Does CHI Health St Mary's have an emergency room?

Yes. Medicare (CMS) data lists emergency services at CHI Health St Mary's. In a medical emergency, call 911.

Where is CHI Health St Mary's?

1301 Grundman Blvd, Nebraska City, NE 68410, in Otoe County, Nebraska.

What is the phone number of CHI Health St Mary's?

(402) 873-3321, as listed by Medicare (CMS).

What is the Medicare star rating of CHI Health St Mary's?

4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

CHI Health St Mary's — Nebraska City, NE

Quick answers

Does CHI Health St Mary's have an emergency room?: Yes. Medicare (CMS) data lists emergency services at CHI Health St Mary's. In a medical emergency, call 911.
Where is CHI Health St Mary's?: 1301 Grundman Blvd, Nebraska City, NE 68410, in Otoe County, Nebraska.
What is the phone number of CHI Health St Mary's?: (402) 873-3321, as listed by Medicare (CMS).
What is the Medicare star rating of CHI Health St Mary's?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4]

Emergency care
Inpatient/acute care
Maternity
Primary care
Radiology
Occupational health
Transitional care
Hospitalist care

Conditions treated^[5][7]

Treatments^[4][5][6][7]

Physical and occupational therapy
Diabetes education
Digital mammography
3D mammography
Focused ultrasound for essential tremor
Laboratory services
Epidural labor pain relief
Nitrous oxide labor pain relief
Medication for opioid use disorder
Medical nutrition therapy
Continuous glucose monitor training
Physical therapy
Speech therapy
Respiratory therapy

Procedures^[4][6]

Mammography
CT
MRI
Ultrasound
Nuclear medicine
DEXA
PET/CT
Car seat angle tolerance testing

Programs and centers^[4][5][6][7]

Opioid and substance use treatment program
Specialty Clinic
Transitional Care
Diabetes Education
Comeback ERA (substance and opioid use support)
Focused Ultrasound program
Maternity Center
Childbirth education classes

Emergency care (hospital website)^[4]

Emergency room	Yes
Open 24/7	Yes
Trauma designation	Level IV

Doctors and clinicians (107)

107 doctors and other clinicians list CHI Health St Mary's 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 (107)

Aaron D. Robinson, MDOtolaryngology
Aaron M. Bott, MDOrthopedic Surgery
Adam Schell, MDOrthopedic Surgery
Adam T. Kafka, MDPhysical Medicine and Rehabilitation
Adrienne S. Dekarske, MDDiagnostic Radiology
Akua Fordjour, MDInternal Medicine
Amanda L. Ensz, MDInternal Medicine
Anand R. Deshmukh, MDInterventional Cardiology
Andrew C. Ensz, MDFamily Practice
Andrew D. Livingston, MDNeurosurgery
Andrew J. SchusterPhysician Assistant
Angela A. BickfordNurse Practitioner
Ankur Saini, MDSleep Medicine
Annaliese M. Bosco, MDNeurology
Anuj Jain, MDCardiovascular Disease (Cardiology)
Beth A. Rawlings, MDHospitalist
Bradley J. Vasa, MDFamily Practice
Brea R. Smith ProffittPhysician Assistant
Brett J. Meyer, MDFamily Practice
Briley J. HakelPhysician Assistant
Cassandra J. Madden, CNACertified Registered Nurse Anesthetist (CRNA)
Cassandra MuellerNurse Practitioner
Chelsy R. BinkleyNurse Practitioner
Christine A. Shank, NPNurse Practitioner

And 83 more: the button below opens the full list.

Other emergency rooms nearby

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

George C Grape Community Hospital12 mi · Hamburg, IA · Critical Access Hospital
Syracuse Area Health15 mi · Syracuse, NE · Critical Access Hospital
Nemaha County Hospital18 mi · Auburn, NE · Critical Access Hospital
Johnson County Hospital24 mi · Tecumseh, NE · Critical Access Hospital
Shenandoah Medical Center28 mi · Shenandoah, IA · Critical Access Hospital

Other hospitals nearby

Bellevue Medical Center32 mi · Bellevue, NE · Acute Care 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

The Ambassador Nebraska City, Inc3.8 mi · Nebraska City, NE · 5 of 5 stars
Prestige Care Center of Nebraska City4.0 mi · Nebraska City, NE · 1 of 5 stars
The Ambassador Sidney Inc15 mi · Sidney, IA · 4 of 5 stars

All nursing homes in the state →

Home health agencies

Good Samaritan Society Home Care of Southeast NE18 mi · Auburn, NE · 5 of 5 stars

All home health agencies 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.

Clinics and urgent care

Nebraska City Medical Clinic0.0 mi · Nebraska City, NE · Rural health clinic
Medical Clinic12 mi · Hamburg, IA · Rural health clinic
Syracuse Area Health15 mi · Syracuse, NE · Rural health clinic

Pharmacies

U Save Pharmacy of Auburn LLC0.0 mi · Nebraska City, NE · Community/retail pharmacy
Walgreen Co0.0 mi · Nebraska City, NE · Pharmacy
Walmart Inc.0.0 mi · Nebraska City, NE · Community/retail pharmacy

Assisted living nearby

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

Morton Senior Living0.0 mi · Nebraska City, NE
The Ambassador Nebraska City Assisted Living0.0 mi · Nebraska City, NE
Good Samaritan Society - Linden View15 mi · Syracuse, 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 CHI Health St Mary's 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.

Summary star rating (all survey topics)	Not reported to Medicare
Overall rating of the hospital	Not reported to Medicare
Would recommend the hospital	Not reported to Medicare
Nurses communicated well	Not reported to Medicare
Doctors communicated well	Not reported to Medicare
Staff explained medicines	Not reported to Medicare
Information about recovery at home	Not reported to Medicare
Room and bathroom kept clean	Not reported to Medicare
Quiet at night	Not reported to Medicare
Rated the hospital 9 or 10 out of 10	77%National average: 72%
Would definitely recommend the hospital	75%National average: 71%
Nurses “always” communicated well	86%National average: 80%
Doctors “always” communicated well	85%National average: 80%
Staff “always” explained medicines before giving them	67%National average: 62%
Were given information about recovery at home	86%National average: 86%
Room and bathroom “always” clean	69%National average: 74%
Area around the room “always” quiet at night	66%National average: 60%
Completed surveys	78Response rate: 22%

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	Too few cases to report
Deaths within 30 days: heart failure patients	10.2%
Deaths within 30 days: pneumonia patients	15.3%
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; data from July 2022 to June 2025.

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	Too few cases to report
Readmitted within 30 days: heart failure	20.9%
Readmitted within 30 days: pneumonia	17.3%
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; data from July 2023 to June 2025.

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)	116 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)	46%National average: 65%

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 64 common services exactly as CHI Health St Mary's 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: HC OFFICE OUTPATIENT NEW 30-44 MINS	$329	$273.07	$70.48 – $315.84
New patient office visit (about 30–44 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $70.48 Amerigroup — Medicare\|All Plans: $138.18 AMPS — Commercial\|All Plans: $292.16 BCBS - NE — Commercial\|All Other Plans: $115.48 BCBS - NE — Commercial\|BluePrint: $109.71 BCBS - NE — Medicare\|All Plans: $131.60 Centene — Medicaid\|NE Total Care: $134.89 Centene — Medicare\|All Plans: $134.24 Great Plains — Medicare\|All Plans: $138.18 Greater Omaha Packing — Commercial\|Broad Network: $315.84
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: PC OFFICE VISIT NEW PRO 30-44 MINS	$314	$260.62	$67.26 – $301.44
New patient office visit (about 30–44 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $67.26 Amerigroup — Medicare\|All Plans: $131.88 AMPS — Commercial\|All Plans: $278.84 BCBS - NE — Commercial\|All Other Plans: $115.48 BCBS - NE — Commercial\|BluePrint: $109.71 BCBS - NE — Medicare\|All Plans: $125.60 Centene — Medicaid\|NE Total Care: $128.74 Centene — Medicare\|All Plans: $128.12 Great Plains — Medicare\|All Plans: $131.88 Greater Omaha Packing — Commercial\|Broad Network: $301.44
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) In the file: HC OFFICE OUTPATIENT NEW 30-44 MINS	$329	$273.07	$296.93 – $315.84
New patient office visit (about 30–44 minutes): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $312.55 BCBS - NE — Commercial\|BluePrint: $296.93 Greater Omaha Packing — Commercial\|Broad Network: $315.84 Greater Omaha Packing — Commercial\|Narrow Network: $315.84 Medica — Commercial\|ACO: $315.84 Medica — Commercial\|All Other Plans: $299.39 Medica — Commercial\|CHI Health: $299.39 Medica — Commercial\|Open Access: $315.84 Midlands Choice — Commercial\|Premier: $315.84 Midlands Choice — Commercial\|Standard: $315.84
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: HC OFFICE OUTPATIENT NEW 45-59 MINS	$506	$419.98	$108.39 – $485.76
New patient office visit (about 45–59 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $108.39 Amerigroup — Medicare\|All Plans: $212.52 AMPS — Commercial\|All Plans: $449.33 BCBS - NE — Commercial\|All Other Plans: $155.02 BCBS - NE — Commercial\|BluePrint: $147.27 BCBS - NE — Medicare\|All Plans: $202.40 Centene — Medicaid\|NE Total Care: $207.46 Centene — Medicare\|All Plans: $206.45 Great Plains — Medicare\|All Plans: $212.52 Greater Omaha Packing — Commercial\|Broad Network: $485.76
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: PC OFFICE VISIT NEW PRO 45-59 MINS	$470	$390.10	$100.68 – $451.20
New patient office visit (about 45–59 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $100.68 Amerigroup — Medicare\|All Plans: $197.40 AMPS — Commercial\|All Plans: $417.36 BCBS - NE — Commercial\|All Other Plans: $155.02 BCBS - NE — Commercial\|BluePrint: $147.27 BCBS - NE — Medicare\|All Plans: $188 Centene — Medicaid\|NE Total Care: $192.70 Centene — Medicare\|All Plans: $191.76 Great Plains — Medicare\|All Plans: $197.40 Greater Omaha Packing — Commercial\|Broad Network: $451.20
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) In the file: HC OFFICE OUTPATIENT NEW 45-59 MINS	$506	$419.98	$456.67 – $485.76
New patient office visit (about 45–59 minutes): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $480.70 BCBS - NE — Commercial\|BluePrint: $456.67 Greater Omaha Packing — Commercial\|Broad Network: $485.76 Greater Omaha Packing — Commercial\|Narrow Network: $485.76 Medica — Commercial\|ACO: $485.76 Medica — Commercial\|All Other Plans: $460.46 Medica — Commercial\|CHI Health: $460.46 Medica — Commercial\|Open Access: $485.76 Midlands Choice — Commercial\|Premier: $485.76 Midlands Choice — Commercial\|Standard: $485.76
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: HC OFFICE OUTPATIENT NEW 60-74 MINS	$623	$517.09	$133.45 – $598.08
New patient office visit (about 60–74 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $133.45 Amerigroup — Medicare\|All Plans: $261.66 AMPS — Commercial\|All Plans: $553.23 BCBS - NE — Commercial\|All Other Plans: $210.16 BCBS - NE — Commercial\|BluePrint: $199.65 BCBS - NE — Medicare\|All Plans: $249.20 Centene — Medicaid\|NE Total Care: $255.43 Centene — Medicare\|All Plans: $254.19 Great Plains — Medicare\|All Plans: $261.66 Greater Omaha Packing — Commercial\|Broad Network: $598.08
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: PC OFFICE VISIT NEW PRO 60-74 MINS	$622	$516.26	$133.24 – $597.12
New patient office visit (about 60–74 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $133.24 Amerigroup — Medicare\|All Plans: $261.24 AMPS — Commercial\|All Plans: $552.34 BCBS - NE — Commercial\|All Other Plans: $210.16 BCBS - NE — Commercial\|BluePrint: $199.65 BCBS - NE — Medicare\|All Plans: $248.80 Centene — Medicaid\|NE Total Care: $255.02 Centene — Medicare\|All Plans: $253.78 Great Plains — Medicare\|All Plans: $261.24 Greater Omaha Packing — Commercial\|Broad Network: $597.12
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) In the file: HC OFFICE OUTPATIENT NEW 60-74 MINS	$623	$517.09	$562.26 – $598.08
New patient office visit (about 60–74 minutes): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $591.85 BCBS - NE — Commercial\|BluePrint: $562.26 Greater Omaha Packing — Commercial\|Broad Network: $598.08 Greater Omaha Packing — Commercial\|Narrow Network: $598.08 Medica — Commercial\|ACO: $598.08 Medica — Commercial\|All Other Plans: $566.93 Medica — Commercial\|CHI Health: $566.93 Medica — Commercial\|Open Access: $598.08 Midlands Choice — Commercial\|Premier: $598.08 Midlands Choice — Commercial\|Standard: $598.08
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: HC CAH OFFICE VIS EST 20-29 MINS	$81	$67.23	$17.36 – $81
Established patient office visit (about 20–29 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $17.36 Amerigroup — Medicare\|All Plans: $34.02 AMPS — Commercial\|All Plans: $71.93 BCBS - NE — Commercial\|All Other Plans: $81 BCBS - NE — Commercial\|BluePrint: $76.95 BCBS - NE — Medicare\|All Plans: $32.40 Centene — Medicaid\|NE Total Care: $33.21 Centene — Medicare\|All Plans: $33.05 Great Plains — Medicare\|All Plans: $34.02 Greater Omaha Packing — Commercial\|Broad Network: $77.76
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: HC OFFICE VISIT EST 20-29 MINS	$392	$325.36	$83.97 – $376.32
Established patient office visit (about 20–29 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $83.97 Amerigroup — Medicare\|All Plans: $164.64 AMPS — Commercial\|All Plans: $348.10 BCBS - NE — Commercial\|All Other Plans: $109.24 BCBS - NE — Commercial\|BluePrint: $103.78 BCBS - NE — Medicare\|All Plans: $156.80 Centene — Medicaid\|NE Total Care: $160.72 Centene — Medicare\|All Plans: $159.94 Great Plains — Medicare\|All Plans: $164.64 Greater Omaha Packing — Commercial\|Broad Network: $376.32
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: PC OFFICE VISIT EST PRO 20-29 MINS	$256	$212.48	$54.84 – $245.76
Established patient office visit (about 20–29 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $54.84 Amerigroup — Medicare\|All Plans: $107.52 AMPS — Commercial\|All Plans: $227.33 BCBS - NE — Commercial\|All Other Plans: $109.24 BCBS - NE — Commercial\|BluePrint: $103.78 BCBS - NE — Medicare\|All Plans: $102.40 Centene — Medicaid\|NE Total Care: $104.96 Centene — Medicare\|All Plans: $104.45 Great Plains — Medicare\|All Plans: $107.52 Greater Omaha Packing — Commercial\|Broad Network: $245.76
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: HC OFFICE VISIT EST 30-39 MINS	$431	$357.73	$92.33 – $413.76
Established patient office visit (about 30–39 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $92.33 Amerigroup — Medicare\|All Plans: $181.02 AMPS — Commercial\|All Plans: $382.73 BCBS - NE — Commercial\|All Other Plans: $146.70 BCBS - NE — Commercial\|BluePrint: $139.36 BCBS - NE — Medicare\|All Plans: $172.40 Centene — Medicaid\|NE Total Care: $176.71 Centene — Medicare\|All Plans: $175.85 Great Plains — Medicare\|All Plans: $181.02 Greater Omaha Packing — Commercial\|Broad Network: $413.76
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: PC OFFICE VISIT EST PRO 30-39 MINS	$363	$301.29	$77.76 – $348.48
Established patient office visit (about 30–39 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $77.76 Amerigroup — Medicare\|All Plans: $152.46 AMPS — Commercial\|All Plans: $322.35 BCBS - NE — Commercial\|All Other Plans: $146.70 BCBS - NE — Commercial\|BluePrint: $139.36 BCBS - NE — Medicare\|All Plans: $145.20 Centene — Medicaid\|NE Total Care: $148.83 Centene — Medicare\|All Plans: $148.11 Great Plains — Medicare\|All Plans: $152.46 Greater Omaha Packing — Commercial\|Broad Network: $348.48
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) In the file: HC OFFICE VISIT EST 30-39 MINS	$431	$357.73	$388.98 – $413.76
Established patient office visit (about 30–39 minutes): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $409.45 BCBS - NE — Commercial\|BluePrint: $388.98 Greater Omaha Packing — Commercial\|Broad Network: $413.76 Greater Omaha Packing — Commercial\|Narrow Network: $413.76 Medica — Commercial\|ACO: $413.76 Medica — Commercial\|All Other Plans: $392.21 Medica — Commercial\|CHI Health: $392.21 Medica — Commercial\|Open Access: $413.76 Midlands Choice — Commercial\|Premier: $413.76 Midlands Choice — Commercial\|Standard: $413.76
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: PC OFFICE CONSULTATION LVL III	$263	$218.29	$56.34 – $252.48
Office consultation with a specialist (moderate): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $56.34 Amerigroup — Medicare\|All Plans: $110.46 AMPS — Commercial\|All Plans: $233.55 BCBS - NE — Commercial\|All Other Plans: $249.85 BCBS - NE — Commercial\|BluePrint: $237.36 BCBS - NE — Medicare\|All Plans: $105.20 Centene — Medicaid\|NE Total Care: $107.83 Centene — Medicare\|All Plans: $107.31 Great Plains — Medicare\|All Plans: $110.46 Greater Omaha Packing — Commercial\|Broad Network: $252.48
Office consultation with a specialist (moderate) CPT 99243 · Inpatient (hospital stay) In the file: PC OFFICE CONSULTATION LVL III	$263	$218.29	$237.36 – $252.48
Office consultation with a specialist (moderate): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $249.85 BCBS - NE — Commercial\|BluePrint: $237.36 Greater Omaha Packing — Commercial\|Broad Network: $252.48 Greater Omaha Packing — Commercial\|Narrow Network: $252.48 Medica — Commercial\|ACO: $252.48 Medica — Commercial\|All Other Plans: $239.33 Medica — Commercial\|CHI Health: $239.33 Medica — Commercial\|Open Access: $252.48 Midlands Choice — Commercial\|Premier: $252.48 Midlands Choice — Commercial\|Standard: $252.48
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: PC OFFICE CONSULTATION LVL IV	$394	$327.02	$84.40 – $378.24
Office consultation with a specialist (moderate to high): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $84.40 Amerigroup — Medicare\|All Plans: $165.48 AMPS — Commercial\|All Plans: $349.88 BCBS - NE — Commercial\|All Other Plans: $374.30 BCBS - NE — Commercial\|BluePrint: $355.59 BCBS - NE — Medicare\|All Plans: $157.60 Centene — Medicaid\|NE Total Care: $161.54 Centene — Medicare\|All Plans: $160.76 Great Plains — Medicare\|All Plans: $165.48 Greater Omaha Packing — Commercial\|Broad Network: $378.24
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient (hospital stay) In the file: PC OFFICE CONSULTATION LVL IV	$394	$327.02	$355.59 – $378.24
Office consultation with a specialist (moderate to high): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $374.30 BCBS - NE — Commercial\|BluePrint: $355.59 Greater Omaha Packing — Commercial\|Broad Network: $378.24 Greater Omaha Packing — Commercial\|Narrow Network: $378.24 Medica — Commercial\|ACO: $378.24 Medica — Commercial\|All Other Plans: $358.54 Medica — Commercial\|CHI Health: $358.54 Medica — Commercial\|Open Access: $378.24 Midlands Choice — Commercial\|Premier: $378.24 Midlands Choice — Commercial\|Standard: $378.24
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: HC EMERGMENCY DEPT VISIT LOW MDM	$654	$542.82	$140.09 – $627.84
Emergency room visit (moderate): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $140.09 Amerigroup — Medicare\|All Plans: $274.68 AMPS — Commercial\|All Plans: $580.76 BCBS - NE — Commercial\|All Other Plans: $621.30 BCBS - NE — Commercial\|BluePrint: $590.24 BCBS - NE — Medicare\|All Plans: $261.60 Centene — Medicaid\|NE Total Care: $268.14 Centene — Medicare\|All Plans: $266.84 Great Plains — Medicare\|All Plans: $274.68 Greater Omaha Packing — Commercial\|Broad Network: $627.84
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: PC EVALUATION MANAGMEMENT 3	$202	$167.66	$43.27 – $193.92
Emergency room visit (moderate): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $43.27 Amerigroup — Medicare\|All Plans: $53.03 AMPS — Commercial\|All Plans: $112.11 BCBS - NE — Commercial\|All Other Plans: $191.90 BCBS - NE — Commercial\|BluePrint: $182.31 BCBS - NE — Medicare\|All Plans: $50.50 Centene — Medicaid\|NE Total Care: $82.82 Centene — Medicare\|All Plans: $51.51 Great Plains — Medicare\|All Plans: $53.03 Greater Omaha Packing — Commercial\|Broad Network: $193.92
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) In the file: HC EMERGMENCY DEPT VISIT LOW MDM	$654	$542.82	$590.24 – $627.84
Emergency room visit (moderate): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $621.30 BCBS - NE — Commercial\|BluePrint: $590.24 Greater Omaha Packing — Commercial\|Broad Network: $627.84 Greater Omaha Packing — Commercial\|Narrow Network: $627.84 Medica — Commercial\|ACO: $627.84 Medica — Commercial\|All Other Plans: $595.14 Medica — Commercial\|CHI Health: $595.14 Medica — Commercial\|Open Access: $627.84 Midlands Choice — Commercial\|Premier: $627.84 Midlands Choice — Commercial\|Standard: $627.84
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: HC EMERGMENCY DEPT VISIT MOD MDM	$1,022	$848.26	$218.92 – $981.12
Emergency room visit (moderately high): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $218.92 Amerigroup — Medicare\|All Plans: $429.24 AMPS — Commercial\|All Plans: $907.54 BCBS - NE — Commercial\|All Other Plans: $970.90 BCBS - NE — Commercial\|BluePrint: $922.36 BCBS - NE — Medicare\|All Plans: $408.80 Centene — Medicaid\|NE Total Care: $419.02 Centene — Medicare\|All Plans: $416.98 Great Plains — Medicare\|All Plans: $429.24 Greater Omaha Packing — Commercial\|Broad Network: $981.12
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: PC EVALUATION MANAGMEMENT 4	$342	$283.86	$73.26 – $328.32
Emergency room visit (moderately high): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $73.26 Amerigroup — Medicare\|All Plans: $89.78 AMPS — Commercial\|All Plans: $189.81 BCBS - NE — Commercial\|All Other Plans: $324.90 BCBS - NE — Commercial\|BluePrint: $308.66 BCBS - NE — Medicare\|All Plans: $85.50 Centene — Medicaid\|NE Total Care: $140.22 Centene — Medicare\|All Plans: $87.21 Great Plains — Medicare\|All Plans: $89.78 Greater Omaha Packing — Commercial\|Broad Network: $328.32
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) In the file: HC EMERGMENCY DEPT VISIT MOD MDM	$1,022	$848.26	$922.36 – $981.12
Emergency room visit (moderately high): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $970.90 BCBS - NE — Commercial\|BluePrint: $922.36 Greater Omaha Packing — Commercial\|Broad Network: $981.12 Greater Omaha Packing — Commercial\|Narrow Network: $981.12 Medica — Commercial\|ACO: $981.12 Medica — Commercial\|All Other Plans: $930.02 Medica — Commercial\|CHI Health: $930.02 Medica — Commercial\|Open Access: $981.12 Midlands Choice — Commercial\|Premier: $981.12 Midlands Choice — Commercial\|Standard: $981.12
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: HC EMERGMENCY DEPT VISIT HI MDM	$1,675	$1,390.25	$358.79 – $1,608
Emergency room visit (high): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $358.79 Amerigroup — Medicare\|All Plans: $703.50 AMPS — Commercial\|All Plans: $1,487.40 BCBS - NE — Commercial\|All Other Plans: $1,591.25 BCBS - NE — Commercial\|BluePrint: $1,511.69 BCBS - NE — Medicare\|All Plans: $670 Centene — Medicaid\|NE Total Care: $686.75 Centene — Medicare\|All Plans: $683.40 Great Plains — Medicare\|All Plans: $703.50 Greater Omaha Packing — Commercial\|Broad Network: $1,608
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: PC EVALUATION MANAGMEMENT 5	$496	$411.68	$106.25 – $476.16
Emergency room visit (high): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $106.25 Amerigroup — Medicare\|All Plans: $130.20 AMPS — Commercial\|All Plans: $275.28 BCBS - NE — Commercial\|All Other Plans: $471.20 BCBS - NE — Commercial\|BluePrint: $447.64 BCBS - NE — Medicare\|All Plans: $124 Centene — Medicaid\|NE Total Care: $203.36 Centene — Medicare\|All Plans: $126.48 Great Plains — Medicare\|All Plans: $130.20 Greater Omaha Packing — Commercial\|Broad Network: $476.16
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) In the file: HC EMERGMENCY DEPT VISIT HI MDM	$1,675	$1,390.25	$1,511.69 – $1,608
Emergency room visit (high): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $1,591.25 BCBS - NE — Commercial\|BluePrint: $1,511.69 Greater Omaha Packing — Commercial\|Broad Network: $1,608 Greater Omaha Packing — Commercial\|Narrow Network: $1,608 Medica — Commercial\|ACO: $1,608 Medica — Commercial\|All Other Plans: $1,524.25 Medica — Commercial\|CHI Health: $1,524.25 Medica — Commercial\|Open Access: $1,608 Midlands Choice — Commercial\|Premier: $1,608 Midlands Choice — Commercial\|Standard: $1,608

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: HC BASIC METABOLIC PANEL	$158	$131.14	$8.46 – $151.68
Basic metabolic panel (blood test): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $33.85 Amerigroup — Medicare\|All Plans: $8.88 AMPS — Commercial\|All Plans: $18.78 BCBS - NE — Commercial\|All Other Plans: $69 BCBS - NE — Commercial\|BluePrint: $65.55 BCBS - NE — Medicare\|All Plans: $8.46 Centene — Medicaid\|NE Total Care: $64.78 Centene — Medicare\|All Plans: $8.63 Great Plains — Medicare\|All Plans: $8.89 Greater Omaha Packing — Commercial\|Broad Network: $151.68
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: HC RHC BASIC METABOLIC PANL	$29	$24.07	$6.22 – $29
Basic metabolic panel (blood test): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $6.22 Amerigroup — Medicare\|All Plans: $8.88 AMPS — Commercial\|All Plans: $18.78 BCBS - NE — Commercial\|All Other Plans: $29 BCBS - NE — Commercial\|BluePrint: $27.55 BCBS - NE — Medicare\|All Plans: $8.46 Centene — Medicaid\|NE Total Care: $11.89 Centene — Medicare\|All Plans: $8.63 Great Plains — Medicare\|All Plans: $8.89 Greater Omaha Packing — Commercial\|Broad Network: $27.84
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) In the file: HC BASIC METABOLIC PANEL	$158	$131.14	$142.60 – $151.68
Basic metabolic panel (blood test): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $150.10 BCBS - NE — Commercial\|BluePrint: $142.60 Greater Omaha Packing — Commercial\|Broad Network: $151.68 Greater Omaha Packing — Commercial\|Narrow Network: $151.68 Medica — Commercial\|ACO: $151.68 Medica — Commercial\|All Other Plans: $143.78 Medica — Commercial\|CHI Health: $143.78 Medica — Commercial\|Open Access: $151.68 Midlands Choice — Commercial\|Premier: $151.68 Midlands Choice — Commercial\|Standard: $151.68
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: HC COMPREHENSIVE PANEL	$170	$141.10	$10.56 – $163.20
Comprehensive metabolic panel (blood test): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $36.42 Amerigroup — Medicare\|All Plans: $11.09 AMPS — Commercial\|All Plans: $23.44 BCBS - NE — Commercial\|All Other Plans: $80.50 BCBS - NE — Commercial\|BluePrint: $76.47 BCBS - NE — Medicare\|All Plans: $10.56 Centene — Medicaid\|NE Total Care: $69.70 Centene — Medicare\|All Plans: $10.77 Great Plains — Medicare\|All Plans: $11.09 Greater Omaha Packing — Commercial\|Broad Network: $163.20
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: HC RHC COMP METABOLIC PANEL	$35	$29.05	$7.50 – $35
Comprehensive metabolic panel (blood test): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $7.50 Amerigroup — Medicare\|All Plans: $11.09 AMPS — Commercial\|All Plans: $23.44 BCBS - NE — Commercial\|All Other Plans: $35 BCBS - NE — Commercial\|BluePrint: $33.25 BCBS - NE — Medicare\|All Plans: $10.56 Centene — Medicaid\|NE Total Care: $14.35 Centene — Medicare\|All Plans: $10.77 Great Plains — Medicare\|All Plans: $11.09 Greater Omaha Packing — Commercial\|Broad Network: $33.60
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) In the file: HC COMPREHENSIVE PANEL	$170	$141.10	$153.43 – $163.20
Comprehensive metabolic panel (blood test): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $161.50 BCBS - NE — Commercial\|BluePrint: $153.43 Greater Omaha Packing — Commercial\|Broad Network: $163.20 Greater Omaha Packing — Commercial\|Narrow Network: $163.20 Medica — Commercial\|ACO: $163.20 Medica — Commercial\|All Other Plans: $154.70 Medica — Commercial\|CHI Health: $154.70 Medica — Commercial\|Open Access: $163.20 Midlands Choice — Commercial\|Premier: $163.20 Midlands Choice — Commercial\|Standard: $163.20
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: HC OBSTETRIC PANEL	$141	$117.03	$30.21 – $141
Obstetric blood test panel: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $30.21 Amerigroup — Medicare\|All Plans: $50.20 AMPS — Commercial\|All Plans: $106.14 BCBS - NE — Commercial\|All Other Plans: $141 BCBS - NE — Commercial\|BluePrint: $133.95 BCBS - NE — Medicare\|All Plans: $47.81 Centene — Medicaid\|NE Total Care: $57.81 Centene — Medicare\|All Plans: $48.77 Great Plains — Medicare\|All Plans: $50.21 Greater Omaha Packing — Commercial\|Broad Network: $135.36
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: HC RHC OBSTETRIC PANEL	$159	$131.97	$34.06 – $159
Obstetric blood test panel: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $34.06 Amerigroup — Medicare\|All Plans: $50.20 AMPS — Commercial\|All Plans: $106.14 BCBS - NE — Commercial\|All Other Plans: $159 BCBS - NE — Commercial\|BluePrint: $151.05 BCBS - NE — Medicare\|All Plans: $47.81 Centene — Medicaid\|NE Total Care: $65.19 Centene — Medicare\|All Plans: $48.77 Great Plains — Medicare\|All Plans: $50.21 Greater Omaha Packing — Commercial\|Broad Network: $152.64
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) In the file: HC OBSTETRIC PANEL	$141	$117.03	$127.26 – $135.36
Obstetric blood test panel: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $133.95 BCBS - NE — Commercial\|BluePrint: $127.26 Greater Omaha Packing — Commercial\|Broad Network: $135.36 Greater Omaha Packing — Commercial\|Narrow Network: $135.36 Medica — Commercial\|ACO: $135.36 Medica — Commercial\|All Other Plans: $128.31 Medica — Commercial\|CHI Health: $128.31 Medica — Commercial\|Open Access: $135.36 Midlands Choice — Commercial\|Premier: $135.36 Midlands Choice — Commercial\|Standard: $135.36
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: HC HEART CHECK LIPID	$8	$6.64	$1.72 – $17.76
Cholesterol panel (lipid panel): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $1.72 Amerigroup — Medicare\|All Plans: $8.40 AMPS — Commercial\|All Plans: $17.76 BCBS - NE — Commercial\|All Other Plans: $8 BCBS - NE — Commercial\|BluePrint: $7.60 BCBS - NE — Medicare\|All Plans: $8 Centene — Medicaid\|NE Total Care: $3.28 Centene — Medicare\|All Plans: $8.16 Great Plains — Medicare\|All Plans: $8.40 Greater Omaha Packing — Commercial\|Broad Network: $7.68
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: HC LIPID PANEL	$137	$113.71	$13.39 – $131.52
Cholesterol panel (lipid panel): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $29.35 Amerigroup — Medicare\|All Plans: $14.06 AMPS — Commercial\|All Plans: $29.73 BCBS - NE — Commercial\|All Other Plans: $73.19 BCBS - NE — Commercial\|BluePrint: $69.53 BCBS - NE — Medicare\|All Plans: $13.39 Centene — Medicaid\|NE Total Care: $56.17 Centene — Medicare\|All Plans: $13.66 Great Plains — Medicare\|All Plans: $14.06 Greater Omaha Packing — Commercial\|Broad Network: $131.52
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: HC RHC LIPID PANEL	$46	$38.18	$9.86 – $46
Cholesterol panel (lipid panel): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $9.86 Amerigroup — Medicare\|All Plans: $14.06 AMPS — Commercial\|All Plans: $29.73 BCBS - NE — Commercial\|All Other Plans: $46 BCBS - NE — Commercial\|BluePrint: $43.70 BCBS - NE — Medicare\|All Plans: $13.39 Centene — Medicaid\|NE Total Care: $18.86 Centene — Medicare\|All Plans: $13.66 Great Plains — Medicare\|All Plans: $14.06 Greater Omaha Packing — Commercial\|Broad Network: $44.16
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: HC RENAL FUNCTION PANEL	$146	$121.18	$8.68 – $140.16
Kidney function panel: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $31.28 Amerigroup — Medicare\|All Plans: $9.11 AMPS — Commercial\|All Plans: $19.27 BCBS - NE — Commercial\|All Other Plans: $33.63 BCBS - NE — Commercial\|BluePrint: $31.95 BCBS - NE — Medicare\|All Plans: $8.68 Centene — Medicaid\|NE Total Care: $59.86 Centene — Medicare\|All Plans: $8.85 Great Plains — Medicare\|All Plans: $9.12 Greater Omaha Packing — Commercial\|Broad Network: $140.16
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: HC RHC RENAL FUNC PANEL	$30	$24.90	$6.43 – $30
Kidney function panel: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $6.43 Amerigroup — Medicare\|All Plans: $9.11 AMPS — Commercial\|All Plans: $19.27 BCBS - NE — Commercial\|All Other Plans: $30 BCBS - NE — Commercial\|BluePrint: $28.50 BCBS - NE — Medicare\|All Plans: $8.68 Centene — Medicaid\|NE Total Care: $12.30 Centene — Medicare\|All Plans: $8.85 Great Plains — Medicare\|All Plans: $9.12 Greater Omaha Packing — Commercial\|Broad Network: $28.80
Kidney function panel CPT 80069 · Inpatient (hospital stay) In the file: HC RENAL FUNCTION PANEL	$146	$121.18	$131.77 – $140.16
Kidney function panel: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $138.70 BCBS - NE — Commercial\|BluePrint: $131.77 Greater Omaha Packing — Commercial\|Broad Network: $140.16 Greater Omaha Packing — Commercial\|Narrow Network: $140.16 Medica — Commercial\|ACO: $140.16 Medica — Commercial\|All Other Plans: $132.86 Medica — Commercial\|CHI Health: $132.86 Medica — Commercial\|Open Access: $140.16 Midlands Choice — Commercial\|Premier: $140.16 Midlands Choice — Commercial\|Standard: $140.16
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HC HEPATIC PROFILE	$162	$134.46	$8.17 – $155.52
Liver function panel: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $34.71 Amerigroup — Medicare\|All Plans: $8.58 AMPS — Commercial\|All Plans: $18.14 BCBS - NE — Commercial\|All Other Plans: $31.65 BCBS - NE — Commercial\|BluePrint: $30.07 BCBS - NE — Medicare\|All Plans: $8.17 Centene — Medicaid\|NE Total Care: $66.42 Centene — Medicare\|All Plans: $8.33 Great Plains — Medicare\|All Plans: $8.58 Greater Omaha Packing — Commercial\|Broad Network: $155.52
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HC RHC HEPAT FUNCTN PANEL	$28	$23.24	$6 – $28
Liver function panel: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $6 Amerigroup — Medicare\|All Plans: $8.58 AMPS — Commercial\|All Plans: $18.14 BCBS - NE — Commercial\|All Other Plans: $28 BCBS - NE — Commercial\|BluePrint: $26.60 BCBS - NE — Medicare\|All Plans: $8.17 Centene — Medicaid\|NE Total Care: $11.48 Centene — Medicare\|All Plans: $8.33 Great Plains — Medicare\|All Plans: $8.58 Greater Omaha Packing — Commercial\|Broad Network: $26.88
Liver function panel CPT 80076 · Inpatient (hospital stay) In the file: HC HEPATIC PROFILE	$162	$134.46	$146.21 – $155.52
Liver function panel: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $153.90 BCBS - NE — Commercial\|BluePrint: $146.21 Greater Omaha Packing — Commercial\|Broad Network: $155.52 Greater Omaha Packing — Commercial\|Narrow Network: $155.52 Medica — Commercial\|ACO: $155.52 Medica — Commercial\|All Other Plans: $147.42 Medica — Commercial\|CHI Health: $147.42 Medica — Commercial\|Open Access: $155.52 Midlands Choice — Commercial\|Premier: $155.52 Midlands Choice — Commercial\|Standard: $155.52
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: HC RHC COMPL UA W MICRO	$10	$8.30	$2.15 – $10
Urine test (automated, with microscope): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $2.15 Amerigroup — Medicare\|All Plans: $3.33 AMPS — Commercial\|All Plans: $7.04 BCBS - NE — Commercial\|All Other Plans: $10 BCBS - NE — Commercial\|BluePrint: $9.50 BCBS - NE — Medicare\|All Plans: $3.17 Centene — Medicaid\|NE Total Care: $4.10 Centene — Medicare\|All Plans: $3.23 Great Plains — Medicare\|All Plans: $3.33 Greater Omaha Packing — Commercial\|Broad Network: $9.60
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: HC URINALYSIS	$22	$18.26	$3.17 – $21.94
Urine test (automated, with microscope): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $4.72 Amerigroup — Medicare\|All Plans: $3.33 AMPS — Commercial\|All Plans: $7.04 BCBS - NE — Commercial\|All Other Plans: $21.94 BCBS - NE — Commercial\|BluePrint: $20.84 BCBS - NE — Medicare\|All Plans: $3.17 Centene — Medicaid\|NE Total Care: $9.02 Centene — Medicare\|All Plans: $3.23 Great Plains — Medicare\|All Plans: $3.33 Greater Omaha Packing — Commercial\|Broad Network: $21.12
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: HC URINALYSIS AUTOMATD W MICRO	$121	$100.43	$3.17 – $116.16
Urine test (automated, with microscope): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $25.92 Amerigroup — Medicare\|All Plans: $3.33 AMPS — Commercial\|All Plans: $7.04 BCBS - NE — Commercial\|All Other Plans: $21.94 BCBS - NE — Commercial\|BluePrint: $20.84 BCBS - NE — Medicare\|All Plans: $3.17 Centene — Medicaid\|NE Total Care: $49.61 Centene — Medicare\|All Plans: $3.23 Great Plains — Medicare\|All Plans: $3.33 Greater Omaha Packing — Commercial\|Broad Network: $116.16
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: HC POCT MANUAL URINALYSIS	$18	$14.94	$3.48 – $17.28
Urine test (manual, without microscope): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $3.86 Amerigroup — Medicare\|All Plans: $3.65 AMPS — Commercial\|All Plans: $7.73 BCBS - NE — Commercial\|All Other Plans: $10.91 BCBS - NE — Commercial\|BluePrint: $10.36 BCBS - NE — Medicare\|All Plans: $3.48 Centene — Medicaid\|NE Total Care: $7.38 Centene — Medicare\|All Plans: $3.55 Great Plains — Medicare\|All Plans: $3.66 Greater Omaha Packing — Commercial\|Broad Network: $17.28
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: HC RHC URINALY WO MICRO	$8	$6.64	$1.72 – $8
Urine test (manual, without microscope): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $1.72 Amerigroup — Medicare\|All Plans: $3.65 AMPS — Commercial\|All Plans: $7.73 BCBS - NE — Commercial\|All Other Plans: $8 BCBS - NE — Commercial\|BluePrint: $7.60 BCBS - NE — Medicare\|All Plans: $3.48 Centene — Medicaid\|NE Total Care: $3.28 Centene — Medicare\|All Plans: $3.55 Great Plains — Medicare\|All Plans: $3.66 Greater Omaha Packing — Commercial\|Broad Network: $7.68
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: HC URINALYSIS MANUAL	$45	$37.35	$3.48 – $43.20
Urine test (manual, without microscope): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $9.64 Amerigroup — Medicare\|All Plans: $3.65 AMPS — Commercial\|All Plans: $7.73 BCBS - NE — Commercial\|All Other Plans: $10.91 BCBS - NE — Commercial\|BluePrint: $10.36 BCBS - NE — Medicare\|All Plans: $3.48 Centene — Medicaid\|NE Total Care: $18.45 Centene — Medicare\|All Plans: $3.55 Great Plains — Medicare\|All Plans: $3.66 Greater Omaha Packing — Commercial\|Broad Network: $43.20
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: HC POC URINE AUTO WO MICRO	$35	$29.05	$2.25 – $33.60
Urine test (automated, without microscope): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $7.50 Amerigroup — Medicare\|All Plans: $2.36 AMPS — Commercial\|All Plans: $5 BCBS - NE — Commercial\|All Other Plans: $8.69 BCBS - NE — Commercial\|BluePrint: $8.26 BCBS - NE — Medicare\|All Plans: $2.25 Centene — Medicaid\|NE Total Care: $14.35 Centene — Medicare\|All Plans: $2.29 Great Plains — Medicare\|All Plans: $2.37 Greater Omaha Packing — Commercial\|Broad Network: $33.60
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: HC RHC UA WO MICRO AUTO	$7	$5.81	$1.50 – $7
Urine test (automated, without microscope): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $1.50 Amerigroup — Medicare\|All Plans: $2.36 AMPS — Commercial\|All Plans: $5 BCBS - NE — Commercial\|All Other Plans: $7 BCBS - NE — Commercial\|BluePrint: $6.65 BCBS - NE — Medicare\|All Plans: $2.25 Centene — Medicaid\|NE Total Care: $2.87 Centene — Medicare\|All Plans: $2.29 Great Plains — Medicare\|All Plans: $2.37 Greater Omaha Packing — Commercial\|Broad Network: $6.72
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: HC URINALYSIS AUTO WO MICRO	$51	$42.33	$2.25 – $48.96
Urine test (automated, without microscope): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $10.93 Amerigroup — Medicare\|All Plans: $2.36 AMPS — Commercial\|All Plans: $5 BCBS - NE — Commercial\|All Other Plans: $8.69 BCBS - NE — Commercial\|BluePrint: $8.26 BCBS - NE — Medicare\|All Plans: $2.25 Centene — Medicaid\|NE Total Care: $20.91 Centene — Medicare\|All Plans: $2.29 Great Plains — Medicare\|All Plans: $2.37 Greater Omaha Packing — Commercial\|Broad Network: $48.96
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: HC PSA	$143	$118.69	$18.39 – $137.28
PSA (prostate specific antigen) blood test: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $30.64 Amerigroup — Medicare\|All Plans: $19.31 AMPS — Commercial\|All Plans: $40.83 BCBS - NE — Commercial\|All Other Plans: $71.24 BCBS - NE — Commercial\|BluePrint: $67.68 BCBS - NE — Medicare\|All Plans: $18.39 Centene — Medicaid\|NE Total Care: $58.63 Centene — Medicare\|All Plans: $18.76 Great Plains — Medicare\|All Plans: $19.31 Greater Omaha Packing — Commercial\|Broad Network: $137.28
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: HC RHC PROST SPEC ANTIGMN	$61	$50.63	$13.07 – $61
PSA (prostate specific antigen) blood test: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $13.07 Amerigroup — Medicare\|All Plans: $19.31 AMPS — Commercial\|All Plans: $40.83 BCBS - NE — Commercial\|All Other Plans: $61 BCBS - NE — Commercial\|BluePrint: $57.95 BCBS - NE — Medicare\|All Plans: $18.39 Centene — Medicaid\|NE Total Care: $25.01 Centene — Medicare\|All Plans: $18.76 Great Plains — Medicare\|All Plans: $19.31 Greater Omaha Packing — Commercial\|Broad Network: $58.56
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) In the file: HC PSA	$143	$118.69	$129.06 – $137.28
PSA (prostate specific antigen) blood test: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $135.85 BCBS - NE — Commercial\|BluePrint: $129.06 Greater Omaha Packing — Commercial\|Broad Network: $137.28 Greater Omaha Packing — Commercial\|Narrow Network: $137.28 Medica — Commercial\|ACO: $137.28 Medica — Commercial\|All Other Plans: $130.13 Medica — Commercial\|CHI Health: $130.13 Medica — Commercial\|Open Access: $137.28 Midlands Choice — Commercial\|Premier: $137.28 Midlands Choice — Commercial\|Standard: $137.28
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: HC RHC TSH	$56	$46.48	$12 – $56
Thyroid stimulating hormone (TSH) test: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $12 Amerigroup — Medicare\|All Plans: $17.64 AMPS — Commercial\|All Plans: $37.30 BCBS - NE — Commercial\|All Other Plans: $56 BCBS - NE — Commercial\|BluePrint: $53.20 BCBS - NE — Medicare\|All Plans: $16.80 Centene — Medicaid\|NE Total Care: $22.96 Centene — Medicare\|All Plans: $17.14 Great Plains — Medicare\|All Plans: $17.64 Greater Omaha Packing — Commercial\|Broad Network: $53.76
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: HC TSH	$137	$113.71	$16.80 – $131.52
Thyroid stimulating hormone (TSH) test: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $29.35 Amerigroup — Medicare\|All Plans: $17.64 AMPS — Commercial\|All Plans: $37.30 BCBS - NE — Commercial\|All Other Plans: $61.72 BCBS - NE — Commercial\|BluePrint: $58.63 BCBS - NE — Medicare\|All Plans: $16.80 Centene — Medicaid\|NE Total Care: $56.17 Centene — Medicare\|All Plans: $17.14 Great Plains — Medicare\|All Plans: $17.64 Greater Omaha Packing — Commercial\|Broad Network: $131.52
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) In the file: HC RHC TSH	$56	$46.48	$50.54 – $53.76
Thyroid stimulating hormone (TSH) test: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $53.20 BCBS - NE — Commercial\|BluePrint: $50.54 Greater Omaha Packing — Commercial\|Broad Network: $53.76 Greater Omaha Packing — Commercial\|Narrow Network: $53.76 Medica — Commercial\|ACO: $53.76 Medica — Commercial\|All Other Plans: $50.96 Medica — Commercial\|CHI Health: $50.96 Medica — Commercial\|Open Access: $53.76 Midlands Choice — Commercial\|Premier: $53.76 Midlands Choice — Commercial\|Standard: $53.76
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: HC CBC W AUTO DIFF	$140	$116.20	$7.77 – $134.40
Complete blood count (CBC) with differential: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $29.99 Amerigroup — Medicare\|All Plans: $8.16 AMPS — Commercial\|All Plans: $17.25 BCBS - NE — Commercial\|All Other Plans: $47.03 BCBS - NE — Commercial\|BluePrint: $44.68 BCBS - NE — Medicare\|All Plans: $7.77 Centene — Medicaid\|NE Total Care: $57.40 Centene — Medicare\|All Plans: $7.93 Great Plains — Medicare\|All Plans: $8.16 Greater Omaha Packing — Commercial\|Broad Network: $134.40
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: HC RHC CBC AUTOMATED W DIFF	$15	$12.45	$3.22 – $17.25
Complete blood count (CBC) with differential: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $3.22 Amerigroup — Medicare\|All Plans: $8.16 AMPS — Commercial\|All Plans: $17.25 BCBS - NE — Commercial\|All Other Plans: $15 BCBS - NE — Commercial\|BluePrint: $14.25 BCBS - NE — Medicare\|All Plans: $7.77 Centene — Medicaid\|NE Total Care: $6.15 Centene — Medicare\|All Plans: $7.93 Great Plains — Medicare\|All Plans: $8.16 Greater Omaha Packing — Commercial\|Broad Network: $14.40
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) In the file: HC CBC W AUTO DIFF	$140	$116.20	$126.35 – $134.40
Complete blood count (CBC) with differential: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $133 BCBS - NE — Commercial\|BluePrint: $126.35 Greater Omaha Packing — Commercial\|Broad Network: $134.40 Greater Omaha Packing — Commercial\|Narrow Network: $134.40 Medica — Commercial\|ACO: $134.40 Medica — Commercial\|All Other Plans: $127.40 Medica — Commercial\|CHI Health: $127.40 Medica — Commercial\|Open Access: $134.40 Midlands Choice — Commercial\|Premier: $134.40 Midlands Choice — Commercial\|Standard: $134.40
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: HC HEMOGMRAM CBC WITHOUT DIFF	$107	$88.81	$6.47 – $102.72
Complete blood count (CBC), automated: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $22.92 Amerigroup — Medicare\|All Plans: $6.79 AMPS — Commercial\|All Plans: $14.36 BCBS - NE — Commercial\|All Other Plans: $25.03 BCBS - NE — Commercial\|BluePrint: $23.78 BCBS - NE — Medicare\|All Plans: $6.47 Centene — Medicaid\|NE Total Care: $43.87 Centene — Medicare\|All Plans: $6.60 Great Plains — Medicare\|All Plans: $6.80 Greater Omaha Packing — Commercial\|Broad Network: $102.72
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: HC RHC HEMOGMRAM CBC W O DIFF	$21	$17.43	$4.50 – $21
Complete blood count (CBC), automated: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $4.50 Amerigroup — Medicare\|All Plans: $6.79 AMPS — Commercial\|All Plans: $14.36 BCBS - NE — Commercial\|All Other Plans: $21 BCBS - NE — Commercial\|BluePrint: $19.95 BCBS - NE — Medicare\|All Plans: $6.47 Centene — Medicaid\|NE Total Care: $8.61 Centene — Medicare\|All Plans: $6.60 Great Plains — Medicare\|All Plans: $6.80 Greater Omaha Packing — Commercial\|Broad Network: $20.16
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) In the file: HC HEMOGMRAM CBC WITHOUT DIFF	$107	$88.81	$96.57 – $102.72
Complete blood count (CBC), automated: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $101.65 BCBS - NE — Commercial\|BluePrint: $96.57 Greater Omaha Packing — Commercial\|Broad Network: $102.72 Greater Omaha Packing — Commercial\|Narrow Network: $102.72 Medica — Commercial\|ACO: $102.72 Medica — Commercial\|All Other Plans: $97.37 Medica — Commercial\|CHI Health: $97.37 Medica — Commercial\|Open Access: $102.72 Midlands Choice — Commercial\|Premier: $102.72 Midlands Choice — Commercial\|Standard: $102.72
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: HC POCT PT	$61	$50.63	$4.29 – $58.56
Blood clotting time test (prothrombin time, PT): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $13.07 Amerigroup — Medicare\|All Plans: $4.50 AMPS — Commercial\|All Plans: $9.52 BCBS - NE — Commercial\|All Other Plans: $29.06 BCBS - NE — Commercial\|BluePrint: $27.61 BCBS - NE — Medicare\|All Plans: $4.29 Centene — Medicaid\|NE Total Care: $25.01 Centene — Medicare\|All Plans: $4.38 Great Plains — Medicare\|All Plans: $4.51 Greater Omaha Packing — Commercial\|Broad Network: $58.56
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: HC PT	$100	$83	$4.29 – $96
Blood clotting time test (prothrombin time, PT): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $21.42 Amerigroup — Medicare\|All Plans: $4.50 AMPS — Commercial\|All Plans: $9.52 BCBS - NE — Commercial\|All Other Plans: $29.06 BCBS - NE — Commercial\|BluePrint: $27.61 BCBS - NE — Medicare\|All Plans: $4.29 Centene — Medicaid\|NE Total Care: $41 Centene — Medicare\|All Plans: $4.38 Great Plains — Medicare\|All Plans: $4.51 Greater Omaha Packing — Commercial\|Broad Network: $96
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: HC RHC PROTIME	$12	$9.96	$2.58 – $12
Blood clotting time test (prothrombin time, PT): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $2.58 Amerigroup — Medicare\|All Plans: $4.50 AMPS — Commercial\|All Plans: $9.52 BCBS - NE — Commercial\|All Other Plans: $12 BCBS - NE — Commercial\|BluePrint: $11.40 BCBS - NE — Medicare\|All Plans: $4.29 Centene — Medicaid\|NE Total Care: $4.92 Centene — Medicare\|All Plans: $4.38 Great Plains — Medicare\|All Plans: $4.51 Greater Omaha Packing — Commercial\|Broad Network: $11.52
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: HC PTT	$94	$78.02	$6.01 – $90.24
Blood clotting test (partial thromboplastin time, PTT): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $20.14 Amerigroup — Medicare\|All Plans: $6.31 AMPS — Commercial\|All Plans: $13.34 BCBS - NE — Commercial\|All Other Plans: $23.28 BCBS - NE — Commercial\|BluePrint: $22.12 BCBS - NE — Medicare\|All Plans: $6.01 Centene — Medicaid\|NE Total Care: $38.54 Centene — Medicare\|All Plans: $6.13 Great Plains — Medicare\|All Plans: $6.32 Greater Omaha Packing — Commercial\|Broad Network: $90.24
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) In the file: HC PTT	$94	$78.02	$84.84 – $90.24
Blood clotting test (partial thromboplastin time, PTT): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $89.30 BCBS - NE — Commercial\|BluePrint: $84.84 Greater Omaha Packing — Commercial\|Broad Network: $90.24 Greater Omaha Packing — Commercial\|Narrow Network: $90.24 Medica — Commercial\|ACO: $90.24 Medica — Commercial\|All Other Plans: $85.54 Medica — Commercial\|CHI Health: $85.54 Medica — Commercial\|Open Access: $90.24 Midlands Choice — Commercial\|Premier: $90.24 Midlands Choice — Commercial\|Standard: $90.24

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 · Outpatient (no overnight stay) In the file: HC CT HEAD WO CONTRAST	$2,299	$1,908.17	$492.45 – $2,207.04
CT scan of the head or brain, without contrast: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $492.45 Amerigroup — Medicare\|All Plans: $965.58 AMPS — Commercial\|All Plans: $2,041.52 BCBS - NE — Commercial\|All Other Plans: $1,405.45 BCBS - NE — Commercial\|BluePrint: $1,335.18 BCBS - NE — Medicare\|All Plans: $919.60 Centene — Medicaid\|NE Total Care: $942.59 Centene — Medicare\|All Plans: $938 Great Plains — Medicare\|All Plans: $965.58 Greater Omaha Packing — Commercial\|Broad Network: $2,207.04
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) In the file: HC CT HEAD WO CONTRAST	$2,299	$1,908.17	$2,074.85 – $2,207.04
CT scan of the head or brain, without contrast: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $2,184.05 BCBS - NE — Commercial\|BluePrint: $2,074.85 Greater Omaha Packing — Commercial\|Broad Network: $2,207.04 Greater Omaha Packing — Commercial\|Narrow Network: $2,207.04 Medica — Commercial\|ACO: $2,207.04 Medica — Commercial\|All Other Plans: $2,092.09 Medica — Commercial\|CHI Health: $2,092.09 Medica — Commercial\|Open Access: $2,207.04 Midlands Choice — Commercial\|Premier: $2,207.04 Midlands Choice — Commercial\|Standard: $2,207.04
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: HC MR BRAIN W WO CONTRAST	$4,836	$4,013.88	$1,035.88 – $4,642.56
MRI of the brain, before and after contrast: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $1,035.88 Amerigroup — Medicare\|All Plans: $2,031.12 AMPS — Commercial\|All Plans: $4,294.37 BCBS - NE — Commercial\|All Other Plans: $4,594.20 BCBS - NE — Commercial\|BluePrint: $4,364.49 BCBS - NE — Medicare\|All Plans: $1,934.40 Centene — Medicaid\|NE Total Care: $1,982.76 Centene — Medicare\|All Plans: $1,973.09 Great Plains — Medicare\|All Plans: $2,031.12 Greater Omaha Packing — Commercial\|Broad Network: $4,642.56
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) In the file: HC MR BRAIN W WO CONTRAST	$4,836	$4,013.88	$4,364.49 – $4,642.56
MRI of the brain, before and after contrast: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $4,594.20 BCBS - NE — Commercial\|BluePrint: $4,364.49 Greater Omaha Packing — Commercial\|Broad Network: $4,642.56 Greater Omaha Packing — Commercial\|Narrow Network: $4,642.56 Medica — Commercial\|ACO: $4,642.56 Medica — Commercial\|All Other Plans: $4,400.76 Medica — Commercial\|CHI Health: $4,400.76 Medica — Commercial\|Open Access: $4,642.56 Midlands Choice — Commercial\|Premier: $4,642.56 Midlands Choice — Commercial\|Standard: $4,642.56
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: HC CHEST 2 VIEWS PA LAT	$316	$262.28	$67.69 – $303.36
Chest X-ray, 2 views: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $67.69 Amerigroup — Medicare\|All Plans: $132.72 AMPS — Commercial\|All Plans: $280.61 BCBS - NE — Commercial\|All Other Plans: $300.20 BCBS - NE — Commercial\|BluePrint: $285.19 BCBS - NE — Medicare\|All Plans: $126.40 Centene — Medicaid\|NE Total Care: $129.56 Centene — Medicare\|All Plans: $128.93 Great Plains — Medicare\|All Plans: $132.72 Greater Omaha Packing — Commercial\|Broad Network: $303.36
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: HC RHC CHEST PA AND LAT	$69	$57.27	$14.78 – $66.24
Chest X-ray, 2 views: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $14.78 Amerigroup — Medicare\|All Plans: $28.98 AMPS — Commercial\|All Plans: $61.28 BCBS - NE — Commercial\|All Other Plans: $65.55 BCBS - NE — Commercial\|BluePrint: $62.28 BCBS - NE — Medicare\|All Plans: $27.60 Centene — Medicaid\|NE Total Care: $28.29 Centene — Medicare\|All Plans: $28.16 Great Plains — Medicare\|All Plans: $28.98 Greater Omaha Packing — Commercial\|Broad Network: $66.24
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) In the file: HC CHEST 2 VIEWS PA LAT	$316	$262.28	$285.19 – $303.36
Chest X-ray, 2 views: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $300.20 BCBS - NE — Commercial\|BluePrint: $285.19 Greater Omaha Packing — Commercial\|Broad Network: $303.36 Greater Omaha Packing — Commercial\|Narrow Network: $303.36 Medica — Commercial\|ACO: $303.36 Medica — Commercial\|All Other Plans: $287.56 Medica — Commercial\|CHI Health: $287.56 Medica — Commercial\|Open Access: $303.36 Midlands Choice — Commercial\|Premier: $303.36 Midlands Choice — Commercial\|Standard: $303.36
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: HC LUMBR SPINE W OBLIQUES 4OR>	$531	$440.73	$113.75 – $509.76
X-ray of the lower spine, at least 4 views: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $113.75 Amerigroup — Medicare\|All Plans: $223.02 AMPS — Commercial\|All Plans: $471.53 BCBS - NE — Commercial\|All Other Plans: $504.45 BCBS - NE — Commercial\|BluePrint: $479.23 BCBS - NE — Medicare\|All Plans: $212.40 Centene — Medicaid\|NE Total Care: $217.71 Centene — Medicare\|All Plans: $216.65 Great Plains — Medicare\|All Plans: $223.02 Greater Omaha Packing — Commercial\|Broad Network: $509.76
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: HC RHC LUMB SAC SPINE 4 VWS	$143	$118.69	$30.64 – $137.28
X-ray of the lower spine, at least 4 views: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $30.64 Amerigroup — Medicare\|All Plans: $60.06 AMPS — Commercial\|All Plans: $126.99 BCBS - NE — Commercial\|All Other Plans: $135.85 BCBS - NE — Commercial\|BluePrint: $129.06 BCBS - NE — Medicare\|All Plans: $57.20 Centene — Medicaid\|NE Total Care: $58.63 Centene — Medicare\|All Plans: $58.35 Great Plains — Medicare\|All Plans: $60.06 Greater Omaha Packing — Commercial\|Broad Network: $137.28
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) In the file: HC LUMBR SPINE W OBLIQUES 4OR>	$531	$440.73	$479.23 – $509.76
X-ray of the lower spine, at least 4 views: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $504.45 BCBS - NE — Commercial\|BluePrint: $479.23 Greater Omaha Packing — Commercial\|Broad Network: $509.76 Greater Omaha Packing — Commercial\|Narrow Network: $509.76 Medica — Commercial\|ACO: $509.76 Medica — Commercial\|All Other Plans: $483.21 Medica — Commercial\|CHI Health: $483.21 Medica — Commercial\|Open Access: $509.76 Midlands Choice — Commercial\|Premier: $509.76 Midlands Choice — Commercial\|Standard: $509.76
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: HC MR LUMBAR WO CONTRAST	$3,755	$3,116.65	$804.33 – $3,604.80
MRI of the lower back (lumbar spine), without contrast: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $804.33 Amerigroup — Medicare\|All Plans: $1,577.10 AMPS — Commercial\|All Plans: $3,334.44 BCBS - NE — Commercial\|All Other Plans: $2,003.17 BCBS - NE — Commercial\|BluePrint: $1,903.01 BCBS - NE — Medicare\|All Plans: $1,502 Centene — Medicaid\|NE Total Care: $1,539.55 Centene — Medicare\|All Plans: $1,532.04 Great Plains — Medicare\|All Plans: $1,577.10 Greater Omaha Packing — Commercial\|Broad Network: $3,604.80
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) In the file: HC MR LUMBAR WO CONTRAST	$3,755	$3,116.65	$3,388.89 – $3,604.80
MRI of the lower back (lumbar spine), without contrast: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $3,567.25 BCBS - NE — Commercial\|BluePrint: $3,388.89 Greater Omaha Packing — Commercial\|Broad Network: $3,604.80 Greater Omaha Packing — Commercial\|Narrow Network: $3,604.80 Medica — Commercial\|ACO: $3,604.80 Medica — Commercial\|All Other Plans: $3,417.05 Medica — Commercial\|CHI Health: $3,417.05 Medica — Commercial\|Open Access: $3,604.80 Midlands Choice — Commercial\|Premier: $3,604.80 Midlands Choice — Commercial\|Standard: $3,604.80
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: HC CT PELVIS W CONTRAST	$3,184	$2,642.72	$682.02 – $3,056.64
CT scan of the pelvis, with contrast: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $682.02 Amerigroup — Medicare\|All Plans: $1,337.28 AMPS — Commercial\|All Plans: $2,827.40 BCBS - NE — Commercial\|All Other Plans: $3,024.80 BCBS - NE — Commercial\|BluePrint: $2,873.56 BCBS - NE — Medicare\|All Plans: $1,273.60 Centene — Medicaid\|NE Total Care: $1,305.44 Centene — Medicare\|All Plans: $1,299.08 Great Plains — Medicare\|All Plans: $1,337.28 Greater Omaha Packing — Commercial\|Broad Network: $3,056.64
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) In the file: HC CT PELVIS W CONTRAST	$3,184	$2,642.72	$2,873.56 – $3,056.64
CT scan of the pelvis, with contrast: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $3,024.80 BCBS - NE — Commercial\|BluePrint: $2,873.56 Greater Omaha Packing — Commercial\|Broad Network: $3,056.64 Greater Omaha Packing — Commercial\|Narrow Network: $3,056.64 Medica — Commercial\|ACO: $3,056.64 Medica — Commercial\|All Other Plans: $2,897.44 Medica — Commercial\|CHI Health: $2,897.44 Medica — Commercial\|Open Access: $3,056.64 Midlands Choice — Commercial\|Premier: $3,056.64 Midlands Choice — Commercial\|Standard: $3,056.64
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: HC MR JOINT LOWER EXT WO CONT	$3,001	$2,490.83	$642.82 – $2,880.96
MRI of a leg joint (such as the knee), without contrast: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $642.82 Amerigroup — Medicare\|All Plans: $1,260.42 AMPS — Commercial\|All Plans: $2,664.89 BCBS - NE — Commercial\|All Other Plans: $1,521.76 BCBS - NE — Commercial\|BluePrint: $1,445.67 BCBS - NE — Medicare\|All Plans: $1,200.40 Centene — Medicaid\|NE Total Care: $1,230.41 Centene — Medicare\|All Plans: $1,224.41 Great Plains — Medicare\|All Plans: $1,260.42 Greater Omaha Packing — Commercial\|Broad Network: $2,880.96
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) In the file: HC MR JOINT LOWER EXT WO CONT	$3,001	$2,490.83	$2,708.41 – $2,880.96
MRI of a leg joint (such as the knee), without contrast: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $2,850.95 BCBS - NE — Commercial\|BluePrint: $2,708.41 Greater Omaha Packing — Commercial\|Broad Network: $2,880.96 Greater Omaha Packing — Commercial\|Narrow Network: $2,880.96 Medica — Commercial\|ACO: $2,880.96 Medica — Commercial\|All Other Plans: $2,730.91 Medica — Commercial\|CHI Health: $2,730.91 Medica — Commercial\|Open Access: $2,880.96 Midlands Choice — Commercial\|Premier: $2,880.96 Midlands Choice — Commercial\|Standard: $2,880.96
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: HC CT ABDOMEN PELVIS W CONTRST	$6,149	$5,103.67	$1,317.12 – $5,903.04
CT scan of the abdomen and pelvis, with contrast: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $1,317.12 Amerigroup — Medicare\|All Plans: $2,582.58 AMPS — Commercial\|All Plans: $5,460.32 BCBS - NE — Commercial\|All Other Plans: $2,789.35 BCBS - NE — Commercial\|BluePrint: $2,649.88 BCBS - NE — Medicare\|All Plans: $2,459.60 Centene — Medicaid\|NE Total Care: $2,521.09 Centene — Medicare\|All Plans: $2,508.80 Great Plains — Medicare\|All Plans: $2,582.58 Greater Omaha Packing — Commercial\|Broad Network: $5,903.04
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) In the file: HC CT ABDOMEN PELVIS W CONTRST	$6,149	$5,103.67	$5,549.48 – $5,903.04
CT scan of the abdomen and pelvis, with contrast: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $5,841.55 BCBS - NE — Commercial\|BluePrint: $5,549.48 Greater Omaha Packing — Commercial\|Broad Network: $5,903.04 Greater Omaha Packing — Commercial\|Narrow Network: $5,903.04 Medica — Commercial\|ACO: $5,903.04 Medica — Commercial\|All Other Plans: $5,595.59 Medica — Commercial\|CHI Health: $5,595.59 Medica — Commercial\|Open Access: $5,903.04 Midlands Choice — Commercial\|Premier: $5,903.04 Midlands Choice — Commercial\|Standard: $5,903.04
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: HC US ABDOMEN	$1,069	$887.27	$228.98 – $1,026.24
Ultrasound of the abdomen, complete: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $228.98 Amerigroup — Medicare\|All Plans: $448.98 AMPS — Commercial\|All Plans: $949.28 BCBS - NE — Commercial\|All Other Plans: $711.01 BCBS - NE — Commercial\|BluePrint: $675.46 BCBS - NE — Medicare\|All Plans: $427.60 Centene — Medicaid\|NE Total Care: $438.29 Centene — Medicare\|All Plans: $436.16 Great Plains — Medicare\|All Plans: $448.98 Greater Omaha Packing — Commercial\|Broad Network: $1,026.24
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) In the file: HC US ABDOMEN	$1,069	$887.27	$964.78 – $1,026.24
Ultrasound of the abdomen, complete: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $1,015.55 BCBS - NE — Commercial\|BluePrint: $964.78 Greater Omaha Packing — Commercial\|Broad Network: $1,026.24 Greater Omaha Packing — Commercial\|Narrow Network: $1,026.24 Medica — Commercial\|ACO: $1,026.24 Medica — Commercial\|All Other Plans: $972.79 Medica — Commercial\|CHI Health: $972.79 Medica — Commercial\|Open Access: $1,026.24 Midlands Choice — Commercial\|Premier: $1,026.24 Midlands Choice — Commercial\|Standard: $1,026.24
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: HC ULTRASOUND COMPLETE	$997	$827.51	$213.56 – $957.12
Pregnancy ultrasound (after the first trimester): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $213.56 Amerigroup — Medicare\|All Plans: $418.74 AMPS — Commercial\|All Plans: $885.34 BCBS - NE — Commercial\|All Other Plans: $947.15 BCBS - NE — Commercial\|BluePrint: $899.80 BCBS - NE — Medicare\|All Plans: $398.80 Centene — Medicaid\|NE Total Care: $408.77 Centene — Medicare\|All Plans: $406.78 Great Plains — Medicare\|All Plans: $418.74 Greater Omaha Packing — Commercial\|Broad Network: $957.12
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: HC US PREGMNANCY >14 WKS	$1,070	$888.10	$229.20 – $1,027.20
Pregnancy ultrasound (after the first trimester): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $229.20 Amerigroup — Medicare\|All Plans: $449.40 AMPS — Commercial\|All Plans: $950.16 BCBS - NE — Commercial\|All Other Plans: $1,016.50 BCBS - NE — Commercial\|BluePrint: $965.68 BCBS - NE — Medicare\|All Plans: $428 Centene — Medicaid\|NE Total Care: $438.70 Centene — Medicare\|All Plans: $436.56 Great Plains — Medicare\|All Plans: $449.40 Greater Omaha Packing — Commercial\|Broad Network: $1,027.20
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) In the file: HC ULTRASOUND COMPLETE	$997	$827.51	$899.80 – $957.12
Pregnancy ultrasound (after the first trimester): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $947.15 BCBS - NE — Commercial\|BluePrint: $899.80 Greater Omaha Packing — Commercial\|Broad Network: $957.12 Greater Omaha Packing — Commercial\|Narrow Network: $957.12 Medica — Commercial\|ACO: $957.12 Medica — Commercial\|All Other Plans: $907.27 Medica — Commercial\|CHI Health: $907.27 Medica — Commercial\|Open Access: $957.12 Midlands Choice — Commercial\|Premier: $957.12 Midlands Choice — Commercial\|Standard: $957.12
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: HC US TRANSVAGMINAL	$779	$646.57	$166.87 – $747.84
Transvaginal ultrasound: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $166.87 Amerigroup — Medicare\|All Plans: $327.18 AMPS — Commercial\|All Plans: $691.76 BCBS - NE — Commercial\|All Other Plans: $740.05 BCBS - NE — Commercial\|BluePrint: $703.05 BCBS - NE — Medicare\|All Plans: $311.60 Centene — Medicaid\|NE Total Care: $319.39 Centene — Medicare\|All Plans: $317.84 Great Plains — Medicare\|All Plans: $327.18 Greater Omaha Packing — Commercial\|Broad Network: $747.84
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) In the file: HC US TRANSVAGMINAL	$779	$646.57	$703.05 – $747.84
Transvaginal ultrasound: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $740.05 BCBS - NE — Commercial\|BluePrint: $703.05 Greater Omaha Packing — Commercial\|Broad Network: $747.84 Greater Omaha Packing — Commercial\|Narrow Network: $747.84 Medica — Commercial\|ACO: $747.84 Medica — Commercial\|All Other Plans: $708.89 Medica — Commercial\|CHI Health: $708.89 Medica — Commercial\|Open Access: $747.84 Midlands Choice — Commercial\|Premier: $747.84 Midlands Choice — Commercial\|Standard: $747.84
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: HC DX MAMMO INCL CAD UNI	$381	$316.23	$81.62 – $365.76
Diagnostic mammogram, one breast: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $81.62 Amerigroup — Medicare\|All Plans: $160.02 AMPS — Commercial\|All Plans: $338.33 BCBS - NE — Commercial\|All Other Plans: $361.95 BCBS - NE — Commercial\|BluePrint: $343.86 BCBS - NE — Medicare\|All Plans: $152.40 Centene — Medicaid\|NE Total Care: $156.21 Centene — Medicare\|All Plans: $155.45 Great Plains — Medicare\|All Plans: $160.02 Greater Omaha Packing — Commercial\|Broad Network: $365.76
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) In the file: HC DX MAMMO INCL CAD UNI	$381	$316.23	$343.86 – $365.76
Diagnostic mammogram, one breast: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $361.95 BCBS - NE — Commercial\|BluePrint: $343.86 Greater Omaha Packing — Commercial\|Broad Network: $365.76 Greater Omaha Packing — Commercial\|Narrow Network: $365.76 Medica — Commercial\|ACO: $365.76 Medica — Commercial\|All Other Plans: $346.71 Medica — Commercial\|CHI Health: $346.71 Medica — Commercial\|Open Access: $365.76 Midlands Choice — Commercial\|Premier: $365.76 Midlands Choice — Commercial\|Standard: $365.76
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: HC DX MAMMO INCL CAD BI	$431	$357.73	$92.33 – $413.76
Diagnostic mammogram, both breasts: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $92.33 Amerigroup — Medicare\|All Plans: $181.02 AMPS — Commercial\|All Plans: $382.73 BCBS - NE — Commercial\|All Other Plans: $409.45 BCBS - NE — Commercial\|BluePrint: $388.98 BCBS - NE — Medicare\|All Plans: $172.40 Centene — Medicaid\|NE Total Care: $176.71 Centene — Medicare\|All Plans: $175.85 Great Plains — Medicare\|All Plans: $181.02 Greater Omaha Packing — Commercial\|Broad Network: $413.76
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) In the file: HC DX MAMMO INCL CAD BI	$431	$357.73	$388.98 – $413.76
Diagnostic mammogram, both breasts: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $409.45 BCBS - NE — Commercial\|BluePrint: $388.98 Greater Omaha Packing — Commercial\|Broad Network: $413.76 Greater Omaha Packing — Commercial\|Narrow Network: $413.76 Medica — Commercial\|ACO: $413.76 Medica — Commercial\|All Other Plans: $392.21 Medica — Commercial\|CHI Health: $392.21 Medica — Commercial\|Open Access: $413.76 Midlands Choice — Commercial\|Premier: $413.76 Midlands Choice — Commercial\|Standard: $413.76
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: HC SCR MAMMO BI INCL CAD	$496	$411.68	$81.96 – $476.16
Screening mammogram, both breasts: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $106.25 Amerigroup — Medicare\|All Plans: $86.06 AMPS — Commercial\|All Plans: $181.95 BCBS - NE — Commercial\|All Other Plans: $242.32 BCBS - NE — Commercial\|BluePrint: $230.20 BCBS - NE — Medicare\|All Plans: $81.96 Centene — Medicaid\|NE Total Care: $203.36 Centene — Medicare\|All Plans: $83.60 Great Plains — Medicare\|All Plans: $86.06 Greater Omaha Packing — Commercial\|Broad Network: $476.16
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) In the file: HC SCR MAMMO BI INCL CAD	$496	$411.68	$447.64 – $476.16
Screening mammogram, both breasts: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $471.20 BCBS - NE — Commercial\|BluePrint: $447.64 Greater Omaha Packing — Commercial\|Broad Network: $476.16 Greater Omaha Packing — Commercial\|Narrow Network: $476.16 Medica — Commercial\|ACO: $476.16 Medica — Commercial\|All Other Plans: $451.36 Medica — Commercial\|CHI Health: $451.36 Medica — Commercial\|Open Access: $476.16 Midlands Choice — Commercial\|Premier: $476.16 Midlands Choice — Commercial\|Standard: $476.16

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: HC POLYSOMNOGMRAPHY=> 6 YR	$4,293	$3,563.19	$919.57 – $4,121.28
Sleep study (overnight, in a sleep lab): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $919.57 Amerigroup — Medicare\|All Plans: $1,803.06 AMPS — Commercial\|All Plans: $3,812.19 BCBS - NE — Commercial\|All Other Plans: $4,078.35 BCBS - NE — Commercial\|BluePrint: $3,874.44 BCBS - NE — Medicare\|All Plans: $1,717.20 Centene — Medicaid\|NE Total Care: $1,760.13 Centene — Medicare\|All Plans: $1,751.55 Great Plains — Medicare\|All Plans: $1,803.06 Greater Omaha Packing — Commercial\|Broad Network: $4,121.28
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) In the file: HC POLYSOMNOGMRAPHY=> 6 YR	$4,293	$3,563.19	$3,874.44 – $4,121.28
Sleep study (overnight, in a sleep lab): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $4,078.35 BCBS - NE — Commercial\|BluePrint: $3,874.44 Greater Omaha Packing — Commercial\|Broad Network: $4,121.28 Greater Omaha Packing — Commercial\|Narrow Network: $4,121.28 Medica — Commercial\|ACO: $4,121.28 Medica — Commercial\|All Other Plans: $3,906.63 Medica — Commercial\|CHI Health: $3,906.63 Medica — Commercial\|Open Access: $4,121.28 Midlands Choice — Commercial\|Premier: $4,121.28 Midlands Choice — Commercial\|Standard: $4,121.28

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: HC OT THER EXERCISE 15M M59	$104	$86.32	$22.28 – $99.84
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $22.28 Amerigroup — Medicare\|All Plans: $43.68 AMPS — Commercial\|All Plans: $92.36 BCBS - NE — Commercial\|All Other Plans: $73.24 BCBS - NE — Commercial\|BluePrint: $69.58 BCBS - NE — Medicare\|All Plans: $41.60 Centene — Medicaid\|NE Total Care: $42.64 Centene — Medicare\|All Plans: $42.44 Great Plains — Medicare\|All Plans: $43.68 Greater Omaha Packing — Commercial\|Broad Network: $99.84
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: HC OT THERAPEUTIC EXERCISE 15M	$108	$89.64	$23.14 – $103.68
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $23.14 Amerigroup — Medicare\|All Plans: $45.36 AMPS — Commercial\|All Plans: $95.91 BCBS - NE — Commercial\|All Other Plans: $73.24 BCBS - NE — Commercial\|BluePrint: $69.58 BCBS - NE — Medicare\|All Plans: $43.20 Centene — Medicaid\|NE Total Care: $44.28 Centene — Medicare\|All Plans: $44.07 Great Plains — Medicare\|All Plans: $45.36 Greater Omaha Packing — Commercial\|Broad Network: $103.68
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: HC OT THERAPEUTIC PROCEDURE	$91	$75.53	$19.50 – $87.36
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $19.50 Amerigroup — Medicare\|All Plans: $38.22 AMPS — Commercial\|All Plans: $80.81 BCBS - NE — Commercial\|All Other Plans: $73.24 BCBS - NE — Commercial\|BluePrint: $69.58 BCBS - NE — Medicare\|All Plans: $36.40 Centene — Medicaid\|NE Total Care: $37.31 Centene — Medicare\|All Plans: $37.13 Great Plains — Medicare\|All Plans: $38.22 Greater Omaha Packing — Commercial\|Broad Network: $87.36
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: HC PT EVAL LOW COMPLEXITY	$164	$136.12	$35.13 – $157.44
Physical therapy evaluation (low complexity): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $35.13 Amerigroup — Medicare\|All Plans: $68.88 AMPS — Commercial\|All Plans: $145.64 BCBS - NE — Commercial\|All Other Plans: $155.80 BCBS - NE — Commercial\|BluePrint: $148.01 BCBS - NE — Medicare\|All Plans: $65.60 Centene — Medicaid\|NE Total Care: $67.24 Centene — Medicare\|All Plans: $66.92 Great Plains — Medicare\|All Plans: $68.88 Greater Omaha Packing — Commercial\|Broad Network: $157.44
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) In the file: HC PT EVAL LOW COMPLEXITY	$164	$136.12	$148.01 – $157.44
Physical therapy evaluation (low complexity): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $155.80 BCBS - NE — Commercial\|BluePrint: $148.01 Greater Omaha Packing — Commercial\|Broad Network: $157.44 Greater Omaha Packing — Commercial\|Narrow Network: $157.44 Medica — Commercial\|ACO: $157.44 Medica — Commercial\|All Other Plans: $149.24 Medica — Commercial\|CHI Health: $149.24 Medica — Commercial\|Open Access: $157.44 Midlands Choice — Commercial\|Premier: $157.44 Midlands Choice — Commercial\|Standard: $157.44
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: HC PT EVAL MODERATE COMPLEX	$207	$171.81	$44.34 – $198.72
Physical therapy evaluation (moderate complexity): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $44.34 Amerigroup — Medicare\|All Plans: $86.94 AMPS — Commercial\|All Plans: $183.82 BCBS - NE — Commercial\|All Other Plans: $196.65 BCBS - NE — Commercial\|BluePrint: $186.82 BCBS - NE — Medicare\|All Plans: $82.80 Centene — Medicaid\|NE Total Care: $84.87 Centene — Medicare\|All Plans: $84.46 Great Plains — Medicare\|All Plans: $86.94 Greater Omaha Packing — Commercial\|Broad Network: $198.72
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) In the file: HC PT EVAL MODERATE COMPLEX	$207	$171.81	$186.82 – $198.72
Physical therapy evaluation (moderate complexity): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $196.65 BCBS - NE — Commercial\|BluePrint: $186.82 Greater Omaha Packing — Commercial\|Broad Network: $198.72 Greater Omaha Packing — Commercial\|Narrow Network: $198.72 Medica — Commercial\|ACO: $198.72 Medica — Commercial\|All Other Plans: $188.37 Medica — Commercial\|CHI Health: $188.37 Medica — Commercial\|Open Access: $198.72 Midlands Choice — Commercial\|Premier: $198.72 Midlands Choice — Commercial\|Standard: $198.72
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: HC PT EVAL HIGMH COMPLEXITY	$248	$205.84	$53.13 – $238.08
Physical therapy evaluation (high complexity): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $53.13 Amerigroup — Medicare\|All Plans: $104.16 AMPS — Commercial\|All Plans: $220.23 BCBS - NE — Commercial\|All Other Plans: $235.60 BCBS - NE — Commercial\|BluePrint: $223.82 BCBS - NE — Medicare\|All Plans: $99.20 Centene — Medicaid\|NE Total Care: $101.68 Centene — Medicare\|All Plans: $101.19 Great Plains — Medicare\|All Plans: $104.16 Greater Omaha Packing — Commercial\|Broad Network: $238.08
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) In the file: HC PT EVAL HIGMH COMPLEXITY	$248	$205.84	$223.82 – $238.08
Physical therapy evaluation (high complexity): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $235.60 BCBS - NE — Commercial\|BluePrint: $223.82 Greater Omaha Packing — Commercial\|Broad Network: $238.08 Greater Omaha Packing — Commercial\|Narrow Network: $238.08 Medica — Commercial\|ACO: $238.08 Medica — Commercial\|All Other Plans: $225.68 Medica — Commercial\|CHI Health: $225.68 Medica — Commercial\|Open Access: $238.08 Midlands Choice — Commercial\|Premier: $238.08 Midlands Choice — Commercial\|Standard: $238.08

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: PC OPEN EXCISION BREAST LESION	$1,422	$1,180.26	$304.60 – $1,365.12
Removal of breast growth (open surgery): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $304.60 Amerigroup — Medicare\|All Plans: $597.24 AMPS — Commercial\|All Plans: $1,262.74 BCBS - NE — Commercial\|All Other Plans: $1,350.90 BCBS - NE — Commercial\|BluePrint: $1,283.36 BCBS - NE — Medicare\|All Plans: $568.80 Centene — Medicaid\|NE Total Care: $583.02 Centene — Medicare\|All Plans: $580.18 Great Plains — Medicare\|All Plans: $597.24 Greater Omaha Packing — Commercial\|Broad Network: $1,365.12
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) In the file: PC OPEN EXCISION BREAST LESION	$1,422	$1,180.26	$1,283.36 – $1,365.12
Removal of breast growth (open surgery): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $1,350.90 BCBS - NE — Commercial\|BluePrint: $1,283.36 Greater Omaha Packing — Commercial\|Broad Network: $1,365.12 Greater Omaha Packing — Commercial\|Narrow Network: $1,365.12 Medica — Commercial\|ACO: $1,365.12 Medica — Commercial\|All Other Plans: $1,294.02 Medica — Commercial\|CHI Health: $1,294.02 Medica — Commercial\|Open Access: $1,365.12 Midlands Choice — Commercial\|Premier: $1,365.12 Midlands Choice — Commercial\|Standard: $1,365.12
Total knee replacement CPT 27447 · Outpatient (no overnight stay) In the file: PC TOTAL KNEE ARTHROPLASTY	$3,488	$2,895.04	$747.13 – $3,348.48
Total knee replacement: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $747.13 Amerigroup — Medicare\|All Plans: $1,464.96 AMPS — Commercial\|All Plans: $3,097.35 BCBS - NE — Commercial\|All Other Plans: $3,313.60 BCBS - NE — Commercial\|BluePrint: $3,147.92 BCBS - NE — Medicare\|All Plans: $1,395.20 Centene — Medicaid\|NE Total Care: $1,430.08 Centene — Medicare\|All Plans: $1,423.11 Great Plains — Medicare\|All Plans: $1,464.96 Greater Omaha Packing — Commercial\|Broad Network: $3,348.48
Total knee replacement CPT 27447 · Inpatient (hospital stay) In the file: PC TOTAL KNEE ARTHROPLASTY	$3,488	$2,895.04	$3,147.92 – $3,348.48
Total knee replacement: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $3,313.60 BCBS - NE — Commercial\|BluePrint: $3,147.92 Greater Omaha Packing — Commercial\|Broad Network: $3,348.48 Greater Omaha Packing — Commercial\|Narrow Network: $3,348.48 Medica — Commercial\|ACO: $3,348.48 Medica — Commercial\|All Other Plans: $3,174.08 Medica — Commercial\|CHI Health: $3,174.08 Medica — Commercial\|Open Access: $3,348.48 Midlands Choice — Commercial\|Premier: $3,348.48 Midlands Choice — Commercial\|Standard: $3,348.48
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) In the file: PC SHOULDER ARTHROSCOP PART ACROMIOPLAS	$1,042	$864.86	$223.20 – $1,000.32
Shoulder arthroscopy: shaving of shoulder bone: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $223.20 Amerigroup — Medicare\|All Plans: $437.64 AMPS — Commercial\|All Plans: $925.30 BCBS - NE — Commercial\|All Other Plans: $989.90 BCBS - NE — Commercial\|BluePrint: $940.41 BCBS - NE — Medicare\|All Plans: $416.80 Centene — Medicaid\|NE Total Care: $427.22 Centene — Medicare\|All Plans: $425.14 Great Plains — Medicare\|All Plans: $437.64 Greater Omaha Packing — Commercial\|Broad Network: $1,000.32
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient (hospital stay) In the file: PC SHOULDER ARTHROSCOP PART ACROMIOPLAS	$1,042	$864.86	$940.41 – $1,000.32
Shoulder arthroscopy: shaving of shoulder bone: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $989.90 BCBS - NE — Commercial\|BluePrint: $940.41 Greater Omaha Packing — Commercial\|Broad Network: $1,000.32 Greater Omaha Packing — Commercial\|Narrow Network: $1,000.32 Medica — Commercial\|ACO: $1,000.32 Medica — Commercial\|All Other Plans: $948.22 Medica — Commercial\|CHI Health: $948.22 Medica — Commercial\|Open Access: $1,000.32 Midlands Choice — Commercial\|Premier: $1,000.32 Midlands Choice — Commercial\|Standard: $1,000.32
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: HC EGMD DIAGMNOSTIC BRUSH WASH	$2,704	$2,244.32	$579.20 – $2,595.84
Upper GI endoscopy (diagnostic): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $579.20 Amerigroup — Medicare\|All Plans: $1,135.68 AMPS — Commercial\|All Plans: $2,401.16 BCBS - NE — Commercial\|All Other Plans: $2,568.80 BCBS - NE — Commercial\|BluePrint: $2,440.36 BCBS - NE — Medicare\|All Plans: $1,081.60 Centene — Medicaid\|NE Total Care: $1,108.64 Centene — Medicare\|All Plans: $1,103.24 Great Plains — Medicare\|All Plans: $1,135.68 Greater Omaha Packing — Commercial\|Broad Network: $2,595.84
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: PC EGMD DIAGMNOSTIC BRUSH WASH	$859	$712.97	$184 – $824.64
Upper GI endoscopy (diagnostic): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $184 Amerigroup — Medicare\|All Plans: $360.78 AMPS — Commercial\|All Plans: $762.80 BCBS - NE — Commercial\|All Other Plans: $816.05 BCBS - NE — Commercial\|BluePrint: $775.25 BCBS - NE — Medicare\|All Plans: $343.60 Centene — Medicaid\|NE Total Care: $352.19 Centene — Medicare\|All Plans: $350.48 Great Plains — Medicare\|All Plans: $360.78 Greater Omaha Packing — Commercial\|Broad Network: $824.64
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) In the file: HC EGMD DIAGMNOSTIC BRUSH WASH	$2,704	$2,244.32	$2,440.36 – $2,595.84
Upper GI endoscopy (diagnostic): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $2,568.80 BCBS - NE — Commercial\|BluePrint: $2,440.36 Greater Omaha Packing — Commercial\|Broad Network: $2,595.84 Greater Omaha Packing — Commercial\|Narrow Network: $2,595.84 Medica — Commercial\|ACO: $2,595.84 Medica — Commercial\|All Other Plans: $2,460.64 Medica — Commercial\|CHI Health: $2,460.64 Medica — Commercial\|Open Access: $2,595.84 Midlands Choice — Commercial\|Premier: $2,595.84 Midlands Choice — Commercial\|Standard: $2,595.84
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: HC EGMD BIOPSY SINGMLE MULTIPLE	$2,704	$2,244.32	$579.20 – $2,595.84
Upper GI endoscopy with biopsy: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $579.20 Amerigroup — Medicare\|All Plans: $1,135.68 AMPS — Commercial\|All Plans: $2,401.16 BCBS - NE — Commercial\|All Other Plans: $2,568.80 BCBS - NE — Commercial\|BluePrint: $2,440.36 BCBS - NE — Medicare\|All Plans: $1,081.60 Centene — Medicaid\|NE Total Care: $1,108.64 Centene — Medicare\|All Plans: $1,103.24 Great Plains — Medicare\|All Plans: $1,135.68 Greater Omaha Packing — Commercial\|Broad Network: $2,595.84
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: PC EGMD BIOPSY SINGMLE MULTIPLE	$1,100	$913	$235.62 – $1,056
Upper GI endoscopy with biopsy: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $235.62 Amerigroup — Medicare\|All Plans: $462 AMPS — Commercial\|All Plans: $976.80 BCBS - NE — Commercial\|All Other Plans: $1,045 BCBS - NE — Commercial\|BluePrint: $992.75 BCBS - NE — Medicare\|All Plans: $440 Centene — Medicaid\|NE Total Care: $451 Centene — Medicare\|All Plans: $448.80 Great Plains — Medicare\|All Plans: $462 Greater Omaha Packing — Commercial\|Broad Network: $1,056
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) In the file: HC EGMD BIOPSY SINGMLE MULTIPLE	$2,704	$2,244.32	$2,440.36 – $2,595.84
Upper GI endoscopy with biopsy: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $2,568.80 BCBS - NE — Commercial\|BluePrint: $2,440.36 Greater Omaha Packing — Commercial\|Broad Network: $2,595.84 Greater Omaha Packing — Commercial\|Narrow Network: $2,595.84 Medica — Commercial\|ACO: $2,595.84 Medica — Commercial\|All Other Plans: $2,460.64 Medica — Commercial\|CHI Health: $2,460.64 Medica — Commercial\|Open Access: $2,595.84 Midlands Choice — Commercial\|Premier: $2,595.84 Midlands Choice — Commercial\|Standard: $2,595.84
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: PC COLONOSCOPY DX	$750	$622.50	$160.65 – $720
Colonoscopy (diagnostic): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $160.65 Amerigroup — Medicare\|All Plans: $315 AMPS — Commercial\|All Plans: $666 BCBS - NE — Commercial\|All Other Plans: $712.50 BCBS - NE — Commercial\|BluePrint: $676.88 BCBS - NE — Medicare\|All Plans: $300 Centene — Medicaid\|NE Total Care: $307.50 Centene — Medicare\|All Plans: $306 Great Plains — Medicare\|All Plans: $315 Greater Omaha Packing — Commercial\|Broad Network: $720
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) In the file: PC COLONOSCOPY DX	$750	$622.50	$676.88 – $720
Colonoscopy (diagnostic): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $712.50 BCBS - NE — Commercial\|BluePrint: $676.88 Greater Omaha Packing — Commercial\|Broad Network: $720 Greater Omaha Packing — Commercial\|Narrow Network: $720 Medica — Commercial\|ACO: $720 Medica — Commercial\|All Other Plans: $682.50 Medica — Commercial\|CHI Health: $682.50 Medica — Commercial\|Open Access: $720 Midlands Choice — Commercial\|Premier: $720 Midlands Choice — Commercial\|Standard: $720
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: PC COLONOSCOPY W BX	$1,259	$1,044.97	$269.68 – $1,208.64
Colonoscopy with biopsy: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $269.68 Amerigroup — Medicare\|All Plans: $528.78 AMPS — Commercial\|All Plans: $1,118 BCBS - NE — Commercial\|All Other Plans: $1,196.05 BCBS - NE — Commercial\|BluePrint: $1,136.25 BCBS - NE — Medicare\|All Plans: $503.60 Centene — Medicaid\|NE Total Care: $516.19 Centene — Medicare\|All Plans: $513.68 Great Plains — Medicare\|All Plans: $528.78 Greater Omaha Packing — Commercial\|Broad Network: $1,208.64
Colonoscopy with biopsy CPT 45380 · Inpatient (hospital stay) In the file: PC COLONOSCOPY W BX	$1,259	$1,044.97	$1,136.25 – $1,208.64
Colonoscopy with biopsy: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $1,196.05 BCBS - NE — Commercial\|BluePrint: $1,136.25 Greater Omaha Packing — Commercial\|Broad Network: $1,208.64 Greater Omaha Packing — Commercial\|Narrow Network: $1,208.64 Medica — Commercial\|ACO: $1,208.64 Medica — Commercial\|All Other Plans: $1,145.69 Medica — Commercial\|CHI Health: $1,145.69 Medica — Commercial\|Open Access: $1,208.64 Midlands Choice — Commercial\|Premier: $1,208.64 Midlands Choice — Commercial\|Standard: $1,208.64
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: PC LESION REM COLONOSCPY SNARE	$1,310	$1,087.30	$280.61 – $1,257.60
Colonoscopy with removal of polyps (snare): 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $280.61 Amerigroup — Medicare\|All Plans: $550.20 AMPS — Commercial\|All Plans: $1,163.28 BCBS - NE — Commercial\|All Other Plans: $1,244.50 BCBS - NE — Commercial\|BluePrint: $1,182.28 BCBS - NE — Medicare\|All Plans: $524 Centene — Medicaid\|NE Total Care: $537.10 Centene — Medicare\|All Plans: $534.48 Great Plains — Medicare\|All Plans: $550.20 Greater Omaha Packing — Commercial\|Broad Network: $1,257.60
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) In the file: PC LESION REM COLONOSCPY SNARE	$1,310	$1,087.30	$1,182.28 – $1,257.60
Colonoscopy with removal of polyps (snare): 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $1,244.50 BCBS - NE — Commercial\|BluePrint: $1,182.28 Greater Omaha Packing — Commercial\|Broad Network: $1,257.60 Greater Omaha Packing — Commercial\|Narrow Network: $1,257.60 Medica — Commercial\|ACO: $1,257.60 Medica — Commercial\|All Other Plans: $1,192.10 Medica — Commercial\|CHI Health: $1,192.10 Medica — Commercial\|Open Access: $1,257.60 Midlands Choice — Commercial\|Premier: $1,257.60 Midlands Choice — Commercial\|Standard: $1,257.60
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) In the file: PC COLONOSCOPY W ENDO US	$719	$596.77	$154.01 – $690.24
Ultrasound of the lower bowel by endoscope: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $154.01 Amerigroup — Medicare\|All Plans: $301.98 AMPS — Commercial\|All Plans: $638.48 BCBS - NE — Commercial\|All Other Plans: $683.05 BCBS - NE — Commercial\|BluePrint: $648.90 BCBS - NE — Medicare\|All Plans: $287.60 Centene — Medicaid\|NE Total Care: $294.79 Centene — Medicare\|All Plans: $293.36 Great Plains — Medicare\|All Plans: $301.98 Greater Omaha Packing — Commercial\|Broad Network: $690.24
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient (hospital stay) In the file: PC COLONOSCOPY W ENDO US	$719	$596.77	$648.90 – $690.24
Ultrasound of the lower bowel by endoscope: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $683.05 BCBS - NE — Commercial\|BluePrint: $648.90 Greater Omaha Packing — Commercial\|Broad Network: $690.24 Greater Omaha Packing — Commercial\|Narrow Network: $690.24 Medica — Commercial\|ACO: $690.24 Medica — Commercial\|All Other Plans: $654.29 Medica — Commercial\|CHI Health: $654.29 Medica — Commercial\|Open Access: $690.24 Midlands Choice — Commercial\|Premier: $690.24 Midlands Choice — Commercial\|Standard: $690.24
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: PC LAPAROSCOPY CHOLECYSTECTOMY	$1,780	$1,477.40	$381.28 – $1,708.80
Gallbladder removal by laparoscope: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $381.28 Amerigroup — Medicare\|All Plans: $747.60 AMPS — Commercial\|All Plans: $1,580.64 BCBS - NE — Commercial\|All Other Plans: $1,691 BCBS - NE — Commercial\|BluePrint: $1,606.45 BCBS - NE — Medicare\|All Plans: $712 Centene — Medicaid\|NE Total Care: $729.80 Centene — Medicare\|All Plans: $726.24 Great Plains — Medicare\|All Plans: $747.60 Greater Omaha Packing — Commercial\|Broad Network: $1,708.80
Gallbladder removal by laparoscope CPT 47562 · Inpatient (hospital stay) In the file: PC LAPAROSCOPY CHOLECYSTECTOMY	$1,780	$1,477.40	$1,606.45 – $1,708.80
Gallbladder removal by laparoscope: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $1,691 BCBS - NE — Commercial\|BluePrint: $1,606.45 Greater Omaha Packing — Commercial\|Broad Network: $1,708.80 Greater Omaha Packing — Commercial\|Narrow Network: $1,708.80 Medica — Commercial\|ACO: $1,708.80 Medica — Commercial\|All Other Plans: $1,619.80 Medica — Commercial\|CHI Health: $1,619.80 Medica — Commercial\|Open Access: $1,708.80 Midlands Choice — Commercial\|Premier: $1,708.80 Midlands Choice — Commercial\|Standard: $1,708.80
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: PC RPR INGMUINL HERN AGME 5 OR>	$1,414	$1,173.62	$302.88 – $1,357.44
Groin (inguinal) hernia repair, age 5 or older: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $302.88 Amerigroup — Medicare\|All Plans: $593.88 AMPS — Commercial\|All Plans: $1,255.64 BCBS - NE — Commercial\|All Other Plans: $1,343.30 BCBS - NE — Commercial\|BluePrint: $1,276.14 BCBS - NE — Medicare\|All Plans: $565.60 Centene — Medicaid\|NE Total Care: $579.74 Centene — Medicare\|All Plans: $576.92 Great Plains — Medicare\|All Plans: $593.88 Greater Omaha Packing — Commercial\|Broad Network: $1,357.44
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient (hospital stay) In the file: PC RPR INGMUINL HERN AGME 5 OR>	$1,414	$1,173.62	$1,276.14 – $1,357.44
Groin (inguinal) hernia repair, age 5 or older: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $1,343.30 BCBS - NE — Commercial\|BluePrint: $1,276.14 Greater Omaha Packing — Commercial\|Broad Network: $1,357.44 Greater Omaha Packing — Commercial\|Narrow Network: $1,357.44 Medica — Commercial\|ACO: $1,357.44 Medica — Commercial\|All Other Plans: $1,286.74 Medica — Commercial\|CHI Health: $1,286.74 Medica — Commercial\|Open Access: $1,357.44 Midlands Choice — Commercial\|Premier: $1,357.44 Midlands Choice — Commercial\|Standard: $1,357.44
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: HC BIOPSY PROSTATE	$947	$786.01	$202.85 – $909.12
Prostate biopsy: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $202.85 Amerigroup — Medicare\|All Plans: $397.74 AMPS — Commercial\|All Plans: $840.94 BCBS - NE — Commercial\|All Other Plans: $899.65 BCBS - NE — Commercial\|BluePrint: $854.67 BCBS - NE — Medicare\|All Plans: $378.80 Centene — Medicaid\|NE Total Care: $388.27 Centene — Medicare\|All Plans: $386.38 Great Plains — Medicare\|All Plans: $397.74 Greater Omaha Packing — Commercial\|Broad Network: $909.12
Prostate biopsy CPT 55700 · Inpatient (hospital stay) In the file: HC BIOPSY PROSTATE	$947	$786.01	$854.67 – $909.12
Prostate biopsy: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $899.65 BCBS - NE — Commercial\|BluePrint: $854.67 Greater Omaha Packing — Commercial\|Broad Network: $909.12 Greater Omaha Packing — Commercial\|Narrow Network: $909.12 Medica — Commercial\|ACO: $909.12 Medica — Commercial\|All Other Plans: $861.77 Medica — Commercial\|CHI Health: $861.77 Medica — Commercial\|Open Access: $909.12 Midlands Choice — Commercial\|Premier: $909.12 Midlands Choice — Commercial\|Standard: $909.12
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: HC INJ ANE DRGM LUM SAC W IMGM GMDN	$1,448	$1,201.84	$310.17 – $1,390.08
Spinal injection, lower back (epidural), with imaging guidance: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $310.17 Amerigroup — Medicare\|All Plans: $608.16 AMPS — Commercial\|All Plans: $1,285.83 BCBS - NE — Commercial\|All Other Plans: $1,375.60 BCBS - NE — Commercial\|BluePrint: $1,306.82 BCBS - NE — Medicare\|All Plans: $579.20 Centene — Medicaid\|NE Total Care: $593.68 Centene — Medicare\|All Plans: $590.79 Great Plains — Medicare\|All Plans: $608.16 Greater Omaha Packing — Commercial\|Broad Network: $1,390.08
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: PC CRNA INJ LMBR SAC W IMGM GMDN	$486	$403.38	$104.11 – $466.56
Spinal injection, lower back (epidural), with imaging guidance: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $104.11 Amerigroup — Medicare\|All Plans: $204.12 AMPS — Commercial\|All Plans: $431.57 BCBS - NE — Commercial\|All Other Plans: $461.70 BCBS - NE — Commercial\|BluePrint: $438.62 BCBS - NE — Medicare\|All Plans: $194.40 Centene — Medicaid\|NE Total Care: $199.26 Centene — Medicare\|All Plans: $198.29 Great Plains — Medicare\|All Plans: $204.12 Greater Omaha Packing — Commercial\|Broad Network: $466.56
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: PC INJ LMBR SAC W IMGM GMDN	$740	$614.20	$158.51 – $710.40
Spinal injection, lower back (epidural), with imaging guidance: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $158.51 Amerigroup — Medicare\|All Plans: $310.80 AMPS — Commercial\|All Plans: $657.12 BCBS - NE — Commercial\|All Other Plans: $703 BCBS - NE — Commercial\|BluePrint: $667.85 BCBS - NE — Medicare\|All Plans: $296 Centene — Medicaid\|NE Total Care: $303.40 Centene — Medicare\|All Plans: $301.92 Great Plains — Medicare\|All Plans: $310.80 Greater Omaha Packing — Commercial\|Broad Network: $710.40
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: HC INJ TRNSFRM LUM SNGML W IMAGM	$1,335	$1,108.05	$285.96 – $1,281.60
Nerve root injection, lower back, with imaging guidance: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $285.96 Amerigroup — Medicare\|All Plans: $560.70 AMPS — Commercial\|All Plans: $1,185.48 BCBS - NE — Commercial\|All Other Plans: $1,268.25 BCBS - NE — Commercial\|BluePrint: $1,204.84 BCBS - NE — Medicare\|All Plans: $534 Centene — Medicaid\|NE Total Care: $547.35 Centene — Medicare\|All Plans: $544.68 Great Plains — Medicare\|All Plans: $560.70 Greater Omaha Packing — Commercial\|Broad Network: $1,281.60
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: PC CRNA INJ TRNSFRM LUM SNGML W IMGM	$706	$585.98	$151.23 – $677.76
Nerve root injection, lower back, with imaging guidance: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $151.23 Amerigroup — Medicare\|All Plans: $296.52 AMPS — Commercial\|All Plans: $626.93 BCBS - NE — Commercial\|All Other Plans: $670.70 BCBS - NE — Commercial\|BluePrint: $637.17 BCBS - NE — Medicare\|All Plans: $282.40 Centene — Medicaid\|NE Total Care: $289.46 Centene — Medicare\|All Plans: $288.05 Great Plains — Medicare\|All Plans: $296.52 Greater Omaha Packing — Commercial\|Broad Network: $677.76
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) In the file: HC INJ TRNSFRM LUM SNGML W IMAGM	$1,335	$1,108.05	$1,204.84 – $1,281.60
Nerve root injection, lower back, with imaging guidance: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $1,268.25 BCBS - NE — Commercial\|BluePrint: $1,204.84 Greater Omaha Packing — Commercial\|Broad Network: $1,281.60 Greater Omaha Packing — Commercial\|Narrow Network: $1,281.60 Medica — Commercial\|ACO: $1,281.60 Medica — Commercial\|All Other Plans: $1,214.85 Medica — Commercial\|CHI Health: $1,214.85 Medica — Commercial\|Open Access: $1,281.60 Midlands Choice — Commercial\|Premier: $1,281.60 Midlands Choice — Commercial\|Standard: $1,281.60
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: PC REVISE MEDIAN N CARPAL TUNNEL SURGM	$1,228	$1,019.24	$263.04 – $1,178.88
Carpal tunnel release: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $263.04 Amerigroup — Medicare\|All Plans: $515.76 AMPS — Commercial\|All Plans: $1,090.47 BCBS - NE — Commercial\|All Other Plans: $1,166.60 BCBS - NE — Commercial\|BluePrint: $1,108.27 BCBS - NE — Medicare\|All Plans: $491.20 Centene — Medicaid\|NE Total Care: $503.48 Centene — Medicare\|All Plans: $501.03 Great Plains — Medicare\|All Plans: $515.76 Greater Omaha Packing — Commercial\|Broad Network: $1,178.88
Carpal tunnel release CPT 64721 · Inpatient (hospital stay) In the file: PC REVISE MEDIAN N CARPAL TUNNEL SURGM	$1,228	$1,019.24	$1,108.27 – $1,178.88
Carpal tunnel release: 10 of 17 insurance plan rates BCBS - NE — Commercial\|All Other Plans: $1,166.60 BCBS - NE — Commercial\|BluePrint: $1,108.27 Greater Omaha Packing — Commercial\|Broad Network: $1,178.88 Greater Omaha Packing — Commercial\|Narrow Network: $1,178.88 Medica — Commercial\|ACO: $1,178.88 Medica — Commercial\|All Other Plans: $1,117.48 Medica — Commercial\|CHI Health: $1,117.48 Medica — Commercial\|Open Access: $1,178.88 Midlands Choice — Commercial\|Premier: $1,178.88 Midlands Choice — Commercial\|Standard: $1,178.88

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	Not listed in the file	$70,044.42 – $71,417.84
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $70,044.42 Amerigroup — Medicare\|All Plans: $4,541 AMPS — Commercial\|All Plans: $9,513 BCBS - NE — Medicare\|All Plans: $4,324 Centene — Medicaid\|NE Total Care: $5,798 Centene — Medicare\|All Plans: $4,411 Great Plains — Medicare\|All Plans: $4,541 Humana — Medicare\|All Plans: $4,324 IAMolina — Medicaid\|All Plans: $71,417.84 Medica — Medicare\|All Plans: $4,324
Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) In the file: NO ACTIVE CODE DESCRIPTION	Not listed in the file	Not listed in the file	$19,687.02 – $20,073.04
Spinal fusion (not neck), without major complications: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $19,687.02 Amerigroup — Medicare\|All Plans: $4,541 AMPS — Commercial\|All Plans: $9,513 BCBS - NE — Medicare\|All Plans: $4,324 Centene — Medicaid\|NE Total Care: $5,798 Centene — Medicare\|All Plans: $4,411 Great Plains — Medicare\|All Plans: $4,541 Humana — Medicare\|All Plans: $4,324 IAMolina — Medicaid\|All Plans: $20,073.04 Medica — Medicare\|All Plans: $4,324
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$12,278.76 – $12,519.52
Hip or knee replacement (major joint of the leg), without major complications: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $12,278.76 Amerigroup — Medicare\|All Plans: $4,541 AMPS — Commercial\|All Plans: $9,513 BCBS - NE — Medicare\|All Plans: $4,324 Centene — Medicaid\|NE Total Care: $5,798 Centene — Medicare\|All Plans: $4,411 Great Plains — Medicare\|All Plans: $4,541 Humana — Medicare\|All Plans: $4,324 IAMolina — Medicaid\|All Plans: $12,519.52 Medica — Medicare\|All Plans: $4,324
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$11,705.52 – $11,935.04
Neck (cervical) spinal fusion, without complications: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $11,705.52 Amerigroup — Medicare\|All Plans: $4,541 AMPS — Commercial\|All Plans: $9,513 BCBS - NE — Medicare\|All Plans: $4,324 Centene — Medicaid\|NE Total Care: $5,798 Centene — Medicare\|All Plans: $4,411 Great Plains — Medicare\|All Plans: $4,541 Humana — Medicare\|All Plans: $4,324 IAMolina — Medicaid\|All Plans: $11,935.04 Medica — Medicare\|All Plans: $4,324
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$5,549.82 – $5,658.64
Uterus and ovary surgery (not for cancer), without complications: 10 of 30 insurance plan rates Amerigroup — Medicaid\|All Plans: $5,549.82 Amerigroup — Medicare\|All Plans: $4,541 AMPS — Commercial\|All Plans: $9,513 BCBS - NE — Medicare\|All Plans: $4,324 Centene — Medicaid\|NE Total Care: $5,798 Centene — Medicare\|All Plans: $4,411 Great Plains — Medicare\|All Plans: $4,541 Humana — Medicare\|All Plans: $4,324 IAMolina — Medicaid\|All Plans: $5,658.64 Medica — Medicare\|All Plans: $4,324

Source: CHI Health St Mary's’s standard charges file (chihealth.com, JSON, CMS template 3.0.0; it can be a very large file), last updated by the hospital on February 28, 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	1301 Grundman Blvd, Nebraska City, NE 68410
County	Otoe County
State	Nebraska
Phone	(402) 873‑3321
Emergency services	Yes
Ownership	Voluntary non-profit - Church
Medicare overall rating	4 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	281342
Name in Medicare records	CHI HEALTH ST MARY'S
Profile level	Medicare data + hospital website
Official website	chihealth.com
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 ZIP code areas (Gazetteer) — approximate position (center of the ZIP code area) used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-30.

CHI Health St. Mary's | CHI Health — chihealth.com
Opioid and Substance Treatment | CHI Health — chihealth.com
Maternity Center at St. Mary's | CHI Health — chihealth.com
Focused Ultrasound | CHI Health — chihealth.com

CHI Health St Mary's

Summary

Profile from official sources

At a glance