Box Butte General Hospital
Box Butte General Hospital in Alliance, NE publishes cash prices for 237 common procedures listed here, from its own machine-readable price file updated Aug 18, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Nebraska median for 207 of 235 procedures and below it for 23. By typical cash price it ranks #47 of 53 Nebraska hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
2101 Box Butte Ave,Alliance,NE,69301 Collected Sep 29, 2026 Source price file (308) 762-6660
Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 4 of 5 CCN 281360 · CMS hospital register NPI 1811929060
CMS price transparency record
The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 1 action for a hospital named Box Butte General Hospital in Alliance, NE:
- Jul 27, 2026 Warning notice
Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules.
A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS | $210.40 | $263.00 | — | 55% below | 20% |
| Bone scan, whole body (nuclear medicine) CPT 78306 BONE IMAGING WHOLE BODY | $2,060.00 | $2,575.00 | — | 19% above | 20% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SYSTEM IMAGING | $1,828.00 | $2,285.00 | — | 20% above | 20% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT&RESP EFFT | $508.00 | $635.00 | — | 5% above | 20% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM | $4,940.80 | $6,176.00 | — | 26% above | 20% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR C- | $416.00 | $520.00 | $1,222.00 | 33% below | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HT MUSCLE IMAGE SPECT MULT | $4,193.60 | $5,242.00 | — | 1% below | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/> YRS 4/> PARAM | $4,267.20 | $5,334.00 | — | 15% above | 20% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT) | $80.00 | $100.00 | — | 31% above | 20% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT) | $80.00 | $100.00 | — | 40% above | 20% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $335.20 | $419.00 | — | 5% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA | $64.00 | $80.00 | — | 27% above | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY | $160.00 | $200.00 | — | 41% above | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES | $192.00 | $240.00 | — | 134% above | 20% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE | $593.60 | $742.00 | — | 167% above | 20% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PNL TOTAL CA | $148.00 | $185.00 | — | 3% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST | $196.80 | $246.00 | — | 1% below | 20% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA | $252.80 | $316.00 | — | 40% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE | $33.60 | $42.00 | — | 21% above | 20% |
| Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE BLOOD QUANT | $64.00 | $80.00 | — | 22% above | 20% |
| Blood lead test CPT 83655 ASSAY OF LEAD | $112.80 | $141.00 | — | 74% above | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHORIONIC GONADOTROPIN ASSAY | $130.40 | $163.00 | — | 7% above | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO | $81.60 | $102.00 | — | 39% above | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $102.40 | $128.00 | — | at median | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED PROBE | $200.00 | $250.00 | — | 16% above | 20% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR CA 19-9 | $179.20 | $224.00 | — | 1% below | 20% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125 | $177.60 | $222.00 | — | 21% above | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB | $159.20 | $199.00 | — | 21% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE | $188.80 | $236.00 | — | 62% above | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $192.00 | $240.00 | — | 58% above | 20% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $114.40 | $143.00 | — | 24% above | 20% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED | $91.20 | $114.00 | — | 24% above | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL | $167.20 | $209.00 | — | 1% above | 20% |
| D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION QUANT | $152.00 | $190.00 | — | at median | 20% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE | $198.40 | $248.00 | — | 40% above | 20% |
| Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL | $171.20 | $214.00 | — | 25% above | 20% |
| FSH (follicle-stimulating hormone) test CPT 83001 ASSAY OF GONADOTROPIN (FSH) | $220.80 | $276.00 | — | 94% above | 20% |
| Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL | $521.60 | $652.00 | — | 34% above | 20% |
| Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN | $124.80 | $156.00 | — | 16% above | 20% |
| Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM | $188.80 | $236.00 | — | 75% above | 20% |
| Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3) | $215.20 | $269.00 | — | 32% above | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE | $117.60 | $147.00 | — | 31% above | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TEST | $84.80 | $106.00 | — | 53% above | 20% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT) | $170.40 | $213.00 | — | 24% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA AMP PROB | $135.20 | $169.00 | — | 15% above | 20% |
| H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI ANTIBODY | $175.20 | $219.00 | — | 114% above | 20% |
| H. pylori stool antigen test CPT 87338 HPYLORI STOOL AG IA | $257.60 | $322.00 | — | 58% above | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ | $488.00 | $610.00 | — | 4% below | 20% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 1 RESULT ANTBDY | $128.00 | $160.00 | — | 75% above | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA | $101.60 | $127.00 | — | 23% above | 20% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HI-RISK TYP POOLED RSLT | $170.40 | $213.00 | — | 48% above | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $90.40 | $113.00 | — | 12% above | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY | $28.00 | $35.00 | — | 69% below | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA | $28.00 | $35.00 | — | 70% below | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB TEST | $119.20 | $149.00 | — | 30% above | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ | $480.00 | $600.00 | — | 42% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 TEST | $91.20 | $114.00 | — | 9% below | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST | $96.80 | $121.00 | — | 10% below | 20% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS | $202.40 | $253.00 | — | 112% above | 20% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE | $237.60 | $297.00 | — | 48% above | 20% |
| Insulin blood test CPT 83525 ASSAY OF INSULIN | $132.80 | $166.00 | — | 22% above | 20% |
| Iron blood test (serum iron) CPT 83540 ASSAY OF IRON | $76.00 | $95.00 | — | 21% above | 20% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST | $148.00 | $185.00 | — | 88% above | 20% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $148.00 | $185.00 | — | 1% below | 20% |
| LH (luteinizing hormone) test CPT 83002 ASSAY OF GONADOTROPIN (LH) | $207.20 | $259.00 | — | 67% above | 20% |
| Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE | $148.00 | $185.00 | — | 48% above | 20% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $198.40 | $248.00 | — | 49% above | 20% |
| Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY | $300.00 | $375.00 | — | 120% above | 20% |
| Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM | $83.20 | $104.00 | — | 15% above | 20% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY | $116.80 | $146.00 | — | 30% above | 20% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN | $83.20 | $104.00 | — | 28% above | 20% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $319.20 | $399.00 | — | 39% above | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PSA FREE | $156.00 | $195.00 | — | 14% above | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL | $128.00 | $160.00 | — | 18% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATH C/V AUTO FLUID REDO | $150.40 | $188.00 | — | 81% above | 20% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH C/V THIN LAYER | $134.40 | $168.00 | — | 98% above | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE | $256.00 | $320.00 | — | 21% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $96.80 | $121.00 | — | 23% above | 20% |
| Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE | $131.20 | $164.00 | — | 14% above | 20% |
| Prolactin blood test CPT 84146 ASSAY OF PROLACTIN | $220.00 | $275.00 | — | 76% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $60.80 | $76.00 | — | 19% above | 20% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT | $26.40 | $33.00 | — | 52% below | 20% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY | $116.00 | $145.00 | — | 51% above | 20% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE AUTOMATED | $61.60 | $77.00 | — | 15% above | 20% |
| Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS | $244.80 | $306.00 | — | 190% above | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECES | $50.40 | $63.00 | — | 82% above | 20% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 ASSAY TEST FOR BLOOD FECAL | $161.60 | $202.00 | — | 285% above | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL | $56.80 | $71.00 | — | 29% above | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUN MEASURE | $289.60 | $362.00 | — | 41% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE | $144.80 | $181.00 | — | 23% above | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EACH | $250.40 | $313.00 | — | 150% above | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE | $114.40 | $143.00 | — | 1% above | 20% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $109.60 | $137.00 | — | 16% above | 20% |
| Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID | $69.60 | $87.00 | — | 32% above | 20% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE | $76.80 | $96.00 | — | 32% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE | $50.40 | $63.00 | — | 48% above | 20% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST | $94.40 | $118.00 | — | 46% above | 20% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 | $166.40 | $208.00 | — | 43% above | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY | $176.00 | $220.00 | — | 14% above | 20% |
| Zinc blood test CPT 84630 ASSAY OF ZINC | $108.80 | $136.00 | — | 50% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST | $148.00 | $185.00 | — | 31% above | 20% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 REMOVAL OF ADENOIDS | $2,808.00 | $3,510.00 | — | 501% above | 20% |
| Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 ARTHRD ANT NTRBDY CERVICAL | $4,660.00 | $5,825.00 | — | at median | 20% |
| Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 APPENDECTOMY | $6,787.20 | $8,484.00 | — | 246% above | 20% |
| Appendectomy, open surgery CPT 44950 APPENDECTOMY | $10,496.00 | $13,120.00 | — | 622% above | 20% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 ARTHRS AID ACL RPR/AGMNTJ | $6,786.40 | $8,483.00 | — | 81% above | 20% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 SHO ARTHRS SRG RT8TR CUF RPR | $4,523.20 | $5,654.00 | — | 58% above | 20% |
| Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE | $514.40 | $643.00 | — | 18% above | 20% |
| Bunion correction with removal of part of the big toe joint CPT 28292 COR HLX VLGS RSC PRX PHLX BS | $2,714.40 | $3,393.00 | — | 59% above | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT | $1,533.60 | $1,917.00 | — | 7% above | 20% |
| Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURGERY | $2,850.40 | $3,563.00 | — | 68% above | 20% |
| Cataract surgery with lens implant CPT 66984 XCAPSL CTRC RMVL W/O ECP | $3,838.40 | $4,798.00 | — | 4% above | 20% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 CESAREAN DELIVERY | $4,342.40 | $5,428.00 | — | 12% below | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONL BLOCK | $2,493.60 | $3,117.00 | — | 380% above | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/REGIONL BLOCK | $1,700.80 | $2,126.00 | $1,818.45 | — | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLTX DST RDL FX/EPHYS SEP WO | $527.20 | $659.00 | — | 6% above | 20% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION REMOVAL | $2,714.40 | $3,393.00 | — | 86% above | 20% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY | $2,293.60 | $2,867.00 | — | 25% above | 20% |
| Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY | $2,121.60 | $2,652.00 | — | 46% above | 20% |
| Complex cataract surgery with lens implant CPT 66982 XCAPSL CTRC RMVL CPLX WO ECP | $3,420.00 | $4,275.00 | — | 30% above | 20% |
| Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY AND TREATMENT | $5,852.00 | $7,315.00 | — | 105% above | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY | $1,363.20 | $1,704.00 | — | 149% above | 20% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM OPENING | $2,128.00 | $2,660.00 | — | 263% above | 20% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI | $101.60 | $127.00 | — | 118% above | 20% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI | $101.60 | $127.00 | — | 14% above | 20% |
| Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 NSL/SINS NDSC W/TOT ETHMDCT | $3,393.60 | $4,242.00 | — | 156% above | 20% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 ENDOSCOPY MAXILLARY SINUS | $4,798.40 | $5,998.00 | — | 298% above | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC | $1,704.80 | $2,131.00 | — | 55% above | 20% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV | $2,128.80 | $2,661.00 | — | 57% above | 20% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 RPR AA HRN 1ST 3-10 RDC | $6,243.20 | $7,804.00 | — | 34% above | 20% |
| First repair of a front abdominal hernia larger than 10 cm CPT 49595 RPR AA HRN 1ST > 10 RDC | $17,661.60 | $22,077.00 | — | 940% above | 20% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST < 3 CM RDC | $5,240.80 | $6,551.00 | — | 595% above | 20% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY | $2,120.00 | $2,650.00 | — | 308% above | 20% |
| Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $6,372.00 | $7,965.00 | — | 92% above | 20% |
| Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE | $2,828.00 | $3,535.00 | — | 107% above | 20% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S) | $1,500.80 | $1,876.00 | — | 144% above | 20% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVE INT/EXT HEM 1 GROUP | $2,672.00 | $3,340.00 | — | 101% above | 20% |
| Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 TOTAL HIP ARTHROPLASTY | $9,949.60 | $12,437.00 | — | 81% above | 20% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE | $642.40 | $803.00 | — | 229% above | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE | $332.80 | $416.00 | — | 15% above | 20% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDUC >5 YR | $4,918.40 | $6,148.00 | — | 109% above | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 NJX 1 TENDON SHEATH/LIGAMENT | $157.60 | $197.00 | — | at median | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US | $527.20 | $659.00 | — | 176% above | 20% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION DRUG DLVR IMPLANT | $276.00 | $345.00 | — | 17% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US | $312.00 | $390.00 | — | 69% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $251.20 | $314.00 | — | 77% above | 20% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 ARTHRS KNE SRG MNISC RPR M/L | $5,400.00 | $6,750.00 | — | 147% above | 20% |
| Knee arthroscopy with meniscus trim CPT 29881 ARTHRS KNE SRG MNISECTMY M/L | $4,240.00 | $5,300.00 | — | 28% above | 20% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 ARTHRS KNE SRG MNISECTMY M&L | $3,948.80 | $4,936.00 | — | 63% above | 20% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 ARTHRS KNEE SURG DBRDMT/SHVG | $3,857.60 | $4,822.00 | — | 110% above | 20% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY APPENDECTOMY | $5,595.20 | $6,994.00 | — | 161% above | 20% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP ING HERNIA REPAIR INIT | $8,219.20 | $10,274.00 | — | 518% above | 20% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP ING HERNIA REPAIR RECUR | $10,696.80 | $13,371.00 | — | 563% above | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC | $1,610.40 | $2,013.00 | — | 41% above | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 | $2,889.60 | $3,612.00 | — | 97% above | 20% |
| Lumbar discectomy or laminotomy to free a nerve root, one level one side CPT 63030 LAMOT DCMPRN NRV RT 1 LMBR | $7,613.60 | $9,517.00 | — | 112% above | 20% |
| Lumbar laminectomy (spinal decompression), one level CPT 63047 LAM FACETEC & FORAMOT LUMBAR | $6,547.20 | $8,184.00 | — | 66% above | 20% |
| Lumbar spinal fusion (posterior), one level CPT 22612 ARTHRD PST TQ 1NTRSPC LUMBAR | $5,526.40 | $6,908.00 | — | at median | 20% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SIMPLE 1 | $330.40 | $413.00 | — | 38% above | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV | $516.80 | $646.00 | — | 25% above | 20% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING | $1,149.45 | $1,436.81 | — | 35% above | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION NAIL&NAIL MATRIX | $656.00 | $820.00 | — | 96% above | 20% |
| Prostate biopsy CPT 55700 BIOPSY OF PROSTATE | $3,430.40 | $4,288.00 | — | 164% above | 20% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JNT | $2,239.20 | $2,799.00 | — | 9% above | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL | $386.40 | $483.00 | — | 13% above | 20% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CA SCRN NOT HI RSK IND | $2,160.00 | $2,700.00 | — | 160% above | 20% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL SCRN; HI RISK IND | $2,141.60 | $2,677.00 | — | 156% above | 20% |
| Septoplasty to straighten the nasal septum CPT 30520 REPAIR OF NASAL SEPTUM | $3,070.40 | $3,838.00 | — | 21% above | 20% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 FRAGMENTING OF KIDNEY STONE | $12,528.00 | $15,660.00 | — | 368% above | 20% |
| Short arm cast (elbow to hand) CPT 29075 APPL CST ELBW FNGR SHORT ARM | $273.60 | $342.00 | — | 38% above | 20% |
| Short arm splint (forearm and hand) CPT 29125 APPL SHORT ARM SPLINT STATIC | $228.00 | $285.00 | — | 49% above | 20% |
| Short leg cast (below the knee) CPT 29405 APPL SHORT LEG CAST | $250.40 | $313.00 | — | 35% above | 20% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT | $350.40 | $438.00 | — | 115% above | 20% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 SHO ARTHRS SRG DSTL CLAVICLC | $3,544.80 | $4,431.00 | — | 103% above | 20% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHO ARTHRS SRG DECOMPRESSION | $3,408.80 | $4,261.00 | — | 6% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< | $321.60 | $402.00 | — | 55% above | 20% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION | $656.00 | $820.00 | — | 158% above | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR | $593.60 | $742.00 | — | 51% above | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM | $344.80 | $431.00 | — | 41% above | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5 CM/< | $319.20 | $399.00 | — | 39% above | 20% |
| TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP) | $8,948.80 | $11,186.00 | — | 161% above | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES | $330.40 | $413.00 | — | 74% above | 20% |
| Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING | $1,762.40 | $2,203.00 | — | 105% above | 20% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 REMOVE TONSILS AND ADENOIDS | $3,360.80 | $4,201.00 | — | 426% above | 20% |
| Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS AND ADENOIDS | $3,492.00 | $4,365.00 | — | 13% below | 20% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS | $3,740.80 | $4,676.00 | — | 135% above | 20% |
| Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY | $9,722.40 | $12,153.00 | — | 119% above | 20% |
| Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY | $12,400.00 | $15,500.00 | — | 181% above | 20% |
| Total shoulder replacement CPT 23472 RECONSTRUCT SHOULDER JOINT | $14,399.20 | $17,999.00 | — | 229% above | 20% |
| Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH | $2,575.20 | $3,219.00 | — | 78% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 NJX 1/MLT TRIGGER POINT 1/2 | $365.60 | $457.00 | — | 161% above | 20% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30 MM | $2,021.60 | $2,527.00 | — | 14% above | 20% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $2,544.00 | $3,180.00 | — | 32% above | 20% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVE LESION SNARE | $2,428.80 | $3,036.00 | — | 90% above | 20% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 EGD GUIDE WIRE INSERTION | $1,900.80 | $2,376.00 | — | 40% above | 20% |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $2,176.80 | $2,721.00 | — | 106% above | 20% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOURETERO W/LITHOTRIPSY | $11,245.60 | $14,057.00 | — | 786% above | 20% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URETERO W/LITHOTRIPSY | $11,516.00 | $14,395.00 | — | 60% above | 20% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OBSTETRICAL CARE | $3,749.60 | $4,687.00 | $1,818.45 | — | 20% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT(S) | $1,840.00 | $2,300.00 | — | 71% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/< | $656.00 | $820.00 | — | 127% above | 20% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 OPTX DST RD XARTC FX/EPI SEP | $5,316.80 | $6,646.00 | — | 187% above | 20% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLD/BLD COMPNT | $903.20 | $1,129.00 | — | 23% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT | $240.80 | $301.00 | $1,818.45 | — | 20% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR | $643.20 | $804.00 | — | 17% above | 20% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 COMPREHENSIVE HEARING TEST | $200.00 | $250.00 | — | 107% above | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR | $1,888.00 | $2,360.00 | $4,077.00 | 72% above | 20% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ELECTROCARDIOGRAM COMPLETE | $445.60 | $557.00 | — | 386% above | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING | $320.00 | $400.00 | — | 25% above | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMR DPT VST MAYX REQ PHY/QHP | $335.20 | $419.00 | $488.00 | 120% above | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT SF MDM | $504.80 | $631.00 | $853.00 | 125% above | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LOW MDM | $676.80 | $846.00 | $1,325.00 | 100% above | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM | $985.60 | $1,232.00 | $2,280.00 | 81% above | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT HI MDM | $1,675.20 | $2,094.00 | $4,077.00 | 97% above | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CV STRESS TEST TRACING ONLY | $1,154.40 | $1,443.00 | — | 5% above | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT | $352.00 | $440.00 | — | 7% below | 20% |
| IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT | $363.20 | $454.00 | — | 5% below | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM | $153.60 | $192.00 | — | 54% above | 20% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 NRV CNDJ TEST 7-8 STUDIES | $1,320.80 | $1,651.00 | — | 87% above | 20% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30 MIN | $199.20 | $249.00 | — | 3% below | 20% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45 MIN | $286.40 | $358.00 | — | 3% below | 20% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60 MIN | $390.40 | $488.00 | — | 6% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE O/P NEW SF 15 MIN | $148.00 | $185.00 | — | 20% above | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION INDIV IN | $125.60 | $157.00 | — | 149% above | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PREV VISIT NEW AGE 18-39 | $219.20 | $274.00 | — | 10% below | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PREV VISIT NEW AGE 40-64 | $222.40 | $278.00 | — | 20% below | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 PREV VISIT EST AGE 18-39 | $194.40 | $243.00 | — | 11% below | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 PREV VISIT EST AGE 40-64 | $207.20 | $259.00 | — | 10% below | 20% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN | $56.80 | $71.00 | — | 92% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40 MIN | $268.80 | $336.00 | — | 12% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20 MIN | $140.00 | $175.00 | — | 13% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30 MIN | $198.40 | $248.00 | — | 11% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10 MIN | $87.20 | $109.00 | — | 1% above | 20% |
| Speech and language evaluation CPT 92523 SPEECH SOUND LANG COMPREHEN | $395.20 | $494.00 | — | 25% above | 20% |
| Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST | $293.60 | $367.00 | — | 5% above | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY | $198.40 | $248.00 | — | 3% above | 20% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Nebraska | Off list |
|---|---|---|---|---|---|
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN | $39.20 | $49.00 | — | 1% above | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD | $46.40 | $58.00 | — | 40% above | 20% |
Source file: https://apim.services.craneware.com/api-pricing-transparency/api/public/17918c17c905f5eee281a0f0352904f3/charges/mrf