Does Annie Jeffrey Memorial County Health Center have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Annie Jeffrey Memorial County Health Center. In a medical emergency, call 911.

Where is Annie Jeffrey Memorial County Health Center?

P O Box 428, 531 Beebe St, Osceola, NE 68651, in Polk County, Nebraska.

What is the phone number of Annie Jeffrey Memorial County Health Center?

(402) 747-2031, as listed by Medicare (CMS).

What is the Medicare star rating of Annie Jeffrey Memorial County Health Center?

CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Annie Jeffrey Memorial County Health Center

Quick answers

Does Annie Jeffrey Memorial County Health Center have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Annie Jeffrey Memorial County Health Center. In a medical emergency, call 911.
Where is Annie Jeffrey Memorial County Health Center?: P O Box 428, 531 Beebe St, Osceola, NE 68651, in Polk County, Nebraska.
What is the phone number of Annie Jeffrey Memorial County Health Center?: (402) 747-2031, as listed by Medicare (CMS).
What is the Medicare star rating of Annie Jeffrey Memorial County Health Center?: CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Specialties and care areas^[5][7][8]

Cardiology
Gastroenterology
General Surgery
Obstetrics & Gynecology
Orthopaedics
Physical & Sports Medicine
Urology
Dermatology
Audiology
Radiology
Cardiac Rehab
Pulmonary Rehab
Respiratory Therapy
Physical Therapy
Occupational Therapy
Speech Therapy
Behavioral Health

Treatments^[5][8][11]

Blood transfusions
IV therapies
Specialty medication administration
Steroid injections for pain management
Oxygen administration
Nebulizer treatments
Nutritional counseling
Lactation consultation

Procedures^[5][7][8]

C-section
Colonoscopy
Inpatient and outpatient surgery
CT scan
Mammography
Ultrasound
Bone density studies
X-ray
MRI (mobile)
PET/CT (mobile)
Nuclear medicine
Electrocardiogram
Pulmonary function testing
Sleep studies
Nuclear stress testing

Programs and centers^{[5][6][10][11][13]}

Wellness Center
Diabetes Prevention Program
eEmergency telemedicine
ePharmacy
Labor and delivery with nursery

Emergency care (hospital website)^[5][6]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	Main entrance open 6:45 a.m.-5:15 p.m.; after that, visitors use the Emergency Department entrance^[9]

Doctors and clinicians (17)

17 doctors and other clinicians list Annie Jeffrey Memorial County Health Center as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

Doctors with a page on this site (17)

Anthony M. White, MDOrthopedic Surgery
Brent D. Jameson, MDFamily Practice
Cameron L. Sidak, MDFamily Practice
Charisse M. Mertz, CNACertified Registered Nurse Anesthetist (CRNA)
Christopher R. Balwanz, MDCardiovascular Disease (Cardiology)
David B. Jameson, MDFamily Practice
Jake M. Bianco, MDOrthopedic Surgery
Jordan M. Eller, PAPhysician Assistant
Joseph C. Erwin, MDFamily Practice
Katherine J. RystromNurse Practitioner
Logan W. McGuffey, MDUrology
Luke P. Lemke, MDFamily Practice
Matthew Summers, MDFamily Practice
Michael D. Monfore, CNACertified Registered Nurse Anesthetist (CRNA)
Nicolas R. EllerPhysician Assistant
Robert W. Dugas, MDOrthopedic Surgery
Stephen M. Nagengast, MDGeneral Surgery

Other emergency rooms nearby

Hospitals that list emergency services, by straight-line distance (not driving distance).

Genoa Community Hospital21 mi · Genoa, NE · Critical Access Hospital
York General Health Care Services21 mi · York, NE · Critical Access Hospital
Columbus Community Hospital, Inc21 mi · Columbus, NE · Acute Care Hospital
Butler County Health23 mi · David City, NE · Critical Access Hospital
Merrick Medical Center24 mi · Central City, NE · Critical Access Hospital

Other hospitals nearby

Memorial Health Care Systems30 mi · Seward, NE · Critical Access Hospital

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

Good Samaritan Society - Osceola0.9 mi · Osceola, NE · 5 of 5 stars
Midwest Covenant Home4.1 mi · Stromsburg, NE · 5 of 5 stars
York General Hearthstone20 mi · York, NE · 5 of 5 stars

All nursing homes in the state →

Hospice providers

Hospice of Columbus Community Hospital21 mi · Columbus, NE · 4 of 5 stars
Aseracare Hospice21 mi · York, NE · 3 of 5 stars

All hospice providers in the state →

Home health agencies

Home Health of Columbus Community Hospital21 mi · Columbus, NE
York General Hosp Home Health21 mi · York, NE

All home health agencies in the state →

Dialysis facilities

York General Dialysis Services21 mi · York, NE · 3 of 5 stars

All dialysis facilities in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Community health centers

East Central District Health Department/Good Neighbor Community Health Center22 mi · Columbus, NE · Community health center

Clinics and urgent care

Columbus Urgent Care LLC21 mi · Columbus, NE · Urgent care center
Witter Family Medicine22 mi · David City, NE · Rural health clinic
Utica Family Medical Center22 mi · Utica, NE · Rural health clinic

Pharmacies

Kuhill, Inc4.2 mi · Osceola, NE · Community/retail pharmacy

Assisted living nearby

Licensed homes from the official state licence list, by straight-line distance.

Good Samaritan Society - Ridgeview Heights4.2 mi · Osceola, NE
The Plaza5.2 mi · Stromsburg, NE

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What Annie Jeffrey Memorial County Health Center reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Not reported to Medicare

Source: Patient survey (HCAHPS) - Hospital — CMS, released July 22, 2026; patients discharged October 2024 to September 2025.

Infections caught in the hospital

What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.

Central line bloodstream infections (CLABSI)	Not reported to Medicare
Catheter-associated urinary tract infections (CAUTI)	Not reported to Medicare
Surgical site infections after colon surgery	Not reported to Medicare
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	Not reported to Medicare
Clostridioides difficile (C. diff) intestinal infections	Not reported to Medicare

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart attack patients	Not reported to Medicare
Deaths within 30 days: heart failure patients	Too few cases to report
Deaths within 30 days: pneumonia patients	Too few cases to report
Deaths within 30 days: COPD patients	Too few cases to report
Deaths within 30 days: stroke patients	Too few cases to report
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	Not reported to Medicare
Complications after hip or knee replacement	Not reported to Medicare

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	Not reported to Medicare
Readmitted within 30 days: heart failure	Too few cases to report
Readmitted within 30 days: pneumonia	Too few cases to report
Readmitted within 30 days: COPD	Too few cases to report
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Not reported to Medicare

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	86 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	0%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	Too few cases to report

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Nebraska Best hospitals in Nebraska

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 54 common services exactly as Annie Jeffrey Memorial County Health Center lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: UROLOGY CLINIC NEW- PRO FEE LEVEL 3	$270	$259.20	Not listed in the file
New patient office visit (about 30–44 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: UROLOGY CLINIC NEW - FACILITY LEVEL 3	$190	$182.40	Not listed in the file
New patient office visit (about 30–44 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: SURGERY CLINIC NEW- LEVEL 3	$190	$182.40	Not listed in the file
New patient office visit (about 30–44 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: UROLOGY CLINIC NEW- PRO FEE LEVEL 4	$415	$398.40	Not listed in the file
New patient office visit (about 45–59 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: UROLOGY CLINIC NEW- FACILITY LEVEL 4	$200	$192	Not listed in the file
New patient office visit (about 45–59 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: SURGERY CLINIC NEW- LEVEL 4	$200	$192	Not listed in the file
New patient office visit (about 45–59 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: UROLOGY CLINIC NEW - PRO FEE LEVEL 5	$520	$499.20	Not listed in the file
New patient office visit (about 60–74 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: UROLOGY CLINIC NEW - FACILITY LEVEL 5	$230	$220.80	Not listed in the file
New patient office visit (about 60–74 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: UROLOGY CLINIC EST- FACILITY LEVEL 3	$155	$148.80	Not listed in the file
Established patient office visit (about 20–29 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: EST PT-LEVEL 3	$155	$148.80	Not listed in the file
Established patient office visit (about 20–29 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: SURGERY CLINIC ESTABLISHED-LEVEL 3	$155	$148.80	Not listed in the file
Established patient office visit (about 20–29 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: UROLOGY CLINIC EST- PRO FEE LEVEL 4	$274	$263.04	Not listed in the file
Established patient office visit (about 30–39 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: UROLOGY CLINIC EST- FACILITY LEVEL 4	$190	$182.40	Not listed in the file
Established patient office visit (about 30–39 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: SURGERY CLINIC ESTABLISHED- LEVEL 4	$190	$182.40	Not listed in the file
Established patient office visit (about 30–39 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: EMERGENCY ROOM LEVEL 3	$775	$744	Not listed in the file
Emergency room visit (moderate): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: EMERGENCY ROOM LEVEL 4	$1,250	$1,200	Not listed in the file
Emergency room visit (moderately high): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: EMERGENCY ROOM LEVEL 5	$1,750	$1,680	Not listed in the file
Emergency room visit (high): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: BASIC METABOLIC PANEL	$116.39	$111.73	Not listed in the file
Basic metabolic panel (blood test): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: COMPREHENSIVE METABOLIC PANEL	$133.90	$128.54	Not listed in the file
Comprehensive metabolic panel (blood test): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Obstetric blood test panel CPT 80055 · Inpatient or outpatient In the file: OB PANEL W/REFLEX	$180.25	$173.04	Not listed in the file
Obstetric blood test panel: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: LIPID PANEL-PLASMA	$98.88	$94.92	Not listed in the file
Cholesterol panel (lipid panel): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Kidney function panel CPT 80069 · Inpatient or outpatient In the file: RENAL FUNCTION PANEL-SERUM	$103	$98.88	Not listed in the file
Kidney function panel: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Liver function panel CPT 80076 · Inpatient or outpatient In the file: HEPATIC FUNCTION PANEL-SERUM	$97.85	$93.94	Not listed in the file
Liver function panel: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: URINALYSIS MICRO ONLY	$55.62	$53.40	Not listed in the file
Urine test (automated, with microscope): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: URINALYSIS COMPLETE PANEL	$55.62	$53.40	Not listed in the file
Urine test (automated, with microscope): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: URINALYSIS COMPLETE W/REFLEX TO CULTURE	$59.74	$57.35	Not listed in the file
Urine test (automated, with microscope): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient In the file: SPECIFIC GRAVITY OF URINE	$26.78	$25.71	Not listed in the file
Urine test (manual, without microscope): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient In the file: UA RANDOM PROTEIN DIP	$26.78	$25.71	Not listed in the file
Urine test (manual, without microscope): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: .UA DIP STICK	$36.05	$34.61	Not listed in the file
Urine test (automated, without microscope): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: DIPSTICK	$36.05	$34.61	Not listed in the file
Urine test (automated, without microscope): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: URINALYSIS DIPSTICK PANEL	$36.05	$34.61	Not listed in the file
Urine test (automated, without microscope): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: PROSTATE SPECIFIC ANTIGEN (PSA)-SERUM	$92.70	$88.99	Not listed in the file
PSA (prostate specific antigen) blood test: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: PSA (SENDOUT)010322	$92.70	$88.99	Not listed in the file
PSA (prostate specific antigen) blood test: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: TOTAL PSA (92920)	$92.70	$88.99	Not listed in the file
PSA (prostate specific antigen) blood test: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: TSH(THYROTROPIN)	$92.70	$88.99	Not listed in the file
Thyroid stimulating hormone (TSH) test: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: THYROID STIMULATING HORMONE-SERUM	$92.70	$88.99	Not listed in the file
Thyroid stimulating hormone (TSH) test: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: TSH SENSITIVE (93310)	$20.60	$19.78	Not listed in the file
Thyroid stimulating hormone (TSH) test: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: AUTO DIFFERENTIAL	$81.37	$78.12	Not listed in the file
Complete blood count (CBC) with differential: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: .CBC W AUTO DIFFERENTIAL	$81.37	$78.12	Not listed in the file
Complete blood count (CBC) with differential: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: CBC/AUTO CHG	$81.37	$78.12	Not listed in the file
Complete blood count (CBC) with differential: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: .CBC/HEM8D(MAN DIFF)	$103	$98.88	Not listed in the file
Complete blood count (CBC), automated: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: HEMOGRAM	$35.02	$33.62	Not listed in the file
Complete blood count (CBC), automated: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: PROTHROMBIN TIME(SEND OUT)	$55.62	$53.40	Not listed in the file
Blood clotting time test (prothrombin time, PT): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: PT/INR-PLASMA	$55.62	$53.40	Not listed in the file
Blood clotting time test (prothrombin time, PT): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: ZPROTHROMBIN TIME-BLOOD	$55.62	$53.40	Not listed in the file
Blood clotting time test (prothrombin time, PT): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: aPTT	$74.16	$71.19	Not listed in the file
Blood clotting test (partial thromboplastin time, PTT): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: .PTT	$17.51	$16.81	Not listed in the file
Blood clotting test (partial thromboplastin time, PTT): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: PTT RPS	$19.57	$18.79	Not listed in the file
Blood clotting test (partial thromboplastin time, PTT): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient In the file: CT HEAD W/O IV CONTRAST	$2,100	$2,016	Not listed in the file
CT scan of the head or brain, without contrast: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient In the file: MRI BRAIN W/ AND W/O CONTRAST	$4,025	$3,864	Not listed in the file
MRI of the brain, before and after contrast: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient In the file: XR CHEST 2 VIEWS	$375	$360	Not listed in the file
Chest X-ray, 2 views: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient In the file: XR L-SPINE 4 OR MORE VIEWS	$525	$504	Not listed in the file
X-ray of the lower spine, at least 4 views: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: MRI L-SPINE W/O CONTRAST	$3,400	$3,264	Not listed in the file
MRI of the lower back (lumbar spine), without contrast: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient In the file: CT PELVIS W/ IV CONTRAST	$2,600	$2,496	Not listed in the file
CT scan of the pelvis, with contrast: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · modifier RT In the file: MRI LOWER EXT JOINT W/O CONTRAST RT,RIGHT SIDE	$2,750	$2,640	Not listed in the file
MRI of a leg joint (such as the knee), without contrast: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · modifier LT In the file: MRI LOWER EXT JOINT W/O IV CONTRAST LT,LEFT SIDE	$2,750	$2,640	Not listed in the file
MRI of a leg joint (such as the knee), without contrast: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient In the file: CT ABD PELVIS W/ IV CONTRAST	$4,250	$4,080	Not listed in the file
CT scan of the abdomen and pelvis, with contrast: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: US ABDOMEN COMPLETE	$850	$816	Not listed in the file
Ultrasound of the abdomen, complete: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient In the file: US OB COMPLETE FETAL SURVEY	$800	$768	Not listed in the file
Pregnancy ultrasound (after the first trimester): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient In the file: US TRANSVAGINAL	$700	$672	Not listed in the file
Transvaginal ultrasound: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · modifier LT In the file: MAMMO DIAGNOSTIC LEFT,LEFT SIDE	$375	$360	Not listed in the file
Diagnostic mammogram, one breast: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · modifier RT In the file: MAMMO DIAGNOSTIC RIGHT,RIGHT SIDE	$375	$360	Not listed in the file
Diagnostic mammogram, one breast: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: MAMMO DIAGNOSTIC BILATERAL	$475	$456	Not listed in the file
Diagnostic mammogram, both breasts: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: MAMMO DIAGNOSTIC IMPLANT BILATERAL	$475	$456	Not listed in the file
Diagnostic mammogram, both breasts: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: MAMMO SCREENING BILATERAL	$425	$408	Not listed in the file
Screening mammogram, both breasts: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: MAMMO SCREENING IMPLANT BILATERAL	$425	$408	Not listed in the file
Screening mammogram, both breasts: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · modifier 52,LT In the file: MAMMO SCREENING LEFT,REDUCED SERVICE, LEFT SIDE	$325	$312	Not listed in the file
Screening mammogram, both breasts: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: FULL SLEEP STUDY/CPAP	$4,300	$4,128	Not listed in the file
Sleep study (overnight, in a sleep lab): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · modifier GP In the file: PT THERAPEUTIC EXERCISE,PHYSICAL THERAPY SERVICES	$115	$110.40	Not listed in the file
Physical therapy: therapeutic exercise (each 15 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · modifier GO In the file: OT THERAPEUTIC EXERCISES,OCCUPATIONAL THERAPY SERVICES	$175	$168	Not listed in the file
Physical therapy: therapeutic exercise (each 15 minutes): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · modifier GP In the file: PT EVAL LOW COMPLEX 20 MINUTES,PHYSICAL THERAPY SERVICES	$200	$192	Not listed in the file
Physical therapy evaluation (low complexity): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · modifier GP In the file: PT EVAL MOD COMPLEX 30 MINUTES,PHYSICAL THERAPY SERVICES	$225	$216	Not listed in the file
Physical therapy evaluation (moderate complexity): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · modifier GP In the file: PT EVAL HIGH COMPLEX 45 MINUTES,PHYSICAL THERAPY SERVICES	$275	$264	Not listed in the file
Physical therapy evaluation (high complexity): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: EXCISION OF CYST, BREAST	$3,500	$3,360	Not listed in the file
Removal of breast growth (open surgery): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: KNEE ARTHROSCOPY / SURGERY	$4,000	$3,840	Not listed in the file
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: EGD TRANS ORAL DIAGNOSTIC	$1,700	$1,632	Not listed in the file
Upper GI endoscopy (diagnostic): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: EGD BIOPSY SINGLE / MULTIPLE	$1,700	$1,632	Not listed in the file
Upper GI endoscopy with biopsy: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: DIAGNOSTIC COLONOSCOPY	$1,700	$1,632	Not listed in the file
Colonoscopy (diagnostic): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: COLONOSCOPY AND BIOPSY	$1,700	$1,632	Not listed in the file
Colonoscopy with biopsy: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: COLONOSCOPY W/ LESION REMOVAL SNARE TECH	$2,000	$1,920	Not listed in the file
Colonoscopy with removal of polyps (snare): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: COLORECTAL SCREENING NOT HIGH RISK	$1,545	$1,483.20	Not listed in the file
Screening colonoscopy (not high risk): rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: LAPAROSCOPIC CHLOECYSTECTOMY	$5,000	$4,800	Not listed in the file
Gallbladder removal by laparoscope: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: REPAIR INT INQU HERNIA 5YRSOR+ REDUCIABL	$4,500	$4,320	Not listed in the file
Groin (inguinal) hernia repair, age 5 or older: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: PROSTATE BIOPSY (NEEDLE/PUNCH)- PRO FEE	$400	$384	Not listed in the file
Prostate biopsy: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: PROSTATE NEEDLE BIOPSY ANY APPROACH	$2,000	$1,920	Not listed in the file
Prostate biopsy: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: CARPAL TUNNEL SURGERY	$2,250	$2,160	Not listed in the file
Carpal tunnel release: rates for 10 insurance plans Aetna Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount) Ambetter — Default: 96% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE — Default: 95% (a percentage in the contract, not a dollar amount) Blue Cross Blue Shield of NE MCR Adv — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) Midlands Choice, Inc. — Default: 96% (a percentage in the contract, not a dollar amount) Molina Healthcare of Nebraska — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) Nebraska Total Care — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Community Plan Dual Complete — Medicare Advantage: 67% (a percentage in the contract, not a dollar amount) UHC Community Plan NE — Medicaid Replacement: 71% (a percentage in the contract, not a dollar amount) UHC Group Medicare Advantage — Default: 67% (a percentage in the contract, not a dollar amount)

Source: Annie Jeffrey Memorial County Health Center’s standard charges file (ajhc.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on March 18, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Critical Access Hospital
Address	P O Box 428, 531 Beebe St, Osceola, NE 68651
County	Polk County
State	Nebraska
Phone	(402) 747‑2031
Emergency services	Yes
Ownership	Government - Local
Medicare overall rating	Not rated by CMS
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	281314
Name in Medicare records	ANNIE JEFFREY MEMORIAL COUNTY HEALTH CENTER
Profile level	Medicare data + hospital website
Official website	ajhc.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-31.

Welcome to Annie Jeffrey Health Center! — ajhc.org
Welcome to Annie Jeffrey Health Center! — ajhc.org
Welcome to Annie Jeffrey Health Center! — ajhc.org
Welcome to Annie Jeffrey Health Center! — ajhc.org
Welcome to Annie Jeffrey Health Center! — ajhc.org
Welcome to Annie Jeffrey Health Center! — ajhc.org
Welcome to Annie Jeffrey Health Center! — ajhc.org
Welcome to Annie Jeffrey Health Center! — ajhc.org
Welcome to Annie Jeffrey Health Center! — ajhc.org