FCH Cost Estimator

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Insurance

Your out-of-pocket expense will depend on your individual insurance coverage, such as deductible or co-insurance. To determine your estimated out-of-pocket expense, please contact your insurance company by calling the number on the back of your insurance card.

Estimates

The information provided on this website is a best estimate and is not a guarantee of what you will be charged.


These estimates reflect the hospital's charges only. The physician's charge is NOT included. The quotes for procedures performed in the operating room include the professional charge for the administration of anesthesia. Tissue examined by an outside lab may be billed separately. All x-rays are read by a Radiologist and billed through Advanced Medical Imaging.


If you have any questions about the prices listed, please feel free to call us at (402) 759-3167.

CT

DESCRIPTION CPT FCH PRICE NHIS AVG
CT Scan Abdomen/Pelvis W/O Contrast 74176 $3,312.00 $3,640.00
CT Scan Abdomen/Pelvis With Contrast 74177 $3,879.00 $3,920.00
CT Scan Angiography Chest With Contrast 71275 $2,633.00 $2,778.00
CT Scan C-Spine W/O Contrast 72125 $2,059.00 $2,039.00
CT Scan Chest W/O Contrast 71250 $2,035.00 $1,940.00
CT Scan Chest With Contrast 71260 $2,226.00 $2,295.00
CT Scan Head W/O Contrast 70450 $1,758.00 $1,848.00
CT Scan Kidney Stone Search 74176 $1,854.00 $3,257.00
CT Scan Low Extremity W/O Contrast 73700 $1,659.00 $1,841.00
CT Cardiac Calcium Scoring 75571 $150.00 $150.00

Labor & Delivery

DESCRIPTION CPT FCH PRICE NEB AVG
Ceserean Section $13,950.00
Normal Vaginal Delivery with Epidural $7,250.00
Normal Vaginal Delivery without Epidural $5,000.00

Laboratory

DESCRIPTION CPT FCH PRICE NEB AVG
Basic Metabolic Panel 80048 $119.00 $120.00
CBC Inc PLT Auto 85025 $84.00 $83.00
CMP 80053 $137.00 $139.00
Collection of Blood Specimen 36415 $27.00 $24.00
Hemoglobin A1C 83036 $69.00 $68.00
Hemogram (CBC w/Diff) 85027 $68.00 $70.00
Lipid Panel 80061 $104.00 $107.00
Prothrombin Time (Finger) 85610 $35.00 $51.00
Thyroid Stimulating Hormone 84443 $75.00 $97.00
Urinalysis (Complete) 81001 $53.00 $50.00

MRI

DESCRIPTION CPT FCH PRICE NHIS AVG
MRI Abdomen W/O & With Contrast 74183 $2,702.00 $3,408.00
MRI Brain W/O Contrast 70544 $2,515.00 $2,751.00
MRI Brain W/O & With Contrast 70553 $3,153.00 $3,327.00
MRI Cervical Spine W/O Contrast 72141 $2,705.00 $2,875.00
MRI Lower Extremity Joint W/O Contrast 73721 $2,228.00 $2,219.00
MRI Lower Extremity No Joint W/O Contrast 73718 $2,058.00 $2,175.00
MRI Lumbar Spine W/O Contrast 72148 $2,668.00 $2,792.00
MRI Lumbar Spine With & W/O Contrast 72158 $3,162.00 $3,340.00
MRI Thoracic Spine W/O Contrast 72146 $2,668.00 $2,845.00
MRI Upper Extremity Joint W/O Contrast 73221 $2,094.00 $2,176.00

Surgery

DESCRIPTION CPT FCH PRICE NEB AVG
Appendectomy $20,550.00
Cataract Surgery $4,850.00
Colonoscopy with MAC Sedation $2,770.00
Colonoscopy with full Sedation $4,652.00
Knee Arthroscopy $12,250.00
Total Knee Replacement $45,225.00
Total Hip Replacement $46,055.00
Upper Endoscopy $2,470.00

Ultrasound

DESCRIPTION CPT FCH PRICE NHIS AVG
Abdominal Complete 76700 $768.00 $778.00
Abdominal Retroperitoneum 76770 $650.00 $652.00
Abdominal Ultrasound-Limited 76705 $574.00 $613.00
Breast Ultrasound 76642 $341.00 $366.00
Pelvic Ultrasound TransVag 76830 $544.00 $535.00
Pelvic Ultrasound > 14 weeks 76805 $636.00 $635.00
Pelvic Ultrasound < 14 weeks 76801 $522.00 $520.00
Pregnancy Comp TransVag 76817 $461.00 $495.00
Thyroid Ultrasound 76536 $487.00 $487.00
US Extremity Ultrasound 76882 $330.00 $437.00

X-Ray

DESCRIPTION CPT FCH PRICE NHIS AVG
Abdomen Complete (2V) 74020 $290.00 $315.00
Abdomen KUB (1V) 74000 $226.00 $239.00
Chest (1V) 71010 $207.00 $218.00
Chest (2V) 71020 $247.00 $263.00
Foot (Min 3V) 73630 $234.00 $269.00
Hand (3V) 73130 $234.00 $266.00
Knee Complete (Min 4V) 73564 $263.00 $306.00
L-Spine Flex/Ext 72120 $280.00 $316.00
Shoulder (Min 2V) 73030 $253.00 $284.00
Wrist (Min 3V) 73110 $226.00 $252.00