$925.20–$1,310.70	—	58%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC RSW SIMPL H/N/T/E 2.6-7.5CM	$195.72	$466.00	$79.22–$12,765.09	20% below	58%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC RSW SIMPL H/N/T/E 2.6-7.5CM	$195.72	$466.00	$279.60–$396.10	—	58%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC RSW SIMPLE FACE <2.5CM	$201.60	$480.00	$81.60–$12,765.09	14% below	58%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC RSW SIMPLE FACE <2.5CM	$201.60	$480.00	$288.00–$408.00	—	58%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$132.30	$315.00	$53.55–$3,259.25	30% below	58%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$132.30	$315.00	$189.00–$267.75	—	58%
Thoracentesis with imaging guidance CPT 32555 HC ASP PLEURA W/GUIDANCE	$600.60	$1,430.00	$205.46–$3,259.25	27% below	58%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS W IMAGE GUIDE	$714.84	$1,702.00	$205.46–$3,259.25	13% below	58%
Thoracentesis with imaging guidance inpatient CPT 32555 HC ASP PLEURA W/GUIDANCE	$600.60	$1,430.00	$858.00–$1,215.50	—	58%
Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS W IMAGE GUIDE	$714.84	$1,702.00	$1,021.20–$1,446.70	—	58%
Trigger finger release surgery CPT 26055 HC INCISE FINGER TENDON SHEATH	$1,199.94	$2,857.00	$485.69–$3,489.13	17% below	58%
Trigger finger release surgery inpatient CPT 26055 HC INCISE FINGER TENDON SHEATH	$1,199.94	$2,857.00	$1,714.20–$2,428.45	—	58%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ TRIGGER PTS 1 OR 2 MUSC	$180.18	$429.00	$69.76–$3,259.25	8% above	58%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ TRIGGER PTS 1 OR 2 MUSC	$180.18	$429.00	$257.40–$364.65	—	58%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMG	$1,443.54	$3,437.00	$289.42–$3,489.13	31% below	58%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US IMG	$1,443.54	$3,437.00	$2,062.20–$2,921.45	—	58%
Upper endoscopy (EGD) with biopsy CPT 43239 HC EGD BIOPSY SINGLE MULTIPLE	$1,924.86	$4,583.00	$259.52–$3,895.55	at median	58%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC EGD BIOPSY SINGLE MULTIPLE	$1,924.86	$4,583.00	$2,749.80–$3,895.55	—	58%
Upper endoscopy (EGD), diagnostic CPT 43235 HC EGD DIAGNOSTIC BRUSH WASH	$643.02	$1,531.00	$229.87–$3,259.25	55% below	58%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC EGD DIAGNOSTIC BRUSH WASH	$643.02	$1,531.00	$918.60–$1,301.35	—	58%
Vein ablation, radiofrequency, first vein CPT 36475 HC ENDOVENOUS ABLATION RF 1ST	$3,519.18	$8,379.00	$495.68–$9,248.33	at median	58%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC ENDOVENOUS ABLATION RF 1ST	$3,519.18	$8,379.00	$5,027.40–$7,122.15	—	58%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDE SKIN SUBCUTANEOUS	$643.86	$1,533.00	$114.41–$3,489.13	94% above	58%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDE SKIN SUBCUTANEOUS	$643.86	$1,533.00	$919.80–$1,303.05	—	58%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Nebraska	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION 1 UNIT	$420.00	$1,000.00	$78.81–$3,259.25	43% below	58%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION 1 UNIT ER	$428.40	$1,020.00	$78.81–$3,259.25	42% below	58%
Blood transfusion (giving blood or blood components) CPT 36430 HC TRANSFUSION BLOOD/BLOOD COMPONENTS	$469.98	$1,119.00	$78.81–$3,259.25	36% below	58%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION 2 UNIT	$726.18	$1,729.00	$78.81–$3,259.25	1% below	58%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION 2 UNIT ER	$734.58	$1,749.00	$78.81–$3,259.25	at median	58%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION 3 OR > UNITS	$1,028.16	$2,448.00	$78.81–$3,259.25	40% above	58%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION 1 UNIT	$420.00	$1,000.00	$600.00–$850.00	—	58%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION 1 UNIT ER	$428.40	$1,020.00	$612.00–$867.00	—	58%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC TRANSFUSION BLOOD/BLOOD COMPONENTS	$469.98	$1,119.00	$671.40–$951.15	—	58%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION 2 UNIT	$726.18	$1,729.00	$1,037.40–$1,469.65	—	58%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION 2 UNIT ER	$734.58	$1,749.00	$1,049.40–$1,486.65	—	58%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION 3 OR > UNITS	$1,028.16	$2,448.00	$1,468.80–$2,080.80	—	58%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC MDI IN-LINE TREATMENT	$101.64	$242.00	$14.72–$424.19	34% below	58%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC MDI IN-LINE TREATMENT	$101.64	$242.00	$145.20–$205.70	—	58%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO INFUSN INIT UP TO 1HR	$419.58	$999.00	$169.83–$849.15	24% below	58%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO INFUSN INIT UP TO 1HR	$419.58	$999.00	$599.40–$849.15	—	58%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC BASIC COMP AIR BONE SRT DISC	$96.60	$230.00	$39.10–$326.31	at median	58%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC BASIC COMP AIR BONE SRT DISC	$96.60	$230.00	$138.00–$195.50	—	58%
Critical care, first 30 to 74 minutes CPT 99291 HC ED VISIT CRITICAL CARE	$2,250.36	$5,358.00	$405.87–$4,933.00	69% above	58%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC ED VISIT CRITICAL CARE	$2,250.36	$5,358.00	$3,214.80–$4,554.30	—	58%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE AND DROWSY	$651.00	$1,550.00	$262.70–$1,317.50	3% below	58%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG AWAKE AND DROWSY	$651.00	$1,550.00	$930.00–$1,317.50	—	58%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG PACER W WO MAGNET	$188.16	$448.00	$11.55–$380.80	26% below	58%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG ROUTINE	$195.72	$466.00	$11.55–$396.10	23% below	58%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC EKG PACER W WO MAGNET	$188.16	$448.00	$268.80–$380.80	—	58%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC EKG ROUTINE	$195.72	$466.00	$279.60–$396.10	—	58%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC EMR DPT VST MAYX REQ PHY/QHP	$152.46	$363.00	$11.72–$847.00	18% below	58%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC EMR DPT VST MAYX REQ PHY/QHP	$152.46	$363.00	$217.80–$308.55	—	58%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC EMERGENCY DEPT VISIT SF MDM	$304.92	$726.00	$79.28–$967.00	9% below	58%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC EMERGENCY DEPT VISIT SF MDM	$304.92	$726.00	$435.60–$617.10	—	58%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC EMERGENCY DEPT VISIT LOW MDM	$651.00	$1,550.00	$135.01–$1,553.00	11% above	58%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC EMERGENCY DEPT VISIT LOW MDM	$651.00	$1,550.00	$930.00–$1,317.50	—	58%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC EMERGENCY DEPT VISIT MOD MDM	$1,038.24	$2,472.00	$229.78–$3,872.00	9% above	58%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC EMERGENCY DEPT VISIT MOD MDM	$1,038.24	$2,472.00	$1,483.20–$2,101.20	—	58%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC EMERGENCY DEPT VISIT HI MDM	$1,384.32	$3,296.00	$333.02–$5,552.00	at median	58%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC EMERGENCY DEPT VISIT HI MDM	$1,384.32	$3,296.00	$1,977.60–$2,801.60	—	58%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC PROCAINAMIDE CHALLENGE	$192.78	$459.00	$67.17–$649.45	82% below	58%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC LEXISCAN THALLIUM STRESS	$577.92	$1,376.00	$67.17–$1,169.60	47% below	58%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIOVASCULAR STRESS TEST	$875.70	$2,085.00	$67.17–$1,772.25	20% below	58%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC PROCAINAMIDE CHALLENGE	$192.78	$459.00	$275.40–$390.15	—	58%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC LEXISCAN THALLIUM STRESS	$577.92	$1,376.00	$825.60–$1,169.60	—	58%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CARDIOVASCULAR STRESS TEST	$875.70	$2,085.00	$1,251.00–$1,772.25	—	58%
Family therapy with the patient, 50 minutes CPT 90847 HC SP PSY FAMILY THERAPY W PT 50 MIN	$202.44	$482.00	$81.94–$409.70	15% below	58%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC SP PSY FAMILY THERAPY W PT 50 MIN	$202.44	$482.00	$289.20–$409.70	—	58%
Family therapy without the patient, 50 minutes CPT 90846 HC SP PSY FAMILY THERAPY WO PT 50 MIN	$202.44	$482.00	$81.94–$409.70	2% below	58%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC SP PSY FAMILY THERAPY WO PT 50 MIN	$202.44	$482.00	$289.20–$409.70	—	58%
Group psychotherapy session CPT 90853 HC PHP ACTIVITY THERAPY	$52.08	$124.00	$21.08–$568.36	79% below	58%
Group psychotherapy session CPT 90853 HC IOP PSYCHOEDUCATION GROUP	$52.08	$124.00	$21.08–$192.92	79% below	58%
Group psychotherapy session CPT 90853 HC IOP GROUP THERAPY	$52.08	$124.00	$21.08–$192.92	79% below	58%
Group psychotherapy session CPT 90853 HC THERAPIST GRP PSYCHOTHERAPY	$71.82	$171.00	$29.07–$192.92	71% below	58%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY	$79.80	$190.00	$32.30–$192.92	68% below	58%
Group psychotherapy session inpatient CPT 90853 HC PHP ACTIVITY THERAPY	$52.08	$124.00	$74.40–$105.40	—	58%
Group psychotherapy session inpatient CPT 90853 HC IOP GROUP THERAPY	$52.08	$124.00	$74.40–$105.40	—	58%
Group psychotherapy session inpatient CPT 90853 HC IOP PSYCHOEDUCATION GROUP	$52.08	$124.00	$74.40–$105.40	—	58%
Group psychotherapy session inpatient CPT 90853 HC THERAPIST GRP PSYCHOTHERAPY	$71.82	$171.00	$102.60–$145.35	—	58%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY	$79.80	$190.00	$114.00–$161.50	—	58%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC HYDRA INF INIT 31MIN-1HR SD	$247.38	$589.00	$55.44–$500.65	36% below	58%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC HYDRA INF INIT 31MIN-1HR ER	$247.38	$589.00	$55.44–$701.00	36% below	58%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC HYDRA INF INIT 31MIN-1HR SD	$247.38	$589.00	$353.40–$500.65	—	58%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC HYDRA INF INIT 31MIN-1HR ER	$247.38	$589.00	$353.40–$500.65	—	58%
IV infusion of a medicine, first hour CPT 96365 HC THERP INFSN INIT UP TO 1 HR	$313.32	$746.00	$107.67–$634.10	18% below	58%
IV infusion of a medicine, first hour CPT 96365 HC THERAPY INF INITIAL 1ST HR	$313.32	$746.00	$107.67–$847.00	18% below	58%
IV infusion of a medicine, first hour inpatient CPT 96365 HC THERP INFSN INIT UP TO 1 HR	$313.32	$746.00	$447.60–$634.10	—	58%
IV infusion of a medicine, first hour inpatient CPT 96365 HC THERAPY INF INITIAL 1ST HR	$313.32	$746.00	$447.60–$634.10	—	58%
IV push of a medicine, first drug CPT 96374 HC IV PUSH INITIAL SINGLE DRUG	$148.26	$353.00	$60.01–$847.00	39% below	58%
IV push of a medicine, first drug CPT 96374 HC IV PUSH INIT SNGL DRUG SCD	$148.26	$353.00	$60.01–$439.41	39% below	58%
IV push of a medicine, first drug inpatient CPT 96374 HC IV PUSH INIT SNGL DRUG SCD	$148.26	$353.00	$211.80–$300.05	—	58%
IV push of a medicine, first drug inpatient CPT 96374 HC IV PUSH INITIAL SINGLE DRUG	$148.26	$353.00	$211.80–$300.05	—	58%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECT SQ IM THERP PROPHY DX	$99.96	$238.00	$27.30–$202.30	at median	58%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJ SUBQ IM THRP SCHEDULED	$109.62	$261.00	$27.30–$221.85	10% above	58%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECTION SUBQ IM THERP ER	$109.62	$261.00	$27.30–$847.00	10% above	58%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJECT SQ IM THERP PROPHY DX	$99.96	$238.00	$142.80–$202.30	—	58%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJ SUBQ IM THRP SCHEDULED	$109.62	$261.00	$156.60–$221.85	—	58%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJECTION SUBQ IM THERP ER	$109.62	$261.00	$156.60–$221.85	—	58%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSYCH DIAGNOSTIC EVALUATION	$126.84	$302.00	$51.34–$347.01	39% below	58%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PSYCH DIAGNOSTIC EVALUATION	$126.84	$302.00	$181.20–$256.70	—	58%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NRV CNDJ TEST 7-8 STUDIES	$705.18	$1,679.00	$135.79–$1,427.15	at median	58%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC NRV CNDJ TEST 7-8 STUDIES	$705.18	$1,679.00	$1,007.40–$1,427.15	—	58%
Neuromuscular re-education, 15 minutes CPT 97112 HC PT NEUROMUSCULAR RE-EDU 15M	$48.30	$115.00	$19.55–$190.00	49% below	58%
Neuromuscular re-education, 15 minutes CPT 97112 HC OT NEUROMUSCULAR RE-EDU 15M	$48.30	$115.00	$19.55–$190.00	49% below	58%
Neuromuscular re-education, 15 minutes CPT 97112 HC ST NEUROMUSCULAR RE-EDU 15M	$48.30	$115.00	$19.55–$190.00	49% below	58%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC OT NEUROMUSCULAR RE-EDU 15M	$48.30	$115.00	$69.00–$97.75	—	58%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC ST NEUROMUSCULAR RE-EDU 15M	$48.30	$115.00	$69.00–$97.75	—	58%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC PT NEUROMUSCULAR RE-EDU 15M	$48.30	$115.00	$69.00–$97.75	—	58%
New patient office visit, about 30 minutes CPT 99203 HC OFFICE OUTPATIENT NEW 30-44 MINS	$221.34	$527.00	$89.59–$447.95	7% above	58%
New patient office visit, about 30 minutes inpatient CPT 99203 HC OFFICE OUTPATIENT NEW 30-44 MINS	$221.34	$527.00	$316.20–$447.95	—	58%
New patient office visit, about 45 minutes CPT 99204 HC OFFICE OUTPATIENT NEW 45-59 MINS	$291.06	$693.00	$117.81–$589.05	1% below	58%
New patient office visit, about 45 minutes inpatient CPT 99204 HC OFFICE OUTPATIENT NEW 45-59 MINS	$291.06	$693.00	$415.80–$589.05	—	58%
New patient office visit, about 60 minutes CPT 99205 HC OFFICE OUTPATIENT NEW 60-74 MINS	$325.92	$776.00	$131.92–$659.60	12% below	58%
New patient office visit, about 60 minutes inpatient CPT 99205 HC OFFICE OUTPATIENT NEW 60-74 MINS	$325.92	$776.00	$465.60–$659.60	—	58%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OFFICE O/P NEW SF 15-29 MIN	$23.52	$56.00	$9.52–$138.80	81% below	58%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OFFICE OUTPATIENT NEW 15-29 MINS	$194.88	$464.00	$78.88–$394.40	57% above	58%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC OFFICE O/P NEW SF 15-29 MIN	$23.52	$56.00	$33.60–$47.60	—	58%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC OFFICE OUTPATIENT NEW 15-29 MINS	$194.88	$464.00	$278.40–$394.40	—	58%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MEDICL NUTRITION THERAPY IP	$34.86	$83.00	$14.11–$72.44	31% below	58%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MEDICL NUTRITION THERAPY IP	$34.86	$83.00	$49.80–$70.55	—	58%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEXITY	$91.98	$219.00	$37.23–$198.79	45% below	58%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEXITY	$91.98	$219.00	$131.40–$186.15	—	58%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEXITY	$107.10	$255.00	$43.35–$216.75	51% below	58%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEXITY	$107.10	$255.00	$153.00–$216.75	—	58%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEXITY	$98.28	$234.00	$39.78–$198.90	39% below	58%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEXITY	$98.28	$234.00	$140.40–$198.90	—	58%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MODERATE COMPLEX	$107.10	$255.00	$43.35–$216.75	42% below	58%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MODERATE COMPLEX	$107.10	$255.00	$153.00–$216.75	—	58%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC OT MANUAL THERAPY EA 15MIN	$59.22	$141.00	$23.75–$190.00	38% below	58%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC PT MANUAL THERAPY EA 15MIN	$59.22	$141.00	$23.75–$190.00	38% below	58%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC OT MANUAL THERAPY EA 15MIN	$59.22	$141.00	$84.60–$119.85	—	58%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC PT MANUAL THERAPY EA 15MIN	$59.22	$141.00	$84.60–$119.85	—	58%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT THERAPEUTIC EXERCISE 15M	$56.70	$135.00	$22.95–$190.00	41% below	58%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PT THERAPEUTIC EXERCISE 15M	$56.70	$135.00	$22.95–$190.00	41% below	58%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC OT THERAPEUTIC EXERCISE 15M	$56.70	$135.00	$81.00–$114.75	—	58%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC PT THERAPEUTIC EXERCISE 15M	$56.70	$135.00	$81.00–$114.75	—	58%
Psychiatric evaluation with medical services CPT 90792 HC PSYCH DIAG EVAL W/MED SRVCS	$191.52	$456.00	$77.52–$387.60	18% below	58%
Psychiatric evaluation with medical services inpatient CPT 90792 HC PSYCH DIAG EVAL W/MED SRVCS	$191.52	$456.00	$273.60–$387.60	—	58%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC PSYTX CRISIS INITIAL 60 MIN	$102.48	$244.00	$41.48–$847.00	52% below	58%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PSYTX CRISIS INITIAL 60 MIN	$102.48	$244.00	$146.40–$207.40	—	58%
Psychotherapy session, 30 minutes CPT 90832 HC PSYCHOTHERAPY W PATIENT 30 MINUTES	$86.10	$205.00	$34.85–$335.08	46% below	58%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCHOTHERAPY W PATIENT 30 MINUTES	$86.10	$205.00	$123.00–$174.25	—	58%
Psychotherapy session, 45 minutes CPT 90834 HC PSYCHOTHERAPY W PATIENT 45 MINUTES	$92.40	$220.00	$37.40–$335.08	57% below	58%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCHOTHERAPY W PATIENT 45 MINUTES	$92.40	$220.00	$132.00–$187.00	—	58%
Psychotherapy session, 60 minutes CPT 90837 HC PSYCHOTHERAPY W PT 60 MINUTES	$109.20	$260.00	$44.20–$335.08	56% below	58%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYCHOTHERAPY W PT 60 MINUTES	$109.20	$260.00	$156.00–$221.00	—	58%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC SMOKE CESS INTERMED 3-10 MIN	$14.70	$35.00	$5.95–$62.12	50% below	58%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC SMOKE CESS INTERMED 3-10 MIN	$14.70	$35.00	$21.00–$29.75	—	58%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OFFICE VISIT EST 40-54 MINS	$85.26	$203.00	$34.51–$345.78	64% below	58%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OFFICE VISIT EST 40-54 MINS	$85.26	$203.00	$121.80–$172.55	—	58%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OFFICE VISIT EST 20-29 MINS	$61.32	$146.00	$24.82–$173.88	51% below	58%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OFFICE VISIT EST 20-29 MINS	$61.32	$146.00	$87.60–$124.10	—	58%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OFFICE VISIT EST 30-39 MINS	$74.34	$177.00	$30.09–$246.43	58% below	58%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OFFICE VISIT EST 30-39 MINS	$74.34	$177.00	$106.20–$150.45	—	58%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OFFICE VISIT EST 10-19 MINS	$47.88	$114.00	$19.38–$108.41	45% below	58%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC IR GENERAL TUBE PULL	$70.14	$167.00	$28.39–$141.95	19% below	58%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OFFICE VISIT EST 10-19 MINS	$47.88	$114.00	$68.40–$96.90	—	58%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC IR GENERAL TUBE PULL	$70.14	$167.00	$100.20–$141.95	—	58%
Speech and language evaluation CPT 92523 HC ST EVAL SOUND LANG COMPREH	$191.94	$457.00	$77.69–$450.70	39% below	58%
Speech and language evaluation inpatient CPT 92523 HC ST EVAL SOUND LANG COMPREH	$191.94	$457.00	$274.20–$388.45	—	58%
Speech therapy session, individual CPT 92507 HC ST SPEECH TREATMENT INDIVID	$162.12	$386.00	$65.62–$328.10	35% below	58%
Speech therapy session, individual inpatient CPT 92507 HC ST SPEECH TREATMENT INDIVID	$162.12	$386.00	$231.60–$328.10	—	58%
Spirometry (breathing test) CPT 94010 HC SPIROMETRY	$173.46	$413.00	$36.14–$351.05	38% below	58%
Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY	$173.46	$413.00	$247.80–$351.05	—	58%
Spirometry before and after a bronchodilator CPT 94060 HC SPIROMETRY PRE POST BRONCH	$435.54	$1,037.00	$54.43–$881.45	28% below	58%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC SPIROMETRY PRE POST BRONCH	$435.54	$1,037.00	$622.20–$881.45	—	58%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC PT THER ACTIVITY EA 15MIN	$57.12	$136.00	$23.12–$190.00	38% below	58%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC OT THER ACTIVITY EA 15MIN	$57.12	$136.00	$23.12–$190.00	38% below	58%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC OT THER ACTIVITY EA 15MIN	$57.12	$136.00	$81.60–$115.60	—	58%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC PT THER ACTIVITY EA 15MIN	$57.12	$136.00	$81.60–$115.60	—	58%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC THERAPEUTIC PHLEBOTOMY	$82.74	$197.00	$33.49–$12,765.09	57% below	58%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY THERPAPEUTIC	$157.08	$374.00	$63.58–$12,765.09	18% below	58%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC THERAPEUTIC PHLEBOTOMY	$82.74	$197.00	$118.20–$167.45	—	58%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY THERPAPEUTIC	$157.08	$374.00	$224.40–$317.90	—	58%

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 FLU VACC 2024-25(65YR UP)-MF59C(PF) 45 MCG(15 MCGX3)/0.5 ML IM SYRINGE	$37.80	$90.00	$15.30–$137.76	50% below	58%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 FLU VACC 2024-25(65YR UP)-MF59C(PF) 45 MCG(15 MCGX3)/0.5 ML IM SYRINGE	$37.80	$90.00	$18.00–$76.50	—	58%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COVID VACC 2024-2025 (12 YRS UP) (PFIZER)(PF) 30 MCG/0.3 ML IM SYRINGE	$218.26	$519.65	$88.35–$441.71	2% above	58%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COVID VAC 2023-24 (12 YRS AND UP) (RAXTOZIN)(PF) 30 MCG/0.3 ML IM SUSP	$224.60	$534.75	$90.91–$454.54	5% above	58%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COVID VAC 2023-24 (12 YR UP) (RAXTOZIN) (PF) 30 MCG/0.3 ML IM SYRINGE	$234.36	$558.00	$94.86–$474.30	9% above	58%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COVID VACC 2024-2025 (12 YRS UP) (PFIZER)(PF) 30 MCG/0.3 ML IM SYRINGE	$218.26	$519.65	$311.79–$441.71	—	58%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COVID VAC 2023-24 (12 YRS AND UP) (RAXTOZIN)(PF) 30 MCG/0.3 ML IM SUSP	$224.60	$534.75	$320.85–$454.54	—	58%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COVID VAC 2023-24 (12 YR UP) (RAXTOZIN) (PF) 30 MCG/0.3 ML IM SYRINGE	$234.36	$558.00	$334.80–$474.30	—	58%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1350 UNIT/0.5 ML SUBCUTANEOUS SUSP	$199.13	$474.10	$80.60–$402.99	at median	58%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1350 UNIT/0.5 ML SUBCUTANEOUS SUSP	$199.13	$474.10	$284.46–$402.99	—	58%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DIPHPERTUS(ACELL)TETPOLIO (PF) 25 LF-58 MCG-10 LF/0.5 ML IM SYRINGE	$101.14	$240.80	$40.94–$251.74	46% above	58%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DIPHPERTUS(ACELL)TETPOLIO (PF) 25 LF-58 MCG-10 LF/0.5 ML IM SYRINGE	$101.14	$240.80	$144.48–$204.68	—	58%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHPERTUS(ACEL)TET PED(PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SYRINGE	$46.49	$110.68	$13.71–$94.08	8% above	58%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHPERTUS(ACEL)TET PEDI (PF) 15 LF UNIT-10 MCG-5 LF/0.5 ML IM SUSP	$59.44	$141.52	$13.71–$120.30	38% above	58%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHPERTUS(ACEL)TETPOLIO(PF) 25 LF-58 MCG-10 LF/0.5 ML IM SUSP	$109.47	$260.62	$13.71–$221.53	155% above	58%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHPERTUS(ACEL)TET PED(PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SYRINGE	$46.49	$110.68	$66.41–$94.08	—	58%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHPERTUS(ACEL)TET PEDI (PF) 15 LF UNIT-10 MCG-5 LF/0.5 ML IM SUSP	$59.44	$141.52	$84.92–$120.30	—	58%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHPERTUS(ACEL)TETPOLIO(PF) 25 LF-58 MCG-10 LF/0.5 ML IM SUSP	$109.47	$260.62	$156.38–$221.53	—	58%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE	$137.96	$328.46	$55.84–$279.20	17% above	58%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE	$137.96	$328.46	$197.08–$279.20	—	58%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DP(A)T-POLIO-HIB CONJ-TET (PF) 15 LF UNIT-20 MCG-5 LF /0.5 ML IM KIT	$118.52	$282.18	$47.98–$246.84	at median	58%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DP(A)T-POLIO-HIB CONJ-TET (PF) 15 LF UNIT-20 MCG-5 LF /0.5 ML IM KIT	$118.52	$282.18	$169.31–$239.86	—	58%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE	$18.90	$45.00	$7.65–$42.56	36% below	58%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE	$18.90	$45.00	$9.00–$38.25	—	58%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE	$59.52	$141.70	$24.09–$151.08	31% below	58%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE (PF) 1440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE	$142.98	$340.41	$57.87–$289.35	66% above	58%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE	$59.52	$141.70	$85.02–$120.45	—	58%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE (PF) 1440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE	$142.98	$340.41	$204.25–$289.35	—	58%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML INTRAMUSCULAR SYRINGE	$58.71	$139.77	$23.77–$118.81	27% above	58%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML INTRAMUSCULAR SYRINGE	$58.71	$139.77	$83.87–$118.81	—	58%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP	$71.41	$170.02	$28.91–$151.53	16% below	58%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE	$95.75	$227.96	$38.76–$193.77	12% above	58%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP	$71.41	$170.02	$34.01–$144.52	—	58%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE	$95.75	$227.96	$45.60–$193.77	—	58%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 5 MCG/0.5 ML INTRAMUSCULAR SUSP	$41.79	$99.50	$16.92–$84.58	at median	58%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SYRINGE	$77.44	$184.37	$26.12–$156.72	85% above	58%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 5 MCG/0.5 ML INTRAMUSCULAR SUSP	$41.79	$99.50	$19.90–$84.58	—	58%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SYRINGE	$77.44	$184.37	$36.88–$156.72	—	58%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HAEMOPH B POLYSAC CONJ-MENING (PF) 7.5 MCG/0.5 ML INTRAMUSCULAR SOLN	$59.01	$140.48	$18.82–$119.41	6% above	58%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HAEMOPH B POLYSAC CONJ-MENING (PF) 7.5 MCG/0.5 ML INTRAMUSCULAR SOLN	$59.01	$140.48	$84.29–$119.41	—	58%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN	$118.52	$282.18	$19.88–$239.86	239% above	58%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN	$118.52	$282.18	$169.31–$239.86	—	58%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACCINE QS2022-23(65YR UP)(PF)240 MCG/0.7 ML INTRAMUSCULAR SYRINGE	$31.50	$75.00	$12.75–$150.58	63% below	58%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VACCINE QS2022-23(65YR UP)(PF)240 MCG/0.7 ML INTRAMUSCULAR SYRINGE	$31.50	$75.00	$15.00–$63.75	—	58%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLESMUMPSRUBELLA VACCINE LIVE(PF)1000-12500TCID50/0.5 ML SUBCUT	$179.91	$428.35	$72.82–$364.10	56% above	58%
MMR vaccine (measles, mumps and rubella), live CPT 90707 RESP SYNCYTIAL VIRUS VAC PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION	$547.12	$1,302.65	$78.25–$1,107.26	374% above	58%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLESMUMPSRUBELLA VACCINE LIVE(PF)1000-12500TCID50/0.5 ML SUBCUT	$179.91	$428.35	$257.01–$364.10	—	58%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 RESP SYNCYTIAL VIRUS VAC PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION	$547.12	$1,302.65	$781.59–$1,107.26	—	58%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MEASLESMUMPSRUBELVARICEL LIV(PF)10E3-4.3-3-3.99TCID50/0.5 ML SUBCUT	$336.42	$800.98	$136.17–$680.84	at median	58%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MEASLESMUMPSRUBELVARICEL LIV(PF)10E3-4.3-3-3.99TCID50/0.5 ML SUBCUT	$336.42	$800.98	$480.59–$680.84	—	58%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOC VAC ACYW-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS)	$233.10	$555.00	$94.35–$471.75	24% above	58%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOC VAC ACYW-135 DIP (PF) 4 MCG/0.5 ML INTRAMUSCULAR SOLUTION	$263.34	$626.99	$106.59–$532.95	40% above	58%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOC VAC ACYW-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS)	$233.10	$555.00	$333.00–$471.75	—	58%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOC VAC ACYW-135 DIP (PF) 4 MCG/0.5 ML INTRAMUSCULAR SOLUTION	$263.34	$626.99	$376.20–$532.95	—	58%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B VAC4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE	$317.51	$755.96	$128.52–$642.57	15% above	58%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B VAC4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE	$317.51	$755.96	$453.58–$642.57	—	58%
Nasal spray flu vaccine, live (FluMist) CPT 90660 FLU VAC TV LIVE 24-25(2-49YRS) 10EXP6.5-7.5 FF UNIT/0.2 ML NASAL SPRAY	$18.90	$45.00	$7.65–$53.16	at median	58%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 FLU VAC TV LIVE 24-25(2-49YRS) 10EXP6.5-7.5 FF UNIT/0.2 ML NASAL SPRAY	$18.90	$45.00	$9.00–$38.25	—	58%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML (NEO/PEDS)	$393.99	$938.07	$159.48–$797.36	22% above	58%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML (NEO/PEDS)	$393.99	$938.07	$187.62–$797.36	—	58%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$490.98	$1,169.00	$198.73–$993.65	7% above	58%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$490.98	$1,169.00	$701.40–$993.65	—	58%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION	$224.97	$535.63	$91.06–$455.29	20% above	58%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE	$237.26	$564.89	$96.04–$480.16	27% above	58%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION	$224.97	$535.63	$107.13–$455.29	—	58%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE	$237.26	$564.89	$112.98–$480.16	—	58%
Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION	$861.32	$2,050.75	$23.89–$1,743.14	1556% above	58%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION	$861.32	$2,050.75	$1,230.45–$1,743.14	—	58%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE	$1,104.47	$2,629.67	$447.05–$2,235.22	59% above	58%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE	$1,104.47	$2,629.67	$1,577.81–$2,235.22	—	58%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE	$1,104.47	$2,629.67	$447.05–$2,235.22	52% above	58%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE	$1,104.47	$2,629.67	$1,577.81–$2,235.22	—	58%
Rabies vaccine, one dose CPT 90675 HC RABIES VACCINE IM	$219.66	$523.00	$88.91–$764.79	60% below	58%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP	$689.41	$1,641.45	$279.05–$1,395.24	25% above	58%
Rabies vaccine, one dose inpatient CPT 90675 HC RABIES VACCINE IM	$219.66	$523.00	$313.80–$444.55	—	58%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP	$689.41	$1,641.45	$984.87–$1,395.24	—	58%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VACCINE LIVE PENTAVALENT 2 ML ORAL SOLUTION	$170.50	$405.95	$69.02–$345.06	86% above	58%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS VACCINE LIVE PENTAVALENT 2 ML ORAL SOLUTION	$170.50	$405.95	$243.57–$345.06	—	58%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP KIT	$300.98	$716.60	$121.83–$609.11	5% above	58%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP KIT	$300.98	$716.60	$429.96–$609.11	—	58%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS-TD 2 LF UNIT-2 LF UNIT/0.5 ML IM SUSPENSION	$45.69	$108.78	$18.50–$92.47	12% below	58%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE	$81.77	$194.69	$24.57–$165.49	57% above	58%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS-TD 2 LF UNIT-2 LF UNIT/0.5 ML IM SUSPENSION	$45.69	$108.78	$65.27–$92.47	—	58%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE	$81.77	$194.69	$116.82–$165.49	—	58%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTHPERTUSSIS(ACELL)TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML IM SUSP	$71.61	$170.48	$28.99–$144.91	1% above	58%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTHPERTUSSIS(ACEL)TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5ML IM SYRINGE	$77.38	$184.22	$31.32–$156.59	9% above	58%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTHPERTUS(AC)TETANUS(PF)2 LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SYRINGE	$99.74	$237.47	$32.51–$201.85	41% above	58%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTHPERTUS(ACEL)TETANUS(PF)2LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SUSP	$99.75	$237.48	$32.51–$201.86	41% above	58%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTHPERTUSSIS(ACELL)TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML IM SUSP	$71.61	$170.48	$102.29–$144.91	—	58%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTHPERTUSSIS(ACEL)TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5ML IM SYRINGE	$77.38	$184.22	$110.54–$156.59	—	58%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTHPERTUS(AC)TETANUS(PF)2 LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SYRINGE	$99.74	$237.47	$142.49–$201.85	—	58%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTHPERTUS(ACEL)TETANUS(PF)2LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SUSP	$99.75	$237.48	$142.49–$201.86	—	58%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN STATE NEWBORN HEPATITIS B VACCINE	$7.98	$19.00	$3.23–$148.43	79% below	58%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN INFLUENZA VACC	$30.24	$72.00	$12.24–$148.43	22% below	58%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ER IMMUNIZTN INJ SCHEDULED	$53.76	$128.00	$16.35–$148.43	39% above	58%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN STATE NEWBORN HEPATITIS B VACCINE	$7.98	$19.00	$11.40–$16.15	—	58%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN INFLUENZA VACC	$30.24	$72.00	$43.20–$61.20	—	58%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ER IMMUNIZTN INJ SCHEDULED	$53.76	$128.00	$76.80–$108.80	—	58%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMIN EACH ADDTL	$136.92	$326.00	$27.82–$277.10	312% above	58%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADMIN EACH ADDTL	$136.92	$326.00	$195.60–$277.10	—	58%

Source file: https://www.chihealth.com/content/dam/chihealthcom/documents/patients-and-visitors/financial-assistance/price-transparency-standard-charges/470484764-1508941097_alegent-health-bergan-mercy-health-system_standardcharges.json