Does St Francis Memorial Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at St Francis Memorial Hospital. In a medical emergency, call 911.

Where is St Francis Memorial Hospital?

430 North Monitor St, West Point, NE 68788, in Cuming County, Nebraska.

What is the phone number of St Francis Memorial Hospital?

(402) 372-2404, as listed by Medicare (CMS).

What is the Medicare star rating of St Francis Memorial Hospital?

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

St Francis Memorial Hospital — West Point, NE

Quick answers

Does St Francis Memorial Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at St Francis Memorial Hospital. In a medical emergency, call 911.
Where is St Francis Memorial Hospital?: 430 North Monitor St, West Point, NE 68788, in Cuming County, Nebraska.
What is the phone number of St Francis Memorial Hospital?: (402) 372-2404, as listed by Medicare (CMS).
What is the Medicare star rating of St Francis Memorial Hospital?: 2 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^{[4][6][8][11]}

Maternity services
Surgery and anesthesia
Radiology
Laboratory
Respiratory therapy
Rehabilitation and wellness
Specialty clinics
Cardiology
General surgery
Gynecology
Urology
Ear, nose and throat
Ophthalmology
Podiatry
Orthopaedics
Sports medicine
Obstetrics

Conditions treated^[6]

Treatments^{[4][8][9][11][12]}

Procedures^{[6][8][10][11]}

Electrocardiogram
Exercise stress test
Stress echocardiogram
Nuclear stress test
Holter monitor
Zio patch heart monitoring
MRI
CT scan
PET/CT
General ultrasound
Vascular ultrasound
Nuclear medicine
Digital mammography
3D mammography
Stereotactic breast biopsy
Fluoroscopy
Bone density (DEXA) scan
X-ray
Low-dose CT lung cancer screening
Colonoscopy
Sigmoidoscopy
Gastroscopy
Feeding tube insertion
Foreign body retrieval
Esophageal dilatation
Total joint replacement
Cesarean birth

Programs and centers^{[4][6][8][11]}

Cardiopulmonary rehab
Diabetes education
Home health and hospice
Cardiac rehabilitation
Pulmonary rehabilitation
Birthing center
Childbirth education classes
Car seat inspection station
CPR and first aid classes
Lifeline personal emergency response system
Total Joint Class

Emergency care (hospital website)^[4][5]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Patient portal	Patient portal

Recognition^[6]

Cardiac Rehabilitation program certified (American Association of Cardiovascular and Pulmonary Rehabilitation)
Pulmonary Rehabilitation program certified (American Association of Cardiovascular and Pulmonary Rehabilitation)

Doctors and clinicians (89)

89 doctors and other clinicians list St Francis Memorial Hospital 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

And 65 more: the button below opens the full list.

Other emergency rooms nearby

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

Pender Community Hospital19 mi · Pender, NE · Critical Access Hospital
Methodist Fremont Health29 mi · Fremont, NE · Acute Care Hospital
Twelve Clans Unity Hospital30 mi · Winnebago, NE · Acute Care Hospital
Providence Medical Center32 mi · Wayne, NE · Critical Access Hospital
CHI Health Schuyler32 mi · Schuyler, NE · Critical Access Hospital

Other hospitals nearby

Burgess Health Center33 mi · Onawa, IA · Critical Access Hospital

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

St Joseph's Hillside Villa0.0 mi · West Point, NE · 5 of 5 stars
Colonial Haven7.9 mi · Beemer, NE · 5 of 5 stars
Oakland Heights13 mi · Oakland, NE · 5 of 5 stars

All nursing homes in the state →

Community care nearby

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

Community health centers

Midtown Health Center, Inc. West Point1.0 mi · West Point, NE · Community health center

Clinics and urgent care

Franciscan Healthcare West Point Clinic1.1 mi · West Point, NE · Rural health clinic
Beemer Medical Clinic8.3 mi · Beemer, NE · Rural health clinic
Franciscan Healthcare Oakland Clinic11 mi · Oakland, NE · Rural health clinic

Pharmacies

Hy-Vee Inc1.1 mi · West Point, NE · Community/retail pharmacy
Pender Care Centre District Inc1.1 mi · West Point, NE · Community/retail pharmacy
St Francis Services LLC1.1 mi · West Point, NE · Community/retail pharmacy

Assisted living nearby

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

St. Joseph's Retirement Community1.1 mi · West Point, NE
Colonial Courts8.3 mi · Beemer, NE
Oakland Heights Assisted Living11 mi · Oakland, 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 St Francis Memorial Hospital 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	86%National average: 72%
Would definitely recommend the hospital	84%National average: 71%
Nurses “always” communicated well	90%National average: 80%
Doctors “always” communicated well	89%National average: 80%
Staff “always” explained medicines before giving them	69%National average: 62%
Were given information about recovery at home	94%National average: 86%
Room and bathroom “always” clean	87%National average: 74%
Area around the room “always” quiet at night	71%National average: 60%
Completed surveys	90Response rate: 40%

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	16.1%
Deaths within 30 days: pneumonia patients	19.9%
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	Too few cases to report

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	21.4%
Readmitted within 30 days: pneumonia	17.2%
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	Too few cases to report

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)	114 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)	70%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 79 common services exactly as St Francis Memorial Hospital 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 · Inpatient or outpatient · Doctor (professional) fee In the file: Office Visit Level 3 New - 99203 NP/PA	$366	$366	$85.56 – $351.36
New patient office visit (about 30–44 minutes): rates for 10 insurance plans Aetna — Medicare Advantage: $89.84 Aetna Coventry — HMO: $351.36 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $85.56 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $89.84 Humana — Medicare Advantage: $85.56 Medica — Medicare Advantage: $85.56 Midlands Choice — All Plans: $351.36 Molina Healthcare of Nebraska — Medicare Advantage: $89.84 Nebraska Total Care — Medicare Products: $87.27 United Healthcare — All Commercial Plans: $351.36
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW LOW 30 MIN	Not listed in the file	Not listed in the file	$111
New patient office visit (about 30–44 minutes): rates for 1 insurance plan Blue Cross Blue Shield of Nebraska — Blueprint Health: $111
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/New Patient-Comprehensive (45)	$519	$519	$139.67 – $498.24
New patient office visit (about 45–59 minutes): rates for 10 insurance plans Aetna — Medicare Advantage: $146.65 Aetna Coventry — HMO: $498.24 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $139.67 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $146.65 Humana — Medicare Advantage: $139.67 Medica — Medicare Advantage: $139.67 Midlands Choice — All Plans: $498.24 Molina Healthcare of Nebraska — Medicare Advantage: $146.65 Nebraska Total Care — Medicare Products: $142.46 United Healthcare — All Commercial Plans: $498.24
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW MOD 45 MIN	Not listed in the file	Not listed in the file	$149
New patient office visit (about 45–59 minutes): rates for 1 insurance plan Blue Cross Blue Shield of Nebraska — Blueprint Health: $149
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/New Patient-Comprehensive/High Complexity (60)	$660	$660	$189.78 – $633.60
New patient office visit (about 60–74 minutes): rates for 10 insurance plans Aetna — Medicare Advantage: $199.27 Aetna Coventry — HMO: $633.60 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $189.78 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $199.27 Humana — Medicare Advantage: $189.78 Medica — Medicare Advantage: $189.78 Midlands Choice — All Plans: $633.60 Molina Healthcare of Nebraska — Medicare Advantage: $199.27 Nebraska Total Care — Medicare Products: $193.58 United Healthcare — All Commercial Plans: $633.60
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW HI 60 MIN	Not listed in the file	Not listed in the file	$202
New patient office visit (about 60–74 minutes): rates for 1 insurance plan Blue Cross Blue Shield of Nebraska — Blueprint Health: $202
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/Established Patient-Expanded (15)	$240	$240	$69.44 – $230.40
Established patient office visit (about 20–29 minutes): rates for 10 insurance plans Aetna — Medicare Advantage: $72.91 Aetna Coventry — HMO: $230.40 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $69.44 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $72.91 Humana — Medicare Advantage: $69.44 Medica — Medicare Advantage: $69.44 Midlands Choice — All Plans: $230.40 Molina Healthcare of Nebraska — Medicare Advantage: $72.91 Nebraska Total Care — Medicare Products: $70.83 United Healthcare — All Commercial Plans: $230.40
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P EST LOW 20 MIN	Not listed in the file	Not listed in the file	$105
Established patient office visit (about 20–29 minutes): rates for 1 insurance plan Blue Cross Blue Shield of Nebraska — Blueprint Health: $105
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/Established Patient-Detailed (25)	$348	$348	$102.56 – $334.08
Established patient office visit (about 30–39 minutes): rates for 10 insurance plans Aetna — Medicare Advantage: $107.68 Aetna Coventry — HMO: $334.08 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $102.56 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $107.68 Humana — Medicare Advantage: $102.56 Medica — Medicare Advantage: $102.56 Midlands Choice — All Plans: $334.08 Molina Healthcare of Nebraska — Medicare Advantage: $107.68 Nebraska Total Care — Medicare Products: $104.61 United Healthcare — All Commercial Plans: $334.08
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P EST MOD 30 MIN	Not listed in the file	Not listed in the file	$141
Established patient office visit (about 30–39 minutes): rates for 1 insurance plan Blue Cross Blue Shield of Nebraska — Blueprint Health: $141
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient · Doctor (professional) fee In the file: Preventive Medicine 18-39 years New - 99385	$379	$379	$363.84
Preventive checkup, new patient, age 18–39: rates for 3 insurance plans Aetna Coventry — HMO: $363.84 Midlands Choice — All Plans: $363.84 United Healthcare — All Commercial Plans: $363.84
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient · Doctor (professional) fee In the file: Preventive Medicine 40-64 years New - 99386	$432	$432	$414.72
Preventive checkup, new patient, age 40–64: rates for 3 insurance plans Aetna Coventry — HMO: $414.72 Midlands Choice — All Plans: $414.72 United Healthcare — All Commercial Plans: $414.72
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99283 - FAC ED Level 3 - Room Charge	$940	$940	$357.20 – $902.40
Emergency room visit (moderate): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $434.28 Aetna Coventry — HMO: $902.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $893 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $413.60 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $434.28 Humana — Medicare Advantage: $413.60 Medica — Commercial Products: $855.40 Medica — Individual and Family Business Products-Care System Products: $902.40 Medica — Medicare Advantage: $413.60 Midlands Choice — All Plans: $902.40
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · Doctor (professional) fee In the file: Emergency Department Visit Level 3 - 99283	$264	$264	$73.93 – $253.44
Emergency room visit (moderate): rates for 10 insurance plans Aetna — Medicare Advantage: $77.63 Aetna Coventry — HMO: $253.44 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $73.93 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $77.63 Humana — Medicare Advantage: $73.93 Medica — Medicare Advantage: $73.93 Midlands Choice — All Plans: $253.44 Molina Healthcare of Nebraska — Medicare Advantage: $77.63 Nebraska Total Care — Medicare Products: $75.41 United Healthcare — All Commercial Plans: $253.44
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99283 - FAC ED Level 3 - Room Charge	$940	$940	$470 – $902.40
Emergency room visit (moderate): rates for 5 insurance plans Aetna Coventry — HMO: $902.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $893 Midlands Choice — All Plans: $902.40 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $470 United Healthcare — All Commercial Plans: $902.40
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99284 - FAC ED Level 4 Room Charge	$1,390	$1,390	$528.20 – $1,334.40
Emergency room visit (moderately high): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $642.18 Aetna Coventry — HMO: $1,334.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,320.50 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $611.60 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $642.18 Humana — Medicare Advantage: $611.60 Medica — Commercial Products: $1,264.90 Medica — Individual and Family Business Products-Care System Products: $1,334.40 Medica — Medicare Advantage: $611.60 Midlands Choice — All Plans: $1,334.40
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · Doctor (professional) fee In the file: Emergency Department Visit Level 4 - 99284	$447	$447	$125.83 – $429.12
Emergency room visit (moderately high): rates for 10 insurance plans Aetna — Medicare Advantage: $132.12 Aetna Coventry — HMO: $429.12 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $125.83 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $132.12 Humana — Medicare Advantage: $125.83 Medica — Medicare Advantage: $125.83 Midlands Choice — All Plans: $429.12 Molina Healthcare of Nebraska — Medicare Advantage: $132.12 Nebraska Total Care — Medicare Products: $128.35 United Healthcare — All Commercial Plans: $429.12
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99284 - FAC ED Level 4 Room Charge	$1,390	$1,390	$695 – $1,334.40
Emergency room visit (moderately high): rates for 5 insurance plans Aetna Coventry — HMO: $1,334.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,320.50 Midlands Choice — All Plans: $1,334.40 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $695 United Healthcare — All Commercial Plans: $1,334.40
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99285 - FAC ED Level 5 - Room Charge	$1,990	$1,990	$756.20 – $1,910.40
Emergency room visit (high): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $919.38 Aetna Coventry — HMO: $1,910.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,890.50 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $875.60 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $919.38 Humana — Medicare Advantage: $875.60 Medica — Commercial Products: $1,810.90 Medica — Individual and Family Business Products-Care System Products: $1,910.40 Medica — Medicare Advantage: $875.60 Midlands Choice — All Plans: $1,910.40
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · Doctor (professional) fee In the file: Emergency Department Visit Level 5 - 99285	$612	$612	$182.37 – $587.52
Emergency room visit (high): rates for 10 insurance plans Aetna — Medicare Advantage: $191.49 Aetna Coventry — HMO: $587.52 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $182.37 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $191.49 Humana — Medicare Advantage: $182.37 Medica — Medicare Advantage: $182.37 Midlands Choice — All Plans: $587.52 Molina Healthcare of Nebraska — Medicare Advantage: $191.49 Nebraska Total Care — Medicare Products: $186.01 United Healthcare — All Commercial Plans: $587.52
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99285 - FAC ED Level 5 - Room Charge	$1,990	$1,990	$995 – $1,910.40
Emergency room visit (high): rates for 5 insurance plans Aetna Coventry — HMO: $1,910.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,890.50 Midlands Choice — All Plans: $1,910.40 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $995 United Healthcare — All Commercial Plans: $1,910.40

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BMP 2	$269	$269	$102.22 – $258.24
Basic metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $124.28 Aetna Coventry — HMO: $258.24 Blue Cross Blue Shield of Nebraska — Blueprint Health: $110.16 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $118.36 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $124.28 Humana — Medicare Advantage: $118.36 Medica — Commercial Products: $244.79 Medica — Individual and Family Business Products-Care System Products: $258.24 Medica — Medicare Advantage: $118.36 Midlands Choice — All Plans: $258.24
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BMP	$269	$269	$102.22 – $258.24
Basic metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $124.28 Aetna Coventry — HMO: $258.24 Blue Cross Blue Shield of Nebraska — Blueprint Health: $110.16 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $118.36 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $124.28 Humana — Medicare Advantage: $118.36 Medica — Commercial Products: $244.79 Medica — Individual and Family Business Products-Care System Products: $258.24 Medica — Medicare Advantage: $118.36 Midlands Choice — All Plans: $258.24
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BMP 8	$269	$269	$102.22 – $258.24
Basic metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $124.28 Aetna Coventry — HMO: $258.24 Blue Cross Blue Shield of Nebraska — Blueprint Health: $110.16 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $118.36 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $124.28 Humana — Medicare Advantage: $118.36 Medica — Commercial Products: $244.79 Medica — Individual and Family Business Products-Care System Products: $258.24 Medica — Medicare Advantage: $118.36 Midlands Choice — All Plans: $258.24
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$273	$273	$103.74 – $262.08
Comprehensive metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $126.13 Aetna Coventry — HMO: $262.08 Blue Cross Blue Shield of Nebraska — Blueprint Health: $131.33 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $120.12 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $126.13 Humana — Medicare Advantage: $120.12 Medica — Commercial Products: $248.43 Medica — Individual and Family Business Products-Care System Products: $262.08 Medica — Medicare Advantage: $120.12 Midlands Choice — All Plans: $262.08
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CMP 8	$273	$273	$103.74 – $262.08
Comprehensive metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $126.13 Aetna Coventry — HMO: $262.08 Blue Cross Blue Shield of Nebraska — Blueprint Health: $131.33 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $120.12 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $126.13 Humana — Medicare Advantage: $120.12 Medica — Commercial Products: $248.43 Medica — Individual and Family Business Products-Care System Products: $262.08 Medica — Medicare Advantage: $120.12 Midlands Choice — All Plans: $262.08
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CMP 13	$273	$273	$103.74 – $262.08
Comprehensive metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $126.13 Aetna Coventry — HMO: $262.08 Blue Cross Blue Shield of Nebraska — Blueprint Health: $131.33 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $120.12 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $126.13 Humana — Medicare Advantage: $120.12 Medica — Commercial Products: $248.43 Medica — Individual and Family Business Products-Care System Products: $262.08 Medica — Medicare Advantage: $120.12 Midlands Choice — All Plans: $262.08
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel	$257	$257	$97.66 – $246.72
Cholesterol panel (lipid panel): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $118.73 Aetna Coventry — HMO: $246.72 Blue Cross Blue Shield of Nebraska — Blueprint Health: $97.92 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $113.08 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $118.73 Humana — Medicare Advantage: $113.08 Medica — Commercial Products: $233.87 Medica — Individual and Family Business Products-Care System Products: $246.72 Medica — Medicare Advantage: $113.08 Midlands Choice — All Plans: $246.72
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Lipid Panel	$257	$257	$128.50 – $246.72
Cholesterol panel (lipid panel): rates for 5 insurance plans Aetna Coventry — HMO: $246.72 Blue Cross Blue Shield of Nebraska — Blueprint Health: $244.15 Midlands Choice — All Plans: $246.72 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $128.50 United Healthcare — All Commercial Plans: $246.72
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal Function Panel	$300	$300	$114 – $288
Kidney function panel: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $138.60 Aetna Coventry — HMO: $288 Blue Cross Blue Shield of Nebraska — Blueprint Health: $285 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $132 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $138.60 Humana — Medicare Advantage: $132 Medica — Commercial Products: $273 Medica — Individual and Family Business Products-Care System Products: $288 Medica — Medicare Advantage: $132 Midlands Choice — All Plans: $288
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Renal Function Panel	$300	$300	$150 – $288
Kidney function panel: rates for 5 insurance plans Aetna Coventry — HMO: $288 Blue Cross Blue Shield of Nebraska — Blueprint Health: $285 Midlands Choice — All Plans: $288 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $150 United Healthcare — All Commercial Plans: $288
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$226	$226	$85.88 – $216.96
Liver function panel: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $104.41 Aetna Coventry — HMO: $216.96 Blue Cross Blue Shield of Nebraska — Blueprint Health: $214.70 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $99.44 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $104.41 Humana — Medicare Advantage: $99.44 Medica — Commercial Products: $205.66 Medica — Individual and Family Business Products-Care System Products: $216.96 Medica — Medicare Advantage: $99.44 Midlands Choice — All Plans: $216.96
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$226	$226	$113 – $216.96
Liver function panel: rates for 5 insurance plans Aetna Coventry — HMO: $216.96 Blue Cross Blue Shield of Nebraska — Blueprint Health: $214.70 Midlands Choice — All Plans: $216.96 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $113 United Healthcare — All Commercial Plans: $216.96
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UA w/ Microscopic Standard	$100	$100	$29.42 – $96
Urine test (automated, with microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $46.20 Aetna Coventry — HMO: $96 Blue Cross Blue Shield of Nebraska — Blueprint Health: $29.42 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $44 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $46.20 Humana — Medicare Advantage: $44 Medica — Commercial Products: $91 Medica — Individual and Family Business Products-Care System Products: $96 Medica — Medicare Advantage: $44 Midlands Choice — All Plans: $96
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UA w/ Microscopic Standard	$100	$100	$50 – $96
Urine test (automated, with microscope): rates for 5 insurance plans Aetna Coventry — HMO: $96 Blue Cross Blue Shield of Nebraska — Blueprint Health: $95 Midlands Choice — All Plans: $96 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $50 United Healthcare — All Commercial Plans: $96
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER URINE CLINITEK	$63	$63	$23.94 – $60.48
Urine test (manual, without microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $29.11 Aetna Coventry — HMO: $60.48 Blue Cross Blue Shield of Nebraska — Blueprint Health: $59.85 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $27.72 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $29.11 Humana — Medicare Advantage: $27.72 Medica — Commercial Products: $57.33 Medica — Individual and Family Business Products-Care System Products: $60.48 Medica — Medicare Advantage: $27.72 Midlands Choice — All Plans: $60.48
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ER URINE CLINITEK	$63	$63	$31.50 – $60.48
Urine test (manual, without microscope): rates for 5 insurance plans Aetna Coventry — HMO: $60.48 Blue Cross Blue Shield of Nebraska — Blueprint Health: $59.85 Midlands Choice — All Plans: $60.48 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $31.50 United Healthcare — All Commercial Plans: $60.48
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Dipstick	$63	$63	$23.94 – $60.48
Urine test (automated, without microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $29.11 Aetna Coventry — HMO: $60.48 Blue Cross Blue Shield of Nebraska — Blueprint Health: $59.85 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $27.72 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $29.11 Humana — Medicare Advantage: $27.72 Medica — Commercial Products: $57.33 Medica — Individual and Family Business Products-Care System Products: $60.48 Medica — Medicare Advantage: $27.72 Midlands Choice — All Plans: $60.48
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UA w/ Cult if Ind 42	$63	$63	$23.94 – $60.48
Urine test (automated, without microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $29.11 Aetna Coventry — HMO: $60.48 Blue Cross Blue Shield of Nebraska — Blueprint Health: $59.85 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $27.72 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $29.11 Humana — Medicare Advantage: $27.72 Medica — Commercial Products: $57.33 Medica — Individual and Family Business Products-Care System Products: $60.48 Medica — Medicare Advantage: $27.72 Midlands Choice — All Plans: $60.48
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis	$63	$63	$23.94 – $60.48
Urine test (automated, without microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $29.11 Aetna Coventry — HMO: $60.48 Blue Cross Blue Shield of Nebraska — Blueprint Health: $59.85 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $27.72 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $29.11 Humana — Medicare Advantage: $27.72 Medica — Commercial Products: $57.33 Medica — Individual and Family Business Products-Care System Products: $60.48 Medica — Medicare Advantage: $27.72 Midlands Choice — All Plans: $60.48
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prostate Health Index PLAB	$150	$150	$57 – $144
PSA (prostate specific antigen) blood test: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $69.30 Aetna Coventry — HMO: $144 Blue Cross Blue Shield of Nebraska — Blueprint Health: $142.50 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $66 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $69.30 Humana — Medicare Advantage: $66 Medica — Commercial Products: $136.50 Medica — Individual and Family Business Products-Care System Products: $144 Medica — Medicare Advantage: $66 Midlands Choice — All Plans: $144
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA Free and Total PLAB AO	$55	$55	$20.90 – $52.80
PSA (prostate specific antigen) blood test: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $25.41 Aetna Coventry — HMO: $52.80 Blue Cross Blue Shield of Nebraska — Blueprint Health: $52.25 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $24.20 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $25.41 Humana — Medicare Advantage: $24.20 Medica — Commercial Products: $50.05 Medica — Individual and Family Business Products-Care System Products: $52.80 Medica — Medicare Advantage: $24.20 Midlands Choice — All Plans: $52.80
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psa Total	$204	$204	$77.52 – $195.84
PSA (prostate specific antigen) blood test: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $94.25 Aetna Coventry — HMO: $195.84 Blue Cross Blue Shield of Nebraska — Blueprint Health: $193.80 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $89.76 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $94.25 Humana — Medicare Advantage: $89.76 Medica — Commercial Products: $185.64 Medica — Individual and Family Business Products-Care System Products: $195.84 Medica — Medicare Advantage: $89.76 Midlands Choice — All Plans: $195.84
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thyroid Stimulating Hormone	$216	$216	$82.08 – $207.36
Thyroid stimulating hormone (TSH) test: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $99.79 Aetna Coventry — HMO: $207.36 Blue Cross Blue Shield of Nebraska — Blueprint Health: $84.66 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $95.04 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $99.79 Humana — Medicare Advantage: $95.04 Medica — Commercial Products: $196.56 Medica — Individual and Family Business Products-Care System Products: $207.36 Medica — Medicare Advantage: $95.04 Midlands Choice — All Plans: $207.36
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TSH Ultra Sensitive PLAB	$113	$113	$42.94 – $108.48
Thyroid stimulating hormone (TSH) test: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $52.21 Aetna Coventry — HMO: $108.48 Blue Cross Blue Shield of Nebraska — Blueprint Health: $84.66 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $49.72 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $52.21 Humana — Medicare Advantage: $49.72 Medica — Commercial Products: $102.83 Medica — Individual and Family Business Products-Care System Products: $108.48 Medica — Medicare Advantage: $49.72 Midlands Choice — All Plans: $108.48
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: zzTSH Ultra Sensitive PLAB	$113	$113	$42.94 – $108.48
Thyroid stimulating hormone (TSH) test: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $52.21 Aetna Coventry — HMO: $108.48 Blue Cross Blue Shield of Nebraska — Blueprint Health: $84.66 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $49.72 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $52.21 Humana — Medicare Advantage: $49.72 Medica — Commercial Products: $102.83 Medica — Individual and Family Business Products-Care System Products: $108.48 Medica — Medicare Advantage: $49.72 Midlands Choice — All Plans: $108.48
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC w/ Auto Diff 42	$157	$157	$59.66 – $150.72
Complete blood count (CBC) with differential: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $72.53 Aetna Coventry — HMO: $150.72 Blue Cross Blue Shield of Nebraska — Blueprint Health: $79.85 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $69.08 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $72.53 Humana — Medicare Advantage: $69.08 Medica — Commercial Products: $142.87 Medica — Individual and Family Business Products-Care System Products: $150.72 Medica — Medicare Advantage: $69.08 Midlands Choice — All Plans: $150.72
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBC w/ Auto Diff 42	$157	$157	$78.50 – $150.72
Complete blood count (CBC) with differential: rates for 5 insurance plans Aetna Coventry — HMO: $150.72 Blue Cross Blue Shield of Nebraska — Blueprint Health: $149.15 Midlands Choice — All Plans: $150.72 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $78.50 United Healthcare — All Commercial Plans: $150.72
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC w/ Man Diff 42	$110	$110	$41.80 – $105.60
Complete blood count (CBC), automated: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $50.82 Aetna Coventry — HMO: $105.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $104.50 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $48.40 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $50.82 Humana — Medicare Advantage: $48.40 Medica — Commercial Products: $100.10 Medica — Individual and Family Business Products-Care System Products: $105.60 Medica — Medicare Advantage: $48.40 Midlands Choice — All Plans: $105.60
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC w/ No Diff 42	$110	$110	$41.80 – $105.60
Complete blood count (CBC), automated: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $50.82 Aetna Coventry — HMO: $105.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $104.50 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $48.40 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $50.82 Humana — Medicare Advantage: $48.40 Medica — Commercial Products: $100.10 Medica — Individual and Family Business Products-Care System Products: $105.60 Medica — Medicare Advantage: $48.40 Midlands Choice — All Plans: $105.60
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBC w/ Man Diff 42	$110	$110	$55 – $105.60
Complete blood count (CBC), automated: rates for 5 insurance plans Aetna Coventry — HMO: $105.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $104.50 Midlands Choice — All Plans: $105.60 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $55 United Healthcare — All Commercial Plans: $105.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 85610 Protime	$82	$82	$30.47 – $78.72
Blood clotting time test (prothrombin time, PT): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $37.88 Aetna Coventry — HMO: $78.72 Blue Cross Blue Shield of Nebraska — Blueprint Health: $30.47 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $36.08 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $37.88 Humana — Medicare Advantage: $36.08 Medica — Commercial Products: $74.62 Medica — Individual and Family Business Products-Care System Products: $78.72 Medica — Medicare Advantage: $36.08 Midlands Choice — All Plans: $78.72
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Protime/PTT	$82	$82	$30.47 – $78.72
Blood clotting time test (prothrombin time, PT): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $37.88 Aetna Coventry — HMO: $78.72 Blue Cross Blue Shield of Nebraska — Blueprint Health: $30.47 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $36.08 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $37.88 Humana — Medicare Advantage: $36.08 Medica — Commercial Products: $74.62 Medica — Individual and Family Business Products-Care System Products: $78.72 Medica — Medicare Advantage: $36.08 Midlands Choice — All Plans: $78.72
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time	$82	$82	$30.47 – $78.72
Blood clotting time test (prothrombin time, PT): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $37.88 Aetna Coventry — HMO: $78.72 Blue Cross Blue Shield of Nebraska — Blueprint Health: $30.47 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $36.08 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $37.88 Humana — Medicare Advantage: $36.08 Medica — Commercial Products: $74.62 Medica — Individual and Family Business Products-Care System Products: $78.72 Medica — Medicare Advantage: $36.08 Midlands Choice — All Plans: $78.72
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Partial Thromboplastin Time	$146	$146	$55.48 – $140.16
Blood clotting test (partial thromboplastin time, PTT): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $67.45 Aetna Coventry — HMO: $140.16 Blue Cross Blue Shield of Nebraska — Blueprint Health: $138.70 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $64.24 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $67.45 Humana — Medicare Advantage: $64.24 Medica — Commercial Products: $132.86 Medica — Individual and Family Business Products-Care System Products: $140.16 Medica — Medicare Advantage: $64.24 Midlands Choice — All Plans: $140.16
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lupus Anticoagulant Screen w/reflex PLAB AO 2	$160	$160	$60.80 – $153.60
Blood clotting test (partial thromboplastin time, PTT): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $73.92 Aetna Coventry — HMO: $153.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $152 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $70.40 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $73.92 Humana — Medicare Advantage: $70.40 Medica — Commercial Products: $145.60 Medica — Individual and Family Business Products-Care System Products: $153.60 Medica — Medicare Advantage: $70.40 Midlands Choice — All Plans: $153.60
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PTT	$146	$146	$55.48 – $140.16
Blood clotting test (partial thromboplastin time, PTT): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $67.45 Aetna Coventry — HMO: $140.16 Blue Cross Blue Shield of Nebraska — Blueprint Health: $138.70 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $64.24 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $67.45 Humana — Medicare Advantage: $64.24 Medica — Commercial Products: $132.86 Medica — Individual and Family Business Products-Care System Products: $140.16 Medica — Medicare Advantage: $64.24 Midlands Choice — All Plans: $140.16

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) · Hospital (facility) fee In the file: CT Stroke Study	$3,465	$3,465	$1,316.70 – $3,326.40
CT scan of the head or brain, without contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $1,600.83 Aetna Coventry — HMO: $3,326.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,371.03 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,524.60 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $1,600.83 Humana — Medicare Advantage: $1,524.60 Medica — Commercial Products: $3,153.15 Medica — Individual and Family Business Products-Care System Products: $3,326.40 Medica — Medicare Advantage: $1,524.60 Midlands Choice — All Plans: $3,326.40
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Head or Brain w/o Cont	$3,465	$3,465	$1,316.70 – $3,326.40
CT scan of the head or brain, without contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $1,600.83 Aetna Coventry — HMO: $3,326.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,371.03 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,524.60 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $1,600.83 Humana — Medicare Advantage: $1,524.60 Medica — Commercial Products: $3,153.15 Medica — Individual and Family Business Products-Care System Products: $3,326.40 Medica — Medicare Advantage: $1,524.60 Midlands Choice — All Plans: $3,326.40
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Head or Brain w/o Cont	$3,465	$3,465	$1,732.50 – $3,326.40
CT scan of the head or brain, without contrast: rates for 5 insurance plans Aetna Coventry — HMO: $3,326.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $3,291.75 Midlands Choice — All Plans: $3,326.40 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $1,732.50 United Healthcare — All Commercial Plans: $3,326.40
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Brain w/ + w/o Cont	$6,993	$6,993	$2,657.34 – $6,713.28
MRI of the brain, before and after contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $3,230.77 Aetna Coventry — HMO: $6,713.28 Blue Cross Blue Shield of Nebraska — Blueprint Health: $6,643.35 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $3,076.92 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $3,230.77 Humana — Medicare Advantage: $3,076.92 Medica — Commercial Products: $6,363.63 Medica — Individual and Family Business Products-Care System Products: $6,713.28 Medica — Medicare Advantage: $3,076.92 Midlands Choice — All Plans: $6,713.28
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI Brain w/ + w/o Cont	$6,993	$6,993	$3,496.50 – $6,713.28
MRI of the brain, before and after contrast: rates for 5 insurance plans Aetna Coventry — HMO: $6,713.28 Blue Cross Blue Shield of Nebraska — Blueprint Health: $6,643.35 Midlands Choice — All Plans: $6,713.28 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $3,496.50 United Healthcare — All Commercial Plans: $6,713.28
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI BRAIN STEM W/O & W/DYE	Not listed in the file	Not listed in the file	$342.78 – $359.92
MRI of the brain, before and after contrast: rates for 7 insurance plans Aetna — Medicare Advantage: $359.92 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $342.78 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $359.92 Humana — Medicare Advantage: $342.78 Medica — Medicare Advantage: $342.78 Molina Healthcare of Nebraska — Medicare Advantage: $359.92 Nebraska Total Care — Medicare Products: $349.64
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XR Chest 2 Views	$533	$533	$130.15 – $511.68
Chest X-ray, 2 views: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $246.25 Aetna Coventry — HMO: $511.68 Blue Cross Blue Shield of Nebraska — Blueprint Health: $130.15 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $234.52 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $246.25 Humana — Medicare Advantage: $234.52 Medica — Commercial Products: $485.03 Medica — Individual and Family Business Products-Care System Products: $511.68 Medica — Medicare Advantage: $234.52 Midlands Choice — All Plans: $511.68
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: XR Chest 2 Views	$533	$533	$266.50 – $511.68
Chest X-ray, 2 views: rates for 5 insurance plans Aetna Coventry — HMO: $511.68 Blue Cross Blue Shield of Nebraska — Blueprint Health: $506.35 Midlands Choice — All Plans: $511.68 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $266.50 United Healthcare — All Commercial Plans: $511.68
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Doctor (professional) fee In the file: X-RAY EXAM CHEST 2 VIEWS	Not listed in the file	Not listed in the file	$35.10 – $36.85
Chest X-ray, 2 views: rates for 7 insurance plans Aetna — Medicare Advantage: $36.85 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $35.10 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $36.85 Humana — Medicare Advantage: $35.10 Medica — Medicare Advantage: $35.10 Molina Healthcare of Nebraska — Medicare Advantage: $36.85 Nebraska Total Care — Medicare Products: $35.80
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XR Spine Lumbosacral Min 4 Views	$929	$929	$353.02 – $891.84
X-ray of the lower spine, at least 4 views: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $429.20 Aetna Coventry — HMO: $891.84 Blue Cross Blue Shield of Nebraska — Blueprint Health: $882.55 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $408.76 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $429.20 Humana — Medicare Advantage: $408.76 Medica — Commercial Products: $845.39 Medica — Individual and Family Business Products-Care System Products: $891.84 Medica — Medicare Advantage: $408.76 Midlands Choice — All Plans: $891.84
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: XR Spine Lumbosacral Min 4 Views	$929	$929	$464.50 – $891.84
X-ray of the lower spine, at least 4 views: rates for 5 insurance plans Aetna Coventry — HMO: $891.84 Blue Cross Blue Shield of Nebraska — Blueprint Health: $882.55 Midlands Choice — All Plans: $891.84 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $464.50 United Healthcare — All Commercial Plans: $891.84
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Doctor (professional) fee In the file: X-RAY EXAM L-2 SPINE 4/>VWS	Not listed in the file	Not listed in the file	$54.22 – $56.93
X-ray of the lower spine, at least 4 views: rates for 7 insurance plans Aetna — Medicare Advantage: $56.93 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $54.22 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $56.93 Humana — Medicare Advantage: $54.22 Medica — Medicare Advantage: $54.22 Molina Healthcare of Nebraska — Medicare Advantage: $56.93 Nebraska Total Care — Medicare Products: $55.31
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Spine Lumbar w/o Cont	$5,871	$5,871	$1,954.12 – $5,636.16
MRI of the lower back (lumbar spine), without contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $2,712.40 Aetna Coventry — HMO: $5,636.16 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,954.12 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $2,583.24 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $2,712.40 Humana — Medicare Advantage: $2,583.24 Medica — Commercial Products: $5,342.61 Medica — Individual and Family Business Products-Care System Products: $5,636.16 Medica — Medicare Advantage: $2,583.24 Midlands Choice — All Plans: $5,636.16
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI Spine Lumbar w/o Cont	$5,871	$5,871	$2,935.50 – $5,636.16
MRI of the lower back (lumbar spine), without contrast: rates for 5 insurance plans Aetna Coventry — HMO: $5,636.16 Blue Cross Blue Shield of Nebraska — Blueprint Health: $5,577.45 Midlands Choice — All Plans: $5,636.16 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $2,935.50 United Healthcare — All Commercial Plans: $5,636.16
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI LUMBAR SPINE W/O DYE	Not listed in the file	Not listed in the file	$206.05 – $216.35
MRI of the lower back (lumbar spine), without contrast: rates for 7 insurance plans Aetna — Medicare Advantage: $216.35 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $206.05 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $216.35 Humana — Medicare Advantage: $206.05 Medica — Medicare Advantage: $206.05 Molina Healthcare of Nebraska — Medicare Advantage: $216.35 Nebraska Total Care — Medicare Products: $210.17
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Pelvis w/ Cont	$4,316	$4,316	$1,640.08 – $4,143.36
CT scan of the pelvis, with contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $1,993.99 Aetna Coventry — HMO: $4,143.36 Blue Cross Blue Shield of Nebraska — Blueprint Health: $4,100.20 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,899.04 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $1,993.99 Humana — Medicare Advantage: $1,899.04 Medica — Commercial Products: $3,927.56 Medica — Individual and Family Business Products-Care System Products: $4,143.36 Medica — Medicare Advantage: $1,899.04 Midlands Choice — All Plans: $4,143.36
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Pelvis w/ Cont	$4,316	$4,316	$2,158 – $4,143.36
CT scan of the pelvis, with contrast: rates for 5 insurance plans Aetna Coventry — HMO: $4,143.36 Blue Cross Blue Shield of Nebraska — Blueprint Health: $4,100.20 Midlands Choice — All Plans: $4,143.36 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $2,158 United Healthcare — All Commercial Plans: $4,143.36
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Doctor (professional) fee In the file: CT PELVIS W/DYE	Not listed in the file	Not listed in the file	$242.80 – $254.94
CT scan of the pelvis, with contrast: rates for 7 insurance plans Aetna — Medicare Advantage: $254.94 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $242.80 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $254.94 Humana — Medicare Advantage: $242.80 Medica — Medicare Advantage: $242.80 Molina Healthcare of Nebraska — Medicare Advantage: $254.94 Nebraska Total Care — Medicare Products: $247.66
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Knee w/o Cont Rt	$3,931	$3,931	$1,484.50 – $3,773.76
MRI of a leg joint (such as the knee), without contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $1,816.12 Aetna Coventry — HMO: $3,773.76 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,484.50 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,729.64 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $1,816.12 Humana — Medicare Advantage: $1,729.64 Medica — Commercial Products: $3,577.21 Medica — Individual and Family Business Products-Care System Products: $3,773.76 Medica — Medicare Advantage: $1,729.64 Midlands Choice — All Plans: $3,773.76
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI LE Joint w/o Cont Lt	$4,128	$4,128	$1,484.50 – $3,962.88
MRI of a leg joint (such as the knee), without contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $1,907.14 Aetna Coventry — HMO: $3,962.88 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,484.50 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,816.32 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $1,907.14 Humana — Medicare Advantage: $1,816.32 Medica — Commercial Products: $3,756.48 Medica — Individual and Family Business Products-Care System Products: $3,962.88 Medica — Medicare Advantage: $1,816.32 Midlands Choice — All Plans: $3,962.88
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI LE Joint w/o Cont Rt	$4,128	$4,128	$1,484.50 – $3,962.88
MRI of a leg joint (such as the knee), without contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $1,907.14 Aetna Coventry — HMO: $3,962.88 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,484.50 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,816.32 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $1,907.14 Humana — Medicare Advantage: $1,816.32 Medica — Commercial Products: $3,756.48 Medica — Individual and Family Business Products-Care System Products: $3,962.88 Medica — Medicare Advantage: $1,816.32 Midlands Choice — All Plans: $3,962.88
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Abdomen +Pelvis w/ Cont	$7,290	$7,290	$2,721.05 – $6,998.40
CT scan of the abdomen and pelvis, with contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $3,367.98 Aetna Coventry — HMO: $6,998.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $2,721.05 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $3,207.60 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $3,367.98 Humana — Medicare Advantage: $3,207.60 Medica — Commercial Products: $6,633.90 Medica — Individual and Family Business Products-Care System Products: $6,998.40 Medica — Medicare Advantage: $3,207.60 Midlands Choice — All Plans: $6,998.40
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Abdomen +Pelvis w/ Cont	$7,290	$7,290	$3,645 – $6,998.40
CT scan of the abdomen and pelvis, with contrast: rates for 5 insurance plans Aetna Coventry — HMO: $6,998.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $6,925.50 Midlands Choice — All Plans: $6,998.40 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $3,645 United Healthcare — All Commercial Plans: $6,998.40
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Doctor (professional) fee In the file: CT ABD & PELVIS W/CONTRAST	Not listed in the file	Not listed in the file	$325.67 – $341.95
CT scan of the abdomen and pelvis, with contrast: rates for 7 insurance plans Aetna — Medicare Advantage: $341.95 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $325.67 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $341.95 Humana — Medicare Advantage: $325.67 Medica — Medicare Advantage: $325.67 Molina Healthcare of Nebraska — Medicare Advantage: $341.95 Nebraska Total Care — Medicare Products: $332.18
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Abdomen Comp	$1,491	$1,491	$566.58 – $1,431.36
Ultrasound of the abdomen, complete: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $688.84 Aetna Coventry — HMO: $1,431.36 Blue Cross Blue Shield of Nebraska — Blueprint Health: $693.60 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $656.04 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $688.84 Humana — Medicare Advantage: $656.04 Medica — Commercial Products: $1,356.81 Medica — Individual and Family Business Products-Care System Products: $1,431.36 Medica — Medicare Advantage: $656.04 Midlands Choice — All Plans: $1,431.36
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US Abdomen Comp	$1,491	$1,491	$745.50 – $1,431.36
Ultrasound of the abdomen, complete: rates for 5 insurance plans Aetna Coventry — HMO: $1,431.36 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,416.45 Midlands Choice — All Plans: $1,431.36 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $745.50 United Healthcare — All Commercial Plans: $1,431.36
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Doctor (professional) fee In the file: US EXAM ABDOM COMPLETE	Not listed in the file	Not listed in the file	$121.66 – $127.74
Ultrasound of the abdomen, complete: rates for 7 insurance plans Aetna — Medicare Advantage: $127.74 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $121.66 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $127.74 Humana — Medicare Advantage: $121.66 Medica — Medicare Advantage: $121.66 Molina Healthcare of Nebraska — Medicare Advantage: $127.74 Nebraska Total Care — Medicare Products: $124.09
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Pregnant > 14 Weeks 1st Gest	$1,027	$1,027	$390.26 – $985.92
Pregnancy ultrasound (after the first trimester): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $474.47 Aetna Coventry — HMO: $985.92 Blue Cross Blue Shield of Nebraska — Blueprint Health: $975.65 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $451.88 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $474.47 Humana — Medicare Advantage: $451.88 Medica — Commercial Products: $934.57 Medica — Individual and Family Business Products-Care System Products: $985.92 Medica — Medicare Advantage: $451.88 Midlands Choice — All Plans: $985.92
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Gender	$132	$132	$50.16 – $126.72
Pregnancy ultrasound (after the first trimester): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $60.98 Aetna Coventry — HMO: $126.72 Blue Cross Blue Shield of Nebraska — Blueprint Health: $125.40 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $58.08 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $60.98 Humana — Medicare Advantage: $58.08 Medica — Commercial Products: $120.12 Medica — Individual and Family Business Products-Care System Products: $126.72 Medica — Medicare Advantage: $58.08 Midlands Choice — All Plans: $126.72
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US Pregnant > 14 Weeks 1st Gest	$1,027	$1,027	$513.50 – $985.92
Pregnancy ultrasound (after the first trimester): rates for 5 insurance plans Aetna Coventry — HMO: $985.92 Blue Cross Blue Shield of Nebraska — Blueprint Health: $975.65 Midlands Choice — All Plans: $985.92 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $513.50 United Healthcare — All Commercial Plans: $985.92
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Pelvis Transvaginal	$1,024	$1,024	$389.12 – $983.04
Transvaginal ultrasound: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $473.09 Aetna Coventry — HMO: $983.04 Blue Cross Blue Shield of Nebraska — Blueprint Health: $972.80 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $450.56 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $473.09 Humana — Medicare Advantage: $450.56 Medica — Commercial Products: $931.84 Medica — Individual and Family Business Products-Care System Products: $983.04 Medica — Medicare Advantage: $450.56 Midlands Choice — All Plans: $983.04
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US Pelvis Transvaginal	$1,024	$1,024	$512 – $983.04
Transvaginal ultrasound: rates for 5 insurance plans Aetna Coventry — HMO: $983.04 Blue Cross Blue Shield of Nebraska — Blueprint Health: $972.80 Midlands Choice — All Plans: $983.04 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $512 United Healthcare — All Commercial Plans: $983.04
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Doctor (professional) fee In the file: TRANSVAGINAL US NON-OB	Not listed in the file	Not listed in the file	$124.63 – $130.86
Transvaginal ultrasound: rates for 7 insurance plans Aetna — Medicare Advantage: $130.86 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $124.63 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $130.86 Humana — Medicare Advantage: $124.63 Medica — Medicare Advantage: $124.63 Molina Healthcare of Nebraska — Medicare Advantage: $130.86 Nebraska Total Care — Medicare Products: $127.12
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Diag Digital Lt.	$535	$535	$203.30 – $513.60
Diagnostic mammogram, one breast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $247.17 Aetna Coventry — HMO: $513.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $508.25 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $235.40 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $247.17 Humana — Medicare Advantage: $235.40 Medica — Commercial Products: $486.85 Medica — Individual and Family Business Products-Care System Products: $513.60 Medica — Medicare Advantage: $235.40 Midlands Choice — All Plans: $513.60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Diag Digital Rt.	$535	$535	$203.30 – $513.60
Diagnostic mammogram, one breast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $247.17 Aetna Coventry — HMO: $513.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $508.25 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $235.40 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $247.17 Humana — Medicare Advantage: $235.40 Medica — Commercial Products: $486.85 Medica — Individual and Family Business Products-Care System Products: $513.60 Medica — Medicare Advantage: $235.40 Midlands Choice — All Plans: $513.60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Diag Digital Lt	$535	$535	$203.30 – $513.60
Diagnostic mammogram, one breast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $247.17 Aetna Coventry — HMO: $513.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $508.25 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $235.40 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $247.17 Humana — Medicare Advantage: $235.40 Medica — Commercial Products: $486.85 Medica — Individual and Family Business Products-Care System Products: $513.60 Medica — Medicare Advantage: $235.40 Midlands Choice — All Plans: $513.60
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Diag Digital Bil	$715	$715	$271.70 – $686.40
Diagnostic mammogram, both breasts: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $330.33 Aetna Coventry — HMO: $686.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $679.25 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $314.60 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $330.33 Humana — Medicare Advantage: $314.60 Medica — Commercial Products: $650.65 Medica — Individual and Family Business Products-Care System Products: $686.40 Medica — Medicare Advantage: $314.60 Midlands Choice — All Plans: $686.40
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Diag Digital Bil.	$715	$715	$271.70 – $686.40
Diagnostic mammogram, both breasts: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $330.33 Aetna Coventry — HMO: $686.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $679.25 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $314.60 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $330.33 Humana — Medicare Advantage: $314.60 Medica — Commercial Products: $650.65 Medica — Individual and Family Business Products-Care System Products: $686.40 Medica — Medicare Advantage: $314.60 Midlands Choice — All Plans: $686.40
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MA Diag Digital Bil	$715	$715	$357.50 – $686.40
Diagnostic mammogram, both breasts: rates for 5 insurance plans Aetna Coventry — HMO: $686.40 Blue Cross Blue Shield of Nebraska — Blueprint Health: $679.25 Midlands Choice — All Plans: $686.40 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $357.50 United Healthcare — All Commercial Plans: $686.40
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Routine Screen Lt.	$550	$550	$209 – $528
Screening mammogram, both breasts: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $254.10 Aetna Coventry — HMO: $528 Blue Cross Blue Shield of Nebraska — Blueprint Health: $236.39 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $242 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $254.10 Humana — Medicare Advantage: $242 Medica — Commercial Products: $500.50 Medica — Individual and Family Business Products-Care System Products: $528 Medica — Medicare Advantage: $242 Midlands Choice — All Plans: $528
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Routine Screen Rt.	$550	$550	$209 – $528
Screening mammogram, both breasts: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $254.10 Aetna Coventry — HMO: $528 Blue Cross Blue Shield of Nebraska — Blueprint Health: $236.39 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $242 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $254.10 Humana — Medicare Advantage: $242 Medica — Commercial Products: $500.50 Medica — Individual and Family Business Products-Care System Products: $528 Medica — Medicare Advantage: $242 Midlands Choice — All Plans: $528
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Routine Screen Digital Bil.	$550	$550	$209 – $528
Screening mammogram, both breasts: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $254.10 Aetna Coventry — HMO: $528 Blue Cross Blue Shield of Nebraska — Blueprint Health: $236.39 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $242 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $254.10 Humana — Medicare Advantage: $242 Medica — Commercial Products: $500.50 Medica — Individual and Family Business Products-Care System Products: $528 Medica — Medicare Advantage: $242 Midlands Choice — All Plans: $528

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EKG - Cardiology/Nursing	$585	$585	$222.30 – $561.60
Electrocardiogram (ECG/EKG) with reading: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $270.27 Aetna Coventry — HMO: $561.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $555.75 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $257.40 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $270.27 Humana — Medicare Advantage: $257.40 Medica — Commercial Products: $532.35 Medica — Individual and Family Business Products-Care System Products: $561.60 Medica — Medicare Advantage: $257.40 Midlands Choice — All Plans: $561.60
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EKG MEDICARE TECH COMP	$585	$585	$222.30 – $561.60
Electrocardiogram (ECG/EKG) with reading: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $270.27 Aetna Coventry — HMO: $561.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $555.75 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $257.40 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $270.27 Humana — Medicare Advantage: $257.40 Medica — Commercial Products: $532.35 Medica — Individual and Family Business Products-Care System Products: $561.60 Medica — Medicare Advantage: $257.40 Midlands Choice — All Plans: $561.60
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: .EKG NON-MEDICARE	$585	$585	$222.30 – $561.60
Electrocardiogram (ECG/EKG) with reading: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $270.27 Aetna Coventry — HMO: $561.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $555.75 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $257.40 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $270.27 Humana — Medicare Advantage: $257.40 Medica — Commercial Products: $532.35 Medica — Individual and Family Business Products-Care System Products: $561.60 Medica — Medicare Advantage: $257.40 Midlands Choice — All Plans: $561.60
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$909.04 – $954.49
Left heart catheterization (diagnostic): rates for 7 insurance plans Aetna — Medicare Advantage: $954.49 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $909.04 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $954.49 Humana — Medicare Advantage: $909.04 Medica — Medicare Advantage: $909.04 Molina Healthcare of Nebraska — Medicare Advantage: $954.49 Nebraska Total Care — Medicare Products: $927.22
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$232.36 – $243.98
Left heart catheterization (diagnostic): rates for 7 insurance plans Aetna — Medicare Advantage: $243.98 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $232.36 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $243.98 Humana — Medicare Advantage: $232.36 Medica — Medicare Advantage: $232.36 Molina Healthcare of Nebraska — Medicare Advantage: $243.98 Nebraska Total Care — Medicare Products: $237
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$676.68 – $710.52
Left heart catheterization (diagnostic): rates for 7 insurance plans Aetna — Medicare Advantage: $710.52 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $676.68 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $710.52 Humana — Medicare Advantage: $676.68 Medica — Medicare Advantage: $676.68 Molina Healthcare of Nebraska — Medicare Advantage: $710.52 Nebraska Total Care — Medicare Products: $690.22
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$903.01 – $948.17
Heart rhythm study (electrophysiology evaluation): rates for 7 insurance plans Aetna — Medicare Advantage: $948.17 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $903.01 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $948.17 Humana — Medicare Advantage: $903.01 Medica — Medicare Advantage: $903.01 Molina Healthcare of Nebraska — Medicare Advantage: $948.17 Nebraska Total Care — Medicare Products: $921.07
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$363.69 – $381.87
Heart rhythm study (electrophysiology evaluation): rates for 7 insurance plans Aetna — Medicare Advantage: $381.87 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $363.69 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $381.87 Humana — Medicare Advantage: $363.69 Medica — Medicare Advantage: $363.69 Molina Healthcare of Nebraska — Medicare Advantage: $381.87 Nebraska Total Care — Medicare Products: $370.96
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$378.11 – $397.01
Heart rhythm study (electrophysiology evaluation): rates for 7 insurance plans Aetna — Medicare Advantage: $397.01 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $378.11 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $397.01 Humana — Medicare Advantage: $378.11 Medica — Medicare Advantage: $378.11 Molina Healthcare of Nebraska — Medicare Advantage: $397.01 Nebraska Total Care — Medicare Products: $385.67
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPRE EP EVAL ABLTJ ATR FIB	Not listed in the file	Not listed in the file	$919.94 – $965.94
Heart rhythm study with ablation for atrial fibrillation: rates for 7 insurance plans Aetna — Medicare Advantage: $965.94 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $919.94 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $965.94 Humana — Medicare Advantage: $919.94 Medica — Medicare Advantage: $919.94 Molina Healthcare of Nebraska — Medicare Advantage: $965.94 Nebraska Total Care — Medicare Products: $938.34
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: .OVERNIGHT SLEEP STUDY	$6,156	$6,156	$2,339.28 – $5,909.76
Sleep study (overnight, in a sleep lab): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $2,844.07 Aetna Coventry — HMO: $5,909.76 Blue Cross Blue Shield of Nebraska — Blueprint Health: $5,848.20 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $2,708.64 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $2,844.07 Humana — Medicare Advantage: $2,708.64 Medica — Commercial Products: $5,601.96 Medica — Individual and Family Business Products-Care System Products: $5,909.76 Medica — Medicare Advantage: $2,708.64 Midlands Choice — All Plans: $5,909.76
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee In the file: .OVERNIGHT SLEEP STUDY	$6,156	$6,156	$3,078 – $5,909.76
Sleep study (overnight, in a sleep lab): rates for 5 insurance plans Aetna Coventry — HMO: $5,909.76 Blue Cross Blue Shield of Nebraska — Blueprint Health: $5,848.20 Midlands Choice — All Plans: $5,909.76 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $3,078 United Healthcare — All Commercial Plans: $5,909.76
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Doctor (professional) fee In the file: POLYSOM 6/> YRS 4/> PARAM	Not listed in the file	Not listed in the file	$648.68 – $681.11
Sleep study (overnight, in a sleep lab): rates for 7 insurance plans Aetna — Medicare Advantage: $681.11 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $648.68 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $681.11 Humana — Medicare Advantage: $648.68 Medica — Medicare Advantage: $648.68 Molina Healthcare of Nebraska — Medicare Advantage: $681.11 Nebraska Total Care — Medicare Products: $661.65

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) · Hospital (facility) fee In the file: OT THERAPEUTIC EXERCISE CHARGE	$181	$181	$68.78 – $173.76
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $83.62 Aetna Coventry — HMO: $173.76 Blue Cross Blue Shield of Nebraska — Blueprint Health: $71.44 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $79.64 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $83.62 Humana — Medicare Advantage: $79.64 Medica — Commercial Products: $164.71 Medica — Individual and Family Business Products-Care System Products: $173.76 Medica — Medicare Advantage: $79.64 Midlands Choice — All Plans: $173.76
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 97110 PT THERAPEUTIC EXERCISE 15 MINS Charge	$181	$181	$68.78 – $173.76
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $83.62 Aetna Coventry — HMO: $173.76 Blue Cross Blue Shield of Nebraska — Blueprint Health: $71.44 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $79.64 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $83.62 Humana — Medicare Advantage: $79.64 Medica — Commercial Products: $164.71 Medica — Individual and Family Business Products-Care System Products: $173.76 Medica — Medicare Advantage: $79.64 Midlands Choice — All Plans: $173.76
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Therapeutic Exercise Charges	$181	$181	$68.78 – $173.76
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $83.62 Aetna Coventry — HMO: $173.76 Blue Cross Blue Shield of Nebraska — Blueprint Health: $71.44 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $79.64 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $83.62 Humana — Medicare Advantage: $79.64 Medica — Commercial Products: $164.71 Medica — Individual and Family Business Products-Care System Products: $173.76 Medica — Medicare Advantage: $79.64 Midlands Choice — All Plans: $173.76
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 97161 PT EVALUATION, LOW COMPLEXITY	$278	$278	$105.64 – $266.88
Physical therapy evaluation (low complexity): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $128.44 Aetna Coventry — HMO: $266.88 Blue Cross Blue Shield of Nebraska — Blueprint Health: $264.10 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $122.32 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $128.44 Humana — Medicare Advantage: $122.32 Medica — Commercial Products: $252.98 Medica — Individual and Family Business Products-Care System Products: $266.88 Medica — Medicare Advantage: $122.32 Midlands Choice — All Plans: $266.88
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Low Complex Units	$278	$278	$105.64 – $266.88
Physical therapy evaluation (low complexity): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $128.44 Aetna Coventry — HMO: $266.88 Blue Cross Blue Shield of Nebraska — Blueprint Health: $264.10 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $122.32 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $128.44 Humana — Medicare Advantage: $122.32 Medica — Commercial Products: $252.98 Medica — Individual and Family Business Products-Care System Products: $266.88 Medica — Medicare Advantage: $122.32 Midlands Choice — All Plans: $266.88
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PT Low Complex Units	$278	$278	$139 – $266.88
Physical therapy evaluation (low complexity): rates for 5 insurance plans Aetna Coventry — HMO: $266.88 Blue Cross Blue Shield of Nebraska — Blueprint Health: $264.10 Midlands Choice — All Plans: $266.88 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $139 United Healthcare — All Commercial Plans: $266.88
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Moderate Complex Units	$309	$309	$117.42 – $296.64
Physical therapy evaluation (moderate complexity): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $142.76 Aetna Coventry — HMO: $296.64 Blue Cross Blue Shield of Nebraska — Blueprint Health: $293.55 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $135.96 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $142.76 Humana — Medicare Advantage: $135.96 Medica — Commercial Products: $281.19 Medica — Individual and Family Business Products-Care System Products: $296.64 Medica — Medicare Advantage: $135.96 Midlands Choice — All Plans: $296.64
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 97162 PT EVALUATION, MODERATE COMPLEXITY	$309	$309	$117.42 – $296.64
Physical therapy evaluation (moderate complexity): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $142.76 Aetna Coventry — HMO: $296.64 Blue Cross Blue Shield of Nebraska — Blueprint Health: $293.55 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $135.96 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $142.76 Humana — Medicare Advantage: $135.96 Medica — Commercial Products: $281.19 Medica — Individual and Family Business Products-Care System Products: $296.64 Medica — Medicare Advantage: $135.96 Midlands Choice — All Plans: $296.64
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 97162 PT EVALUATION, MODERATE COMPLEXITY	$309	$309	$154.50 – $296.64
Physical therapy evaluation (moderate complexity): rates for 5 insurance plans Aetna Coventry — HMO: $296.64 Blue Cross Blue Shield of Nebraska — Blueprint Health: $293.55 Midlands Choice — All Plans: $296.64 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $154.50 United Healthcare — All Commercial Plans: $296.64
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT High Complex Units	$435	$435	$165.30 – $417.60
Physical therapy evaluation (high complexity): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $200.97 Aetna Coventry — HMO: $417.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $413.25 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $191.40 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $200.97 Humana — Medicare Advantage: $191.40 Medica — Commercial Products: $395.85 Medica — Individual and Family Business Products-Care System Products: $417.60 Medica — Medicare Advantage: $191.40 Midlands Choice — All Plans: $417.60
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 97163 PT EVALUATION, HIGH COMPLEXITY	$435	$435	$165.30 – $417.60
Physical therapy evaluation (high complexity): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $200.97 Aetna Coventry — HMO: $417.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $413.25 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $191.40 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $200.97 Humana — Medicare Advantage: $191.40 Medica — Commercial Products: $395.85 Medica — Individual and Family Business Products-Care System Products: $417.60 Medica — Medicare Advantage: $191.40 Midlands Choice — All Plans: $417.60
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 97163 PT EVALUATION, HIGH COMPLEXITY	$435	$435	$217.50 – $417.60
Physical therapy evaluation (high complexity): rates for 5 insurance plans Aetna Coventry — HMO: $417.60 Blue Cross Blue Shield of Nebraska — Blueprint Health: $413.25 Midlands Choice — All Plans: $417.60 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $217.50 United Healthcare — All Commercial Plans: $417.60
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Doctor (professional) fee In the file: 90832 INDIVIDUAL THERAPY, 30 MIN (16-37 MIN SESSION)	$231	$231	$75.20 – $221.76
Psychotherapy, 30 minutes: rates for 10 insurance plans Aetna — Medicare Advantage: $78.96 Aetna Coventry — HMO: $221.76 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $75.20 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $78.96 Humana — Medicare Advantage: $75.20 Medica — Medicare Advantage: $75.20 Midlands Choice — All Plans: $221.76 Molina Healthcare of Nebraska — Medicare Advantage: $78.96 Nebraska Total Care — Medicare Products: $76.70 United Healthcare — All Commercial Plans: $221.76
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient · Doctor (professional) fee In the file: 90834 INDIVIDUAL THERAPY, 45 MIN (38-52 MIN SESSION)	$304	$304	$99.53 – $291.84
Psychotherapy, 45 minutes: rates for 10 insurance plans Aetna — Medicare Advantage: $104.51 Aetna Coventry — HMO: $291.84 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $99.53 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $104.51 Humana — Medicare Advantage: $99.53 Medica — Medicare Advantage: $99.53 Midlands Choice — All Plans: $291.84 Molina Healthcare of Nebraska — Medicare Advantage: $104.51 Nebraska Total Care — Medicare Products: $101.52 United Healthcare — All Commercial Plans: $291.84
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient · Doctor (professional) fee In the file: 90837 INDIVIDUAL THERAPY, 53 MIN OR LONGER	$452	$452	$146.89 – $433.92
Psychotherapy, 60 minutes: rates for 10 insurance plans Aetna — Medicare Advantage: $154.23 Aetna Coventry — HMO: $433.92 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $146.89 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $154.23 Humana — Medicare Advantage: $146.89 Medica — Medicare Advantage: $146.89 Midlands Choice — All Plans: $433.92 Molina Healthcare of Nebraska — Medicare Advantage: $154.23 Nebraska Total Care — Medicare Products: $149.83 United Healthcare — All Commercial Plans: $433.92
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient · Doctor (professional) fee In the file: 90846 FAMILY THERAPY W/O PATIENT	$325	$325	$107.05 – $312
Family psychotherapy, without the patient: rates for 10 insurance plans Aetna — Medicare Advantage: $112.41 Aetna Coventry — HMO: $312 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $107.05 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $112.41 Humana — Medicare Advantage: $107.05 Medica — Medicare Advantage: $107.05 Midlands Choice — All Plans: $312 Molina Healthcare of Nebraska — Medicare Advantage: $112.41 Nebraska Total Care — Medicare Products: $109.19 United Healthcare — All Commercial Plans: $312
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient · Doctor (professional) fee In the file: 90847 FAMILY THERAPY MIN 26 MIN W/PT AND FAMILY	$337	$337	$111.90 – $323.52
Family psychotherapy, with the patient: rates for 10 insurance plans Aetna — Medicare Advantage: $117.49 Aetna Coventry — HMO: $323.52 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $111.90 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $117.49 Humana — Medicare Advantage: $111.90 Medica — Medicare Advantage: $111.90 Midlands Choice — All Plans: $323.52 Molina Healthcare of Nebraska — Medicare Advantage: $117.49 Nebraska Total Care — Medicare Products: $114.13 United Healthcare — All Commercial Plans: $323.52
Group psychotherapy CPT 90853 · Inpatient or outpatient · Doctor (professional) fee In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$26.34 – $27.65
Group psychotherapy: rates for 7 insurance plans Aetna — Medicare Advantage: $27.65 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $26.34 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $27.65 Humana — Medicare Advantage: $26.34 Medica — Medicare Advantage: $26.34 Molina Healthcare of Nebraska — Medicare Advantage: $27.65 Nebraska Total Care — Medicare Products: $26.86

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Doctor (professional) fee In the file: Excision of cyst fibroadenoma aberrant breast tissue duct lesion areolar lesion 1 or more	$1,546	$1,546	$421.73 – $1,484.16
Removal of breast growth (open surgery): rates for 10 insurance plans Aetna — Medicare Advantage: $442.81 Aetna Coventry — HMO: $1,484.16 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $421.73 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $442.81 Humana — Medicare Advantage: $421.73 Medica — Medicare Advantage: $421.73 Midlands Choice — All Plans: $1,484.16 Molina Healthcare of Nebraska — Medicare Advantage: $442.81 Nebraska Total Care — Medicare Products: $430.16 United Healthcare — All Commercial Plans: $1,484.16
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee In the file: Arthroplasty acetabular and proximal femoral prosthetic replacement w/wo autograft or allograft	$4,954	$4,954	$1,302.15 – $4,755.84
Total hip replacement: rates for 10 insurance plans Aetna — Medicare Advantage: $1,367.25 Aetna Coventry — HMO: $4,755.84 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,302.15 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $1,367.25 Humana — Medicare Advantage: $1,302.15 Medica — Medicare Advantage: $1,302.15 Midlands Choice — All Plans: $4,755.84 Molina Healthcare of Nebraska — Medicare Advantage: $1,367.25 Nebraska Total Care — Medicare Products: $1,328.19 United Healthcare — All Commercial Plans: $4,755.84
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee · modifier AS In the file: TOTAL HIP REPLACEMENT ARTHOPLASTY, ASSIST	$991	$991	$951.36 – $1,367.25
Total hip replacement: rates for 10 insurance plans Aetna — Medicare Advantage: $1,367.25 Aetna Coventry — HMO: $951.36 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,302.15 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $1,367.25 Humana — Medicare Advantage: $1,302.15 Medica — Medicare Advantage: $1,302.15 Midlands Choice — All Plans: $951.36 Molina Healthcare of Nebraska — Medicare Advantage: $1,367.25 Nebraska Total Care — Medicare Products: $1,328.19 United Healthcare — All Commercial Plans: $951.36
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee In the file: TOTAL KNEE ARTHROPLASTY CHARGE	$4,952	$4,952	$1,300.54 – $4,753.92
Total knee replacement: rates for 10 insurance plans Aetna — Medicare Advantage: $1,365.56 Aetna Coventry — HMO: $4,753.92 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,300.54 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $1,365.56 Humana — Medicare Advantage: $1,300.54 Medica — Medicare Advantage: $1,300.54 Midlands Choice — All Plans: $4,753.92 Molina Healthcare of Nebraska — Medicare Advantage: $1,365.56 Nebraska Total Care — Medicare Products: $1,326.55 United Healthcare — All Commercial Plans: $4,753.92
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee · modifier 50 In the file: 27447 ARTHROPLASTY KNEE, MEDIAL AND LATERAL-BILATERAL	$10,201	$10,201	$1,300.54 – $9,792.96
Total knee replacement: rates for 10 insurance plans Aetna — Medicare Advantage: $1,365.56 Aetna Coventry — HMO: $9,792.96 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,300.54 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $1,365.56 Humana — Medicare Advantage: $1,300.54 Medica — Medicare Advantage: $1,300.54 Midlands Choice — All Plans: $9,792.96 Molina Healthcare of Nebraska — Medicare Advantage: $1,365.56 Nebraska Total Care — Medicare Products: $1,326.55 United Healthcare — All Commercial Plans: $9,792.96
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee · modifier AS In the file: ARTHROPLASTY KNEE, ASSIST	$990	$990	$950.40 – $1,365.56
Total knee replacement: rates for 10 insurance plans Aetna — Medicare Advantage: $1,365.56 Aetna Coventry — HMO: $950.40 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,300.54 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $1,365.56 Humana — Medicare Advantage: $1,300.54 Medica — Medicare Advantage: $1,300.54 Midlands Choice — All Plans: $950.40 Molina Healthcare of Nebraska — Medicare Advantage: $1,365.56 Nebraska Total Care — Medicare Products: $1,326.55 United Healthcare — All Commercial Plans: $950.40
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee In the file: 29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty	$684	$684	$172.10 – $656.64
Shoulder arthroscopy: shaving of shoulder bone: rates for 10 insurance plans Aetna — Medicare Advantage: $180.70 Aetna Coventry — HMO: $656.64 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $172.10 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $180.70 Humana — Medicare Advantage: $172.10 Medica — Medicare Advantage: $172.10 Midlands Choice — All Plans: $656.64 Molina Healthcare of Nebraska — Medicare Advantage: $180.70 Nebraska Total Care — Medicare Products: $175.54 United Healthcare — All Commercial Plans: $656.64
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient · Doctor (professional) fee In the file: Arthroscopy, Knee, Surgical; w/Meniscectomy (Medial or Lateral, w/Any Meniscal Shaving) Charge	$2,240	$2,240	$559.41 – $2,150.40
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 10 insurance plans Aetna — Medicare Advantage: $587.38 Aetna Coventry — HMO: $2,150.40 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $559.41 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $587.38 Humana — Medicare Advantage: $559.41 Medica — Medicare Advantage: $559.41 Midlands Choice — All Plans: $2,150.40 Molina Healthcare of Nebraska — Medicare Advantage: $587.38 Nebraska Total Care — Medicare Products: $570.59 United Healthcare — All Commercial Plans: $2,150.40
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee In the file: 42820 - Tonsillectomy and adenoidectomy, under age 12	$899	$899	$304.70 – $863.04
Removal of tonsils and adenoids (under age 12): rates for 10 insurance plans Aetna — Medicare Advantage: $319.94 Aetna Coventry — HMO: $863.04 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $304.70 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $319.94 Humana — Medicare Advantage: $304.70 Medica — Medicare Advantage: $304.70 Midlands Choice — All Plans: $863.04 Molina Healthcare of Nebraska — Medicare Advantage: $319.94 Nebraska Total Care — Medicare Products: $310.80 United Healthcare — All Commercial Plans: $863.04
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Doctor (professional) fee In the file: 43235 UPPER GI ENDOSCOPY	$1,402	$1,402	$125.88 – $1,345.92
Upper GI endoscopy (diagnostic): rates for 10 insurance plans Aetna — Medicare Advantage: $132.17 Aetna Coventry — HMO: $1,345.92 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $125.88 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $132.17 Humana — Medicare Advantage: $125.88 Medica — Medicare Advantage: $125.88 Midlands Choice — All Plans: $1,345.92 Molina Healthcare of Nebraska — Medicare Advantage: $132.17 Nebraska Total Care — Medicare Products: $128.40 United Healthcare — All Commercial Plans: $1,345.92
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient · Doctor (professional) fee In the file: Upper GI endoscopy incl. esophagus stomach the duodenum/jejunum w/ biopsy single or multi	$1,595	$1,595	$142.12 – $1,531.20
Upper GI endoscopy with biopsy: rates for 10 insurance plans Aetna — Medicare Advantage: $149.22 Aetna Coventry — HMO: $1,531.20 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $142.12 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $149.22 Humana — Medicare Advantage: $142.12 Medica — Medicare Advantage: $142.12 Midlands Choice — All Plans: $1,531.20 Molina Healthcare of Nebraska — Medicare Advantage: $149.22 Nebraska Total Care — Medicare Products: $144.96 United Healthcare — All Commercial Plans: $1,531.20
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Doctor (professional) fee In the file: 45378 COLONOSCOPY	$1,607	$1,607	$188.68 – $1,542.72
Colonoscopy (diagnostic): rates for 10 insurance plans Aetna — Medicare Advantage: $198.11 Aetna Coventry — HMO: $1,542.72 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $188.68 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $198.11 Humana — Medicare Advantage: $188.68 Medica — Medicare Advantage: $188.68 Midlands Choice — All Plans: $1,542.72 Molina Healthcare of Nebraska — Medicare Advantage: $198.11 Nebraska Total Care — Medicare Products: $192.45 United Healthcare — All Commercial Plans: $1,542.72
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Doctor (professional) fee · modifier 53 In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$94.52 – $99.24
Colonoscopy (diagnostic): rates for 7 insurance plans Aetna — Medicare Advantage: $99.24 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $94.52 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $99.24 Humana — Medicare Advantage: $94.52 Medica — Medicare Advantage: $94.52 Molina Healthcare of Nebraska — Medicare Advantage: $99.24 Nebraska Total Care — Medicare Products: $96.41
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Doctor (professional) fee In the file: Colonoscopy, Flexible, Proximal to Splenic Flexure; w/Biopsy, Single or Mult Charge	$1,902	$1,902	$205.39 – $1,825.92
Colonoscopy with biopsy: rates for 10 insurance plans Aetna — Medicare Advantage: $215.66 Aetna Coventry — HMO: $1,825.92 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $205.39 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $215.66 Humana — Medicare Advantage: $205.39 Medica — Medicare Advantage: $205.39 Midlands Choice — All Plans: $1,825.92 Molina Healthcare of Nebraska — Medicare Advantage: $215.66 Nebraska Total Care — Medicare Products: $209.50 United Healthcare — All Commercial Plans: $1,825.92
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Doctor (professional) fee In the file: Colonoscopy flexible proximal splenic flexure w/ removal of tumor polyp lesion snare technique	$2,215	$2,215	$259.99 – $2,126.40
Colonoscopy with removal of polyps (snare): rates for 10 insurance plans Aetna — Medicare Advantage: $272.99 Aetna Coventry — HMO: $2,126.40 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $259.99 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $272.99 Humana — Medicare Advantage: $259.99 Medica — Medicare Advantage: $259.99 Midlands Choice — All Plans: $2,126.40 Molina Healthcare of Nebraska — Medicare Advantage: $272.99 Nebraska Total Care — Medicare Products: $265.19 United Healthcare — All Commercial Plans: $2,126.40
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$264.12 – $277.33
Ultrasound of the lower bowel by endoscope: rates for 7 insurance plans Aetna — Medicare Advantage: $277.33 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $264.12 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $277.33 Humana — Medicare Advantage: $264.12 Medica — Medicare Advantage: $264.12 Molina Healthcare of Nebraska — Medicare Advantage: $277.33 Nebraska Total Care — Medicare Products: $269.40
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee In the file: Colorectal cancer screening; colonoscopy on indiv not meeting criteria for high risk Tech Chg	$1,705	$1,705	$188.80 – $1,636.80
Screening colonoscopy (not high risk): rates for 10 insurance plans Aetna — Medicare Advantage: $198.24 Aetna Coventry — HMO: $1,636.80 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $188.80 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $198.24 Humana — Medicare Advantage: $188.80 Medica — Medicare Advantage: $188.80 Midlands Choice — All Plans: $1,636.80 Molina Healthcare of Nebraska — Medicare Advantage: $198.24 Nebraska Total Care — Medicare Products: $192.57 United Healthcare — All Commercial Plans: $1,636.80
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee · modifier 53 In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$94.63 – $99.37
Screening colonoscopy (not high risk): rates for 7 insurance plans Aetna — Medicare Advantage: $99.37 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $94.63 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $99.37 Humana — Medicare Advantage: $94.63 Medica — Medicare Advantage: $94.63 Molina Healthcare of Nebraska — Medicare Advantage: $99.37 Nebraska Total Care — Medicare Products: $96.53
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient · Doctor (professional) fee In the file: Laparoscopy, Surgical; Cholecystectomy Charge	$2,504	$2,504	$659.63 – $2,403.84
Gallbladder removal by laparoscope: rates for 10 insurance plans Aetna — Medicare Advantage: $692.61 Aetna Coventry — HMO: $2,403.84 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $659.63 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $692.61 Humana — Medicare Advantage: $659.63 Medica — Medicare Advantage: $659.63 Midlands Choice — All Plans: $2,403.84 Molina Healthcare of Nebraska — Medicare Advantage: $692.61 Nebraska Total Care — Medicare Products: $672.82 United Healthcare — All Commercial Plans: $2,403.84
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee In the file: Repair Initial Inguinal Hernia, Age 5 Yrs or Over; Reducible Charge	$2,097	$2,097	$524.76 – $2,013.12
Groin (inguinal) hernia repair, age 5 or older: rates for 10 insurance plans Aetna — Medicare Advantage: $550.99 Aetna Coventry — HMO: $2,013.12 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $524.76 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $550.99 Humana — Medicare Advantage: $524.76 Medica — Medicare Advantage: $524.76 Midlands Choice — All Plans: $2,013.12 Molina Healthcare of Nebraska — Medicare Advantage: $550.99 Nebraska Total Care — Medicare Products: $535.25 United Healthcare — All Commercial Plans: $2,013.12
Prostate biopsy CPT 55700 · Inpatient or outpatient · Doctor (professional) fee In the file: Other Professional Services	Not listed in the file	Not listed in the file	$133.94 – $140.64
Prostate biopsy: rates for 7 insurance plans Aetna — Medicare Advantage: $140.64 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $133.94 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $140.64 Humana — Medicare Advantage: $133.94 Medica — Medicare Advantage: $133.94 Molina Healthcare of Nebraska — Medicare Advantage: $140.64 Nebraska Total Care — Medicare Products: $136.62
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient · Doctor (professional) fee In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$1,233.81 – $1,295.50
Prostate removal by laparoscope (radical prostatectomy): rates for 7 insurance plans Aetna — Medicare Advantage: $1,295.50 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,233.81 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $1,295.50 Humana — Medicare Advantage: $1,233.81 Medica — Medicare Advantage: $1,233.81 Molina Healthcare of Nebraska — Medicare Advantage: $1,295.50 Nebraska Total Care — Medicare Products: $1,258.49
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Doctor (professional) fee In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$235.59 – $247.37
Hysteroscopy with biopsy of the uterus lining: rates for 7 insurance plans Aetna — Medicare Advantage: $247.37 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $235.59 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $247.37 Humana — Medicare Advantage: $235.59 Medica — Medicare Advantage: $235.59 Molina Healthcare of Nebraska — Medicare Advantage: $247.37 Nebraska Total Care — Medicare Products: $240.30
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XR Fluoro Pain Management	$1,876	$1,876	$712.88 – $1,800.96
Spinal injection, lower back (epidural), with imaging guidance: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $866.71 Aetna Coventry — HMO: $1,800.96 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,782.20 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $825.44 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $866.71 Humana — Medicare Advantage: $825.44 Medica — Commercial Products: $1,707.16 Medica — Individual and Family Business Products-Care System Products: $1,800.96 Medica — Medicare Advantage: $825.44 Midlands Choice — All Plans: $1,800.96
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: .INJ EPIDURAL, LUMBAR OR CAUDAL, W/IMAGING	$1,876	$1,876	$712.88 – $1,800.96
Spinal injection, lower back (epidural), with imaging guidance: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $866.71 Aetna Coventry — HMO: $1,800.96 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,782.20 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $825.44 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $866.71 Humana — Medicare Advantage: $825.44 Medica — Commercial Products: $1,707.16 Medica — Individual and Family Business Products-Care System Products: $1,800.96 Medica — Medicare Advantage: $825.44 Midlands Choice — All Plans: $1,800.96
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJ EPIDURAL, LUMBAR OR CAUDAL, W/IMAGING CHARGE	$1,876	$1,876	$712.88 – $1,800.96
Spinal injection, lower back (epidural), with imaging guidance: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $866.71 Aetna Coventry — HMO: $1,800.96 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,782.20 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $825.44 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $866.71 Humana — Medicare Advantage: $825.44 Medica — Commercial Products: $1,707.16 Medica — Individual and Family Business Products-Care System Products: $1,800.96 Medica — Medicare Advantage: $825.44 Midlands Choice — All Plans: $1,800.96
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJ TRANSF, LUMB/SACR, SINGLE LEVEL CHARGE	$1,597	$1,597	$606.86 – $1,533.12
Nerve root injection, lower back, with imaging guidance: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $737.81 Aetna Coventry — HMO: $1,533.12 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,517.15 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $702.68 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $737.81 Humana — Medicare Advantage: $702.68 Medica — Commercial Products: $1,453.27 Medica — Individual and Family Business Products-Care System Products: $1,533.12 Medica — Medicare Advantage: $702.68 Midlands Choice — All Plans: $1,533.12
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJ TRANSF, LUMB/SACR, SINGLE LEVEL, BIL	$1,852	$1,852	$703.76 – $1,777.92
Nerve root injection, lower back, with imaging guidance: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $855.62 Aetna Coventry — HMO: $1,777.92 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,759.40 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $814.88 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $855.62 Humana — Medicare Advantage: $814.88 Medica — Commercial Products: $1,685.32 Medica — Individual and Family Business Products-Care System Products: $1,777.92 Medica — Medicare Advantage: $814.88 Midlands Choice — All Plans: $1,777.92
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: .INJ TRANSF, LUMB/SACR, SINGLE LEVEL	$1,597	$1,597	$606.86 – $1,533.12
Nerve root injection, lower back, with imaging guidance: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $737.81 Aetna Coventry — HMO: $1,533.12 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,517.15 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $702.68 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $737.81 Humana — Medicare Advantage: $702.68 Medica — Commercial Products: $1,453.27 Medica — Individual and Family Business Products-Care System Products: $1,533.12 Medica — Medicare Advantage: $702.68 Midlands Choice — All Plans: $1,533.12
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Doctor (professional) fee In the file: Neuroplasty and/or Transposition; Median Nerve At Carpal Tunnel Charge	$1,362	$1,362	$453.89 – $1,307.52
Carpal tunnel release: rates for 10 insurance plans Aetna — Medicare Advantage: $476.59 Aetna Coventry — HMO: $1,307.52 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $453.89 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $476.59 Humana — Medicare Advantage: $453.89 Medica — Medicare Advantage: $453.89 Midlands Choice — All Plans: $1,307.52 Molina Healthcare of Nebraska — Medicare Advantage: $476.59 Nebraska Total Care — Medicare Products: $462.97 United Healthcare — All Commercial Plans: $1,307.52
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: YAG LASER, UNILATERAL	$864	$864	$328.32 – $829.44
Laser treatment of clouding after cataract surgery: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $399.17 Aetna Coventry — HMO: $829.44 Blue Cross Blue Shield of Nebraska — Blueprint Health: $820.80 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $380.16 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $399.17 Humana — Medicare Advantage: $380.16 Medica — Commercial Products: $786.24 Medica — Individual and Family Business Products-Care System Products: $829.44 Medica — Medicare Advantage: $380.16 Midlands Choice — All Plans: $829.44
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: YAG LASER, BILATERAL	$1,078	$1,078	$409.64 – $1,034.88
Laser treatment of clouding after cataract surgery: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $498.04 Aetna Coventry — HMO: $1,034.88 Blue Cross Blue Shield of Nebraska — Blueprint Health: $1,024.10 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $474.32 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $498.04 Humana — Medicare Advantage: $474.32 Medica — Commercial Products: $980.98 Medica — Individual and Family Business Products-Care System Products: $1,034.88 Medica — Medicare Advantage: $474.32 Midlands Choice — All Plans: $1,034.88
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient (hospital stay) · Hospital (facility) fee In the file: YAG LASER, UNILATERAL	$864	$864	$432 – $829.44
Laser treatment of clouding after cataract surgery: rates for 5 insurance plans Aetna Coventry — HMO: $829.44 Blue Cross Blue Shield of Nebraska — Blueprint Health: $820.80 Midlands Choice — All Plans: $829.44 Molina Healthcare of Nebraska — Managed Medicaid/CHIP: $432 United Healthcare — All Commercial Plans: $829.44
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient · Doctor (professional) fee In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$567.59 – $595.97
Cataract removal with lens implant: rates for 7 insurance plans Aetna — Medicare Advantage: $595.97 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $567.59 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $595.97 Humana — Medicare Advantage: $567.59 Medica — Medicare Advantage: $567.59 Molina Healthcare of Nebraska — Medicare Advantage: $595.97 Nebraska Total Care — Medicare Products: $578.95

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Inpatient or outpatient · Doctor (professional) fee In the file: 59400 OBSTETRICAL CARE TOTOL	$6,300	$6,300	$2,400.91 – $6,048
Vaginal delivery, with care before and after: rates for 10 insurance plans Aetna — Medicare Advantage: $2,520.96 Aetna Coventry — HMO: $6,048 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $2,400.91 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $2,520.96 Humana — Medicare Advantage: $2,400.91 Medica — Medicare Advantage: $2,400.91 Midlands Choice — All Plans: $6,048 Molina Healthcare of Nebraska — Medicare Advantage: $2,520.96 Nebraska Total Care — Medicare Products: $2,448.93 United Healthcare — All Commercial Plans: $6,048
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient · Doctor (professional) fee In the file: Routine Obstetric Care w/Anterepartum Care, Cesarean Delivery, & Postpartum Care Charge	$6,857	$6,857	$2,642.83 – $6,582.72
Cesarean delivery (C-section), with care before and after: rates for 10 insurance plans Aetna — Medicare Advantage: $2,774.97 Aetna Coventry — HMO: $6,582.72 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $2,642.83 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $2,774.97 Humana — Medicare Advantage: $2,642.83 Medica — Medicare Advantage: $2,642.83 Midlands Choice — All Plans: $6,582.72 Molina Healthcare of Nebraska — Medicare Advantage: $2,774.97 Nebraska Total Care — Medicare Products: $2,695.68 United Healthcare — All Commercial Plans: $6,582.72
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient or outpatient · Doctor (professional) fee In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$2,488.91 – $2,613.36
Vaginal delivery after a previous C-section, with care before and after: rates for 7 insurance plans Aetna — Medicare Advantage: $2,613.36 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $2,488.91 Good Samaritan Insurance Plan of Nebraska — Medicare Advantage: $2,613.36 Humana — Medicare Advantage: $2,488.91 Medica — Medicare Advantage: $2,488.91 Molina Healthcare of Nebraska — Medicare Advantage: $2,613.36 Nebraska Total Care — Medicare Products: $2,538.69

Source: St Francis Memorial Hospital’s standard charges file (sthpiprd.blob.core.windows.net, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on March 18, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Critical Access Hospital
Address	430 North Monitor St, West Point, NE 68788
County	Cuming County
State	Nebraska
Phone	(402) 372‑2404
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	2 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	281322
Name in Medicare records	ST FRANCIS MEMORIAL HOSPITAL
Profile level	Medicare data + hospital website
Name on the hospital’s website	Franciscan Healthcare
Official website	franhealth.org
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

Franciscan Healthcare — franhealth.org
Emergency Services : Services : Franciscan Healthcare — franhealth.org
Cardiopulmonary Rehab : Services : Franciscan Healthcare — franhealth.org
Maternity Services : Services : Franciscan Healthcare — franhealth.org
Patient Care : Patient Care : Services : Franciscan Healthcare — franhealth.org
Radiology : Services : Franciscan Healthcare — franhealth.org
Surgery and Anesthesia : Services : Franciscan Healthcare — franhealth.org
Overview : Rehabilitation and Wellness : Services : Franciscan Healthcare — franhealth.org

St Francis Memorial Hospital

Summary

Profile from official sources

At a glance